Calculus Buildup

A last maturation stage of some dental plaques is dental calculus. Some people do not form calculus, others form only moderate amounts, and still others form heavy amounts. Until supra-gingival plaque mineralizes as dental calculus, it can be removed by tooth-brushing and flossing. As the plaque matures, it becomes more resistant to removal with a toothbrush, and significantly more pressure is required for its removal. Once dental calculus is formed, professional instrumentation is necessary for its removal.

Calculus itself is not harmful; however calculus needs to be removed because its presence makes routine oral hygiene more difficult or even impossible and it may contribute to greater plaque accumulation and stagnation. It also has the ability to push the gums away from the teeth. Calculus formation is related to the fact that saliva is saturated with calcium and phosphate ions as well as other ions, such as magnesium, zinc, fluoride, and carbonate. Supra-gingival calculus that forms on the tooth crown frequently developing opposite the duct orifices (openings) of the major salivary glands and is often found where saliva pools on the lingual surfaces of the mandibular incisors. It can also form in the grooves of the tooth (called fissures). Sub-gingival calculus forms from calcium phosphate and organic materials derived from blood serum which contributes to its mineralization, and may be darker in appearance.

Calculus Modifying Factors
In addition to local factors, behavioral and systemic conditions may affect calculus formation. For example, smoking causes an accelerated formation of calculus; and children afflicted with asthma or cystic fibrosis form calculus at approximately twice the rate of other children. Similarly, non-ambulatory, mentally handicapped individuals that are tube-fed for long periods may develop heavy calculus within 30 days, despite the fact that no food passes through the mouth.

Conversely, medications such as beta-blockers, diuretics, and anti-cholinergics can result in significantly reduced levels of calculus: it was concluded that either the medications were excreted directly into the saliva affecting the rate of crystallization, or they altered the composition of the saliva and as a result indirectly affected calculus formation.

Mouth Dryness (Xerostomia)

Dry mouth, also known as xerostomia, is a condition that is frequently encountered with the use of certain systemic medications, such as cyclic antidepressants. The major effects of xerostomia are increased oral diseases (particularly caries), speech dysfunction, difficulty in chewing and swallowing, and altered or diminished taste acuity.

Individuals with xerostomia and pre-existing periodontal disease are also at increased risk for developing root surface caries. Root surface caries can occur when there is a loss of supporting bone around the necks of the teeth. The neck areas of the teeth are more prone to caries development because the tooth structure is much softer there when compared to the hardness of enamel. Therefore, root surface caries can progress much faster than enamel caries and can be more detrimental to the tooth’s health

Nutritionally, individuals with mouth dryness have been shown to have significant deficiencies in fiber, potassium, vitamin B6, iron, calcium, and zinc. Treatments may include the use of salivary substitutes and stimulants, ongoing dental treatment (i.e., fillings) and prevention. Your physician may also be able to help by reviewing your medications and possibly eliminating or substituting drugs that have an anticholinergic effect. Mouth care products can help alleviate mouth dryness. Xylitol has been shown to stimulate salivary flow.