Periodontology - Calculus

Marin Contemporary Perio & Implant Concepts

In dentistry, calculus or Tar-Tar is a specific form of dental plaque which has hardened. It is caused by the collection of minerals from saliva and gingival crevicular fluid in plaque found on the teeth. This process of precipitation actually kills off the bacterial cells that are within the dental plaque. However, the rough and hard surface which forms acts as a perfect surface for the further formation of plaque. This results in calculus buildup and compromises the gum’s health. Calculus can form both along the gumline or supragingival and within the narrow sulcus that exists between the teeth and the gingiva. This is called subgingival.

The formation of calculus is associated with various clinical issues which include bad breath, receding gums and inflamed gingiva. Regular brushing and flossing can help remove the plaque from which calculus forms. Unfortunately, once it is formed, the calculus is too hard to effectively remove it with a toothbrush. Ultrasonic tools or dental hand instruments can be used to remove calculus buildup.

Calculus formation

The processes of the formation of calculus from dental plaque is not well understood. The supragingival calculus formation is most prevalent on the check surfaces of the upper jaw molars in addition to the tongue’s surfaces of the lower jaw incisors. These areas experience a particularly high flow of saliva because of their location to the salivary glands. Subgingival calculus forms just below the gumline and is usually dark in color from the presence of black-pigmented bacteria. The bacteria cells are coated in a layer of iron obtained from heme which occurs during gingival bleeding. Dental calculus often forms in layers which are easily visible through the use of both electron and light microscopy. These layers form during the calcification process of the dental plaque. The timing and triggers of these events are not well understood. The formation of calculus can drastically vary from patient to patient. Various components influence how and where the dental calculus forms. These variables can including age, gender, ethnic background, diet, location in the mouth, oral hygiene, bacterial plaque composition, genetics, dental care access, physical disabilities, systemic diseases, use of tobacco, drugs and medications.

The accumulation of plaque causes the gingiva to become irritated and inflamed. This is commonly referred to as gingivitis. When the gingiva becomes chronically irritated, there is a loss of the connective tissue fibers which attach the gums to the teeth and bone which surrounds the tooth. This condition is referred to as periodontitis. Dental plaque does not exclusively cause periodontitis, however, it is it is often associated with the condition. Plaque which remains in the oral cavity for long periods of time will eventually calcify and turn to calculus. Calculus is bad for gingival health because it leads to the additional formation of plaque.

When plaque is supragingival, the bacterial content has higher levels of aerobic bacteria and yeast. This type of bacteria can survive in an environment which contains oxygen. Subgingival plaque contains a higher amount of anaerobic bacteria. This includes bacteria which cannot exist in an environment which contains oxygen. Various types of anaerobic plaque bacteria, including Porphyromonas gingivalis, secretes antigenic proteins which trigger a strong inflammatory response in the periodontium. The periodontium are the specialized tissues that surround and support the teeth. The prolonged inflammation of the periodontium can result in bone loss and weakened gingival fibers which attach the teeth to the gums. Both side effects which are major issues associated with periodontitis. Almost all patients who have periodontitis exhibit high levels of subgingival calculus deposits. The bacteria found in dental plaque has also been linked to cardiovascular disease in addition to mothers giving birth to pre-term low weight infants. However, there is no evidence to prove that periodontitis is a significant risk factor for these conditions.

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When you come to Marin Contemporary Perio and Implant Concepts, you can expect a friendly and professional dental team. Dr. Seda will listen carefully to your dental goals and provide a custom treatment plan that works with your budget and needs. We want you to fall in love with your smile again, so all our services are performed with the patient in mind. We want you to feel comfortable in the dental chair, and to feel confident in our services.

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