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AIM The World Health Organization (WHO) periodontal probe is recommended for epidemiologic surveys and periodontal screening, but its ability to identify subgingival dental calculus (DC) relative to a #11/12 explorer is not known. This study compared in vitro the ability of the WHO probe and a #11/12 explorer to detect subgingival DC. MATERIALS AND METHODS Three typodont models with randomly distributed artificial DC on mandibular molar and premolar root surfaces were assessed with a WHO periodontal probe and a #11/12 explorer by two periodontists. The diagnostic performance of the two instruments for subgingival DC detection was compared using 2 × 2 contingency table analysis. RESULTS A #11/12 explorer provided better reproducibility, a higher level of sensitivity, higher positive predictive values, higher negative predictive values, and greater overall accuracy (diagnostic effectiveness) (76.9% vs. 68.5% for the first periodontist; 87.0% vs. 75.0% for the second periodontist) for detection of subgingival DC than the WHO probe. CONCLUSION The in vitro diagnostic performance of a #11/12 explorer was superior to the WHO periodontal probe for identification of subgingival DC. CLINICAL SIGNIFICANCE A #11/12 explorer, rather than the WHO probe, is recommended for identification of subgingival DC.

Objective The aim of this in vitro study was to evaluate the ability of optical coherence tomography (OCT) to display calculus on root surfaces. Material and methods Ten teeth with calculus on the root surface were embedded in resin, omitting the root surface. A region of interest (ROI) was marked by small drill holes coronally and apically of the calculus and imaged by spectral-domain optical coherence tomography ([SD OCT], Telesto SP5, centre wavelength 1310 nm) and light microscopy (LM). To evaluate the impact of different fluids on calculus visualisation, using OCT, root surfaces were covered by a layer of NaCl and blood and displayed by OCT. Subsequently, teeth were completely covered with resin and sectioned for histological evaluation. Within the ROI, lengths of root surface and calculus were measured by LM and OCT, and the ratio [%] was calculated. In addition, at three sites of each ROI, agreement of presence and length of calculus was evaluated. Both methods were compared using Pearson’s correlation. Results Regarding the presence of calculus, agreement between LM and OCT was strong (κi = 0.783, p = 0.033), and measurements regarding the length of the calculus were strongly correlated (ri >0.906; pi Conclusion Calculus on the root surface can be displayed by SD-OCT, which therefore may be suited as imaging technology for subgingival calculus in periodontal pockets.

Background Previous in vitro studies have proven laser fluorescence measurement using a 655-nm Indium Gallium Arsenide Phosphide (InGaAsP) based diode laser radiation to be a useful tool to detect subgingival calculus. The aim of this prospective study was to evaluate the 655-nm InGaAsP diode laser in detecting subgingival calculus in patients with periodontal disease compared with photographic assessment during periodontal surgery. Methods Twelve patients (six women, six men) aged between 21 and 75 years with periodontitis scheduled for periodontal surgery were included in this prospective study. All laser fluorescence measurements were made before periodontal surgery. Intraoperatively a mucoperiostal flap was performed, subgingival calculus was visualized, and photographic images were taken. The presence of calculus was recorded for each evaluated site. Results A total of 115 tooth surface sites of 32 teeth from the 12 patients were evaluated before (laser) and during surgery (image). Compared with image evaluation the laser assessment showed a sensitivity of 0.70 (CI0 .025 0.53 to CI0.975 0.83) and a specificity of 0.97 (CI0.025 0.85 to CI0.975 0.99). The overall probability to correctly detect subgingival calculus with the laser (accuracy) was 0.82 (CI0.025 0.74 to CI0.975 0.88). Conclusions The 655-nm diode laser was able to detect subgingival calculus. Hence, the 655 nm diode laser may be used as an additional tool for calculus detection in non-surgical periodontal therapy.

