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Role of Calculus and Local Factors

DENT 371

Dr. Hisham Al-Shorman

Dental

Plaque is the primary etiologic (initiating) factor of periodontal inflammation

Factors

that facilitates and favor plaque retention and accumulation are LOCAL PREDISPOSING FACTORS conditions that alter the host response (i.e. make a person more susceptible to disease) are SYSTEMIC FACTORS. These will be covered next lecture

Systemic

Calculus Malocclusion Faulty

restorations Orthodontic therapy Self-inflected injuries Radiation therapy

Mineralized

dental plaque that forms on the surfaces of teeth and prostheses

Supragingival

Subgingival

A. Inorganic Components (70 90 %):


Calcium phosphate (76 %) Calcium carbonate (3 %) Magnesium phosphate and other metals

Inorganic

component of calculus is made of crystals with different chemical composition as follows:


Hydroxyapatite 58 % Magnesium Whitlockite 21 % (more in posterior regions) Octacalcium phosphate 12 % Brushite 9 % (more in mandibular anterior regions)

B. Organic Components (10 30 %):


Carbohydrates (2 9%) Proteins (6 8 %) Lipids (< 1%) such as fatty acids, neutral fats, cholesterol, and phospholipids Host cells and microorganisms

Same

as subgingival calculus with some differences: Magnesium Whitlockite Brushite and Octacalcium phosphate calcium to phosphate ratio No salivary proteins (because its minerals are derived from the gingival fluid)

Four

modes of attachment have been described:

1. Attachment by means of an organic pellicle

2. Mechanical locking into surface irregularities such as resorption lacunae

Four

modes of attachment have been described:

3. Close adaptation of calculus undersurface to cementum surfaces

4. Penetration of calculus bacteria into cementum

Plaque is hardened by precipitation of mineral salts It starts 1 14 days of plaque formation

It is mineralized 50% in 2 days and 60-90& in 12 days Plaque concentrates calcium ions 2 -20 times its level in saliva

Source of minerals:

Supragingival calculus: SALIVA Subgingival calculus: GCF


Ca++ bind to glycoprotein complexes of organic matrix of dental plaque and form crystalline structures made of calcium phosphate salts

Calcification

begins along the inner surface of supra-gingival plaque toward the tooth surface calculus is formed in layers, which are separated by thin cuticle that embed in calculus as the calcification progresses time required for calculus to reach its maximum level is 2.5 to 6 months

Therefore,

The

Heavy, moderate, slight and non-calculus formers due to:


salivary pH salivary Ca++ bacterial protein and lipid concentration protein and urea in submandibular salivary gland secretions total salivary lipid levels individual inhibitory factors

Anti-calculus (anti-tarter) agents have been incorporated into some dentifrices to reduce the calculus formation These toothpastes may be help in heavy calculus formers However, plaque control measures are the cornerstone in reduction of calculus rate

Local rise in saturation of Ca++ & P++ leads to their precipitation. This precipitation is due to any of the following factors:

pH Colloidal proteins in saliva bind Ca++ & P++ hydrolysis of organic phosphate due to the action of phosphatase enzyme from desquamated epithelial cells and bacteria

Epitactic concept or heterogenous nucleation: Seeding agents (e.g. intercellular matrix) induce small foci of calcification that enlarge and coalesce to form calcified masses

Covered

in previous lecture

Interfere

with the oral hygiene measures favor the multiplication of disease-associated microorganisms

They

Margins

of restorations are better to be placed supragingivally as aesthetically as possible


restorations should be as smooth as possible when they are related to the gingiva

Dental

Over-contoured

crowns and restorations accumulate and retain more plaque than under-contoured restorations

Integrity

of proximal contacts prevents food impaction that deteriorates the periodontal health plunger cusp

Malocclusion

interferes with plaque control by the patient roots are associated with gingival recession and less adequate attached gingiva
health deteriorates in mouth-breathers

Prominent

Gingival

Interfere

with normal oral hygiene measures

They

change the plaque ecology (increase P. intermedia, and Aa)


may cause trauma to periodontal tissues with increased incidence of gingival recession, pocketing, and bone loss

Bands

The

misuse of toothbrushes may result in gingival abrasion and alteration of teeth shape

A. Localized tooth-related factors that modify or predispose to gingival diseases/periodontitis:


Tooth anatomic factors:
Enamel Pearls Cervical Enamel Projections

Localized tooth-related factors that modify or predispose to gingival diseases/periodontitis:


Root fractures

Cervical root resorption and cemental tears