Diet and Calcilus Build-up - Research Paper Example

?Running Head: Diet and Calculus Build Up. Diet and Calculus Build Up                 Diet and Calculus Build Up. Introduction Dental calculus alternatively known as tartar is a layer of calcified material that results from the accumulation of precipitated minerals on dental plaque. The plaque, which provides the calculus base, is a layer or bio-film that is made by micro-flora consisting of bacteria that attaches to the teeth surface. The calculus layer develops from the accumulation of layers of minerals from saliva. According to Hicks and Garcia-Cordoy (2008), the mineral precipitation that primarily causes calculus development results from pH changes. The pH changes between resting pH (7.0) and acidic pH (5.0) is a common cyclic process that facilitates demineralization and re-mineralization of outer crown layers to control for dental carries. This process is facilitated by acidogenic bacteria, which reacts with dietary sucrose on the dental bio-film to create an acidic environment. The high-acidified environment with a high hydrogen ion concentration causes egression of phosphates and calcium to the surface, which accumulate in saliva and on the plaque layer. When the cyclical changes occur and pH increases or reaches resting level, re-mineralization occurs as phosphate and calcium move into the outer crown layers (Pacak et al. 2006). Actively fermentable carbohydrates that initiate pH change by creating an acidic environment through the help of acidogenic bacteria actively facilitate this process. The subsequent rise after the lowering of pH results in precipitation that characterizes calculus. As such, if foods high in fermentable carbohydrates are taken regularly, they are likely to facilitate a highly acidic environment that persists for longer and thus causing egression of calculus causing minerals onto the plaque layer where they will increasingly accumulate to form calculus. This implies that diet is an essential element in determining calculus formation. Background The development of calculus is largely facilitated by oral micro-flora that facilitates the cyclical pH changes necessary in the precipitation of calculus material. This precipitation may result from both carbohydrate fermentation facilitated by acidogenic bacteria or from the metabolization of amino acids from dietary protein (Pacak et al. 2006). From the earlier explained cyclical pH changes, high pH facilitated by fermentation of a high carbohydrate develops a high hydrogen ion (H+) driving force, which causes diffusion of the H+ in to the subsurface crown enamel and the pores around the hydroxyapatatite crystals. The hydrogen ions diffusion results in phosphate and calcium release from the de-mineralization process of the enamel subsurface. The two elements egress and accumulate in the bio-film and saliva, after which pH increase causes rapid precipitation to form calculus (Hicks & Garcia-Cordoy, 2008). A high dietary intake of calcium and phosphate is also likely to contribute to the development of calculus when the precipitation facilitating pH levels are attained (Hicks & Garcia-Cordoy, 2008). Apart from the carbohydrate diet, there is also a possibility of calculus development facilitated by oral flora changes caused by a high protein intake. People that have a high protein and low carbohydrate intake will deprive carbohydrate dependent bacteria and thus cause their decline whilst causing an increase in amino acid metabolizing micro-flora. This has a kind of opposite influence on pH, because the breakdown of amino acids will yield ammonia, which is basic, and thus raise the pH, which will in turn favour precipitation of minerals that develop calculus (Pacak et al. 2006). The above highlighted processes that lead to calculus accumulation are aggravated by high concentrations of free phosphate and calcium in the circulatory system. According to Pacak et al. (2006), high blood levels of free phosphate and calcium are directly related to higher saliva levels, which in turn means that more precipitation will be possible and faster development of calculus. Like the first two scenarios, this challenge is also diet related. Pacak et al. (2006), states that people on a high protein diet have a higher pH, which ranges between 6 and 6.5. This pH causes acidity that activates the phosphate buffering system, which makes phosphate available by breaking down the skeletal structure to release both calcium and phosphate (Mobley, 2008). The high release levels in turn lead to high saliva levels, which are implicated in calculus formation. A higher oral intake of fluoride through drinking water, which may be termed as part of the diet, is also known to cause high precipitation of calculus causing minerals, and this can be experienced by extreme discoloration of teeth in