This document discusses dental calculus, including its definition, composition, formation, and classification. It provides the following key points: - Dental calculus is mineralized bacterial plaque that forms on tooth surfaces. It consists of inorganic minerals like calcium phosphate embedded within an organic matrix. - Calculus is classified as supragingival or subgingival based on its location relative to the gingival margin. Supragingival calculus is visible while subgingival is within the gingival pocket. - Calculus formation occurs as plaque mineralizes over time. Various local and systemic factors can influence the rate of calculus accumulation on teeth. Regular removal is needed to prevent its buildup.

1. Dr. Ishu Singla
M.D.S Student

2. ▶ Once a tooth erupts, various materials gather on its
surfaces, these substances are frequently called tooth –
accumulated materials/deposits.
▶They are classified as:
Soft deposits:
▶Acquired pellicle
▶Microbial plaque
▶Materia alba
▶Food debris
Hard deposits:
▶Calculus
▶Stains
INTRODUCTION

3. Dental calculus can be considered as an ectopic
mineralized structure.
Dental Calculus consists of mineralized bacterial
plaque that forms on the surfaces of natural teeth and
dental prosthesis. [Carranza ]
The word "calculus" was derived from the Latin word for a
pebble or stone.
Tartar, a common synonym for dental calculus, is taken from
the Latin word tartarum which means the accumulated
sediment or crust.

4. Calculus can be defined as a hard concretion that forms on teeth or
dental prostheses through calcification of bacterial plaque
[GPT 4th edition].
▶ Calculus is Mineralized dental plaque that is permeated with
crystals of various calcium phosphates (Schroeder,1969).
▶when dental plaque calcifies, the resulting deposit is called
CALCULUS (GRANT).

5. *Calculus was recognized as a clinical entity in some way related
to periodontal disease as far back as the 10th century.
*In 1683 Van Leeuwenhoek described microorganisms in tartar.
He called them ‘animalcules’.
*Fauchard, in 1728, termed it tartar or slime, and referred to it
as “a substance which accumulates on the surface of the teeth
and which becomes, when left there, a stony crust of more or
less considerable volume.1
HISTORY

6. Dental calculus is classified by its location on a tooth surface as
related to the adjacent free gingival margin:

7. SUPRAGINGIVAL CALCULUS
Location –
▶On the clinical crown coronal to the margin of the gingiva and
visible in the oral cavity.
Distribution –
▶Most frequent sites are on the lingual surfaces of the mandibular
anterior teeth opposite Warton’s duct and on the buccal surfaces of
the maxillary molars opposite Stenson’s duct.6
▶Crowns of teeth out of occlusion; non-functional or teeth that are
neglected during daily plaque removal.
▶Surfaces of dentures and dental prosthesis.

8. SUBGINGIVAL CALCULUS
Location-
*On the clinical crown apical to the margin of the gingiva,
usually in periodontal pockets,
* Not visible upon direct oral examination.
*Extends to bottom of the pocket and follows contour of soft
tissue attachment.
Occurs with or without associated supragingival deposits.

10. Characteristic
SUPRAGINGIVAL
CALCULUS
SUBGINGIVAL
CALCULUS
COLOR
White creamy–yellow, Or Gray
May be stained by tobacco,
food
Light to dark brown, dark green
or black stains .
SHAPE
Amorphous, bulky
Gross deposits may
form interproximal bridge
between adjacent teeth.
Extend over the margin of the
gingiva.
Shape of the calculus is
determined by the anatomy of
the teeth.
Flattened to conform with
pressure from the pocket wall.
Combination of the following
calculus forms occur:
1.crusty, spiny, or nodular
2.Ledge or ring like forms

11. CONSISTENCY
AND TEXTURE
Moderately hard newer
deposits- less dense and hard
and porous.
Surface covered with
nonmineralized plaque
Brittle, flint-like.
Hardens and more dense than
supragingival calculus.
QUANTITY
Direct relationship to
1.Personal oral care procedures
2. Physical character of diet.
3. Function and use
4. Increased amount in
tobacco smokers.
Related to pocket depth
Increased amount with age

12. Calculus consists of
*inorganic (70 to 90%) *organic components (20 to 30%)
Inorganic portion consist of:
✓76% calcium phosphate, Ca(PO4)2
✓3% calcium carbonate, CaCO3.
✓4% magnesium phosphate,Mg3(PO4)2
✓2% carbon dioxide, CO2
✓Traces of Sodium, zinc, iron, aluminum, tungsten, gold,
copper

13. FLOURIDE IN CALCULUS-
*Concentration of fluoride in calculus varies and is
influenced by the amount of fluoride received from
• fluoride in the drinking water
• topical application
• dentifrices
or any form that is received by contact with the
external surface of calculus.
*highest near the outermost regions of the calculus.