This study evaluated the effectiveness of swept-source optical coherence tomography (ss-OCT) for detecting calculus and root cementum during periodontal therapy. Optical coherence tomography (OCT) images were taken before and after removal of subgingival calculus from extracted teeth and compared with non-decalcified histological sections. Porcine gingival sheets of various thicknesses were applied to the root surfaces of extracted teeth with calculus and OCT images were taken. OCT images were also taken before and after scaling and root planing (SRP) in human patients. In vitro, calculus was clearly detected as a white-gray amorphous structure on the root surface, which disappeared after removal. Cementum was identified as a thin, dark-gray layer. The calculus could not be clearly observed when soft tissues were present on the root surface. Clinically, supragingival calculus and cementum could be detected clearly with OCT, and subgingival calculus in the buccal cervical area of the anterior and premolar teeth was identified, which disappeared after SRP. Digital processing of the original OCT images was useful for clarifying the calculus. In conclusion, ss-OCT showed potential as a periodontal diagnostic tool for detecting cementum and subgingival calculus, although the practical applications of subgingival imaging remain limited.

The objective of this study is to compare the performance of the DIAGNOdent laser fluorescence (LF) Pen to conventional periodontal probing for detection of subgingival calculus under defined laboratory conditions. Extracted teeth with various levels of subgingival deposits of calculus were mounted anatomically in stone casts, and an impression material was used to replicate periodontal soft tissues. The casts were examined for the presence of subgingival calculus at eight surfaces per tooth (240 sites) using LF and a periodontal probe. Sites were rescored after 1 and 3 weeks. Direct imaging of the root surfaces under magnification was the gold standard. As a result, for an experienced operator, LF was more accurate than tactile assessment (across all sites, 84.0% vs. 59.8%). The performance difference was greater for multi‐rooted teeth (85.8% vs. 56.9%) than single‐rooted teeth (77.2% vs. 66.7%). The performance of LF in this laboratory trial was influenced strongly by clinician skill and experience. When used by an experienced operator, LF was more sensitive (75.1% vs. 69.2%), specific (92.6% vs. 86.3%), and accurate (84% vs. 77.9%) than for an inexperienced operator. In conclusion, under the defined laboratory conditions used, LF had better performance than tactile examination, particularly for multi‐rooted teeth. This method may have value clinically as an adjunct for detecting subgingival deposits of calculus in clinical practice. The usefulness of the method improves with operator experience.

This study compared the performance of three laser fluorescence (LF) devices (DIAGNOdent Classic, DIAGNOdent Pen and KEY3 laser) under standardized laboratory conditions for detecting subgingival deposits of calculus on root surfaces of extracted teeth in typodonts. While some studies show the efficacy of LF devices for calculus detection compared with conventional periodontal probes, little is known regarding the differential performance of different LF devices. In this laboratory study, extracted teeth were set in an anatomical configuration in stone typodont models in a phantom head and impression material used to replicate periodontal soft tissues. A total of 240 sites were assessed on three occasions using the three different LF devices and results compared to direct microscopic examination of the roots of the extracted teeth under magnification. The KEY3 showed greater accuracy (86.4 %) than the DIAGNOdent Pen (84 %) and DIAGNOdent Classic (80.2 %). The intra-examiner reproducibility was also higher for the KEY3 (mean Cohen kappa 0.74) than the DIAGNOdent Pen (0.66) and DIAGNOdent Classic (0.6). Of the three LF devices, the KEY3 has greater accuracy and reproducibility.

Objective : Despite promising results of Er:YAG laser in periodontal debridement, to date there is no consensus about the ideal settings for clinical use. This experimental clinical trial aimed to determine the effects of debridement using Er:YAG laser and to compare with ultrasonic treatment. Materials and Methods : 64 teeth, were divided into two in vivo and in vitro subgroups. Each tooth received ultrasonic treatment on one side and Er:YAG laser debridement at either 60 , 100, 160 or 250mJ/pulse and at 10Hz on the other side on a random basis. All samples were morphologically analyzed afterwards under scanning electron microscope for surface changes and dentinal tubules exposure. Treatment duration(d) was also recorded. Results : Laser debridement produced an irregular, rough and flaky surface free of carbonization or meltdown while ultrasound produced a relatively smoother surface. The number of exposed dentinal tubules (n) followed an energy-dependent trend. The number of exposed tubules among the in vivo laser groups was: n60mJ=n100mJd100mJ>dUltrasound=d160mJ>d250mJ (p≤0.046), while for the in vitro groups it was: d60mJ>d100mJ=dUltrasound=d160mJ>d250mJ (p≤0.046). Conclusions : Due to excessive treatment duration and surface damage, Er:YAG laser debridement at 60 and 250mJ/pulse, respectively, is not appropriate for clinical use. Although laser debridement at 100 and 160 mJ/pulse seems more suitable for clinical application, compared to ultrasound the former is more time-consuming and the latter is more aggressive. Using a feedback device or lower pulse energies are recommended when using laser in closed field.

