Role of calculus and local factor :

We started that periodontal diseases case by the pattern if left for enough period to form dental plaque then it mineralizes to form hard tissue so dental plaque is called the initiating factor the primary case of gingival disease and periodontal disease and any thing facilitate or favor plaque retention and accumulation are LOCAL PREDISPOSING FACTORS or risk factor for periodontal disease we have some few examples this could be local or systemic local means there is intra oral things that make a plaque accumulation easy or plaque removal difficult >>>>>>>

and as we said periodontal disease is the disease of reaction of the body so any thing agree with this ability of the body as a reaction specially with patient with load immune capacity these patient have more periodontal destruction and next lecture maybe have lecture in systemic factor so it is Systemic conditions that alter the host response (i.e. make a person more susceptible to disease) are SYSTEMIC factor >

Dental Plaque is the primary etiologic (initiating) factor of periodontal inflammation

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 teeth and prostheses

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

So calculus could be :

Supragingival

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 .

Composition of supragingival calculus (which 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 )

Magnesium phosphate and other metals But basically its ca ++

Inorganic component of calculus is made of crystals with 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 components

Organic Components (10 30 %):

Carbohydrates (2 9%) Proteins (6 8 %) Lipids (< 1%) such as fatty acids, neutral fats, cholesterol, and phospholipids Host cells and microorganisms

(Note : the percentages for memorization)

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 from the 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 some thing like blue between the enamel surface and the

calculus

- Mechanical locking into surface irregularities such as resorption lacunae :basically in the root where cementum is desorbed this will occupied mechanical interlocking calculus and irregularities in root surface although ;the space is small but its important ( the idea like composite filling ) they thought that the irregularities in healthy cementum surface its the area for calculus to accumulate and bacteria to penetrate .

3.Close adaptation of calculus undersurface to cementum surfaces

4.Penetration of calculus bacteria into cementum

_calculus formation :

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 in saliva >saliva is rich in ca++ although the sliva is the main source of ca++ but the plaque absorb it quickly fortunately so this property is important to explanation of the mineralization
Note : mineralization it is the set of inorganic matter in organic matrix

Source of minerals: Supragingival calculus: SALIVA The color of supragingival calculus is white_yellowish Subgingival calculus: GCF The color of subgingival greenish _bluish Ca++ bind to glycoprotein complexes of organic matrix of dental plaque and form crystalline structures made of calcium phosphate salts note : the color of calculus is explained through the contents of it and the color of minerals . Calcification begins along the inner surface of supra-gingival plaque toward the tooth surface

And it start from organic to inorganic > basically its calcium and form crystals Therefore, calculus is formed in layers, which are separated by thin cuticle that embed in calculus as the calcification progresses not like cementum ( cementum has time lines but calculus dose not ) The time required for calculus to reach its maximum level is 2.5 to 6 months (become really tensions hardly attached difficult to remove )we talk about subgingival calculus in particular supragingival calculus is easier to remove because it has in the top no calculus can attach when the layer reach the all thikness it will be then chip out so there is a free end lets imagine the last layer for minerals to attach there is no enough space so we don't have deposition of mineral for over. subgingival although its suspending to chipping out it is away 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-calculus so don't be surprise if you see a patient with plenty attached and he or she dose not brush his teeth and very minimal amount of calculus thats normal finding because it depends on the composition of the saliva and the ca++content in the saliva and even the JSF and the organic of the saliva and if there is inhibitory factor formers due to: salivary pH salivary Ca++ bacterial protein and lipid concentration

 protein and urea in submandibular salivary gland secretions total salivary lipid levels individual inhibitory factors This made scientists to think about material reduced the calculus amount and there is product for removal calculus and many components in tooth baste it self and many research found that there is beneficent to use this component in reducing the amount of calculus for natural this will be helpful with out much details about the name when you go to clinic inshaa' Allah you will know it better but you need to know this :

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

These toothpastes may be help in heavy calculus formers

However, plaque control measures are the cornerstone in reduction of calculus rate And there is a theories about calculus FORMATON JUST CONCENTRATE VERY SIMPLE THING just logical they thought if the concentration of minerals increases in its level it will be start to

precipitate and bacteria which got mix them the mineral precipitate they increase PH and the bonding capacity of mineral and similar mechanism and they found that there is Epitactic concept or heterogenous nucleation Nucaleation : 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

to trans from gas to liquid it has to be which called nucaleation that particles of water gathers things to form and this is how to make an artificial rain where the gas accumulate and going to form a liquid so similarly we have some 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 their precipitation. This precipitation is due to any of the following factors: pH Colloidal proteins in saliva bind Ca++ & P++ hydrolysis of organic phosphate due to the action of phosphatase enzyme from desquamated epithelial cells and bacteria Epitactic concept or heterogenous nucleation: Seeding agents (e.g. intercellular matrix) induce small foci of calcification that enlarge and coalesce to form calcified masses We focus in calculus because or treatment depend on calculus , calculus it self is not a causative disease it works by providing rough surface where plaque can attach and live And 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 factor saliva 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 teeth Ortho treatment brushing became difficult Fillings are a cause if they bad especially class two where overhanging restoration or open contact which is make it

difficult to clean due to brush can't reach these area even dental 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 as

aesthetically as possible

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

Contours and open contact

Over-contoured crowns and restorations accumulate and retain more plaque than under-contoured restorations

Integrity of proximal contacts prevents food impaction that deteriorates the periodontal health plunger cusp So 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 adequate
attached gingiva

Gingival health deteriorates in mouth-breathers

Ortho appliance :

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 of gingival recession, pocketing, and bone loss

Tooth brush trauma

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

Self juries _ inflected in

Devolapmantal or aquired deformities & condition :

A. Localized tooth-related factors that modify or predispose to gingival diseases/periodontitis: Tooth anatomic factors: Enamel Pearls Cervical Enamel Projections

Localized tooth-related factors that modify or predispose to gingival diseases/periodontitis:

Root fractures

Cervical root resorption and cemental tears For more details refer to book >

Thats all , Done by : Zain al-salameen Hebah rae'd al-jabri

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