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Table of Contents
CASE REPORT
Year : 2019  |  Volume : 7  |  Issue : 2  |  Page : 73-74

Dental calculus – An evergrowing heap of periodontal pathogens


Department of Periodontology, K.M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India

Date of Submission29-Apr-2019
Date of Decision04-Aug-2019
Date of Acceptance02-Nov-2019
Date of Web Publication02-Jan-2020

Correspondence Address:
Dr. Prasad Nadig
K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, At and Po, Piparia, Waghodia, Vadodara - 391 760, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JIHS.JIHS_21_19

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  Abstract 


Dental calculus is defined as an adherent, calcified, or calcifying mass that forms on the surface of teeth and dental appliances. Calculus plays a key role in maintaining and accentuating periodontal disease by withholding the plaque in close contact with the tooth surface and gingival tissue, leading to various pathological changes, thereby creating areas where plaque removal is impossible. The distribution of calculus is very versatile and it differs from individual to individual, from tooth to tooth, and from surface to surface. At certain period of time, the maximum level of calculus formation occurs after which a reversal phenomenon takes place, in reversal phenomenon is the decline from maximal calculus accumulation. This case report describes a case of patient with extensive calculus deposits.

Keywords: Dental calculus, oral hygiene, periodontal disease, reversal phenomenon


How to cite this article:
Saraiya K, Nadig P, Shah M, Dave D. Dental calculus – An evergrowing heap of periodontal pathogens. J Integr Health Sci 2019;7:73-4

How to cite this URL:
Saraiya K, Nadig P, Shah M, Dave D. Dental calculus – An evergrowing heap of periodontal pathogens. J Integr Health Sci [serial online] 2019 [cited 2020 Feb 29];7:73-4. Available from: http://www.jihs.in/text.asp?2019/7/2/73/274525




  Introduction Top


Dental calculus is defined as an adherent, calcified or calcifying mass that forms on the surface of teeth and dental appliances. Bacterial plaque and calculus are considered as major etiological agents in the initiation and progression of periodontal diseases.[1] Dental calculus is formed by the mineralization of dental plaque on the surface of natural teeth and dental prosthesis, generally covered by the layer of unmineralized plaque.[2] This plaque has been proven as the main etiologic factor in causing periodontitis[3] which is a chronic inflammatory disease of supporting tissues of tooth, which is caused by specific microorganisms in a susceptible host. The versatility of calculus is depicted by its area-specific formation that differs in different individuals as well as their personal and access to professional oral health care.[4] In populations who do not practice regular oral hygiene and who do not have access to professional care, supragingival and subgingival calculus occurs throughout the dentition, and the extent of calculus formation can be extreme.


  Case Report Top


A 38-year-old female patient has been reported to the Department of Periodontology of K. M. Shah Dental College and Hospital, Vadodara, Gujarat, with the chief complain of bleeding gums, bad breath, and yellowish deposits on the tooth surface. No relevant medical and/or dental history was reported. Intraoral examination showed dental calculus with soft plaque-like deposits covering almost whole of the teeth and extending into the mucobuccal and mucolabial folds in the lower anterior region [Figure 1]. This hampered the grading of true mobility of the teeth. Pathologic migration and gingival inflammation were also noted.
Figure 1: Extensive dental calculus on the mandibular anterior region

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Treatment

Thorough scaling and root planing was done [Figure 2]. Oral hygiene instructions included brushing twice daily followed by mouthrinsing with 0.2% chlorhexidine (Clohex ADS) for 15 days. The patient was recalled after 10 days for oral prophylaxis.
Figure 2: Immediately after scaling and root planing

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  Discussion Top


The distribution of calculus is very versatile and it differs from tooth to tooth, from surface to surface, and from individual to individual; this article describes a patient with an extensive amount of calculus with deposits covering the labial and buccal surface of the mandibular anterior teeth and also extending over the facial and buccal mucosa. There is classification of patients with calculus as heavy and light calculus formers based on the rate of accumulation and calcification of calculus. Heavy calculus formers are characterized by high salivary concentration of calcium and phosphorus as compared to light calculus formers. Mandel has indicated that even in heavy calculus formers, 90% of the deposits are in the lower anterior region.[5] In this case, the patient is classified as heavy calculus former. At certain period of time, the maximum level of calculus formation occurs after which a reversal phenomenon takes place, in reversal phenomenon is the decline from maximal calculus accumulation. It occurs due to the mechanical wear from food, cheeks, lips, and tongue; yet, certain case reports have reported that formation of calculus can continue unhindered by the physiologic mechanisms.[6] This is a similar case where the calculus formation continued unhindered even with the mechanical trauma of the tongue. Calculus acts as a mechanical accumulation site for the bacterial plaque which would be responsible to initiate a periodontal disease process. Regular skilled professional oral health treatment is essential to maintain a healthy state and prevent diseases.


  Conclusion Top


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

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

This study was self-funded.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Masud M, Zahari HI, Sameon AS, Mohamed NA. Manual and electronic detection of subgingival calculus: Reliability and accuracy. Int J Adv Med Res 2014;1:52-6.  Back to cited text no. 1
    
2.
Kevin DS, Nadig SP, Monali AS, Deepak HD. Carranza's Clinical Periodontology. 11th ed., Ch. 22; p. 291.  Back to cited text no. 2
    
3.
Anand U, Triveni MG, Mehta DS. Dental calculus: A castle of periodontal destruction. 100 Interesting Cases in Dentistry. Vol. 1.  Back to cited text no. 3
    
4.
Aghanashini S, Puvvalla B, Mundinamane DB, Apoorva SM, Bhat D, Lalwani M. A comprehensive review on dental calculus. J Health Sci Res 2016;7:42-50.  Back to cited text no. 4
    
5.
Mandel ID. Plaque and calculus measurements – Rate of formation and pathologic potential. J Periodontol 1967;38:721.  Back to cited text no. 5
    
6.
Moskow BS. A case report of unusual dental calculus formation. J Periodontol 1978;49:326-31.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

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