12/29/2023 0 Comments Subgingival calculus removal![]() ![]() ![]() Bacterial cells become mineralized in the calculus, but do not form a solid mass there are channels in which bacteria survive so that calculus is filled with bacteria that perpetuate the disease process. The pocket contents are composed of subgingival calculus adjacent to the root surface, attached plaque biofilm, and loosely attached or unattached bacteria. 2 There is no salivary protein present in subgingival calculus and, interestingly, the sodium content of subgingival calculus increases with the depth of the periodontal pockets. The organic components of subgingival calculus are similar to those of supragingival calculus, but contain more calcium, magnesium, and fluoride because of the higher concentrations of these minerals in crevicular fluid. The mineral content is derived from crevicular fluid rather than from saliva, differentiating it from supragingival calculus. Pellicle forms first, subgingival plaque is seeded or forms by extension of supragingival plaque biofilm, and then mineralization occurs. Like supragingival calculus, subgingival calculus forms from mineralized plaque biofilm. Dental calculus, salivary duct calculus (calculi that can form and block the openings of major and minor salivary ducts, referred to as sialoliths, or salivary stones), and calcified dental tissues are all similar in organic composition, but subgingival calculus lacks the quantity of salivary protein. 2 Carbohydrates make up 1.9% to 9.1% of the organic component of supragingival calculus, salivary proteins account for 5.9% to 8.2% of the mass, and there are trace amounts of lipids. Half is protein from the bacterial cells, but it also includes carbohydrates and lipids from bacteria and saliva. The organic component of calculus makes up to 15% to 20% of the dry weight of calculus. After a few weeks or months, the predominant crystal type becomes hydroxyapatite. About 21% magnesium whitlockite (Ca 3 2)īrushite appears in large proportions, up to 50%, in young, recently deposited calculus.About 21% octacalcium phosphate (Ca 8 4).As oral biologic research continues to increase the understanding of this relationship, dental hygienists will be better able to help patients control calculus formation. The role of the bacteria in relation to calculus formation is not completely understood. 6 (See Chapter 7 for a discussion of aggressive periodontitis.) Importantly, the aggressive periodontitis group had significantly more subgingival calculus than those with attachment loss, but no aggressive disease, suggesting an association between gingival disease and the presence of subgingival calculus. ![]() The young people with measurable attachment loss had significantly more gingival bleeding and subgingival calculus than matched control subjects. adolescents indicated that subgingival calculus is associated with both attachment loss and aggressive forms of periodontitis. 5 An evaluation of data from 1285 young people aged 13 to 20 years who participated in the 1986-1987 national survey of the oral health of U.S. A study of Thai children aged 11 to 13 years showed a significant association among gingivitis, plaque status, and calculus accumulation, but no association between calculus status and caries. It is also clear that even in young people, the presence of calculus is associated with increased levels of gingival disease. 4 Colonies of bacteria inside the calculus are impossible to remove by any oral hygiene procedure and provide sheltered areas in periodontal pockets that keep plaque in close proximity to the tissues.Ĭalculus is not itself the causative agent of periodontal diseases its removal permits healing of periodontal tissues by reducing and eliminating the plaque bacterial biofilm that is always associated with mineral deposits. Calculus has been shown to have nonmineralized areas appearing microscopically as channels that contain bacteria and other debris. This finding suggested that calculus may be a result of disease rather than the cause and that more strongly identified plaque bacteria biofilm is a causative factor.Ĭalculus does contribute to the development of disease, serving as a reservoir for bacterial plaque biofilm, the etiologic agent. A thoughtful review by Mandel and Gaffar 3 reported that 11% of sites with calculus also had gingivitis, whereas 75% of tooth surfaces with plaque had gingivitis. It has long been thought to be the cause of periodontal diseases due to its association with gingival infections and the improved gingival health observed following its removal. Calculus is formed by the deposition of calcium and phosphate salts present in bacterial plaque. ![]()
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