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DENTAL CALCULUS: a STRATEGIC REVIEW Rajiv Saini1 1.Associate Professor,Department of Periodontology,Pravra Institute of Medical Sciences-Loni

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DENTAL CALCULUS: a STRATEGIC REVIEW Rajiv Saini1 1.Associate Professor,Department of Periodontology,Pravra Institute of Medical Sciences-Loni International Journal of Dental and Health Sciences Review Article Volume 01,Issue 05 DENTAL CALCULUS: A STRATEGIC REVIEW Rajiv Saini1 1.Associate Professor,Department of Periodontology,Pravra Institute of Medical Sciences-Loni ABSTRACT: Dental calculus or tartar is an adherent calcified mass that form on the surface of teeth and dental appliance through mineralization of bacterial dental plaque in aqueous environment. Dental calculus plays a vital role in aggravating the periodontal disease by acting as reservoir for the bacterial plaque and providing the protected-covered niche for bacteria to proliferate. Based upon the location of dental calculus in relation to marginal gingiva, it is classified into mainly two types: 1. Supragingival calculus and subgingival calculus. Calcium and phosphate are two salivary ions which are raw materials for dental calculus formation. The various techniques and equipments involved for calculus removal is Hand Instruments, Ultrasonic, Ultrasound Technology and Lasers. Chemotherapeutic agents have been used to supplement the mechanical removal of dental plaque, but a more potent oral rinse with anti-calculus properties to prevent mineralization will be the need of time to suppress calculus formation. Key Words: Periodontitis, Anti-calculus, Periogen. INTRODUCTION: biofilm is that it allows the micro-organisms to stick and to multiply on surfaces. [3] Periodontitis is a destructive inflammatory Mineralization of dental plaque leads to disease of the supporting tissues of the calculus formation. Dynamic state of tooth teeth and is caused either by specific surface is responsible for mineralization of microorganisms or by a group of specific plaque. A continuous exchange of ions is microorganisms, resulting in progressive always happening on the tooth surface with destruction of periodontal ligament and a constant exchange of calcium and alveolar bone with periodontal pocket phosphate ions. The whole process leads to formation, gingival recession, or both. [1] the accumulation of dental plaque which in The oral cavity appears as an open turn forms dental calculus. Dental calculus ecosystem, with a dynamic balance plays an instrumental role in further between the entrance of microorganisms infuriating the periodontal disease. and colonization modalities. [2] Biofilms are ubiquitous; they form on virtually all Dental calculus or tartar is an adherent surfaces immersed in natural aqueous calcified mass that form on the surface of environments. Biofilms form particularly teeth and dental appliance through fast in flow systems where a regular mineralization of bacterial dental plaque in nutrient supply is provided to the bacteria. aqueous environment. Dental calculus is The reason for the existence of the dental layered by non-mineralized bacterial *Corresponding Author Address: Dr Rajiv Saini,Associate Professor,Department of Periodontology,Pravra Institute of Medical Sciences-Loni,Ahmednagar, Maharashtra, India,Email Address: [email protected] Saini R. et al., Int J Dent Health Sci 2014; 1(5):788-795 plaque; hence act as reservoir of incisors from the submaxillary and microorganisms in the oral cavity. Various sublingual glands, respectively. [5] studies carried out to reveal the presence Supragingival calculus is composed of more of calculus have shown that calculus is brushite and octacalcium phosphate with present in 70-100% cases. These studies do less magnesium whitlockite. Salivary not discriminate between supra and proteins are present and sodium content is subgingival calculus but they indicate high less. prevalence of calculus in all studied Subgingival Calculus: populations. [4] Subgingival calculus is located below the CLASSIFICATION: crest of the marginal gingiva and therefore Based upon the location of dental calculus is not visible on routine clinical in relation to marginal gingiva, it is classified examination. The location and extent of into mainly two types: subgingival calculus may be evaluated by careful tactile perception with a delicate 1. Supragingival calculus dental instrument such as an explorer. 