Laser fluorescence (LF) and differential reflectometry (DR) are two new optical methods which have been used to help diagnose subgingival deposits of dental calculus. This study compared the performance of LF using the KEY3 laser system versus DR using the DetecTar system under controlled laboratory conditions designed to simulate clinical conditions as much as possible. A total of 30 extracted human posterior teeth were set in an anatomical configuration in stone typodonts with impression material replicating the periodontal soft tissues. LF was more accurate than DR (76.2% vs. 68.2%) and gave higher reproducibility (Bangdiwala’s B statistic 0.71 vs. 0.54). The better performance of LF makes it the preferred option of the two methods for detection of subgingival dental calculus.

The VistaCam® intra‐oral camera system (Dürr Dental, Bietigheim‐Bissingen, Germany) is a fluorescence system using light emitting diodes that produce a 405‐nm violet light. This wavelength has potential application for detection of dental calculus based on red emissions from porphyrin molecules. This study assessed the digital scores obtained for both supragingival and subgingival calculus on 60 extracted teeth and compared these with lesions of dental caries. It has also examined the effect of saliva and blood on the fluorescence readings for dental calculus. VistaCam fluorescence scores for both supragingival (1.7–3.3) and subgingival calculus (1.3–2.4) were higher than those for sound root surfaces (0.9–1.1) and dental caries (0.9–2.2) (p

To review the data available on the laser-induced calculus fluorescence phenomenon and the calculus detection devices as well as to determine the clinical relevance of using commercialized calculus detection devices in periodontal treatment.In vitro or in vivo English publications found on Medline.In vitro and in vivo studies showed that the devices on the market had a satisfactory detection capacity. Very few studies demonstrated that the erbium:yttrium-aluminium-garnet (Er:YAG) laser debridement, when performed with automatic calculus detection, could lead to improvements at the clinical level, and the outcome was similar to that obtained with conventional treatments.Although preliminary data were encouraging, there was a lack of scientific data concerning the calculus detection devices. Therefore, future studies are crucial for determining the clinical relevance of such equipment.

The aim of the study was to overview the gingival and periodontal disease in children and adolescents aged 12 to 15 years in Belgaum city. Visible plaque, gingival bleeding, supragingival and subgingival calculus and periodontal pockets were measured. Examination of buccal, lingual and mesial areas of each tooth was recorded sequentially in both arches using Gingivitis and Periodontitis Site Prevalence Index (WHO, 1978). The prevalence of gingival and periodontal disease was more in males than females and in Hindu population compared to others. The sites affected by gingivitis and periodontitis increased with the age. Periodontal problems were significantly more prevalent in patients with betel nut chewing habit. Visible plaque was most common while periodontal pockets were least common in the adolescents. Age, socioeconomic status, brushing habits and brushing frequency did not affect much to the prevalence of sites of gingivitis and periodontal disease. It was concluded that early diagnosis and preventive measures would surely reduce the growing problem of gingival and periodontal diseases among the children and adolescents.

Objectives: The aim of the present study was to evaluate the effectiveness of a novel optical calculus detection system under in vivo conditions. Methods: One hundred and seventy-six tooth surfaces from 44 adult teeth that were indicated for extraction were selected for the present study. The patients were randomly assigned to one of the two experimental groups. In group A (n = 96), clinical presence or absence of subgingival calculus deposits was determined using the light-emitting diode-based optical probe (OP). In group B (n = 80), the subgingival deposits were first recorded with the OP followed by root surface debridement until no subgingival deposits could be detected by the device. Teeth were then extracted and examined under a stereomicroscope by two trained dentists (DENT 1, DENT 2) and a dental student. Results were compared with the measurements of the OP and direct visual control. Results: In group A, post-extraction results revealed 89% and 90% agreement with the positive and negative OPs detection. In group B, 17% of the surfaces demonstrated even after subgingival debridement and control with the detecting device still calcified deposits in the microscopic evaluation. The highest inter-examiner agreements were observed between DENT 1 and DENT 2. Conclusion: It was shown that the optical detection system identifies subgingival calculus with a high efficacy and therefore, may be a support for the operator to determine the endpoint of root surface instrumentation.

