Supragingival Calculus Formation Research Articles

Comparative Assessment of Octenidine and Chlorhexidine Mouthwash in Gingivitis and Periodontitis Patient: A Clinical Trial

Background: A common and tried-and-true ingredient in mouthwashes that works well against the development of plaque, gingivitis, and oral microbial growth is chlorhexidine gluconate (CHX). However, when it must be taken for an extended period of time, its benefits are limited by the accompanying side effects, which include taste modification, cytotoxicity, supragingival calculus formation, mucosal irritation, and tooth discoloration. In the 1980s, octenidine dihydrochloride (OCT), a new antibacterial cationic surfactant molecule, was produced at the Sterling-Winthrop Research Institute in Rensselaer, NY. OCT binds to negatively charged microbial surfaces and has a strong adherence to lipid components, which causes disruption of the cell membrane of bacteria, yeast, and fungus. Aim: The purpose of the study was to evaluate the efficacy of mouthwashes with 0.1% octenidine and 0.2% chlorhexidine in patients with gingivitis and periodontitis. Material and Method: Participants in this clinical experiment were split into two groups, each consisting of forty patients with periodontitis and gingivitis. Next, as an addition to scaling and root planning (SRP), 20 patients from each group were provided chlorhexidine mouthwash and 20 patients were recommended to use octenidine mouthwash. At baseline and three months later, clinical measures such as the O’Leary plaque index (PI), bleeding index, probing pocket depth (POD), and clinical attachment loss (CAL) were assessed. Result: All clinical measurements showed that the Octenidine group performed much better than the chlorhexidine group in both the gingivitis and periodontitis groups. Conclusion: When compared to chlorhexidine, Octenidine performed better across all of the previously listed clinical parameters. As a result, it can be regarded as a promising mouthwash for upcoming medical and scientific investigations.

Efficacy of a Rinse Containing Tetrapotassium Pyrophosphate and Sodium Tripolyphosphate on Calculus Formation in a Group of Adults

Objectives: To evaluate a mouth rinse containing tetrapotassium pyrophosphate and sodium tripolyphosphate on supragingival calculus formation in a group consisting initially of forty adults seeking periodontal treatment at a Canadian dental school. Methods: The extent of supragingival calculus in relation to the lingual surfaces of the lower anterior teeth was measured using the Volpe-Manhold Calculus Index (VMI). In addition, The Plaque Index (PI) was used to evaluate plaque scores while the presence or absence of gingival bleeding index (GBI) was used to determine gingival health. At the completion of the hygiene appointment (baseline), the PI, GBI and VMI was assumed to be zero and the subjects were randomly assigned to test (rinsed twice a day with the anticalculus mouthwash) or control groups (only used regular dentifrice) and appropriate instructions provided. After a 60-day trial period, the test and control subjects were recalled, and the clinical measurements were conducted using the indices indicated above. Results: There were no statistically significant differences in the overall reduction in the mean VMI scores between the test and control groups. Conclusion: Within the limitations of the study, rinsing with tetrapotassium pyrophosphate and sodium tripolyphosphate for sixty days did not affect the formation of supragingival calculus in the present cohort of adults.

Chemical additives in toothpastes to inhibit calculus formation

Dental calculus has a secondary effect on the pathogenesis of periodontal diseases by harboring bacterial biofilm on its rough surfaces. Consequently, professional removal of both calculus and biofilm is a crucial part of the therapy and prevention of gingivitis and periodontitis. Today, crystal growth inhibitors such as zinc ions in the form of zinc chloride or zinc citrate, and pyrophosphates alone or in combination with copolymer are added to toothpastes to prevent the mineralization of the dental biofilm. In addition, triclosan is used as an antimicrobial agent in combination with copolymer as an additive in toothpastes to reduce the amount of plaque and thus the substrate for calculus formation. In clinical trials, chemical additives have demonstrated an inhibiting impact on calculus formation. However, it must be clarified that in addition to home-based oral hygiene, the formation of dental calculus depends on other factors such as access to professional dental care, diet, age, ethnicity, time since last professional tooth cleaning, systemic diseases or medications. However, since chemical additives in toothpastes do not reach the deeper sites of periodontal pockets, they are recommended for the inhibition of supragingival calculus formation, thus assisting the primary prevention of gingivitis as well as the secondary prevention of periodontal disease.

Comparative clinical efficacy of three toothpastes in the control of supragingival calculus formation.

