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Dental calculus
- 1. DENTAL CALCULUS DEPARTMENT OFPERIODONTICS PRESENTED BY:- PAWAN KUMAR BDS 3YR
- 2. CONTENTS:- • DEFINITIONS • CLASSIFICATION •SUPRAGINGIVAL CALCULUS • SUBGINGIVAL CALCULUS • STRUCTURE • COMPOSITION • FORMATION OF CALCULUS • THEORIES OF CALCULUS FORMATION • ANTICALCULUS AGENT • COMMERCIAL ANTICALCULUS PRODUCT • REFFERENCE
- 3. DEFINITION :- • CALCULUSIS A HARD DEPOSIT THAT IS FORMED BY MINERALIZATION OF DENTAL PLAQUE ON THE SURFACE OF NATURAL TEETH AND DENTAL PROSTHESIS, GENERALLY COVERED BY UNMINERALIZED PLAQUE. (CARRANZA’S CLINICAL PERIODONTOLOGY) (11TH EDITION)
- 4. CLASSIFICATION :- DENTALCALCULUS IS CLASSIFIED ON THE BASIS OF ITS LOCATION. 1. SUPRAGINGIVAL CALCULUS 2. SUBGINGIVAL CALCULUS
- 5. SUPRAGINGIVAL CALCULUS :- •SUPRAGINGIVAL CALCULUS IS THE TIGHTLY ADHERENT CALCIFIED DEPOSIT THAT FORMS ON THE CLINICAL CROWN OF THE TEETH ABOVE THE FREE GINGIVAL MARGINS. • IT IS CLINICALLY VISIBLE. • IT IS ALSO CALLED “SALIVARY CALCULUS” BECAUSE IT FORMS FROM THE SALIVA.
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- 7. SUBGINGIVAL CALCULUS:- • SUBGINGIVALCALCULUS IS CALCIFIED DEPOSIT THAT IS FORMED ON THE ROOT SURFACE BELOW THE FREE MARGINAL GINGIVA. • IT IS BELIEVED TO BE FORMED FROM THE GINGIVAL EXUDATE AND HENCE CALLED “ SERUMAL CALCULUS” .
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- 9. STRUCTURE:- • SUPRAGINGIVAL CALCULUSARE USUALLY WHITISH YELLOW IN COLOUR AND CAN STAINED BY TOBACCO OR FOOD PIGMENTS. • ITS CONCISTENCY IS HARD AND CLAY LIKE. • THEY DERIVE FROM MINERAL SALTS FROM SALIVARY SECRETION,THESARE MORE ABDUNDENT ON THE LINGUAL SURFACE OF ANTERIOR TEETH,OPPOSITE TO “WHARTON’S DUCT” AND “BARTHOLOIN’S DUCT” AND BUCCAL ASPECT OF MAXILLARY MOLARS OPPOSITE TO THE “STENSEN’S DUCT”.
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- 11. • SUBGINGIVAL CALCULUSIS DARK BROWN OR GREENISH BLACK IN COLOR AND THE DEPOSIT ARE FIRMLY ATTACH TO THE TEETH SURFACE. • THESE ARE FIRM AND HARD AND CANNOT BE REMOVED EASILY. • THERE ARE FOUND ON ANY ROOT SURFACE WITH A PERIODONTAL POCKET. • THEY ARE COMMONLY RING -LIKE OR LEDGE-LIKE FORMATION,CRUSTY,SPINY OR NODULAR DEPOSITS. • LESS COMMONLY SEEN AS FINGER -LIKE AND FERN- LIKE FORMATIONS.
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- 13. COMPOSITION:- INORGANIC COMPONENT (IN%) •INORGANIC 70-90(%) • CALCIUM 27-29 • PHOSPHOROUS 16-18 • CARBONATE 2-3 • SODIUM 1.5-2.5 • MAGNESIUM 0.6-0.8 • FLUORIDE 0.003-0.04 • CRYSTAL FORMS • HYDROXYAPATITE 58 • MAGNESIUM WHITLOCKITE 21 • OCTACALCIUM PHOSPHATE 12 • BRUSHITE 9
- 14. ORGANIC COMPONENTS (IN%) •MIXTURE OF PROTEIN POLYSACCHARIDE COMPLEX , 1.9-9.1 DESQUAMATED EPITHELIAL CELLS, LEUKOCYTES, AND MICROORGANISM • PROTEINS 5.9-8.2 • LIPIDS 0.2
- 15. FORMATION OF CALCULUS:- •CALCULUS IS FORMED BY THE PRECIPITATION OF MINERAL SALTS BETWEEN 1ST AND 14TH DAY OF PLAQUE FORMATION. • IN 2 DAYS PLAQUE CAN BE 50% MINERALIZED AND 60%-90% GETS MINERALIZED IN 12 DAYS. • CALCIFICATION STARTS IN THE SEPARATE FOCI ON THE INNER SURFACE OF THE PLAQUE. • THE FOCI OF MINERALIZATION GRADUALLY INCREASES IN SIZE AND COALESCE TO FORM A SOLID MASS OF CALCULUS .
