Primary Preventive Dentistry 6th Ed. (2004)
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Dental Calculus Answers and Explanations |
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Question 3 Which of the following statements, if any, are correct? A. Dental plaques typically exhibit uniform structures, composition, and properties. B. The intercellular dental plaque matrix is probably formed by a combination of host materials, such as salivary proteins, and bacterial metabolites. C. The term "corn-cob" configuration, describes one of several possible aggregates between different kinds of bacterial cells in the dental plaque matrix. D. The acid dissolution of tooth mineral supplies calcium for both bacterial nutrition and for calcium binding. E. Gingival inflammation is generally caused by bacteria that reside in dental plaque adjacent to the tooth. ^ A last stage in the maturation of some dental plaques is characterized by the appearance of mineralization in the deeper portions of the plaque to form dental calculus99. The term calculus is derived from the Latin word meaning pebble or stone. The lay term, tartar, refers to an accumulated sediment or crust on the sides of a wine cask. Some people do not form calculus, others form only moderate amounts, and still others form heavy amounts. Calculus itself is not harmful. However, a layer of unmineralized, viable, metabolically active bacteria that are closely associated with the external calculus surface is potentially pathogenic. Calculus cannot be removed by brushing or flossing. It is often difficult to remove all the calculus, even professionally, without damaging the tooth, especially the softer root cementum. However, calculus needs to be removed because its presence makes routine oral hygiene more difficult or even impossible by forming calculus spurs (Figure 2-9). These structures may contribute to plaque accumulation and stagnation. Calculus removal is also a prerequisite to regenerate lost or damaged periodontal tissues following treatment. In addition to local factors, behavioral and systemic conditions may affect calculus formation. For example, smoking causes an accelerated formation of calculus.100 Children afflicted with asthma or cystic fibrosis form calculus at approximately twice the rate of other children.101 Similarly, non-ambulatory, mentally handicapped individuals, tube-fed over long periods, may develop heavy calculus within 30 days, despite the fact that no food passes through the mouth.102 Conversely, medications such as beta-blockers, diuretics, and anticholinergics can result in significantly reduced levels of calculus. The authors of the latter study concluded that either the medications were excreted directly into the saliva, affecting the rate of crystallization, or altered the composition of the saliva and thus indirectly affected calculus formation.103 Calculus formation is related to the fact that saliva is saturated with respect to calcium and phosphate ions.104 Precipitation of these elements leads to mineralization of dental plaque giving rise to calculus. The crystals in calculus include hydroxyapatite, brushite, and whitlockite, all of which have different proportions of calcium and phosphate in combination with other ions, such as magnesium, zinc, fluoride, and carbonate. Supragingival calculus forms on the tooth coronal to the gingival margin, and frequently develops opposite the duct orifices of the major salivary glands. It is often found where saliva pools on the lingual surfaces of the mandibular incisors (Figure 2-10), and can form in the fissures of teeth. Subgingival calculus forms from calcium phosphate and organic materials derived from serum, which contribute to mineralization of subgingival plaque. One of the means by which formation and growth of calculus may be studied is by ligating thin plastic strips around the teeth and then removing the strips at various intervals.105 Within 12 hours after placement, x-ray diffraction studies demonstrate mineral elements in the forming plaque. By 3 to 4 days, the concentration of calcium and phosphate is significantly higher in the plaque of those with heavy calculus formation than in the plaque of those with no calculus formation. Subgingival calculus is about 60% mineralized, whereas supragingival calculus is only about 30% mineralized.106 Because it is harder, thinner, and more closely adapted to tooth surface imperfections, subgingival calculus can be more difficult to remove than supragingival calculus. The two types of calculus may differ in color. Supragingival calculus, which derives its mineral content from saliva, usually appears as a yellow to white mass with a chalky consistency. Subgingival calculus, which derives its mineral from the inflammatory exudate in the sulcus and periodontal pocket, appears gray to black in color and has a flint-like consistency. The dark coloration may be caused by bacterial degradation of components of the hemorrhagic exudate that accompanies