Role of Calculus and Local Factor

7/27/2019 Role of Calculus and Local Factor

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:Role of calculus and local factor

We started that periodontal diseases case by the pattern ifleft for enough period to form dental plaque then itmineralizes to form hard tissue so dental plaque is called theinitiating factor the primary case of gingival disease andperiodontal disease and any thing facilitate or favor plaqueretention and accumulation are LOCAL PREDISPOSINGFACTORS or risk factor for periodontal disease we have

some few examples this could be local or systemiclocal means there is intra oral things that make a plaqueaccumulation easy or plaque removal difficult >>>>>>>

and as we said periodontal disease is the disease of reactionof the body so any thing agree with this ability of the body asa reaction specially with patient with load immune capacitythese patient have more periodontal destruction and nextlecture maybe have lecture in systemic factor so it isSystemic conditions that alter the host response (i.e. make aperson more susceptible to disease) are SYSTEMIC factor >

Dental Plaque is the primary etiologic (initiating) factor

of periodontal inflammation


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Local factors ::Calculus

Malocclusion

Faulty restorations

Orthodontic therapy

Self-inflected injuries

Radiation therapy( just know this we won't going to talk a bout it in details about radiation )

Calculus :

Mineralized dental plaque that forms on the surfaces of teethand prostheses


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So its plaque or mineralize set on the surface of the patternbut it starts at the bottom rather than the surface of thesurface and become this and don't get surprise if you seepatient of all the teeth covered with calculus like this happensbasically in the post. Teeth if the patient didn't use this sideof the mouth we call it nonfunctional this area we not usedfor daily mastication that retains plaque and calculus more .this particular tooth is not exposed but other one is exposedfor example nothing will wash out plaque if he or she dosenot brush his or her teeth so what happen for calculus forma crown in top of the teeth we remove them in clinic

So calculus could be : Supragingival


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Subgingival

You see how the gingival dark color is it .it try to get rid

on the factor which is calculus but unfortunately the

pattern is failure of the gingival so it recedes and

subgingiva calculus appeared and start to extend more

and more and it reachs a stage where the calculus is

covered all the root apex when you extract the tooth

you see how it cover the apex totally .

(whichragingival calculusComposition of sup

similar to subgingival calculus with some

differences you will see )

All minerals sort to be inorganic

Inorganic Components (70 90 %):Calcium phosphate (76 %)

Calcium carbonate (3 %)

(ca++ is a major mineral in human the body )


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Magnesium phosphate and other metalsBut basically its ca ++

Inorganic component of calculus is made of crystalswith different chemical composition as follows:Hydroxyapatite 58 %

Magnesium Whitlockite 21 % (more in posterior regions)

Octacalcium phosphate 12 %

Brushite 9 % (more in mandibular anterior regions)

(Note : the percentages for memorization)

Basically mineralization starts on organic componentsOrganic Components (10 30 %):Carbohydrates (2 9%)

Proteins (6 8 %)

Lipids (< 1%) such as fatty acids, neutral fats, cholesterol, andphospholipids

Host cells and microorganisms

(Note : the percentages for memorization)


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calculus can ( sometimes

detected on radiograph so we should look careful

to radiograph )

calculus Composition of subgingival

Same as supragingival calculus with some differences:

Magnesium Whitlockite

Brushite and Octacalcium phosphate

calcium to phosphate ratio

No salivary proteins (because its minerals are derived fromthe gingival fluid)

- Attachment of calculus to the tooth structure:- 1.Attachment by means of an organic pellicle look to pic

there a thin layer of organic particles which something like blue between the enamel surface and the


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calculus

- Mechanical locking into surface irregularities such asresorption lacunae :basically in the root wherecementum is desorbed this will occupied mechanicalinterlocking calculus and irregularities in root surfacealthough ;the space is small but its important ( the idealike composite filling ) they thought that theirregularities in healthy cementum surface its the areafor calculus to accumulate and bacteria to penetrate .


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3.Close adaptation of calculus undersurface to cementumsurfaces

4.Penetration of calculus bacteria into cementum

_calculus formation :


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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 insaliva >saliva is rich in ca++ although the sliva is the main

source of ca++ but the plaque absorb it quickly fortunately sothis property is important to explanation of themineralization

Note : mineralization it is the set of inorganic matter in organic matrix

Source of minerals:

Supragingival calculus: SALIVAThe color of supragingival calculus is white_yellowish

Subgingival calculus: GCFThe color of subgingival greenish _bluish

Ca++ bind to glycoprotein complexes of organic matrix ofdental plaque and form

crystalline structures made of calcium phosphate salts

note : the color of calculus is explained through the contentsof it and the color of minerals .