- 16. • CALCULUS FORMATIONCONTINUES UNTILL IT REACHES MAXIMUM LEVELS IN ABOUT 10 WEEKS AND 6 MONTHS, AFTER WHICH THERE IS DECLINE IN ITS FORMATION DUE TO MECHANICAL WEAR FROM FOOD AND FROM LIPS, CHEEKS AND TONGUE. • THIS DECLINE IS REFFERED TO AS “REVERSAL PHENOMENON”.
- 17. THEORIES OF CALCULUSFORMATION:- CALCULUS FORMATION THEORIES ARE AS FOLLOWS:- • BOOSTER MECHANISM • EPITACTIC CONCEPT • INHIBITION THEORY
- 18. BOOSTER MECHANISM:- • ACCORDINGTO THIS THEORY, PRECIPITATION OF CALCIUM AND PHOSPHATE SALTS RESULT IN LOCAL RISE IN THE pH OF SALIVA . • FACTORS SUCH AS LOSS OF CARBON DIOXIDE AND AMMONIA COULD LEAD TO RISE IN pH .
- 19. OTHER WAYS BYWHICH THE PRECIPITATION OF CALCIUM PHOSPHATE SALTS CAN OCCUR ARE:- 1) COLLOIDAL PROTEINS IN SALIVA BIND TO CALCIUM AND PHOSPHATE IONS, THUS PRODUCING A SUPERSATURATED SOLUTION. • WHEN SALIVA STAGNATES IN THE ORAL CAVITY, COLLOIDS SETTLES AND RESULT IN THE PRECIPITATION OF CLCIUM AND PHOSPHOROUS SALTS.
- 20. 2) PHOSPHATASE LIBERATEDFROM DENTAL PLAQUE, DESQUAMATED EPITHELIAL CELLS OR BACTERIA PRECIPITATED CALCIUM PHOSPHATE BY HYDROLIZING ORGANIC PHOSPHATES IN SALIVA, THUS INCREASING THE CONCENTRATION OF FREE PHOSPHATE ION.
- 21. EPITACTIC CONCEPT:- • ACCORDINGTO THIS CONCEPT ,SEEDING AGENTS INDUCE SMALL FOCI OF CALCIFICATION. THESE FOCI ENLARGE AND COALESCE TO FORM CALCULUS. • THE SEEDING AGENTS IN CALCULUS ARE NOT CLEARLY KNOWN, BUT SUSPECTED AGENTS COULD BE INTERCELLULAR MATRIX OF PLAQUE, CARBOHYDRATE-PROTEIN COMPLEX AND PLAQUE BACTERIA.
- 22. INHIBITION THEORY :- •THIS THEORY CONSIDER THE POSSIBILITY OF CALCIFICATION OCCURING ONLY AT SPECIAL SITE BECAUSE THERE EXIST AN INHIBITING MECHANISM AT NON-CALCIFYINGSITES. • WHEREVER CALCIFICATION OCCUR THE INHIBITOR IS EITHER ALTERED OR REMOVED. • ONE SUCH INHIBITING AGENT COULD BE POLYSULHATE, WHICH PREVENT THE INITIAL NUCLEUS FROM GROWING BY POSSIBILY ‘POISONING’ THE GROWTH CENTER OF CRYSTAL.
- 23. ANTICALCULUS AGENT:- FIRST GENERATIONAGENTS: • DISSOLUTION AGENTS: • ACIDS • SPRING SALTS • SODIUM RICINOLEATE • PLAQUE ATTACHMENT INHIBITORS: • SILICONS • ION EXCHANGE RESINS
- 24. • PLAQUE INHIBITONAGENTS: • ANTIBIOTICS (NIDDAMYCIN) • ANTISEPTICS (CHLORAMINE-T) • MATRIX DISRUPTION AGENTS: • ENZYMES (MUCINASE) • ASCORBIC ACID • SODIUM PERCARBONATE • COPPER SULPHITE • 30% UREA
- 25. SECOND GENERATION AGENTS:- •INHIBITORS OF CRYSTAL GROWTH: • VITAMIN C • PYROPHOSPHATE • DIPHOSPHONATE • ZINC SALT • CALCIUM LACTATE • SODIUM FLOURIDE • COPOLYMER • CITROXAIN • SODIUM CITERATE
- 26. COMMERCIAL ANTICALCULUS PRODUCT MOUTHWASH • CHLORHEXIDINE GLUCONATE (0.2%) IS THE RECOMMENDED BY THE WORLD HEALTH ORGANISATION. • IT IS A CATIONIC BISBIGUANIDE. • EXHIBIT ANTIPLAQUE AND ANTI BACTERIAL PROPERTY. • EFFECTIVE AGAINST GRAM +VE AND GRAM –VE ORGANISMS.
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- 29. REFFERENCE:- • CARRANZA’S CLINICLPERIODONTOLOGY (11TH EDITION) • ESSENTIALS OF CLINICAL PERIODONTOLOGY AND PERIODONTICS (SHANTIPRIYA REDDY) (4TH EDITION) • PICTURE COURTESY – GOGGLE