Objectives:The purpose of this double-blind, parallel clinical study was to assess clinical efficacy in supragingival calculus formation reduction using Abhaibhubejhr Herbal Toothpaste compared to Colgate Total and Colgate Cavity Protection toothpastes.Materials and Methods:A total of 150 subjects participated in the pretest phase. All subjects were given oral soft/hard tissue evaluation, calculus examination using Volpe-Manhold calculus, and whole mouth oral prophylaxis. They received noncalculus control fluoride toothpaste and a soft-bristled toothbrush to brush for 1 min two times daily for 8 weeks. After which, subjects were given a test phase oral soft/hard tissue evaluation and calculus examination and were randomized into one of the three toothpaste groups. All subjects in the test phase received a whole mouth oral prophylaxis and were given their assigned toothpaste and a soft-bristled toothbrush to brush for 1 min two times a day for 12 weeks. Thereafter, subjects were assessed for their oral soft/hard tissue and calculus formation.Results:Mean Volpe-Manhold calculus index scores for the Cavity Protection, Abhaibhubejhr, and Total toothpaste groups were 0.78, 0.62, and 0.48, respectively, at the 12-week test phase evaluation. Abhaibhubejhr and Total toothpaste groups show 20.51% and 38.46% significantly less calculus formation than the Cavity Protection toothpaste group (P < 0.05). Total toothpaste group also show 22.58% significantly less calculus formation than the Abhaibhubejhr toothpaste group (P < 0.05).Conclusion:The use of Colgate Total toothpaste over a 12-week period was clinically more effective than either Abhaibhubejhr or Colgate Cavity Protection toothpastes in controlling supragingival calculus formation.

A Prospective Experimental Comparative Study on the Clinical Effects of Calculus Dissolution based Oral Rinse in Gingivitis Patients

ABSTRACT Aim The present study was aimed to evaluate the efficacy of calculus/tartar dissolution based oral rinse as an adjunct to toothbrushing in gingivitis patients for long-term effects on new supragingival calculus formation. Materials and methods After undergoing a dental prophylaxis, 60 gingivitis subjects with a moderate rate of calculus formation were stratified and randomly assigned to one of two groups: Control group (regular dentifrice alone) and experimental group (using a regular dentifrice and a calculus/tartar control mouthrinse). Subjects brushed and rinsed twice daily, unsupervised, for 6 months. All subjects were assessed with gingival index (GI), plaque index (PI) and calculus levels using the Volpe-Manhold Index (VMI) after 3 and 6 months. Results Statistical analysis found that the experimental group (which used a calculus/tartar contain mouthrinse) demonstrated statistically significantly lower VMI scores (p = 0.001) than control group (which used a regular dentifrice alone). In experiment test group A, there was decline in VMI score from 3 to 6 months by 23.12% as compared to group B where there was continuous increase in VMI scores from 3 to 6 months by 22.16%. Conclusion A mouthrinse containing tetrapotassium pyrophosphate and sodium tripolyphosphate as the anticalculus agent provides a clinically relevant reduction in calculus formation in subjects with a moderate rate of such formation. How to cite this article Saini R. A Prospective Experimental Comparative Study on the Clinical Effects of Calculus Dissolution based Oral Rinse in Gingivitis Patients. Int J Experiment Dent Sci 2015;4(1):33-39.

A randomized controlled clinical study of the effect of daily intake of Ascophyllum nodosum alga on calculus, plaque, and gingivitis.

The aim of this study is to evaluate, in a randomized controlled cross-over study, the effect of daily intake of the alga Ascophyllum nodosum on supragingival calculus, plaque formation, and gingival health over a 6-month period. Sixty-one adults with moderate to heavy calculus formation since their last yearly recall visit participated. In a randomized order over two 6-month periods, they swallowed two capsules daily, comprising a total of 500 mg dried marine alga powder (Ascophyllum nodosum, ProDen PlaqueOff®) or two negative control tablets. During the study, the participants maintained their regular oral habits. Their teeth were professionally cleaned at the start of each period and after the 6-month registrations. A wash out period of 1 month separated the two 6-month periods. Supragingival calculus (Volpe Manhold), gingivitis (Löe and Silness), gingival bleeding (Ainamo and Bay), and plaque (Quigley-Hein) were registered at screening and at the end of the two periods. Differences in oral health between the test and control periods were analyzed using a paired t test and Wilcoxon signed rank test. Fifty-five participants completed the study. After the alga intake, the mean calculus reduction was 52% compared to the control (p < 0.0001). Fifty-two participants showed less calculus formation in the alga group than in the control group. Plaque (p = 0.008) and gingival bleeding (p = 0.02) were also significantly less in the alga group. However, no significant difference was found between the groups for gingivitis (p = 0.13). The alga intake significantly reduced the formation of supragingival calculus and plaque and occurrence of gingival bleeding. The alga has a systemic effect on oral health. Daily intake of the alga Ascophyllum nodosum as an adjunct to customary oral hygiene showed a major reduction of supragingival calculus formation and reduced plaque formation. In addition, the calculus in the alga group was characterized by a more porous and less solid structure and was easier to remove than the calculus in the control group.

