The correlation between dental calculus and disturbed mineral metabolism in paediatric patients with chronic kidney disease.

BACKGROUND: Vascular calcifications have been documented in children with end-stage renal disease. However, only a few reports have described abundant dental calculus formation in children suffering from chronic kidney disease (CKD). Moreover, dental calculus scores (DCS) and their correlation with renal disease severity have not been studied. METHODS: DCS in 74 young CKD patients were evaluated: 25 pre-dialytic (PrD), 18 on dialysis (D) and 31 with transplants (T) compared to 32 healthy participants (C). Saliva and serum analysis included creatinine (Cr), urea (U), calcium (Ca), phosphorous (P), magnesium (Mg) as well as intraoral pH levels. RESULTS: All patient groups presented high DCS. DCS and pH levels were higher in the D group with a positive correlation between pH and lower incisor DCS (r = 0.56, P = 0.017). The highest salivary Ca was found in the PrD group. Salivary P in the PrD group was found to be higher than in the T and C groups. The lowest salivary Mg was found in the D group while the highest salivary Ca x P product was found in the PrD group. In all patient groups, salivary U was higher than in the C group with a 2.5-fold increase in the D group. Salivary Cr resembled the U salivary concentrations. CONCLUSIONS: Alterations in salivary Ca, P, Mg, U, Cr and intraoral pH levels were observed in the patient groups. DCS correlated with renal disease severity and therefore may be a reflection of other tissue calcification pathologies found in these patients.

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.

Fluoride distribution in human dental calculus obtained from different sites on the tooth surface.

We examined the site specificity of fluoride (F) distribution in human dental calculus. Teeth with supra- and subgingival calculus were obtained from patients who resided in non-fluoridated areas in Japan and China. Sequential layers of the dental calculus (30 microns thick) were abraded by an abrasive micro-sampling technique and fluoride and phosphorus in the powdered samples were analyzed. Fluoride concentrations were highest in the outer, lowest in the middle and intermediate in the inner layers of dental calculus in general. In the outermost layers fluoride concentrations were highest in calculus found near the tooth cervix both in supra- and subgingival calculus. Fluoride concentrations decreased markedly toward the apical region in subgingival calculus, while it did not change toward the incisal or occlusal region in supragingival calculus. In the inner layers, fluoride concentrations in both supra- and subgingival calculus were not affected by position on the teeth. Fluoride concentrations in subgingival calculus near the apex were lower than in supragingival calculus near the incisal or occlusal region. It was concluded that the fluoride concentrations differ in different regions of dental calculus, probably due to their different mechanisms of formation.

Localized silicon distribution in supragingival calculus from Japanese monkeys (Macaca fuscata).

Using an electron-probe microanalyser, the distribution of silicon and other elements in supragingival dental calculus in domestic Japanese monkeys (Macaca fuscata) was studied. In two out of four monkeys kept in animals centres, a localized silicon distribution was found in both fracture and oral surfaces of the calculi. The silicon-rich area consisting of silicon alone resembled opal, but the areas containing silicon and other metal ions such as magnesium, aluminium, potassium and iron resembled clay minerals. In eight domestic monkeys, including the four animals described above, abundant calculus deposits were found. However, in four captured wild monkeys and in one which had been kept for less than a year at an animal centre, no dental calculus was found. There was almost no dental plaque accumulation in captured wild monkeys. It is suggested that calculus formation in Japanese monkeys is dependent on length of exposure to a commercial diet.

Fish-eaters and farmers: dental pathology in the Arabian Gulf.

Twelve skeletal samples, previously published, from the Arabian Gulf have been used to trace differences in diet and subsistence patterns through an analysis of dental pathology. The skeletons date from 3,000 BC to AD 1,500 and cover a variety of geographical locations: off-shore islands, Eastern Arabia, and Oman. The dental conditions analyzed are attrition, caries, calculus, abscessing, and antemortem tooth loss (AMTL). Results indicate four basic patterns of dental disease which, while not mutually exclusive, correspond to four basic subsistence patterns. Marine dependency, represented by the Ras el-Hamra population, is indicated by severe attrition, low caries rates, wear-caused abscessing, and a lack of AMTL. The second group of dental diseases--moderate attrition and calculus, low rates of caries, wear-caused abscessing, and low-moderate rates of AMTL--affects populations subsisting on a mixture of pastoralism or fishing and agriculture (Failaka, Umm an-Nar, Bronze Age Maysar, Bronze Age Shimal, and Iron Age Galilah). Mixed farming populations (Iron Age Maysar and Islamic Bahrain) experienced low-moderate attrition, high rates of caries and calculus, abscessing due to caries, and severe AMTL. The final group of dental diseases affects populations practicing intensive gardening (Bronze and Iron Age Bahrain, and Sites 3 and 5, Ras al-Khaimah). These groups experienced slight attrition, high rates of caries, low rates of calculus deposition, and severe AMTL.

The natural history and clinical course of calculus formation in man.

This paper describes levels and progression of supra- and subgingival calculus undisturbed by active professional intervention or home care between 1970 and 1985 in Sri Lanka, or when removed at regular intervals between 1969 and 1988 in Norway. In the Sri Lankan tea laborers, both supra- and subgingival calculus formation started before age 14 years. At 40 years of age, all participants and almost all teeth and tooth surfaces had calculus. Tea laborers who both smoked tobacco and chewed betel had significantly higher calculus scores than those who only had one of these habits, and those who neither chewed nor smoked had the lowest calculus scores. Teeth with calculus showed a significantly higher rate of loss of attachment than teeth that remained calculus free. For the Norwegians who had enjoyed regular dental care throughout their lives, supragingival calculus did not increase in frequency from adolescence to the forties. Approximately 70% of the interproximal surfaces were calculus free after 40-50 years of age. Subgingival calculus scores, although low, showed some increase with longer times of exposure. On average, each person had 0.4 interproximal surfaces with subgingival calculus as they approached 50 years of age. In this Norwegian population, subgingival calculus had no impact on loss of attachment.

In vivo remineralization of human enamel and dental calculus formation.

The aim of this investigation was to determine the inorganic composition and the surface morphology of remineralized enamel areas and of dental calculus in heavy-calculus-formers (five subjects) and to compare these results with those of non-calculus-formers (two subjects). Electron probe micro-analysis (EPMA) was carried out on sound, acid-etched, and in vivo remineralized enamel samples from heavy- and non-calculus-formers. The mean values of Ca, P, Na, Mg, Al, Si, S, Cl, and K were compared with the SEM morphology. EPMA measurements showed no significant differences in the Ca/P ratio of the surface layers of prism-oriented and/or homogeneous enamel remineralization. The variations of remineralization pattern after acid-etching are similar in teeth from heavy dental-calculus-forming patients and in teeth from non-calculus-formers. The SEM appearances of remineralized areas and of the inner surface of mature dental calculus must be considered to be totally different. The experiments carried out suggest that the remineralization of enamel is not related to the formation of calculus.

A case report of unusual dental calculus formation.

A case is presented in which an unusual amount of intraoral calculus was seen in a 59-year-old woman. The deposits completely covered all surfaces of most teeth and extended over the facial and lingual gingivae. The relationship between certain chemical salivary parameters and heavy calculus formers is briefly described.