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• is formed when minerals deposit in organic framework
• Medical dictionary p. 244 -- an abnormal stone formed in body tissues by an accumulation of mineral salts.

1. hard, tenacious mass that forms on crowns and roots of teeth.

1. Supragingival -- must come from saliva.  Above the gumline
2. Subgingival -- if tissues are inflamed, gums bleed.  Exudate (pus) Gingival sulcus fluid provides minerals for this formation.  Below the gumline.

1. Can occur at any age.  Increases with age.  Kids do get it but it occurs more in older mouths.  Harder.

1. Inorganic -- Calcium phosphate, magnesium phosphate, calcium carbonate.  Trace elements of:
   sodium, copper, chlorine, zinc, fluorine, iron, strontium.
   • 2/3 is crystalline in structure.  Makes up 75-85%.
   • comes from saliva
2. Formation time
   
   • varies accoring to individuals
   • average soft forms to hard is 12 days
   • reason why it varies
     1.  Chemical formation of person's body
     2.  oral hygiene
     3.  Diet
     4.  Smoking -- indirectly
3. Structure of Calculus
   1. Formed in layers
      1.  pellicle
      2.  plaque
      3.  calculus
          a.  outer layer less dense than inner layer
          b.  related to inner lining of gingiva.

    

4. Supragingival (pictures coming soon)
   1. lingual surface -- most cervical part of tooth
   2. cervical third
   3. whole surface
   4. bridge of calculus
   5. Most common areas are buccals of maxillary molars and mandibular lingual anteriors due to salivary glands.
    
5. Subgingival

• finger-like projection -- pretty broad but flat
• spicules - off mesial and distal surfaces
• ledge or ring around circumference of entire tooth.
• burnished calculus -- partially removed calculus
  *  harder to find and remove
  *  causes inflammation
  *  best indicator is the condition of the tissue
    * Always check previously scaled areas.

II.  See p. 274 in Wilkens Table 17-2

III.  Calculus detection

•   Visual -- if large enough.  Big deposits can be seen easily.  Dry tooth with air (dehydrates area), makes more visible.  Deflect tissue with little spurts of air to see into calculus.
• Tactile Sensitivity
  • using the explorer.  Best one to use
  • feels rough, bumpy, hard, grainy
• Radiographic
  • must be dense to see
  • If don't see, doesn't mean that calculus isn't there.

  IV.  Mode of attachment to tooth surface

  • By means of the pellicle
    • very superficial attachment
    • very easy to remove
  • Minute irregularities to the surface of the tooth
    • very difficult to remove
    • might remove some cementum
  • Direct contact between the matrix of the calculus and the matrix of the tooth.
    • very difficult to remove

• Calculus is mineralized plaque
• Plaque forms on top of a layer of plaque of calculus
• Plaque bacteria and toxins they produce cause inflammation which causes periodontal pocket formation
• Pocket comes first, then calculus
• Calculus is a rough surface and attracts more plaque.  Traps and holds bacteria to the tooth.  Acts as a reservoir for plaque and microbes
• Calculus does not cause disease, toxic biproducts of plaque bacteria do.
• Looks unsightly and can't perform good oral hygiene procedures

IV.  Controlling calculus formation

• Has a definite role in disease process
• Antimicrobial rinses
• Good oral hygiene (brushing and flossing)
  **Interdental brush
  **Stimulants
  **Waterpik
  **Rubber tip
• Nutritional counseling
• Frequent visits to the dentist
• Tartar control toothpaste, chemical interferes with the mineralization process -- Calcium phosphate.  Can reduce above the gumline
• Soft scale -- breaks bond between tooth and calculus.  Soft gel.

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