14. CRYSTALS-
According to Electron microscopy & x-ray
diffraction studies,4 distinct phosphate crystals :
*Hydroxyapatite Ca1
0
(OH)2
(PO4
)6– approximately 58%
*Magnesium whitlockite Ca9(PO4)6XPO4 - 21%
*Octacalcium phosphate Ca4H(PO4)3.2H2O - 12%
*Brushite CaHPO4.2H2O - 9%

15. *Generally, two or more crystal forms are typically
found in a sample of calculus.
*Hydroxyapatite
detected most frequently (in 97-100% of
and octacalcium phosphate are
all
supragingival calculus) and constitute the bulk of
the specimen.
*Brushite is more common in the mandibular
anterior region.
*Magnesium whitlockite is common in the posterior
areas and sublingually.

17. ORGANIC CONTENT
Consist of mixture of protein- polysaccharide complexes,
desquamated epithelial cells, leukocytes, and various types
of microorganisms.
– between 1.9%-9.1%
*Carbohydrate
consist of :
Galactose
Glucose
Mannose
of organic component,
sometimes: Arabinose
Glucosamine
Glucuronic acid
Galactosamine
Salivary proteins
5.9% to 8.2% of organic component, include most amino acids.
Lipids-
0.2% of organic component

18. Subgingival calculus-
has composition similar to supragingival calculus, with some
differences.
*More homogenous with equally high density of minerals.
*Same hydroxyapatite content, but with more magnesium
*Less brucite and octacalcium phosphate

19. *The ratio of calcium to phosphate is higher subgingivally.
*The sodium content increases with the depth of
periodontal pockets.
*Salivary protein found in supragingival calculus is not found
subgingivally

20. BACTERIAL CONTENT-
*The percentage of gram positive and gram- negative
filamentous organisms is greater within calculus than in the
remainder of oral cavity.7
*The microorganisms at the periphery are predominantly
gram-negative rods and cocci.
*Most of the organisms within the calculus is non-viable.

21. SUPRAGINGIVAL CALCULUS
✓ Predominance of gram-positive filaments.
✓Next in frequency; gram-negative filaments & cocci.
✓Gram-positive cocci seen in calculus about which
suppuration had taken place.
SUBGINGIVAL CALCULUS
*Superficial layers : gram- negative filaments
most numerous
*Deep and middle zones : gram-positive
filaments predominant.

22.  Calculus is dental plaque which has undergone mineralization.

23. Not all of plaque develops into calculus.
Plaque that do not develop into calculus reaches a plateau of maximal
mineral content within 2 days.
Calcification requires “Binding of calcium ions to carbohydrate-protein
complexes of organic matrix and precipitation of crystalline calcium
phosphate salts”.
Calculus formation continues until it reaches a maximum from
which it may be reduced in amount.
The time required to reach the maximum level has been
reported as 10 weeks and 6 months.
Reversal phenomenon : decline from maximal calculus accumulation
(mechanical wear of bulky calculus)

24. *As calcification progresses, Number of filamentous bacteria
increases.
*Foci of calcification changes from basophilic to eosinophilic.
*Calculus is formed in layers, which are often separated by a thin
cuticle that becomes embedded in the calculus as calcification
progresses.
* Sulfhydryl & Amino groups are reduced

26. *BOOSTER CONCEPT
According to this concept, mineral precipitation results
from a local rise in the degree of saturation of calcium and
phosphate ions which may be brought about in several ways:
(A) A rise in the pH of saliva causes precipitation of calcium
phosphate salts by lowering the precipitation constant.
(B) Colloidal proteins in saliva bind to calcium and phosphate ions
(c) Increasing conc. of free phosphate ions by activity of
phosphatase

27. EPITACTIC CONCEPT / SEEDING
THEORY/ HETEROGENOUS NUCLEATION: (Mandel 1957)

28. *FACTORS AFFECTING THE
RATE OF CALCULUS
FORMATION
*Diet and nutrition –the significance of diet in calculus
formation depends more upon its consistency than upon its
content.
*Increased calculus formation has been associated with
deficiencies of vitamin A, niacin, or pyridoxine, and with an
increase in dietary calcium, phosphorus, bicarbonate,
protein and carbohydrate.

29. *Age – there is an increase in calculus deposition with an
increasing age.(Schroeder et al,1969).
*This increase, is not only increase in the number of
surfaces, but also the size of calculus deposits.
*Habits –In populations that practice regular oral hygiene and
with access to regular professional care have low tendency
for calculus formation.
*Smoking- is associated with an elevated risk for supragingival
calculus deposition.
Smoking may exert its influence systemically
(elevated levels of salivary calcium and phosphorus) or
locally via a conditioning of tooth surfaces.

