Dental Calculus

DENTAL CALCULUS (calculus dentalis), incorrectly called wine stone, according to research (Vergne, Hoppe-Seyler, Freeman) has the following composition (in round numbers): Ca3(PO4)2-60 parts, organic substances and alkaline salts-25 parts, CaCO3-8 parts, FePO4, SiO2 hydr.-7 parts. The source of the salts forming the main mass of dental calculus is saliva. The cause of precipitation of salts from saliva and the process of formation of dental calculus cannot be considered fully clarified. The main importance is attached to the volatilization of CO2 from saliva poured into the oral cavity and the change in the normal state of colloids Pauli and Samec (Prinz), which, being in saliva, keep lime salts in a dissolved state. Some authors (Heinemann) consider the existence of inflammatory changes in the oral mucosa a necessary condition for the deposition of dental calculus. The role of the organic basis, matrix, is played by a soft, easily removable plaque consisting of desquamated epithelium, mucus, food residues, and bacteria. Dental calculus is found predominantly on those teeth that for one reason or another do not participate sufficiently in chewing (in the absence of antagonists or when there are diseased teeth on this side and when consuming soft and liquid food). In general, dental calculus is deposited first and most in the immediate vicinity of the openings of the salivary gland ducts, i.e., on the lingual surface of the lower front teeth and on the buccal surface of the upper molars. The consistency and color of dental calculus show great variations. White, yellowish-white, greenish dental calculus, etc., up to black, is encountered. The different coloration is due to chromogenic bacteria and coloring substances whose source is food substances, the use of medicines (iron, bismuth), work with metals. The use of tobacco gives dental calculus a dark brown color-up to black. The most common white dental calculus corresponds in consistency to plaster. Darker colored dental calculus has greater density, is deposited more slowly and in smaller quantities. Such a character is usually possessed by the so-called subgingival dental calculus (see figure), deposited on the root of the tooth and covered by the gingival pocket. Many authors speak in favor of a hematogenous origin of this subgingival dental calculus, and therefore call it serum calculus. Kantorowicz (Kantorowicz) considers the process of formation of subgingival calculus analogous to the process of formation of stones in hollow organs and in the excretory ducts of glands. The amount and rate of formation of dental calculus are subject to large fluctuations. In this respect, age and individual predisposition play a large role. In children, dental calculus is rarely encountered; with age, the accumulation of dental calculus proceeds faster. In persons prone to the formation of dental calculus, the latter arises unusually quickly, despite careful care of the teeth, and such persons are forced to consult a doctor at short intervals for mechanical removal of the stone. In the presence of predisposition and lack of care, the amount of dental calculus can reach enormous sizes, so that it can cover an entire group of teeth. The significance of dental calculus lies in the fact that, as a foreign body, it irritates the gum, maintaining and enhancing its inflammatory state. Removal of dental calculus is done mechanically with the help of instruments specially designed for this purpose. Removal must be very thorough, since remaining particles of the concrement serve as a nucleus for the precipitation of new amounts of dental calculus. Removal of dental calculus is completed by polishing the surface of the tooth with pumice or tooth powder using brushes and wooden sticks fixed in a dental engine. Prevention consists in the systematic use of a toothbrush and powder, and mainly in creating conditions for the proper act of chewing, since the act of chewing, accompanied by friction of the food bolus against the teeth, as well as the lips, cheeks, and tongue, best promotes the cleaning of teeth. The benefit of various advertised pastes and mouthwashes that supposedly dissolve dental calculus is highly doubtful.