This document discusses dental calculus, which consists of mineralized bacterial plaque that forms on teeth. There are two types: supragingival calculus located above the gums and subgingival calculus located below. Calculus forms from plaque mineralization over 1-14 days and becomes increasingly mineralized over time. It attaches to teeth through organic pellicles, surface irregularities, cementum adaptation, and bacterial penetration. Factors like poor oral hygiene, malocclusion, tobacco use, and radiation therapy can predispose individuals to increased calculus formation and periodontal disease. Removing subgingival plaque and calculus is a cornerstone of periodontal therapy.

1. Presented by
Dr. Devarathanama M.V
MDS Sr. Lecturer

2. DENTAL CALCULUS
Consists of mineralized bacterial plaque that
forms on the surfaces of natural teeth and
dental prostheses

3. SUPRA GINGIVAL CALCULUS
Located coronal to the gingival margin
Usually white or whitish yellow in color
Hard with clay like consistency
Locations :
Buccal surfaces of maxillary molars
Lingual surfaces of mandibular anterior teeth

4. SUBGINGIVAL CALCULUS
Located below the crest of marginal gingiva
Hard and dense
Dark brown or greenish black in color

5. PREVALENCE
Deposition of supragingival calculus reaches
the maximum by the age of 25-30years
and
subgingival calculus by age of 30years

6. COMPOSITION
INORGANIC CONTENT : 70-90%
CALCIUM PHOSPHATE– 75.9%
CALCIUM CORBONATE– 3.1%
TRACES OF MAGNESIUM PHOSPHATE
TWO THIRDS OF THE INORGANIC COMPONENT IS
CRYSTALLINE IN STRUCTURE
THE FOUR MAIN CRYSTAL FORMS ARE
HYDROXYAPETITE—58%
MAGNESIUM WHITELOCKITE– 21%
OCTACALCIUM PHOSPHATE—12%
BRUSHITE—9%

7. ORGANIC CONTENT
PROTEIN POLYSACHARIDE COMPLEXES
DESQUAMATD EPITHELIAL CELLS
LEUKOCYTES
MICRO-ORGANISMS
CARBOHYDRATES -- 9.1% -- 1.9%
PROTEINS -- 5.9% -- 8.2%
LIPIDS -- 0.2%

8. ATTACHMENT TO THE TOOTH SURFACE
FOUR MODES
Organic pellicle
Mechanical locking into surface irregularities
such as resorption lacunae and caries
Close adaptation of calculus undersurface
depressions to the gently sloping mounds of
the unaltered cementum surface
Penetration of calculus bacteria into cementum

9. CALCULO - CEMENTUM
Calculus embedded deeply into cementum may
appear morphologically similar to cementum

10. FORMATION
Calculus is dental plaque that has undergone
mineralization
The soft plaque is hardened by the
precipitation of mineral salts, which usually
starts between the 1st and 14th days of
plaque formation

11. Calcification occur in 4 - 8 hours which
become
-- 50% mineralized in 2 days and
-- 60% to 90% mineralized in 12 days

12. Saliva is the source of mineralization for
supragingival calculus
Gingival crevicular fluid furnishes the
minerals for subgingival calculus

13. Heavy calculus formers contains
-- more calcium
-- three times more phosphorus and
-- less potassium than
that of non-calculus formers

14. MINERALIZATION OF CALCULUS — THEORIES
TWO PRINCIPALS
1 MINERAL PRECIPITATION
brought about in several ways
A rise in the PH of the saliva causes
precipitation of calcium phosphate salts by
lowering the precipitation constant

15. Colloidal proteins in saliva bind calcium and
phosphate ions and maintain a supersaturated
solution with respect to calcium phosphate salts

16. Phosphate liberated from dental plaque
desquamated epithelial cells or bacteria
precipitate calcium phosphate by hydrolyzing
organic phosphate in saliva thus increasing
the concentration of free phosphate ions

17. 2 SEEDING AGENTS induce
Small foci of calcification that enlarge and
coalesce to form a calcified
mass
This concept has been referred to as the
“epitactic concept” or “heterogenous nucleation”
The corbohydrate –protein complexes may
initiate calcification by removing calcium
from the saliva [chelation] and binding it
to form nuclei that induce subsequent

18. ETIOLOGICAL SIGNIFICANCE
Non-mineralized plaque on the calculus
surface is the principal irritant, but the
underlying calcified portion may be a
significant contributing factor
Subgingival calculus may be the product
rather than cause of periodontal pockets

19. Bacterial plaque that coats the teeth is the
main etiological factor in the development
of periodontal
disease
The removal of subgingival plaque and
calculus constitute the corner stone of
periodontal therapy

20. MATERIA ALBA
Microorganisms
Desquamated epithelial cells
Leukocytes
Salivary proteins
Lipids

21. PREDISPOSING FACTORS
1 IATROGENIC FACTORS
Deficiencies in the quality of
-- dental restorations
-- prostheses
Inadequate dental procedures
Contribute to detoriation of periodontal tissues

22. 2 MALOCCLUSION
Irregular alignment of teeth
Failure to replace missing teeth
Tongue thrusting

23. 3 ORTHODONTIC THERAPY
Plaque retention
Gingival trauma – avoid excessive force

24. 4 HABITS AND SELF–INFLICTED INJURIES
Improper tooth brushing
Wedging of toothpicks between the teeth
Fingernail pressure against the gingiva
Pizza burns
Chemical irritation include
-- topical applications of caustic medications
such as aspirin or
cocaine
-- allergic reactions to toothpaste and
chewing gum
-- use of chewing tobacco and concentrated
mouthrinses

25. OVERZEALOUS TOOTH BRUSHING TRAUMA – FINGER NAIL
CHEMICAL IRRITATION

26. 5 TOBACCO USE
Smokers had more sites of
Deeper pockets
Greater attachment loss
Furcation involvement
Boneloss
Calculus formation

27. 6 RADIATION THERAPY
induces
Soft tissue ischemia and fibrosis
Bone becomes hypovascular and hypoxic
Periodontal attachment loss and tooth loss