gingival inflammation. Alkaline conditions in dental plaque may be an important predisposing factor for calculus formation.107 Calculus formation is not restricted to one bacterial species, or even to those growing at neutral or slightly acidic pHs. This is evidenced by the fact that caries-related streptococci may mineralize.108 Not all plaques mineralize, but a plaque that is destined to mineralize begins to do so within a few days of its initial formation, even though this early change is not detectable at a clinical level. Mineralization usually begins in the intercellular plaque matrix but eventually occurs within the bacterial cells (Figure 2-11). Bacterial phospholipids and other cell-wall constituents may act as initiators of mineralization,109 in which case mineralization may begin in the cell wall and subsequently extend to the rest of the cell and into the surrounding matrix (Figure 2-12). Calculus may also form on the tooth surfaces of germfree animals.110 This type of calculus consists of an organic matrix of nonmicrobial origin which becomes mineralized. Attachment of Calculus to the Teeth At the tooth interface with calculus, the enamel or root cementum are never perfectly smooth and invariably contain a variety of surface imperfections. These normal irregularities such as the perikymatad and the point of origin of Sharpey's fiberse on the cementum appear to aid calculus attachment. Other defects in the enamel and cementum, including areas of demineralization and cemental tears,111 may also contribute to a stronger calculus attachment to the tooth. Electron micrographs indicate a very close relationship between the matrix of the tooth surface and the matrix of calculus; the crystalline structures of both are also very similar.112 dPerikymata are the numerous, small, transverse ridges on the exposed surface of the enamel of the permanent teeth. eThe tooth is anchored by connective tissue fibers that extend between the cementum and the bone; the ends embedded in the cementum and bone are known as Sharpey's fibers. Inhibiting Calculus Formation Several agents are currently available to reduce calculus formation, including dentifrices that contain pyrophosphate, or metal ions such as zinc.113,114 One dentifrice contains two soluble phosphates, tetrasodium pyrophosphate and disodium dihydrogen pyrophosphate, in addition to fluoride.114,115 The pyrophosphate ion not only serves as a structural analog of the orthophosphate ion, disrupting the formation of calcium phosphate crystals, but also inhibits some bacterial growth at concentrations significantly lower than the levels found in dentifrices.
Question 4 Which of the following statements, if any, are correct? A. Intracellular polysaccharides are a source of energy available to bacteria, but levans are available only to the synthesizing bacteria. B. An operational definition of calculus might be that it is "a mineralized dental plaque that cannot be removed from the tooth by brushing or flossing." C. The flow of saliva over the tooth surfaces near the major salivary gland ducts keeps those teeth free of calculus deposits. D. Subgingival calculus is usually more densely mineralized than supragingival calculus. E. Calculus formation usually begins in the bacterial cell wall and extends to the intercellular matrix. Summary Bacteria in dental plaque are the direct cause of the most widespread of all human diseasesdental caries and inflammatory periodontal diseases. These diseases, however, are not classical infections. They arise because of complex changes in plaque ecology and are affected by many factors in the host's protective responses. To understand the role of dental plaque in disease and how to prevent or control the plaque-associated diseases, it is essential to understand the nature of dental plaque. Plaque forms initially on the organic layer coating the erupted tooth. This organic layer originates from salivary products that are deposited on the teeth, forming an acquired pellicle to which bacteria adhere. Adhesion is mediated by a variety of bonding mechanisms, including physicochemical and electrostatic interactions, and stereo-chemical interactions between bacterial adhesins and receptors in the acquired pellicle and bacterial surfaces. The earliest of the primary bacterial colonizers are mainly Gram-positive facultative cocci. They are followed by a variety of Gram-positive and Gram-negative speciesthe secondary colonizers. Caries-related bacterial species have a greater ability than others to adapt to excess sugars and their metabolites. Supragingival plaque is associated with caries and gingivitis, whereas subgingival plaque is associated with gingivitis and periodontitis. With higher pH (i.e., less acidity), some plaques mineralize to form supra- and subgingival dental calculus. In calculus formation, mineralization of dental plaque generally begins in the extracellular matrix and eventually spreads to include the bacteria. Rarely, mineralization may