Dental Calculus — An Accumulation of Periodontal Pathogens Over Time.

Describing Dental Calculus

Dental calculus is a calcified or calcifying mass that forms on the surface of teeth and, surprisingly, on some dental appliances. It is formed from the mineralization of plaque over a certain period. This mineralization process takes weeks to months, making it difficult to remove from the teeth and the surrounding gingival tissue.

What is plaque you ask? Plaque is produced when the bacteria present in the oral cavity releases acids that break down carbohydrates present in the food and drinks consumed by the patient. It can be seen as a soft, white or yellow mass present on or in between the surfaces of the teeth. It is usually hard to detect with the naked eye, given that it matches the colour of the teeth.

This plaque has been proven as the main etiologic factor in causing periodontitis, which is a chronic inflammatory disease of supporting tissues of the tooth caused by specific microorganisms in a susceptible host.

The versatility of calculus is depicted by its area-specific formation that differs in individuals. It’s based on their habits and access to professional oral health care. In areas, or regions, that do not have access to proper dental healthcare, dental calculus spreads through the dentition, and the extent of periodontitis becomes extreme.

How does it affect us?

Dental calculus is detrimental to gingival health. It is because it serves as a trap for increased plaque formation and retention. Therefore, calculus, combined with several factors that cause the localized build-up of plaque, is referred to as a secondary aetiology of periodontitis.

Did you know there are two types of plaque? Plaque can be classified as supragingival and subgingival. Supragingival plaque, as the name suggests, exists above the gingival tissues, in an oxygen-rich environment. It consists of great proportions of aerobic bacteria, i.e., the supply of oxygen to these bacteria plays a crucial role. Subgingival plaque, on the other hand, lies right under the gingival tissues. It consists of great proportions of anaerobic bacteria, which cannot exist in an environment containing oxygen. Yikes!

If plaque thrives too long in the oral cavity it will eventually calcify and turn into calculus. The calculus, if not treated before it’s too late, can proceed from gingivitis to periodontitis.

Gruesome Gingivitis

Gingivitis can be defined as the inflammation of the gums, or gingiva. It usually occurs because a film of plaque has accumulated on the teeth. Gingivitis is a non-destructive periodontal disease that, if left untreated, progresses to periodontitis. With the help of periodontal index, periodontists can screen and identify the level of damage the calculus has caused the patient’s teeth and surrounding gingival tissues. It also gauges whether there is bleeding on probation or not, how deep does the probe go when the sulcus of the gingiva is being probed and whether or not has the mild gingivitis progressed to a much more severe case of periodontitis.

Chronic periodontitis consists of chronic inflammation, reddening and/or swelling of the periodontal tissues with deep gingival pockets, caused by the profuse accumulation of dental plaque, and in turn, dental calculus.

The Periodontal Index, which is used to conduct periodontal examinations, demarcates the patient’s teeth in the mouth into sextants. A probe is conducted across the gingival sulcus areas and the interdental papillae to check for pockets, and it notes how deep those gingival pockets are. The Basic Periodontal Examination (BPE) scores, depending on the depth of the gingival pockets, are as follows:

0 — No disease (gingival pockets < 3 mm)

1 — Bleeding on probing, but gingival pockets < 3 mm

2 — Periodontal pocketing < 3mm, but calculus present with or without plaque retentive factors

3 — Shallow periodontal pockets 4–5 mm (i.e., first band on probe partially visible)

4 — Deep periodontal pockets > 6 mm (first band on probe disappears)

*(star added to the score, e.g. 4*) — Periodontal defect furcation

The markings on the probe, used for probing and measuring the depths of the gingival pockets, guides the periodontist to measure how deep the gingival tissue has been affected. Once the severity of the case has been determined by how far the plaque/calculus has gone into the periodontium, the doctor can take a call if the damage is salvageable and if the disease can be prevented from destroying the structure of the teeth and/or the alveolar bone with effective treatment.

Wrapping it up

Dental calculus formation is an unavoidable process, and the amount of calculus formed over a while varies among individuals. However, complete removal of calculus may prevent further periodontal disease progression and tooth loss.

Just visit a reliable periodontist at a clinic or dental hospital. In most cases, an ultrasonic scaling procedure is advised. This procedure consists of a hand-held machine/device that sprays a thin jet stream of water, with the added efforts of a metal pin, which effectively ‘cleans’ the densely packed calculus from your teeth. Opting to repeat this procedure every 6 months helps upkeep oral hygiene.