30. *Salivary pH- increase pH increases the calculus formation.
*Salivary calcium concentration- Elevated salivary calcium
concentration, increases the rate of calculus formation.
salivary lipid levels – is associated with increased calculus
formation
▶ Emotional status- increased calculus formation has been
associated with disturbed emotional status.
▶Nucleation inhibitors - Mg blocks apatite
crystallization and stabilizes calcium phosphate as amorphous
mineral (Ennever and Vogel, 1981)

31. ATTACHMENT OF CALCULUS TO
TOOTH SURFACE
1. The cuticular type of attachment
2. Direct attachment
3. Penetration of bacteria within cementum
4. Mechanical locking
By Zander 1953
By Seling 1969
By Mandel and Levy ( 1957)
Conroy (1968)
By Schaff 1955, Kapezyk1968
By Mandel, levy, Thelaide (1964)

33. SUBGINGIVAL EXAMINATION:
Visual Examination – dark edge of calculus may be seen at or
just beneath the gingival margin.gentle air blast can deflect
the margin from the tooth for observation into the pocket.
▶Gingival tissue colour change – dark calculus may reflect
through a thin margin and suggest its presence.
▶Tactile examination- Clerehugh 1996 used WHO # 621
probe and a fine subgingival explorer is also used.
SUPRAGINGIVAL EXAMINATION :
Direct Examination – supragingival calculus can be seen
directly or indirectly.
Using a mouth mirror with a combination of retraction, light
and drying with air, small deposits can be seen.

34. Calculus Detection Only
*Perioscopy™ Fiberoptic Endoscopy Based Technology
*DetecTar™ Spectro-Optical Technology
*Diagnodent™ Auto fluorescence Based Technology
*Perioscan™ Ultrasound technology
*Keylaser3™ Laser Based Technology
Calculus detection and Removal

35. Other predisposing factors
1.Iatrogenic factors
i. Location of gingival margin for the restoration
ii. Space b/w margin of restoration and unprepared tooth
iii. Contour of restoration
iv. Occlusion
v. Material used in the restoration
vi. Restorative procedure itself
vii. Design of the RPD

36. 2.Malocclusion
• Positive correlation between crowding and periodontal disease due
to difficulty in plaque control measures
• Roots of teeth that are prominent in arch are associated with high
frenal attachment and frequently exhibit recession
• Tongue thrusting habit lateral pressure on anterior teeth resulting in
spreading and tilting of anterior teeth leading to open bite
• Mouth-breathers may have marginal and papillary gingivitis in
maxillary anterior region
• Restorations that do not make occlusal harmony (traumatic
occlusion leads to widening of PDL space, reduction in collagen
fibres & increased no. of osteoclasts near alveolar border

37. A. Plaque retention and composition
• Retention of bacterial plaque and food debris, resulting in Gingivitis
• excess bonding composite around bracket base creates site for
plaque accumulation due to its rough surface texture and gap b/w
enamel-composite surface
3.Periodontal complication associated with
orthodontic therapy
B. Gingival trauma and alveolar bone height
Orthodontic bands should not be forcefully placed beyond level of attachment
The mean alveolar bone loss per patient for adolescent who went 2 years of
orthodontic care during 5 yr period range b/w 0.1 and 0.5mm

38. C. Tissue response to orthodontic forces
 Excessive orthodontic forces also increase the risk of apical root
resorption
Surgical exposure of impacted teeth and orthodontic- assisted
eruption may compromise the periodontal attachment on adjacent
teeth
Dento-alveolar gingival fibers located within the marginal and
attached gingiva are stretched when teeth are rotated during
orthodontic treatment

39. 4.Extraction of impacted third molars
Various clinical studies have suggested that extraction of
impacted third molars results in creation of vertical defect distal
to second molars
5.Habits and self-inflicted injuries
• Toothbrush trauma
• Chemical injury
• Trauma associated with oral jewelry

40. 6. Tobacco use
• Smokers are 2.6 to 6 times more likely to develop periodontal
disease than non-smokers
• Smokers have more pathogenic subgingival microflora with increased
virulence
• Smokers have negative effect on periodontal therapy
• Use of smokeless tobacco is associated with localized gingival
recession, clinical attachment loss, leukoplakia & susceptibility to
severe periodontitis
• 3rd National Health and Nutrition Examination survey investigated
adverse effects of Tobacco on periodontium & found double
incidence of severe periodontitis among adults with smokeless
tobacco but never smoked

41. 7. Radiation therapy
• Oral mucositis
• Soft tissue ischemia & fibrosis (obliterative endarteritis)
• Irradiated bone is hypovascular and hypoxic
• Osteoradionecrosis
• Xerostomia
• Administration of Pentoxifylline + Vit. E = Revascularization