![]() Ammonia also results in increase in pH of saliva. ![]() Salivary gland secretion also consists of urea which further breaks into ammonia. The CO 2 tension within salivary duct is higher than surrounding atmosphere as a result, when saliva comes out of ducts, CO 2 gets dissociate from saliva making pH of saliva alkaline. Various concepts were proposed to understand the formation of calculus. Moreover, prolonged nonfunctional teeth (usually during mastication) tend to accumulate more calculus. The site of calculus mainly depends on the location of the opening of salivary duct and composition of saliva from glands. This, in turns, causes mineralization of plaque retained over calculus. Ortopantomograph was also done.ĭental calculus is a plaque retentive factor and deposition of calculus for a long period, which alters the anatomy of crown, making it difficult to perform plaque control measure. Routine hematological investigations were performed which is in normal range. Both the masses of calculi had approximately same dimensions of 4 cm × 3 cm. Calculus of approximately the same size was present at 47 with mucogingival junction, alveolingual sulcus, and retromolar pad as its buccal, lingual, and distal extensions, respectively. Huge calculus mass extending from 14 to 17 was seen, which had extended up to the mucogingival junction buccally, below the marginal gingiva palatally, and hamular notch distally. Based on clinical examination, these hard masses were diagnosed as calculi. Two yellowish-brown color, hard, nontender masses were present: one at maxillary and one at mandibular posterior teeth region. Teeth with Grade III mobility include 47 and Grade II mobility include 14 and 15. On intraoral examination, partially edentulous maxillary and mandibular arch with a total of 15 teeth were present including 11, 12, 13, 14, 15, 16, 17, 21, 22, 23, 24, 25, 27, 37, and 47. ![]() There was no contributory past medical history.Įxtraoral examination showed a loss of bilateral symmetry with swelling at the lower right side of the face. She used to take toothpowder on her index finger and rub the index finger in horizontal direction on teeth. She used to clean her teeth with toothpowder. She has a habit of tobacco chewing for 30 years. She also had a complaint of loosening of her remaining teeth for 3–4 years. Bleeding from gums and bad breath was also reported by her for 6 years. Oral hygiene habits, dental professional visits, diet, prescribed medication, genetic variation in salivary content, age, gender, and masticatory habits contribute to extent and location of calculus formation.Ī 55-year-old female visited the department of periodontology with a chief complaint of heavy mass at the right maxillary and mandibular posterior teeth region for 10 years. ![]() Recent technology for the detection of calculus includes miniature endoscopic system, ultrasound technology, and laser technology. The smooth and clean root surface is often considered as the endpoint of scaling and root planing. Visible and tactile sense of operator serves as a primary and important means of detection for calculus. Furthermore, increased salivary phosphates and oxalates are found to be associated with increased dental calculus formation. Alkaline saliva and high urea concentration are associated with increased dental calculus formation. The composition of saliva also determines the calculus formation in different individuals. Subgingival calculus consists of around 58% of minerals, whitlockite being primary mineral. Supragingival calculus contains an average of 37% of mineral, with octacalcium phosphate forms outer layer and hydroxiapetite forms inner layer. Calcified biofilms usually consist of brushite, octacalcium phosphate, hydroxyapatite, and whitlockite. Empty space of dental calculus consists of nonmineralized bacteria surrounded by calcified matrix. Usually, morphological analysis of calculus shows spongy appearance of calcified masses with empty spaces and tubular holes. The formation of calculus occurs when fluid phase of plaque becomes supersaturated with calculus components. Mineralization of dental plaque leads to the formation of dental calculus. Dental calculus serves as loci for retention of plaque and is only a secondary phenomenon for infectious periodontal disease and not the primary etiological factor. Untreated gingivitis eventually leads to attachment loss causing periodontitis. Pathogenic microorganisms present in dental plaque release toxins and produce enzymatic effect, thereby inducing gingivitis. Dental calculus was considered as the primary etiological factors from the period of Sumerians about 5000 years ago.
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