people taking natural sources of water with high fluoride levels (Mobley, 2008). Discussion Calculus should be a great health concern in the dental field because of its high prevalence, which in essence indicates a future of more resultant dental problems such as peridontitis. According to the “American Dental Hygienists Association” (ADHA) 90% of people surveyed by the NIDR (“National Institute of Dental Research”) showed some calculus development. Out of this huge percentage, 67% and 23% had subgingival and supragingival calculus respectively. Part of the 67% percent with subgingival calculus also had supragingival calculus. The rates of prevalence of the condition were found to be 74% for people between 13 and 17 years of age. In older groups, the prevalence was at an even higher rate of 90% (ADHA, 2011). The high rates of calculus prevalence should be worrying because the condition causes other dental problems such as the irritation of the gingival, which finally causes recession. Additionally, it may cause entrapment of food particles that raise the chances of developing periodontal diseases (ADA, 2010). Prolonged and untreated cases weaken the gums and roots of teeth through de-mineralization and starved re-mineralization, which may eventually lead to a loss of teeth. As such, it becomes necessary to seek earlier treatment, which may include physical removal by the dentist. As highlighted earlier through the pathophysiological process, it is also essential to practice good oral hygiene that eliminates food remnants in the mouth that facilitates the fermentation processes that precede calculus formation. Proper dietary intake that ensures both balanced circulatory and oral pH levels is also essential in influencing the precipitation of minerals that cause calculus as well as affect the levels of circulating free phosphates and calcium-which are implicated as the major precipitants (Dawes, 2008). Eating less fermentable carbohydrates and immediate oral cleaning after such meals is necessary in preventing these occurrences (ADA, 2010). Therefore, the most essential observations should be dietary intake, oral hygiene and prompt removal in established calculus cases. Conclusion In conclusion, calculus is a layer of mineral deposits that occurs on developed plaque on dental surfaces. There is mineral precipitation facilitated by bacterial flora that metabolizes fermentable carbohydrates and amino acids to effect pH cyclical changes that lead to shifting in phosphate and calcium from the subsurface crown layers onto the plaque and saliva. The rise and fall leads to precipitation of the accumulated precipitants when pH is higher. The precipitation is aggravated by higher free phosphate and calcium levels in the blood, which in turn increase saliva levels of the precipitants. Diet is thus a major influence because it plays a role in all identified processes. As such, dietary control in order to reduce free blood levels of calcium and phosphate as well as the presence of oral, fermentable carbohydrates is necessary. The condition is highly prevalent and directly implicated in other serious periodontal diseases, and as such, it should be controlled to prevent its progression. Interventions available may include diet, oral hygiene and early removal of established calculus (Robertson & Armitage, 2009). Notably, diet control provides the best and long lasting non-medical intervention, because it is directly involved in the development of calculus. References American Dental Association (ADA) Division of Science (2010). Tips for good oral health: Periodontal diseases. The Journal of the American Dental Association, 141 (7), 926. American Dental Hygienists Association. (2011). American dental hygienists’ association position paper on the oral prophylaxis. Retrieved 5th April 2012 from http://www.adha.org/profissues/prophylaxis.htm. Dawes, C. (2008). Salivary flow patterns and the health of hard and soft oral tissues. The Journal of the American Dental Association, 139 (2), 18S-24S. Hicks, J. M. & Garcia-Godoy. (2008). The role of dental bio-film, saliva and preventive agents in enamel demineralization and re-mineralization; The Journal of the American Dental Association, 139 (2), 25S-34S. Mobley, C. (2008). Fad Diets: Facts for Dental Professionals. The Journal of the American Dental Association, 139 (1), 48-50. Pacak, D., McClure, E., Kunselman, B. & Stegeman, C. (2006). Fad diets: Implications for oral health care treatment. Access, 20 (3), 30-5. Robertson, B. P. & Armitage, C. G. (2009). The biology, prevention, diagnosis and treatment of periodontal diseases: Scientific advances in the United States. The Journal of the American Dental Association, 140 (1) 36S-43S. NOTE: The first reference was prepared/authored by the American Dental Association (ADA) Division of Science (author). Read More