Orthodontic therapy is not contraindicated for patients with advanced periodontal destruction, provided that factors such as inflammation, plaque, subgingival calculus, and occlusal trauma are well controlled both before and during the orthodontic treatment. The application of extremely light continuous forces might have a better effect on the cell biology of tooth movements. By minimizing necrosis, and the subsequent hyalinization and indirect resorption, it might be possible to achieve continuous progress in tooth movement, avoiding the repeated interruptions occurring when the blood vessels are occluded, and reducing the great risk for further bone loss when treatment is rendered for individuals with decreased osseous support. A new generation of low friction, passive self-ligating brackets, in combination with newer wire and coil materials and longer activation spans, seems to be capable of exerting lower force levels providing more favorable periodontal reactions in patients with previous bone loss. A patient treated following these principles and using these newer technologies is presented. (Semin Orthod 2008;14:36-45.) © 2008 Elsevier Inc. All rights reserved.

Aim:We have recently tested a surface detection system based on a conventional dental ultrasonic scaler in vitro. The aim of the present study was to investigate sensitivity and the specificity of the detection device in vivo. Material and Methods:Subgingival buccal surfaces of 63 arbitrarily selected periodontally compromised teeth were scanned intra-orally, while the supragingival positions of the insert, along with the corresponding signals of the detection system, were saved as separate files. After extraction, the surface detection results were evaluated by re-positioning the inserts’ position on the tooth in vitro and comparing the detection results with visual findings. Results:On the scanned tooth surfaces, there were 44 calculus spots, which covered 22.3% of all scanned surfaces (prevalence). The calculus-free surface was divided into ‘‘spots’’ mathematically. The device correctly classified 40 calculus and 125 cementum spots, whereas four calculus and 28 cementum spots were classified incorrectly. Calculus and cementum were discriminated with a sensitivity of 91% and a specificity of 82%. The positive and negative predictive values were 0.59 and 0.97. Conclusion:The surface detection device was able to clinically differentiate cementum and calculus in vivo. Therefore, this method may support the decision of whether continued subgingival scaling could damage the cementum.

Aim: We recently introduced an experimental surface detection system based on a conventional dental ultrasonic scaler. This device automatically discriminates cementum and dental calculus, which is the prerequisite for complete and thorough calculus removal. In the present study, the detection limits of this device were tested in vitro. Material and Methods: From 50 extracted teeth, subgingival calculus was gradually removed using a Gracey curette. During this stepwise procedure, detection properties of the surface detection system were continuously monitored and systematically verified until the system stopped discriminating calculus from the root surface. By measuring the diameter, circumference and area of the smallest, yet recognizable deposit, and of the no longer recognizable deposit, the cut-off point of the discriminative capability of the detection device was determined. Results: The cut-off points for the correct classification of residual deposits averaged on a diameter of 219 μm, an area of 21,600 μm2, and a circumference of 748 μm. This means a sensitivity of 73% and a specificity of 80% in this critical area. Conclusions: This calculus detection system was able to detect small deposits. In clinical practice, this device may support dentists in deciding whether to stop or to continue the debridement.

The aim of this study was to evaluate the effects of Nd:YAG laser treatment on subgingival calculus, cementum and dentine, in vitro at different power settings and durations. The study included 2 experiments. In the 1st experiment, 32 extracted teeth with calculus were divided into 8 laser treatment groups. Each tooth was treated on 2, 3 or 4 sites. In the 2nd experiment, 3 extracted cementum covered teeth and 3 extracted root planed teeth with exposed dentine were selected. 1 surface of each tooth was subjected to 8 different laser treatments. In both experiments, all specimens were assessed using scanning electron microscopy. Micrographs were taken from each treated site at x 100 and x 750 magnifications. An arbitrary scale (from 0 to 3) was used to score the degree of damage caused by the laser. Generally, the laser caused greater damage on calculus than either cementum or dentine. Linear regression analysis showed that higher total energy input caused a greater mean damage score on calculus (R2 = 66%, p < 0.001). 3-way analysis of variance showed that for calculus, the power setting, number of pulses per second and the duration of exposure contributed independently to the mean damage score in an additive way. Cementum specimens were not affected by treatment 1 (50 mJ, 10 pps, 1 s), treatment 2 (50 mJ, 10 pps, 5 s), and treatment 5 (50 mJ, 20 pps, 1 s). Dentine specimens were not affected by treatment 1 (50 mJ, 10 pps, 1 s).(ABSTRACT TRUNCATED AT 250 WORDS)

