In dentistry, calculus or tartar is a form of hardened dental plaque. This is due to the mineral deposition of saliva and gingival crevicular fluid (GCF) in dental plaque. This precipitation process kills bacterial cells in dental plaque, but the rough and hardened surfaces formed provide an ideal surface for further plaque formation. This leads to accumulation of calculus, which compromises the health of the gingiva (gum). Calculus may form along the gum line, where it is referred to as supragingiva ("above the gums"), and in the narrow sulcus between the tooth and gingiva, where it is referred to as subgingiva ("under chewing gum"). ).
The formation of calculus is associated with a number of clinical manifestations, including bad breath, receding gums and chronic inflamed gingiva. Brushing and flossing can remove the plaque from which the calculus forms; However, once formed, too hard (tightly attached) to be removed with a toothbrush. The accumulation of calculus can be removed by ultrasonic or dental instrument (such as a periodontal scaler).
Video Calculus (dental)
Etymology
This word is derived from the Latin calculus "small stone", from calx "limestone, lime", probably related to the Greek ????? chalix "small rocks, gravel, debris" which are widely traced to Proto-Indo-European roots for "split, break up". Calculus is a term used for different types of stones. It separates many modern words, including "counting" (using stone for mathematical purposes), and "calculus", used in the 18th century, for the accumulation of accidental or accidental minerals in human and animal bodies, such as kidney stones. and minerals on the teeth.
The tartar, on the other hand, comes from the Greek as well (tartaron ), but as a term for white encrustation inside the barrel, aka potassium bitartrate commonly known as tartar cream. This became the term used for calcium phosphate in teeth at the beginning of the 19th century.
Maps Calculus (dental)
Calculus composition
Calculus consists of inorganic components (minerals) and organic (cellular and extracellular). The proportion of calculus minerals ranges from about 40-60%, depending on the location in the tooth, and consists mainly of "calcium phosphate" crystals arranged into four major mineral phases, listed here in order to increase the ratio of phosphate to calcium:
- hydroxyapatite, Ca
5 (PO
4 )
3 OH , - whitlockite, Ca 9 (Mg, Fe) (PO 4 ) 6 (PO 3 OH) ,
- octacalcium phosphate, Ca 8 H 2 (PO 4 ) 6 .5 H 2 O,
- and brushite CaHPO
4 Ã, Â · 2 H
2 O .
The organic component of calculus is about 85% cellular and 15% extracellular matrix. Cell density in dental plaque and calculus is very high, consisting of about 200,000,000 cells per milligram. The cells in the calculus are mainly bacteria, but also include at least one archaea species ( oralis Methanobrevibacter ) and some yeast species (eg, Candida albicans). The organic extracellular matrix in calculus consists primarily of proteins and lipids (fatty acids, triglycerides, glycolipids, and phospholipids), as well as extracellular DNA. Host microdryrises, diet, and environmental traces are also found in calculus, including salivary proteins, plant DNA, milk proteins, starch granules, textile fibers, and smoke particles.
Calculus formation
The process of calculus formation of dental plaque is not well understood. The supragingival calculus formation is most abundant on the maxillary (maxilla) (maxillary) buccal surface and on the lingual surface (tongue) of the mandibular incisor (mandible below). These areas have high salivary flow due to their proximity to the parotid and sublingual salivary glands. The subgingival form of calculus is below the gum line and is usually dark in the presence of black pigmented bacteria, whose cells are coated with a layer of iron obtained from the heme during gingival bleeding. Dental calculus usually forms in an additional layer that is easily visible using an electron microscope and a light microscope. These layers are formed during periodic calcification events of dental plaque, but the timing and triggers of these events are poorly understood. The formation of calculus varies greatly among individuals and in different locations within the mouth. Many variables have been identified that affect the formation of dental calculus, including age, sex, ethnic background, diet, location in the oral cavity, oral hygiene, bacterial plaque composition, host genetics, access to professional dental care, physical disability, systemic disease. , tobacco use, and drugs and medicines.
Clinical interests
The accumulation of plaque causes the gingiva to become irritated and inflamed, and this is referred to as gingivitis. When the gingiva becomes very irritated, there is a loss of connective tissue fibers that attach to the teeth and bone surrounding the tooth, this is known as periodontitis. Dental plaque is not the only cause of periodontitis, but is often referred to as primary etiology. The plaque remaining in the oral cavity for a long time will eventually harden and become calculus. Calculus adversely affects the health of the gingiva as it serves as a trap to enhance the formation and retention of plaque; Thus, calculus, along with other factors that cause local plaque buildup, is referred to as the secondary etiology of periodontitis.