Calcium, vitamin D supplements with or without alendronate and supragingival calculus formation in osteoporotic women: a preliminary study

Objectives: Long-term calcium intake is related to the formation of urinary stones. Structure and composition of kidney and gallstones are similar to dental calculus. Saliva is the source of calcium for supragingival dental calculus formation. The aim of this preliminary study was to evaluate the possible effects of long-term calcium and vitamin D supplementation with or without alendronate administration on salivary electrolyte concentrations and supragingival calculus formation in osteoporotic women. Methods: Thirty-one female patients with osteoporosis for at least 3 years participated in this study. Eighteen women were taking calcium plus vitamin D plus alendronate, while 13 women were taking only calcium plus vitamin D supplements. Eleven systemically healthy women volunteered for the control group. Whole saliva samples were collected from all women before initiation of any periodontal intervention. Plaque index, probing depth, clinical attachment level, bleeding on probing, and calculus index were recorded at six sites/tooth. Salivary concentrations of ionic calcium, potassium, magnesium and sodium were determined by atomic absorption spectrophotometer. Results were evaluated statistically by non-parametric tests. Results: No significant differences were found in clinical parameters or results of saliva analysis between the study groups (p > 0.05). Conclusion: Within the limits of this preliminary study, it is suggested that long-term calcium and vitamin D supplementation with or without alendronate does not appear to have a significant effect on supragingival calculus formation or saliva total calcium, potassium, magnesium and sodium concentrations. Larger-scale studies investigating the possible effects of various treatment modalities of osteoporosis on supragingival calculus formation are required to better clarify this issue.

The release of vitamin C from chewing gum and its effects on supragingival calculus formation

The aims of this study were to evaluate (i): whether vitamin C in chewing gum, alone or in combination with carbamide, influences calculus formation, and (ii) whether carbamide affects the release, stability and uptake of vitamin C in a chewing gum. In two test series (Series I and II), 30 subjects, all calculus formers, participated. They were instructed to chew on five (Series I) or 10 (Series II) pieces of gum per day for a period of 3 months. The chewing gums were: vitamin C (60 mg, Series I), non-vitamin C (Series I) and vitamin C + carbamide (30 mg + 30 mg, Series II). In both series, no gum was used as a negative control. Calculus formation was scored on three lingual sites on the six anterior mandibular teeth according to the Volpe-Manhold index. The effect on plaque and gingivitis was also determined. A significant reduction in the total calculus score was observed after the use of vitamin C (33%) and vitamin C + carbamide (12%) gums compared with no gum use; this reduction was most pronounced in the heavy calculus formers. A reduced amount of visible plaque was also observed after use of vitamin C and non-vitamin C gum, but only the vitamin C gum reduced the number of bleeding sites (37%). In a separate study, the release, stability and uptake of vitamin C were evaluated using the iodine titration method in both saliva and urine after exposure to the following gums: vitamin C + carbamide (30 mg + 30 mg) and vitamin C (30 mg). There was no indication that carbamide affected the release, stability or uptake of vitamin C when used in a chewing gum.

Dental calculus: recent insights into occurrence, formation, prevention, removal and oral health effects of supragingival and subgingival deposits.