2. subgingival calculus. Subgingival calculus is typically hard and dense and frequently appears dark brown Supragingival Calculus: or greenish black in color while being firmly attached to the tooth surface. Supragingival Supragingival calculus is located coronal to calculus and subgingival calculus generally the gingival margin and therefore is visible occur together, but one may be present in the oral cavity. It is usually white or without the other. Microscopic studies whitish yellow in color, hard with clay-like demonstrate that deposits of subgingival consistency, and easily detached from the calculus usually extend nearly to the base of tooth surface. The color is influenced by periodontal pockets in chronic periodontitis contact with such substances as tobacco but do not reach the junctional epithelium. and food pigments. It may localize on a When the gingival tissues recede, single tooth or group of teeth, or it may be subgingival calculus becomes exposed and generalized throughout the mouth. After is therefore reclassified as supragingival. removal, it may rapidly recur, especially in Thus supragingival calculus can be the lingual area of the mandibular incisors. composed of both supragingival calculus The two most common locations for and previous subgingival calculus. A supragingival calculus to develop are the reduction in gingival inflammation and buccal surfaces of the maxillary molars and probing depths and a gain in clinical the lingual surfaces of the mandibular attachment can be observed after the anterior teeth. Saliva from the parotid removal of subgingival plaque and calculus. gland flows over the facial surfaces of upper [5] Subgingival calculus is composed of less molars via Stensen's duct, whereas brushite and octacalcium phosphate with Wharton's duct and Bartholin's duct empty more magnesium whitlockite. Salivary onto the lingual surfaces of the lower 795 Saini R. et al., Int J Dent Health Sci 2014; 1(5):788-795 proteins are absent and sodium content is important for estimation of saturation more. degree (SD) with respect to a given salt. If Ip > Ksp, the fluid is supersaturated and Plaque Mineralization Process: precipitation of the salt can occur; if Ip = Calculus Formation Ksp, the fluid is just saturated with respect to the salt, and if Ip < Ksp, the salt tends to The mineralization of dental plaque is a dissolve, since the fluid is not saturated complex process and calcification has been with respect to the salt. [8] The rate of reported to occur as soon as 4 to 8 hours. calculus formation varies from person to The soft plaque is hardened by the person and can be increased by such precipitation of mineral salts, which usually factors as elevated salivary pH, starts between the 1st and 14th days of concentration of salivary calcium, urea, plaque formation. Calcifying plaques may bacterial proteins or lipids. Four modes of become 50% mineralized in 2 days and 60% attachment of calculus to tooth surface [5, 6] to 90% mineralized in 12 days. Within have been observed [5, 7]: 24-72 hours of plaque formation, more and more mineralization centers develop close 1. Attachment by means of an organic to the underlying tooth surface. The pellicle. centers grow large enough to touch and 2. Mechanical locking into surface unite. The average time for mineralization irregularities such as resorption by rapid calculus formers is 10-12 days and lacunae and caries. slow calculus former is 20 days. Mineralization can begin as early as 24-48 3. Close adaptation of calculus hours. Calculus forms in layers that are undersurface depressions to the parallel to the tooth surface. The layers are gently sloping mounds of the separated by line that appears to be pellicle unaltered Cementum surface. which later undergoes mineralization. 4. Penetration of calculus bacteria into These lines are called incremental lines. cementum. Calcification starts in separate foci on inner surface of plaque, these foci of The various theories associated with mineralization gradually increases in size theories of calculus formation are and coalesce to form a solid mass of illustrated in Table 2. calculus. [7] The mineralization of plaque is illustrated in Table 1. Calcium and Composition of Dental Calculus: phosphate are two salivary ions which are Calculus consists of both Inorganic and raw materials for dental calculus formation. Organic components as illustrated in Table Theoretically, super saturation of saliva, 3. especially plaque fluid, with respect to calcium phosphate salts is the driving force for dental plaque mineralization. Ion product (Ip) and solubility product (Ksp) are 796 Saini R. et al., Int J Dent Health Sci 2014; 1(5):788-795 Detection of Calculus: used for its removal. Percentage of residual calculus on tooth surfaces varies between Most significant feature of calculus 3-80%. [11, 12, 13] detection is using tactile sense of the operator. Visibility is a key factor that Future Outlook: confines detection of sub-gingival calculus. There have been many advances in our Hence operator has to rely on either perceptiveness of how plaque and periodontal probe or explorer or curette to microbial mineralization proceeds and detect the presence of subgingival calculus. regulated by various inhibitors and Smooth and clean root surface is often promoters, and how it can be suppressed considered as the endpoint of scaling and and prevented. The roles of root planing. Current
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