Introduction: Though dental calculus is generally recognised as comprising mineralised bacteria, areas of non-mineralised bacteria may be present. Aim: To investigate the ultrastructure of non-decalcified young and mature supragingival calculus and subgingival calculus, and the possible presence of internal viable bacteria. Materials and methods: Supragingival calculus was harvested from five patients, 9–10 weeks after scaling and root debridement. Five samples of mature supragingival and subgingival calculus were taken from patients presenting with adult periodontitis. Specimens were fixed and embedded for transmission electron microscopy. Results: The ultrastructure of young and mature supragingival calculus was similar with various large and small crystal types. Non-mineralised channels were observed extending into the calculus, often joining extensive lacunae, both containing intact non-mineralised coccoid and rod-shaped microorganisms. Subgingival calculus possessed more uniform mineralisation without non-mineralised channels and lacunae. Conclusion: Supragingival calculus contains non-mineralised areas which contain bacteria and other debris. The viability of the bacteria, and their identification could not be determined in this preliminary investigation. As viable bacteria within these lacunae may provide a source of re-infection, further work needs to be done to identify the bacteria in the lacunae, and to determine their viability.

The aim of the present study was to investigate laser-fluorescence effects on the root surface. The possibility of detecting subgingival calculus should be evaluated to control complete calculus removal after scaling and root planing. Twenty freshly extracted human teeth, partially covered with calculus on the root surface, were fixed on a translation stage. The specimens were irradiated by light from a laser source (diode laser,1 mW) with a wavelength of 655 nm using the Diagnodent trade mark -system. To simulate the conditions in a periodontal pocket during the measurement procedure, the teeth were covered by a layer of physiological saline solution or blood in order to determine the influence of different inflammatory fluids. The root surface was scanned on a line of about 1 cm in steps of 0.5 mm. The start and end was marked by a notch. The results of the laser-fluorescence detection were compared to clinical and histological findings. Clinically apparent calculus on the root surface was always accompanied with a statistically significant increase of laser-fluorescence values ( p0.05). These values were not influenced by the different fluids ( p0.05). The laser-fluorescence values were reproducible ( p0.05). After scaling, when no debris remained at the root surface, laser-fluorescence values decreased significantly ( p0.05). The histological findings supported the clinical results. In conclusion, the present study indicates that laser-fluorescence values on the root surface are strongly correlated to the presence of calculus. This fluorescence effect can basically be used to develop a new detecting system for subgingival calculus in periodontal pockets.

The aim of this study was to determine the association between the quantity of subgingival calculus and the following factors: type and severity of periodontal disease, age, gender and tobacco consumption. A sample of 622 periodontal patients was studied. The radiographically detectable subgingival calculus in proximal root surfaces was recorded in periapical radiographs, considering the number of surfaces without calculus and the number of surfaces exhibiting deposits equal or greater than I mm. The association between the subgingival calculus and the factors under study was analyzed by distinct non-parametric tests. A statistically significant association was found between the absence/presence of subgingival calculus and the type and severity of periodontal disease (p