Dental calculus, both supra- and subgingival occurs in the majority of adults worldwide. Dental calculus is calcified dental plaque, composed primarily of calcium phosphate mineral salts deposited between and within remnants of formerly viable microorganisms. A viable dental plaque covers mineralized calculus deposits. Levels of calculus and location of formation are population specific and are affected by oral hygiene habits, access to professional care, diet, age, ethnic origin, time since last dental cleaning, systemic disease and the use of prescription medications. In populations that practice regular oral hygiene and with access to regular professional care, supragingival dental calculus formation is restricted to tooth surfaces adjacent to the salivary ducts. Levels of supragingival calculus in these populations is minor and the calculus has little if any impact on oral-health. Subgingival calculus formation in these populations occurs coincident with periodontal disease (although the calculus itself appears to have little impact on attachment loss), the latter being correlated with dental plaque. In populations that do not practice regular hygiene and that do not have access to professional care, supragingival calculus occurs throughout the dentition and the extent of calculus formation can be extreme. In these populations, supragingival calculus is associated with the promotion of gingival recession. Subgingival calculus, in "low hygiene" populations, is extensive and is directly correlated with enhanced periodontal attachment loss. Despite extensive research, a complete understanding of the etiologic significance of subgingival calculus to periodontal disease remains elusive, due to inability to clearly differentiate effects of calculus versus "plaque on calculus". As a result, we are not entirely sure whether subgingival calculus is the cause or result of periodontal inflammation. Research suggests that subgingival calculus, at a minimum, may expand the radius of plaque induced periodontal injury. Removal of subgingival plaque and calculus remains the cornerstone of periodontal therapy. Calculus formation is the result of petrification of dental plaque biofilm, with mineral ions provided by bathing saliva or crevicular fluids. Supragingival calculus formation can be controlled by chemical mineralization inhibitors, applied in toothpastes or mouthrinses. These agents act to delay plaque calcification, keeping deposits in an amorphous non-hardened state to facilitate removal with regular hygiene. Clinical efficacy for these agents is typically assessed as the reduction in tartar area coverage on the teeth between dental cleaning. Research shows that topically applied mineralization inhibitors can also influence adhesion and hardness of calculus deposits on the tooth surface, facilitating removal. Future research in calculus may include the development of improved supragingival tartar control formulations, the development of treatments for the prevention of subgingival calculus formation, the development of improved methods for root detoxification and debridement and the development and application of sensitive diagnostic methods to assess subgingival debridement efficacy.

Human supragingival in vivo calculus formation in relation to saturation of saliva with respect to calcium phosphates

The aim was to establish if there is a correlation between the rate of formation of supragingival calculus and the degree of supersaturation of saliva with respect to apatite, brushite and other calcium phosphates. The rate of calculus formation was estimated by measuring the calculus formed on lingual surfaces of the lower incisors in 15 individuals during 30 days. Submandibular saliva stimulated with citric acid and resting whole saliva, after pH determination and ultrafiltration to remove protein, was analysed for calcium, phosphate, sodium, potassium and carbonate. The degree of saturation with respect to calcium phosphates was calculated using a computer program. The rate of calculus formation among the 15 participants ranged widely, from a score of 0.5 to a high of 15. A close correlation ( r = 0.91) between salivary pH and degree of supersaturation was found. A weak correlation between calcium and calculus formation was also found. But neither for unstimulated nor stimulated saliva was a significant relation between supersaturation with respect to any of the calcium phosphates and the rate of calculus formation observed. Therefore, taking into consideration the background of the wide range of rates of calculus formation and of degrees of supersaturation, it was concluded that relation between them is unlikely, and that the use of degree of saturation as a diagnostic tool seems unreliable.

Control of supragingival calculus

The removal of supragingival calculus by scaling and polishing of the teeth is only one aspect of a dental prophylaxis. However in many countries, a large number of individuals only require and receive, at regular intervals, a supragingival scale and polish. The association of supragingival calculus to gingival and periodontal disease is unclear, however, it is logical to assume a plaque retention role. Moreover, for the individual, supragingival calculus may pose cosmetic problems. Regular calculus removal is both time consuming and exacting for dental professionals and has important financial implications to patients and/or health schemes. The benefits of regular supragingival calculus removal are not established, yet potential detrimental effects for the patient are known, and certain groups are susceptible to systemic disease consequent on scaling and polishing of the teeth. The oral hygiene habits of most individuals appear insufficient to prevent the reformation of supragingival calculus once removed and for this reason chemical inhibition is an attractive proposition. Most success to date has been with agents which inhibit crystal growth, notably pyrophosphates, and toothpaste products are available containing such agents. Clinical studies support efficacy for some products and indicate that the magnitude of calculus inhibition would reduce the need for or frequency of scaling and polishing of teeth in a proportion of individuals. Anticalculus toothpastes would appear to be proven worthy of recommendation for those individuals in whom supragingival calculus formation is a problem.

