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Role of Calculus and Local Factors

DENT 371

Dr. Hisham Al-Shorman


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


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


Calculus Malocclusion Faulty

restorations Orthodontic therapy Self-inflected injuries Radiation therapy


dental plaque that forms on the surfaces of teeth and prostheses



A. Inorganic Components (70 90 %):

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


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


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)


modes of attachment have been described:

1. Attachment by means of an organic pellicle

2. Mechanical locking into surface irregularities such as resorption lacunae


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


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



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


in previous lecture


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



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



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


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


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




with normal oral hygiene measures


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



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