When plaque is supragingival, the bacterial content contains most of the aerobic and yeast bacteria, or bacteria that utilize and can survive in an oxygen-containing environment. Subgingival plaque contains a higher proportion of anaerobic bacteria, or bacteria that do not exist in an oxygen-containing environment. Some anaerobic plaque bacteria, such as Porphyromonas gingivalis, secrete antigenic proteins that trigger a strong inflammatory response in the periodontium, a special tissue that surrounds and supports the tooth. Prolonged periodontium inflammation leads to bone loss and weakening of the gingival fibers that attach tooth to the gums, the two main signs of periodontitis. The formation of supragingival calculus is almost ubiquitous in humans, but to different degrees. Almost all individuals with periodontitis showed substantive calculus deposits. Dental plaque bacteria have been linked to cardiovascular disease and women who gave birth to low-weight pre-weight babies, but there is no convincing evidence that periodontitis is a significant risk factor for either of these two conditions.
Prevention
Toothpaste with zinc citrate has been shown to produce statistically significant plaque reduction, but it is very simple that its clinical importance is questionable. Some calculus can be formed even without plaque deposits, by direct mineralization of the pellicle.
Calculus on animals
The formation of calculus in animals is less studied than in humans, but is known to form in a variety of species. Domestic pets, such as dogs and cats, often collect large calculus deposits. Animals with very abrasive diets, such as ruminants and equids, rarely form thick deposits and instead tend to form thin calculus deposits that often have metallic or opalescent luster. In animals, the calculus should not be equated with a cemental crown, a layer of calcified tooth tissue that encloses the tooth root below the gingival margin and gradually disappears through periodontal disease.
Archeological meaning
Calculus teeth have been shown to contain well-preserved DNA and proteins in archaeological samples. The information contained in these molecules may reveal information about oral microbiomes of the host and the presence of pathogens. It is also possible to identify food sources and learn diet.
Formation of sub-gingival calculus and chemical dissolution
The sub-gingival calculus is composed almost entirely of two components: a petrified anaerobic bacterium whose biological composition has been replaced by calcium phosphate salts, and calcium phosphate salts that have joined the bacteria that are fossilized in calculus formation. The initial attachment mechanism and the development of a mature calculus formation are based on electrical charges. Unlike calcium phosphate, the main component of the tooth, calcium phosphate salt exists as an electrically unstable ion. The following minerals can be detected in calculus by X-ray diffraction: brushite (CaHPO 4 Ã, Â · 2H 2 O), octacalcium phosphate (Ca 8 H 2 (PO 4 ) 6 .5 H 2 O), whitlockite containing magnesium (Ca < sub> 9 (MgFe) (PO 4 ) 6 PO 3 OH), and hydroxyapatite containing carbonate (more or less Ca 5 (PO 4 ) 3 (OH) but contains some carbonate).
The reason why the fossilized bacteria was initially attracted to one part of the subgingival tooth surface above the other is not fully understood; after the first layer is installed, the ionized calculus component is naturally attracted to the same place due to the electrical charge. The fossilized bacteria piled on top of each other, in a rather haphazard way. Meanwhile, the free-floating ionic component fills the gap left by the petrified bacteria. The resulting hardening structure can be compared with concrete; with the petrified bacteria playing the role of aggregates, and the smaller calcium phosphate salts being cement. Electrical associations formerly pure from the bacteria that became fossils then became mechanical, with the introduction of free floating calcium phosphate salts. The "hard" calculus formation is at the heart of disease and periodontal treatment.
Abolition of calculus after forming
The College of Dental Hygienists Listed from Alberta (CRDHA) defines dental hygiene as "a health care professional working on focusing on the oral health of individuals or communities." These dentists aim to improve oral health by educating patients about the prevention and management of oral diseases. Dental hygienists can be found performing oral health services in a variety of settings, including private dental offices, schools, and other community settings, such as long-term care facilities. As mentioned above in the section of clinical significance, plaque deposits and calculus are the major etiologic factors in the development and development of oral diseases. An important part of the practice of dental hygiene is the removal of plaque and calculus deposits. This is achieved through the use of instruments designed specifically for surface tooth debridement. Treatment with this type of instrument is necessary because the stone deposit can not be removed by brushing or flossing alone. To effectively manage disease or maintain oral hygiene, comprehensive removal of calculus deposits should be completed at frequent intervals. The recommended frequency for dental care can be performed by registered professionals, and depending on the needs of each patient. Factors to be considered include the overall health status of the individual, the use of tobacco, the amount of calculus available, and the adherence to the professionally recommended home care routine.
