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TOOTH DEPOSITS
Dr. Majambo M.
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DEPOSITS
• Hard or soft deposit on the tooth surface
• Hard = calculus + stain
• Dental stain Can be either
– Intrinsic
– extrinsic
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Dental deposits
• Material alba
• Plaque
• Calculus
• Stains
–Intrinsic
–extrinsic
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stains
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Stain cont.
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Causes
• Causes
• multiple local conditions
• systemic conditions
• Extrinsic dental deposits/stains
– Dental plaque and calculus,
– Foods and beverages,
– Tobacco,
– Chromogenic bacteria,
– Metallic compounds,
– Topical medications.
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• Intrinsic dental stains
– Causes
• Dental materials
• Dental conditions and caries
• Trauma
• Infections
• Medications
• Nutritional deficiencies
• Genetic
– Amelogenesis imparfecta. (AI)
– Dentinogenesis imparfecta. (DI)
– Dentinal dysplasia (DD)
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• Definition
Extrinsic stains
– stains located on the outer surface of the tooth
structure and caused by topical or extrinsic agents.
• Predisposing factors
– Enamel defects
• pits, fissures, and defects in the outer surface of the
enamel are susceptible to the accumulation of stainproducing food, beverages, tobacco, and other topical
agents
– Salivary dysfunction
– Poor oral hygiene
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• Other factors
– Plaque and calculus
– Tannin (tea, coffee, and other beverages)
– betel nut chewing
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Extrinsic stain
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Intrinsic stains
• Causes
– Numerous
– Stain distribution varies
• localized (e.g., 1 or 2 teeth)
– Pre-eruptive or post-eruptive processes
• generalized - involvement of primary and
secondary teeth.
– indicates a deviation in normal tooth formation.
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Morbidity
• If tooth discoloration is not treated, it can affect
– person's smile (esthetics)
– social and psychological sequelae.
NB
• Smiling
– End result of a complex: neurological, muscular,
sensory, and psychological process.
– Unattractive smile, due to discolored teeth, can have
negative psychological, social, and clinical
implications.
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Clinical
• History
– The patient's history of tooth discoloration
provides useful information regarding the
etiology.
– Chief complaint and history of chief complaint
• Aesthetics
• pain
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• Medical history:
– A history of maternal or childhood
diseases or the use of medications (see
Causes) .
– This may explain tooth discoloration
because the conditions can adversely
influence normal tooth development
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Family history:
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Several genetic diseases are associated
with tooth-associated disorders the most
common include AI, DI, and DD.
Patients may be unaware of the diseases
but often confirm that a family member had
similar tooth discoloration.
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Social history:
The use of tobacco and similar products,
such as the chewing of areca (betel) nuts,
commonly leads to staining of the teeth.
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Determining the type of tobacco habit (eg,
smoking vs chewing) is important because
the distribution of the stain may vary.
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Dental history:
The dental history can reveal useful information
regarding the
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Last dental cleaning
Previous dental treatments
Oral hygiene practices
Use of mouthwash
Traumatic events involving dentition.
Diet history:
A history of nutritional deficiencies or ingestion of
foods that can stain teeth is important.
Querying patients about the quality of their dietis
always useful.
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Physical
• Extrinsic stain/discoloration
– Usually, discoloration colors include
– brown, black, gray, green, orange, and
yellow
– on occasion, a metallic sheen is
present.
– The scratch test is usually used to
distinguish between extrinsic and
intrinsic discoloration.
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• intrinsic discoloration
– Intrinsic discoloration cannot be removed by
using the scratch test.
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Amelogenesis imparfecta
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Material alba
– Material alba = white material
– composition
• microorganisms,
• desquamated epith. cells,
• Disintegrated WBC
• food debris
– MA is loosely adherent to surfaces of
plaques, teeth, gingiva or dental
appliances.
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Plaque
• Plaque is a soft, sticky accumulation that
occurs on dental and various other intraoral surfaces.
• It is the host to a complex micro-system of
micro-organisms whose pathogenicity and
virulence cause inflammatory diseases of
the gingival & periodontal tissues.
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Plaque cont.
• Plaque can be removed from tooth
surfaces by direct brushing.
• It is possible to have a mouth with plaque
but no calculus.
• Calculus acts as a focal point for plaque
accumulation, a nidus of bacteria and
hinders complete removal of plaque.