begin within the walls of bacterial cells and spread to the extracellular matrix. Calculus is generally covered by actively metabolizing bacteria, which can cause caries, gingivitis, and periodontitis. Regular toothbrushing and flossing can remove dental plaque and control its formation. Once dental plaque mineralizes to form calculus, professional instrumentation is necessary for its removal. Notwithstanding the contribution of calculus to inflammatory periodontal diseases, it is stagnation of pathogenic bacteria at critical sites that leads to both dental caries and periodontal diseases. Later chapters deal with the wide range of methods, mechanical and chemical, increasingly used to control plaque and calculus formation. All of these methods have the aim of preventing, arresting, or reversing the progression of dental caries and periodontal tissue inflammation. ^ 1. B and Ccorrect. AIncorrect. The acquired pellicle is "acellular," i.e., cell-free. DIncorrect. The acquired pellicle begins to reform immediately and is reestablished within several hours. EIncorrect. Even though some binding sites are occupied by immunoglobulins, many more are occupied by bacteria. 2. A, B, D, and Ecorrect. CIncorrect. Like charges (i.e., negative to negative or positive to positive) repel; unlike charges attract. 3. B, C, D, and Ecorrect. AIncorrect. So many factors affect plaque formation that composition, structure, and properties are greatly varied. 4. B and Dcorrect. AIncorrect. It should be the reverse, with intracellular polysaccharides available to the synthesizing bacteria, and levans to the surrounding bacteria with the enzyme levanase. CIncorrect. The presence of high concentrations of calcium and phosphate ions at the duct openings results in more, not less, calculus formation. EIncorrect. Calculus usually begins in the intercellular matrix, and spreads to engulf the cells. Self-evaluation Questions 1. The presence of a preponderance of cocci is a sign of (early)(late) plaque formation. 2. Following prophylaxis, it takes about _____ (hours)(days) for the acquired pellicle to completely reform. 3. Two of the host's defensive proteins that compete with bacteria for receptor sites on the acquired pellicle are ________ and ________. 4. It takes approximately _____ (hours) (days) for the initial plaque to form and about _____ days to double in mass. Once formed, the growth is rapid for about _____ days and finally stabilizes in mass around the _____ day. 5. Given the choice of (water)(a toothbrush) or a (prophylaxis); which one is required to remove each of the following: (1) materia alba, (2) plaque, or (3) calculus? 6. Bacteria can attach to the acquired pellicle via _________ bonding, by calcium _________, via attachment to the sticky _________, and by surface proteins called _________. 7. The three places on the teeth where bacterial colonization is most abundant are _________, _________, and _________. 8. "Corn-cob" configurations are caused by (cocci) (rods) radially attached to a central rod, whereas the "___________" configuration is caused by rods radially attached to a central rod. 9. Between the cells of the plaque is the (extracellular polysaccharide)(intracellular polysaccharide) containing _________ and levans that serve as energy sources for the bacteria. 10. The "safe haven" where a bacterial colony can exist in the plaque environment is known as a(n) _________. 11. Calculus is mainly made up of calcified ________. 12. One condition causing accelerated calculus formation is ___________. Reduced formation is seen after use of _________ (drugs). 13. Supragingival calculus derives its minerals from the __________; whereas subgingival calculus derives them from the __________. References 1. Listgarten, M. A. (1976). Structure of the microbial flora associated with periodontal health and disease in man. A light and electron microscopic study. J Periodontol, 47:1-17. 2. Listgarten, M. A. (1999). Formation of dental plaque and other oral biofilms. In Newman, H. N., & Wilson, M., Eds. Dental plaque revisitedOral biofilms in health and disease. 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(1970). Attachment of plaque and calculus to tooth surfaces. J Periodontol Res, 5:8-18. 113. Zacherl, W. A., Pfeiffer, H. J., & Swancar, J. R. (1985). The effect of soluble pyrophosphates on dental calculus in adults. J Am Dent Assoc, 110:737-38. 114. Ciancio, S. G. (1995). Chemical agents: Plaque control, calculus reduction and treatment of dentinal hypersensitivity. Periodontol 2000, 8:75-86. 115. Drake, D. R., Chung, J., Grigsby, W., & Wu-Yuan, C. (1992). Synergistic effect of pyrophosphate and sodium dodecyl sulfate on periodontal pathogens. J Periodontol, 63:696-700. 0.203125 Copyright © 2004 by Pearson Education, Inc., Pearson Prentice Hall. All rights reserved.  (+/-) Show / Hide Bibliography Working... × Chapter 3. The Developing Carious Lesion - Norman O. Harris Adriana Segura |
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