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How does calculus attach
to the tooth?
From: Renee Marchant-Turner
To: periotherapist groups
Sent: Saturday, April 5, 2008 11:59:23 AM
Subject: [periotherapist] Calculus attachment
I gotta' question. This may seem simple or stupid, but I
don't know the answer. How does calculus attach to the
tooth? Someone told me that leukopolysaccharide s (sp?)
are involved. She said LPS are proteins, so using a laser
which denatures proteins would make deposits less adherent.
Are LPS's proteins? I should remember this, but chemistry
was a lifetime ago and I didn't like it then! - Renee
LPSs are complex combinations of lipids and polysaccharides
(carbohydrates). There are no proteins involved. As the
plaque on the teeth thickens by bacterial growth, the
bacteria in the depths eventually die because of nurtient
deprivation. As the saliva is supersturated with calcium
and phosphate, these ions diffuse into the depths of the
plaque and calcify around and in these dead bacteria.
The bonds which had initially attached the bacteria to the
teeth presumably remain intact and hold the newly formed
calcified plaque to the teeth.
Pregnancy gingivitis is a well known entity. It is thought
that the increase in progesterone in the 2nd trimester both
influences the integrity of the gingival blood vessels
causing them to bleed, and/or serves as a nutrient which
selects for certain anaerobic members of the plaque flora
such as Prevotella intermedia. The overgrowth of these
anaerobes can be associated with gingivitis and recently
with pre-term births and low birth weight. This is the
subject of much recent research and can be found by
googling "pregnancy periodontal."
Walter Loesche
Marcus Ward Professor Emeritus School of Dentistry
Professor Emeritus of Microbiology& Immunology, School of Medicine
University of Michigan
Sent: Monday, March 26, 2007 11:29 PM
I stay up to late at night, sometimes! For the life of me, something
is puzzling me and I still don't understand it. Why don't the really
deep pockets heal when we leave subgingival calculus behind? I have
watched some of the best clinicians around use the periodontal
endoscope in residual pockets. . . in hard to access areas like
furcations. . . and sure enough, there's a hunk of subgingival
calculus there surrounded by heavy, billowing plaque. Does the
calculus act as a foreign body or is it the plaque
periodontopathogens that are causing the problem? - Lynne
Dear Lynne,
Because of its location the measures used have not disinfected
the residual calculus. Calculus provides and excellent surface for
the propagation of bacterial biofilms. Have you ever seen the
surface of calculus disclosed with a scanning electron microscope? It
looks like a piece of coral. When I was giving lectures I used to
show the surface of coral and the surface of calculus. It is not easy
to disinfect such surfaces. I have always advised removing as much
calculus as possible. I compared cleaning the surface of tile with
cleaning the surface of a cinder block. This where microscopic
examination of lesions with residual calculus can be helpful. One
knows immediately if residual biofilms are still present. If so,
intensive pocket irrigations and other antibacterial measures need to
be used.
In my lectures I used to show excellent healing with bone
regeneration and tissue adaptation around small pieces of calculus
that were missed during the initial clearing of root surfaces.
Obviously there were no pathogenic bacteria on the surfaces of these
remnants. The question was:to remove or leave alone? I was inclined
to leave alone but to watch closely. Don't lose any more sleep over
this problem. - Dr. PAul
>> In a message dated 3/26/2007 5:32:16 P.M. Pacific Daylight Time,
>> Sub-gingival calculus is a different babe from supragingival
>> calculus. Just about all of it needs to be removed or the pocket
>> DOES NOT heal. John Kwan and Anna Pattison have both found that
>> to be true when using Perioscopy. Lynne
>>
>> I promise to dig out the research article and post the reference,
>> but I know there is also research showing that most times when
>> the perioscope is used in a pocket with NO BLEEDING there is
>> imbedded calculus in the root structure. So, the fact there is
>> calculus present in a bleeding pocket does not mean so much.
>> Calcified bugs are everywhere and we will never get them all.
> Well I don't believe I ever said that all the calculus needs to be
> removed or the pocket does not heal. In fact because of my
> experience with healing with and without the endoscope it is very
> apparent that you can get healing and NOT remove all the calculus.
> BUT if you can see it and remove it your chances are probably
> greater than if you are just fishing around. Because when you fish
> you normally can't see them, unless you are sight fishing in which
> case it is all the more exciting... Embeded calculus then requires
> removing the root surface which can be done with our without
> visualization. Predictablility of root surface cleaning is
> improved with visualization. So why don't we all get scopes and
> see what we are doing?
> "Healing through better Vision". John Kwan
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