Hand instruments are specially designed tools used by dental professionals to remove plaque and precipitate calculus that has formed on the teeth. These tools include scalers, curettes, jaquettes, hoes, files and chisels. Each type of tool is designed for use in certain areas of the mouth. Some commonly used instruments include a crescent scaler designed with a pointed tip and mainly used supragingiva. Curettage is mainly used to remove subgingival calculus, smooth root surface and to clean the periodontal pouch. Curettes can be divided into two subgroups: universal and regional special instruments. Universal curettage can be used in many areas, while area specific instruments are designed for selected tooth surfaces. The elegant curette is a popular area-specific curette type. Due to its design, the region-specific curettage allows for better adaptation to the root surface and can be slightly more effective than universal. Hoes, chisels, and files are less widely used than scalars and curettes. This is useful when removing large quantities of stone or calculus that can not be removed with a curette or scaler only. Chisels and hoes are used to remove the calculus bands, while files are used to destroy shiny or ductile calculus.
In order for hand instrumentation to be effective and efficient, it is important for physicians to ensure that the instruments used are sharp. It is also important for clinicians to understand the design of hand instruments to be able to adjust them properly.
The ultrasonic scaler, also known as scalar power, is effective in removing calculus, stains, and plaques. The scaler is also useful for root planing, curettage, and surgical debridement. Not only is the castle strong and stains removed more effectively with ultrasonic scalars than with hand instrumentation alone, it is clear that the most satisfactory clinical outcome is when ultrasonics are used in addition to hand instrumentation. There are two types of ultrasonic scalars; piezoelectric and magnetostrictive. The oscillating material in both these handpieces causes the scaler end to vibrate at high speed, between 18,000 and 50,000 Hz. The tip of each scaler uses a different vibration pattern to remove the calculus. Vibration magnetostrictive power scaler is an ellipse, activating all sides of the tip, while the piezoelectric vibration is linear and more active on both sides of the tip.
Special tips for ultrasonic scalars are designed to address various areas of the mouth and various amounts of calculus buildup. A larger tip is used for depositing subgingival or heavy supragingival calculus, while thinner tips are designed more for definitive subgingival debridement. When high-frequency vibrations loosen calculus and plaque, heat is generated at the ends. The water spray is directed to the tip end to cool it and irrigate the gingiva during debridement. Only the first 1-2 mm of the tip on the ultrasonic scaler is most effective to remove, and therefore need to be in direct contact with the calculus to break the precipitate. A small adaptation is required to keep the scaler tip touching the tooth surface, while overlapping italics, horizontal, or vertical strokes are used for the adequate removal of calculus.
Recent research on potentially more effective method of removal of calculus subgingiva calculus focuses on the use of near-ultraviolet (NUV) lasers and near-infrared lasers, such as the Er, Cr: YSGG laser. The use of lasers in periodontal therapy offers a unique clinical advantage over conventional hand instruments, because thin and flexible fibers can deliver laser energy into an inaccessible periodontal pocket. Near-infrared lasers, such as Er, CR: YSGG lasers, have been proposed as an effective addition to the removal of calculus as the wavelength of emissions is highly absorbed by water, a large component of calculus deposits. Optimal output power settings 1.0-W with infrared light near Er, Cr: YSGG has proven effective for root scaling. Near-ultraviolet (NUV) lasers have also been promising as they enable dentists to quickly remove rock deposits, without removing the underlying healthy tooth structure, which often occurs during hand instrumentation. In addition, NUV lasers are effective at various angles of irradiation for the removal of calculus. The difference in displacement efficiency is due to the physical and optical properties of precipitated calculus, not to the point of laser use. Dental hygienists should receive additional theoretical and clinical training on laser use, where legislation allows.
See also
- Calculus (medicine)
- Toothbrush
- Dental caries
- Teeth cleaned
References
Source of the article : Wikipedia
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