Evaluation of anti‐calculus efficacy

A double-blind, cross-over study was carried out to assess the anti-calculus effectiveness of a pyrophosphate containing cleaning gel. 2 groups of 30 heavy calculus formers were followed up comparing conventional clinical scoring systems (Volpe-Manhold-Index and Marginal-Line-Calculus-Index) and micromorphologic SEM criteria of calculus formation and inhibition. The results indicated that after a 3-month period, there was a significant reduction of calculus formation compared to a placebo gel. The proposed SEM calculus index (SEMCI) objectively reflects the reduction of supragingival calculus formation.

Therapeutic Mineral Enrichment of Dental Plaque Visualized by Transmission Electron Microscopy

The form, location, and distribution of fluorhydroxyapatite deposited in dental plaque by a urease-mediated mineral enrichment process have been studied by transmission electron microscopy. Artificial plaque was formed in terylene gauze in the mouth of one subject and immersed for five min four times per day in a mineral-enriching solution. Contralateral control plaque remained untreated. The effect on natural plaque was studied in two subjects who withheld oral hygiene for four days and mouthrinsed with this solution for two min four times per day during the last two days. Mineral deposits were seen in all plaque samples exposed to the test solution. None was detected in any control sample. The deposits were scattered in the interbacterial matrix as needle-shaped crystals, the size and shape of apatite, together with amorphous material. The crystals appeared larger and more perfect, and the amorphous material less conspicuous, with longer in vivo rinsing periods. Platelet-shaped crystals of octacalcium phosphate were never seen. Mineral was also seen within the remnants of dead bacterial cells and within degenerating epithelial cells. Crystals were never seen within intact bacterial cells, as in calculus formation. The presence of a single crystal type and the relative absence of densely-mineralized foci are other differences between this mineral-enrichment process and supra-gingival calculus formation. A longer-term study is necessary to determine whether the solution promotes calculus by providing nucleation seeds.

Reduced formation of supragingival calculus with use of fluoride-zinc chloride dentifrice

Results of this comparative, double-blind, clinical study show that fluoride dentifrice with 2.0% zinc chloride is effective in reducing calculus accumulation after a dental prophylaxis. The data also confirm earlier observations on calculus formation in that accumulation was not constant during the two 3-month study phases.

Salivary Composition and Calculus Formation in Patients Undergoing Hemodialysis

The purpose of this report is to provide further information regarding oral changes in patients with chronic renal disease who are undergoing hemodialysis. Quantitative changes in salivary flow rate and alterations in the composition of stimulated and unstimulated sliva were studied along with the rate of formation of supragingival calculus. Results revealed a lower salivary flow rate and increased salivary urea concentration in the dialysis group. Dialysis patients also formed more heavy calculus.

The relationship of gingival bradykinin activity to chronic gingivitis and periodontitis.

THE EFFECT ON HUMAN SUPRAGINGIVAL CALCULUS FORMATION OF ACETOHYDROXAMIC ACID Sons, S. and Muhlemann, H. R. Helv. Odontol. Acta, 15:158, Supplementum VII, October, 1971 Rinsing twice daily with a 1.5 percent solution of acetohy- droxamic acid in ten dental students ages 22 to 25 years of age was assessed using the standardized foil technique of Muhle- mann and Schroeder (1964). No significant decreases in cal- culus formation were found but there were significant differ- ences in dry weights of the samples, collected at the end of seven days of exposure to the oral environment. Dental Insti- tute, University of Zurich, Department of Cariology and Perio- dontology, Zurich, Switzerland.

PREVENTION OF THE SUPRAGINGIVAL CALCULUS FORMATION BY MEANS OF THE CALCULUS SPLINT

Calcium amount in the deposit on clinical crown of 1|1 during one month will be considered to express the individual activity of supragingival calculus formation (ACF). It will be more reasonable that geometric mean is adopted in the case of statistical treatment of the results, when the test for some preventive measure against calculus formation will conduct with some population group.Application of a dentogingival splint has been proved to be a new effective measure to prevent supragingival calculus formation. Eventhough the tightness of the splint depends upon the material and method to prepare it, it is the most important requirement to insure its effectiveness. Veillonella count was measured when it was withdrawn from the mouth, but the splint has no influence of their population at the time of sampling.