Calculus (dental)
Calculus formation is associated with a number of clinical manifestations, including bad breath, receding gums and chronically inflamed gingiva.
The mineral proportion of supragingival calculus ranges from approximately 40–60%, depending on its location in the dentition,[5] and consists primarily of calcium phosphate crystals organized into four principal mineral phases, listed here in order of decreasing ratio of phosphate to calcium: The organic component is approximately 85% cellular and 15% extracellular matrix.
Many variables have been identified that influence the formation of dental calculus, including age, sex, ethnic background, diet, location in the oral cavity, oral hygiene, bacterial plaque composition, host genetics, access to professional dental care, physical disabilities, systemic diseases, tobacco use, and drugs and medications.
Subgingival calculus forms below the gumline and is typically darkened in color by the presence of black-pigmented bacteria,[18] whose cells are coated in a layer of iron obtained from heme during gingival bleeding.
The fossilized bacteria pile up rather haphazardly, while free-floating ionic components (calcium phosphate salts) fill in the gaps.
[15] The resultant hardened structure can be compared to concrete, with the fossilized bacteria playing the role of aggregate, and the smaller calcium phosphate salts being the cement.
When the gingiva become so irritated that there is a loss of the connective tissue fibers that attach the gums to the teeth and bone that surrounds the tooth, this is known as periodontitis.
Several anaerobic plaque bacteria, such as Porphyromonas gingivalis,[21] secrete antigenic proteins that trigger a strong inflammatory response in the periodontium, the specialized tissues that surround and support the teeth.
Prolonged inflammation of the periodontium leads to bone loss and weakening of the gingival fibers that attach the teeth to the gums, two major hallmarks of periodontitis.
[18] Dental plaque bacteria have been linked to cardiovascular disease[25] and mothers giving birth to pre-term low weight infants,[26] but there is no conclusive evidence yet that periodontitis is a significant risk factor for either of these two conditions.
[31] In animals, calculus should not be confused with crown cementum,[32] a layer of calcified dental tissue that encases the tooth root underneath the gingival margin and is gradually lost through periodontal disease.
To effectively manage disease or maintain oral health, thorough removal of calculus deposits should be completed at frequent intervals.
The recommended frequency of dental hygiene treatment can be made by a registered professional, and is dependent on individual patient needs.
[41] Factors that are taken into consideration include an individual's overall health status, tobacco use, amount of calculus present, and adherence to a professionally recommended home care routine.
[42] Hand instruments are specially designed tools used by dental professionals to remove plaque and calculus deposits that have formed on the teeth.
[39] Special tips for ultrasonic scalers are designed to address different areas of the mouth and varying amounts of calculus buildup.
[39] Only the first 1–2 mm of the tip on the ultrasonic scaler is most effective for removal, and therefore needs to come into direct contact with the calculus to fracture the deposits.
[39] Small adaptations are needed in order to keep the tip of the scaler touching the surface of the tooth, while overlapping oblique, horizontal, or vertical strokes are used for adequate calculus removal.
[45] An optimal output power setting of 1.0-W with the near-infrared Er,Cr:YSGG laser has been shown to be effective for root scaling.
