Calculus is the hard residue ranging from yellow to brown forming on teeth when oral hygiene is incomplete or improper. Calculus is formed from Plaque (a soft sticky substance that accumulates on teeth; composed largely of bacteria and food substances suspended in saliva) which can build up and become hard. This hard plaque is known as tartar or calculus. Brushing and flossing alone cannot remove calculus. A dentist or hygienist must remove it manually to stop the disease process.
Although plaque and calculus have different characteristics a relationship exists between them. It is the host to a complex micro-system of microorganisms that cause inflammatory diseases of the gingival & periodontal tissues. Plaque can be removed from tooth surfaces by direct brushing. It is possible to have a mouth with plaque but no calculus. Calculus is formed by the deposition of mineral salts in plaque. It is hard and firmly adherent to the tooth surfaces on which it forms and it cannot be removed by brushing. Calculus acts as a focal point for plaque accumulation bacteria and hinders complete removal of plaque. Both plaque and calculus play an important role in gum disease. As gums ”pull away” from the teeth as a result of gum-disease pockets begin to form between the teeth and gums. Plaque and calculus fill these pockets until eventually the jawbone supporting the teeth are destroyed. Calculus deposits can be classified as s light moderate or heavy.
Calculus forms in various areas of the mouth. The terms Supra-gingival calculus and subgingival calculus are given to the most common areas of calculus build up.
Supra-gingival calculus is found on the tooth surface next to the tongue (lingual) on the mandibular incisors and on the buccal surfaces (area near the cheek) of maxillary molars. Subgingival calculus forms on root surfaces below the gingival margin and can extend deep into periodontal pockets. A more irregular subgingival cemental surface allows deposits to form into the cemental irregularities. This makes the attachment of the subgingiva calculus more tenacious and difficult to remove. Subgingival calculus can often be seen on radiographs but explorer detection is needed to evaluate the amount of calculus present.
Rate of calculus formation varies from person to person but the following can certain factors can increase the rate of calculus formation. These factors are
· Elevated salivary pH.
· Elevated salivary calcium concentration.
· Elevated bacterial protein and lipid concentration.
· Elevated concentration of protein and urea in submandibular salivary gland secretions.
· Low individual inhibitory factors.
· Higher total salivary lipid levels.
Treatments to remove or prevent calculus build up are numerous and include surgical and non-surgical procedures. A surgical approach is when full thickness tissue flaps are reflected to expose the root surfaces and gain direct access to them. A non-surgical approach is when access to the root surfaces is via the periodontal pockets.
The efficacy of subgingival plaque and calculus removal utilizing a non-surgical approach is limited.
Procedures to remove calculus include the following.
The meticulous removal from the root surfaces of the teeth to remove plaque calculus and stains from these surfaces.· Root Planing:
A treatment procedure designed to remove cementum or surface dentin that is rough impregnated with calculus or contaminated with toxins or microorganisms.· Periodontal Debridement:
This includes the removal of plaque and calculus both above and below the gingiva.· Prophy / Prophylaxis:
A preventive procedure to remove local irritants to the gingiva including debridements of calculus and removal of plaque.
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