Calculus (dental)
In
Calculus formation is associated with a number of clinical manifestations, including
Etymology
The word comes from Latin calculus "small stone", from calx "limestone, lime",[1] probably related to Greek χάλιξ chalix "small stone, pebble, rubble",[2] which many[who?] trace to a Proto-Indo-European root for "split, break up".[3] Calculus was a term used for various kinds of stones. This spun off many modern words, including "calculate" (use stones for mathematical purposes), and "calculus", which came to be used, in the 18th century, for accidental or incidental mineral buildups in human and animal bodies, like kidney stones and minerals on teeth.[3]
Tartar, on the other hand, originates in Greek as well (tartaron), but as the term for the white encrustation inside casks (a.k.a. potassium bitartrate, commonly known as cream of tartar). This came to be a term used for calcium phosphate on teeth in the early 19th century.[4]
Calculus chemical composition
Calculus is composed of both inorganic (mineral) and organic (cellular and extracellular matrix) components. The mineral proportion of 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:
- whitlockite, Ca9(Mg,Fe)(PO4)6(PO3OH)
- hydroxyapatite, Ca5(PO4)3OH
- octacalcium phosphate, Ca8H2(PO4)6 · 5 H2O
- and brushite, CaHPO4 · 2 H2O
The organic component of calculus is approximately 85% cellular and 15% extracellular matrix.
Calculus formation
The processes of calculus formation from dental plaque are not well understood. Supragingival calculus formation is most abundant on the buccal (cheek) surfaces of the
Clinical significance
When plaque is supragingival, the bacterial content contains a great proportion of
Prevention
Calculus in other animals
Calculus formation in other animals is less well studied than in humans, but it is known to form in a wide range of species. Domestic pets, such as
Archaeological significance
Dental calculus has been shown to contain well preserved microparticles, DNA and protein in archaeological samples.[31][32] The information these molecules contain can reveal information about the oral microbiome of the host and the presence of pathogens.[33] It is also possible to identify dietary sources[34] as well as study dietary shifts[35] and occasionally evidence of craft activities.[36]
Sub-gingival calculus formation and chemical dissolution
This section may require cleanup to meet Wikipedia's quality standards. The specific problem is: Significant overlap with section "Calculus chemical composition" above; really the only difference is "anaerobic", but even that is covered by above section when discussing the kinds of fossilized cells. (March 2024) |
Sub-gingival calculus is composed almost entirely of two components: fossilized anaerobic bacteria whose biological composition has been replaced by
The reason fossilized bacteria are initially attracted to one part of the subgingival tooth surface over another is not fully understood; once the first layer is attached, ionized calculus components are naturally attracted to the same places due to electrical charge. The fossilized bacteria pile on top of one another, in a rather haphazard manner. All the while, free-floating ionic components fill in the gaps left by the fossilized bacteria. 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. The once purely electrical association of fossilized bacteria then becomes mechanical, with the introduction of free-floating calcium phosphate salts. The "hardened" calculus formations are at the heart of periodontal disease and treatment.[38]
Removal of calculus after formation
Plaque and calculus deposits are a major etiological factor in the development and progression of oral disease. An important part of the scope of practice of a dental hygienist is the removal of plaque and calculus deposits. This is achieved through the use of specifically designed instruments for debridement of tooth surfaces.[41][42] Treatment with these types of instruments is necessary as calculus deposits cannot be removed by brushing or flossing alone. 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.[43] 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.[44]
Hand instruments are specially designed tools used by dental professionals to remove plaque and calculus deposits that have formed on the teeth.[41][42] These tools include scalers, curettes, jaquettes, hoes, files and chisels.[41][42] Each type of tool is designed to be used in specific areas of the mouth.[42] Some commonly used instruments include sickle scalers which are designed with a pointed tip and are mainly used supragingivally.[41][42] Curettes are mainly used to remove subgingival calculus, smooth root surfaces and to clean out periodontal pockets.[41][45] Curettes can be divided into two subgroups: universals and area specific instruments. Universal curettes can be used in multiple areas, while area specific instruments are designed for select tooth surfaces.[42] Gracey curettes are a popular type of area specific curettes.[42] Due to their design, area specific curettes allow for better adaptation to the root surface and can be slightly more effective than universals.[41][42] Hoes, chisels, and files are less widely used than scalers and curettes. These are beneficial when removing large amounts of calculus or tenacious calculus that cannot be removed with a curette or scaler alone.[41] Chisels and hoes are used to remove bands of calculus, whereas files are used to crush burnished or tenacious calculus.[41]
Ultrasonic scalers, also known as power scalers, are effective in removing calculus, stain, and plaque. These scalers are also useful for root planing, curettage, and surgical debridement.[41] Not only is tenacious calculus and stain removed more effectively with ultrasonic scalers than with hand instrumentation alone, it is evident that the most satisfactory clinical results are when ultrasonics are used in adjunct to hand instrumentation.[41] There are two types of ultrasonic scalers; piezoelectric and magnetostrictive. Oscillating material in both of these handpieces cause the tip of the scaler to vibrate at high speeds, between 18,000 and 50,000 Hz.[41] The tip of each scaler uses a different vibration pattern for removal of calculus.[41] The magnetostrictive power scaler vibration is elliptical, activating all sides of the tip, whereas the piezoelectric vibration is linear and is more active on the two sides of the tip.[41]
Special tips for ultrasonic scalers are designed to address different areas of the mouth and varying amounts of calculus buildup. Larger tips are used for heavy subgingival or supragingival calculus deposits, whereas thinner tips are designed more for definitive subgingival debridement.[41] As the high frequency vibrations loosen calculus and plaque, heat is generated at the tip.[41] A water spray is directed towards the end of the tip to cool it as well as irrigate the gingiva during debridement.[41] 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.[41] 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.[41]
Current research on potentially more effective methods of subgingival calculus removal focuses on the use of near-ultraviolet and near-infrared lasers, such as Er,Cr:YSGG lasers.[46][47] The use of lasers in periodontal therapy offers a unique clinical advantage over conventional hand instrumentation, as the thin and flexible fibers can deliver laser energy into periodontal pockets that are otherwise difficult to access.[47] Near-infrared lasers, such as the Er,CR:YSGG laser, have been proposed as an effective adjunct for calculus removal as the emission wavelength is highly absorbed by water, a large component of calculus deposits.[47] 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.[47] Near-ultraviolet lasers have also shown promise as they allow the dental professional to remove calculus deposits quickly, without removing underlying healthy tooth structure, which often occurs during hand instrumentation.[46] Additionally, near-ultraviolet lasers are effective at various irradiation angles for calculus removal.[46] Discrepancies in the efficiency of removal are due to the physical and optical properties of the calculus deposits, not to the angle of laser use.[46] Dental hygienists must receive additional theoretical and clinical training on the use of lasers, where legislation permits.[48]
See also
References
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