Introduction and Etymology of Calculus
- The word 'calculus' comes from Latin, meaning 'small stone' or 'limestone.'
- The term 'calculus' was used for various kinds of stones.
- The word 'calculate' is derived from 'calculus,' referring to the use of stones for mathematical purposes.
- 'Calculus' in the 18th century came to be used for mineral buildups in human and animal bodies, such as kidney stones and minerals on teeth.
- 'Tartar' originates from Greek as the term for the white encrustation inside casks.
Composition and Formation of Calculus
- The organic component of calculus is approximately 85% cellular and 15% extracellular matrix.
- Calculus contains primarily bacterial cells, including species of archaea and yeast.
- The organic extracellular matrix in calculus consists of proteins, lipids, and extracellular DNA.
- Trace amounts of host, dietary, and environmental microdebris are also found within calculus.
- These microdebris include salivary proteins, plant DNA, milk proteins, starch granules, textile fibers, and smoke particles.
- Supragingival calculus forms on the buccal surfaces of upper molars and lingual surfaces of lower incisors.
- Subgingival calculus forms below the gumline and is typically darkened in color by black-pigmented bacteria.
- Dental calculus forms in incremental layers, visible through electron microscopy and light microscopy.
- The timing and triggers of calculus formation events are poorly understood.
- Various factors influence the formation of dental calculus, including age, gender, diet, oral hygiene, bacterial plaque composition, and systemic diseases.
Clinical Significance of Calculus
- Calculus accumulation causes gingivitis and periodontitis.
- Calculus serves as a trap for increased plaque formation and retention.
- Supragingival plaque contains aerobic bacteria and yeast, while subgingival plaque contains anaerobic bacteria.
- Anaerobic plaque bacteria trigger inflammation in the periodontium, leading to bone loss and weakening of gingival fibers.
- Almost all individuals with periodontitis exhibit considerable subgingival calculus deposits.
Prevention and Removal of Calculus
- Toothpaste with pyrophosphates or zinc citrate can reduce plaque accumulation.
- Some calculus may form without plaque deposits through direct mineralization of the pellicle.
- Regular brushing and flossing can help prevent calculus formation.
- Regular dental check-ups and professional cleanings can remove calculus buildup.
- Maintaining good oral hygiene practices is essential for preventing calculus formation.
- Plaque and calculus deposits are major contributors to oral disease.
- Dental hygienists use specially designed instruments to remove plaque and calculus deposits.
- Calculus deposits cannot be removed by brushing or flossing alone.
- The frequency of dental hygiene treatment depends on individual patient needs.
- Hand instruments like scalers, curettes, jaquettes, hoes, files, and chisels are used for calculus removal.
- Ultrasonic scalers are effective in removing calculus, stain, and plaque.
- There are two types of ultrasonic scalers: piezoelectric and magnetostrictive.
- Special tips for ultrasonic scalers are designed for different areas of the mouth and amounts of calculus buildup.
- Heat is generated at the tip of the scaler, so a water spray is used to cool it during debridement.
- Small adaptations are necessary to keep the tip of the scaler in contact with the tooth surface.
- Near-ultraviolet and near-infrared lasers are being researched for more effective calculus removal.
- Lasers offer advantages over conventional hand instrumentation for accessing periodontal pockets.
- Near-infrared lasers, like the Er,Cr:YSGG laser, are effective for root scaling due to their absorption by water.
- Near-ultraviolet lasers allow for quick calculus removal without removing healthy tooth structure.
- Dental hygienists require additional training on laser use where permitted by legislation.
Miscellaneous Information
- Dental calculus is a hard deposit that forms on teeth.
- It is composed of inorganic mineralized substances such as calcium phosphate and calcium carbonate.
- Calculus formation is influenced by factors like oral hygiene, diet, and saliva composition.
- Bacteria in dental plaque play a crucial role in calculus formation.
- Calculus can accumulate both above and below the gumline.
- Calculus can lead to gum inflammation and periodontal disease.
- It provides a rough surface for plaque bacteria to adhere to, making oral hygiene more challenging.
- Calculus buildup can cause bad breath (halitosis).
- It can contribute to tooth decay and cavities.
- Dental calculus can also harbor harmful bacteria that may contribute to systemic health issues.
- Dental calculus can preserve a wealth of biological data from ancient populations.
- Microbial analysis of ancient dental calculus provides insights into the oral microbiome of past populations.
- Studies have identified ancient pathogens and evidence of dietary habits through dental calculus analysis.
- Ancient dental calculus has revealed the consumption of plants, milk, and even evidence of medicinal plant use.
- Dental calculus analysis has also shed light on the oral health and hygiene practices of ancient populations.
- Dental calculus analysis is not limited to human studies; it has been used in animal studies as well.
- Studies have examined the oral health and diet of domestic pets through dental calculus analysis.
- Dental calculus analysis in chimpanzees has provided insights into their plant consumption and life history transitions.
- Ancient DNA analysis of dental calculus has revealed information about Neanderthal behavior, diet, and disease.
- Dental calculus analysis has also been used to study changes in oral microbiota with dietary shifts in different time periods.
In dentistry, calculus or tartar is a form of hardened dental plaque. It is caused by precipitation of minerals from saliva and gingival crevicular fluid (GCF) in plaque on the teeth. This process of precipitation kills the bacterial cells within dental plaque, but the rough and hardened surface that is formed provides an ideal surface for further plaque formation. This leads to calculus buildup, which compromises the health of the gingiva (gums). Calculus can form both along the gumline, where it is referred to as supragingival ("above the gum"), and within the narrow sulcus that exists between the teeth and the gingiva, where it is referred to as subgingival ("below the gum").
Calculus formation is associated with a number of clinical manifestations, including bad breath, receding gums and chronically inflamed gingiva. Brushing and flossing can remove plaque from which calculus forms; however, once formed, calculus is too hard (firmly attached) to be removed with a toothbrush. Calculus buildup can be removed with ultrasonic tools or dental hand instruments (such as a periodontal scaler).