Calcification begins along the inner surface of supra-gingivalplaque toward the tooth surface


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And it start from organic to inorganic > basically its calciumand form crystals

Therefore, calculus is formed in layers, which are separatedby thin cuticle that embed in calculus as the calcificationprogresses not like cementum ( cementum has time lines butcalculus dose not )

The time required for calculus to reach its maximum levelis 2.5 to 6 months (become really tensions hardly attached

difficult to remove )we talk about subgingival calculus inparticular supragingival calculus is easier to remove becauseit has in the top no calculus can attach when the layer reachthe all thikness it will be then chip out so there is a free endlets imagine the last layer for minerals to attach there is noenough space so we don't have deposition of mineral for over.subgingival although its suspending to chipping out it isaway from mastication and tongue movement so we need

special instrument which you will see in clinic ( inshaa'Allah )

So we have :

Heavy, moderate, slight and non-calculusso don't be surprise if you see a patient with plenty attachedand he or she dose not brush his teeth and very minimalamount of calculus thats normal finding because it depends

on the composition of the saliva and the ca++content in thesaliva and even the JSF and the organic of the saliva and ifthere is inhibitory factorformers due to:

salivary pH

salivary Ca++

bacterial protein and lipid concentration


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protein and urea in submandibular salivary glandsecretions

total salivary lipid levels

individual inhibitory factorsThis made scientists to think about material reduced thecalculus amount and there is product for removal calculusand many components in tooth baste it self and manyresearch found that there is beneficent to use this componentin reducing the amount of calculus for natural this will behelpful with out much details about the name when you go

to clinic inshaa' Allah you will know it better but you need toknow this :

Anti-calculus (anti-tarter) agents have been incorporated into somedentifrices to reduce the calculus formation

These toothpastes may be help in heavy calculus formers

However, plaque control measures are the cornerstone in reductionof calculus rate

And there is a theories about calculus FORMATON JUST

CONCENTRATE VERY SIMPLE THING just logical they thought ifthe concentration of minerals increases in its level it will be start toprecipitate and bacteria which got mix them the mineralprecipitate they increase PH and the bonding capacity ofmineral and similar mechanism and they found that there isEpitactic concept or heterogenous nucleationNucaleation : happen due particles form

We know water in gas form is basically pure water when you

ever have cup of water its not a pure water because for water


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to trans from gas to liquid it has to be which callednucaleation that particles of water gathers things to form andthis is how to make an artificial rain where the gasaccumulate and going to form a liquid so similarly we havesome factors bacteria will accumulate these components just

you need to know this concept in this simple was >

Local rise in saturation of Ca++ & P++ leads to theirprecipitation. This precipitation is due to any of the followingfactors:

pHColloidal proteins in saliva bind Ca++ & P++

hydrolysis of organic phosphate due to the action ofphosphatase enzyme from desquamated epithelial cells andbacteria

Epitactic concept or heterogenous nucleation: Seeding agents

(e.g. intercellular matrix) induce small foci of calcificationthat enlarge and coalesce to form calcified masses

We focus in calculus because or treatment depend oncalculus , calculus it self is not a causative disease it works byproviding rough surface where plaque can attach and liveAnd bacterial can cause periodontal disease so the irritation

that cause by calculus it self it present but it is aminimal .Know we talk a bout intra oral predoposing factorsaliva flow ( saliva content excited plaque formation ) ,crowded its a factor that we can't brush your teeth well .Lack of function in patient don't brush there teethOrtho treatment brushing became difficultFillings are a cause if they bad especially class two whereoverhanging restoration or open contact which is make it


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difficult to clean due to brush can't reach these area evendental floss

Over hang dental restoration :Interfere with the oral hygiene measures

They favor the multiplication of disease-associated microorganisms

Margins of restorations are better to be placed supragingivally asaesthetically as possible

Dental restorations should be as smooth as possible when they are related tothe gingiva

Contours and open contact

Over-contoured crowns and restorations accumulate and retain more plaque

than under-contoured restorations


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Integrity of proximal contacts prevents food impaction that deteriorates theperiodontal health plunger cuspSo if you make a crown or you will increase the space and make which is called

self-clearance

Malocclusion:

Malocclusion interferes with plaque control by the patient

Prominent roots are associated with gingival recession and less adequateattached gingiva

Gingival health deteriorates in mouth-breathers

Ortho appliance :


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Interfere with normal oral hygiene measures

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

Bands may cause trauma to periodontal tissues with increased incidence ofgingival recession, pocketing, and bone loss

Tooth brush trauma

The misuse of toothbrushes may result in gingival abrasion and alteration of

teeth shape

_ inflected injuriesSelf

Devolapmantal or aquired deformities &

condition :

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

Tooth anatomic factors:Enamel Pearls

Cervical Enamel Projections

Localized tooth-related factors that modify or predispose to gingivaldiseases/periodontitis:Root fractures

Cervical root resorption and cemental tears

For more details refer to book >


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Thats all ,

Done by :Zain al-salameenHebah rae'd al-jabri

Everything is okay in the end. If it's not okay, then it's not

the end

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Role of Calculus and Local Factor