• It is almost impossible to have a mouth
with calculus but no plaque.
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Plaque Formation
Passes through several stages
Pellicle formation
↓
Bacterial Colonization
↓
Growth and Maturation of Plaque:
↓
Plaque Retention Factors
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Plaque Retention Factors
• These are conditions that favor plaque accumulation
and hinder plaque removal by the patient and the
dental professional.
• Examples of these are:
» Orthodontic Appliances
» Partial Dentures
» Malocclusions
» Faulty Restorations
» Calculus
» Deep Pockets
» Mouth Breathing
» Tobacco Use
» Certain Medications
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Calculus
• In dentistry, calculus or tartar refers to
calcified deposits on the teeth, formed by
the continuous mineralization of presence
of dental plaque.
• Its rough surface provides an ideal
medium for further plaque formation,
threatening the health of the gingiva.
• Calculus absorbs unaesthetic stains far
more easily than natural teeth.
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• Calculus accumulations occur in the
absence of adequate oral care.
• Once formed, it is generally too firmly
adherant to teeth to be removed with
anything available to an individual at home
• Patients with calculus must therefore visit
their dental professionals so that the
calculus can be removed (Scaling)
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Clinical significance
• Plaque accumulation causes the gingiva to become
irritated and inflamed leading to gingivitis.
• When the gingiva become so irritated that there is a loss
of the connective tissue fibers and bone that surrounds
then it leads to periodontitis.
• Dental plaque is the most important cause of
periodontitis and it is referred to as the primary etiology.
• Plaque that remains in the oral cavity long enough will
eventually calcify and become calculus.
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• Calculus is detrimental to gingival health
because it serves as a trap for increased
plaque formation and retention
• Thus, calculus, along with everything else
that causes a localized build-up of plaque,
is referred to as a secondary etiology of
periodontitis.
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Types
• Supragingival calculus
– Calculus formed on the tooth surface above the gum
line.
– Supra-gingival calculus is adherent to the crown.
– Found mostly on the lingual surfaces of the
mandibular incisors in relation to the opening of
Wharton's ducts and on the buccal surfaces of
maxillary molars in relation to the opening of
Stensen's ducts.
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• Subgingival calculus
– Subgingival calculus forms on root surfaces below the
gingival margin and can extend deep into periodontal
pockets.
– A more irregular subgingival cemental surface allows
deposits to form into the cemental irregularities.
– This makes the attachment of the subgingiva calculus
more tenacious and difficult to remove.
– It also tends to be darker or black in color.
All calculus can however absorb extrinsic stains (coffee;
tea; tobacco;etc) and appear dark brown or black. 36
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• Subgingival calculus can often be seen on
radiographs on the mesial and distal
aspect of teeth (proximal surfaces) but
explorer detection is needed to evaluate
the amount of calculus present
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Calculus formation
• Calculus is formed by the deposition of calcium
and phosphate salts in bacterial plaque.
• These salts are present in salivary and gingival
crevicular fluids.
• Plaque mineralization begins within 24-72 hours
and takes an average of 12 days to mature.
• Calculus contributes to the disease by providing
foci for plaque accumulation. It is not the
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causative or etiologic factor.
Rate of Calculus Formation
• It is known that certain people form calculus
faster than others.
• The following factors increase the rate of
calculus formation.
– Elevated salivary pH.
– Elevated salivary calcium concentration.
– Elevated bacterial protein and lipid
concentration.
– Low individual inhibitory factors.
– Higher total salivary lipid levels.
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Microbiology of Dental Plaque
• Dental plaque is a soft deposit that
accumulates on the teeth.
• Plaque can be defined as a complex
microbial community, with greater than
1010 bacteria per milligram.
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SELECTED BACTERIAL SPECIES FOUND IN DENTAL PLAQUE
• Facultative
• Gram-Positive
– Streptococcus mutans
– Streptococcus sanguis
– Actinomyces viscosus
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Facultative
Gram-negative
– Actinobacillus actinomycetemcomitans
– Capnocytophypa species
– Eikenella corrodens
Anaerobic
– Porphyromonas gingivalis
– Fusobacterium nucleatum
– Prevotella intermedia
– Bacteroides forsythus
– Campylobacter rectus
SpirochetesT
– reponema denticola
(Other Treponema species)
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Thank you!!!
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