Whether the fluoride concentrations and profiles differ in human dental calculus obtained from different countries was investigated. A total of 203 dental calculus deposits on 203 permanent teeth from residents (mean age, 52.1 years) of Nagoya (Japan), Shanghai (China), Leeds (Great Britain) and the Wuhan mountainous area (China, fluoridated area) were analysed. An abrasive microsampling procedure was used to examine fluoride distribution. There were five types of fluoride profiles in dental calculus in each area/country (designated types L, J, U, T, W). In supragingival calculus, type L (highest in the outermost layers) and type J (highest in the innermost layers) both had significantly higher values than type U (high in the surface and innermost layers) but were relatively identical. In subgingival calculus, type W (high in the outermost, mid and innermost layers) was characteristic. Calculus from the Wuhan mountainous area (fluoridated) had the highest fluoride concentration, followed by Leeds (non-fluoridated), and Nagoya and Shanghai (non-fluoridated) calculus had the lowest. Fluoride concentrations in supragingival calculus were higher in teeth extracted because of periodontal diseases than dental caries. It is concluded that fluoride concentrations and distribution in dental calculus differ from country to country, probably due to different fluoride environments.

Salivary calcium level was determined in this study in individuals with good oral hygiene who have no repetitive history of calculus accumulation, and in individuals with a history of repetitive calculus formation whether subgingival or supragingival in spite of their attempts in controlling their oral hygiene. Salivary calcium concentration was significantly higher in the second group. Moreover, salivary calcium concentration in this study varied according to age. It is advisable to use alkaline mouthwashes and intensive good oral hygiene to control their calculus formation

Objectives: The aims of this study were to assess the validity of the WHO 621 probe for the detection of subgingival calculus and to assess the effect of subgingival calculus on the measurement of probing pocket depths and clinical attachment levels. Methods: Teeth used in the study were designated for extraction under local analgesia. Prior to extraction the clinical detection of subgingival calculus was made with a WHO 621 probe. Probing pocket depths and clinical attachment levels were measured. The location and direction of the gingival margin and probing measurements were marked on the teeth with a fine, sterile pencil and following extraction, permanent reference grooves were cut with a fine, tapered diamond bur. The extracted teeth were stained with Gomori's stain and examined for the presence of calculus, and the pocket depths and attachment levels were measured using a stereomicroscope. Results: There was an 80% agreement between the clinical and laboratory detection of subgingival calculus. There was no systematic difference between clinical and histopathological measurements when calculus was present or absent (P > 0.05). Analysis of variance indicated a random error effect due to the presence of subgingival calculus. Conclusion: This study has demonstrated the validity of the WHO 621 probe in detecting subgingival calculus and has shown that subgingival calculus could be a source of error in the measurement of probing depths and clinical attachment levels.

A prescale gel product, designed to facilitate the removal of calculus, has recently been introduced and marketed to the dental profession. The purpose of this study was to evaluate the effectiveness of this gel on the removal of subgingival calculus. 10 patients, each with 5 periodontally diseased teeth scheduled for extraction, participated in this in vivo/in vitro study. 4 teeth per patient were randomly assigned using a 2-by-2 block design and treated in vivo with either active or placebo gel, with or without scaling, prior to extraction. To assess possible overexposure to the product, 10 selected teeth from the sample were treated with active gel for an extended exposure time. Standardized scaling was performed on a 4x4 mm treated root area in vitro on groups as assigned. Quantification of residual calculus was determined by one examiner blind to treatment group assignment using SEM photomicrograph montages and the Java image analysis computer system. Repeated measures ANOVA showed no statistically significant treatment effect for gel (p > 0.05) in the scaled and no-scaled groups. The 5th group exposed to the prescale gel for an extended time was evaluated descriptively for root surface morphological changes with no noticeable effect. Based on the results of this investigation, treatment of subgingival calculus with prescale gel offers no advantage for calculus removal over scaling alone. The findings suggest no significant clinical impact of product use.

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.

Visible red (655 nm) laser fluorescence (LF) devices are currently used for identifying deposits of subgingival calculus on the root surfaces of teeth during dental examination and treatment; however, it is not known how the fluorescence readings produced by commercially available LF systems correlate to the nature of the deposits. This laboratory study explored the correlation between LF digital readings and the surface area and volume of subgingival calculus deposits on teeth. A collection of 30 extracted human posterior teeth with various levels of subgingival deposits of calculus across 240 sites were used in a clinical simulation, with silicone impression material used to replicate periodontal soft tissues. The teeth were scored by two examiners by using three commercial LF systems (DIAGNOdent, DIAGNOdent Pen and KEY3). The silicone was removed, and the teeth were removed for photography at × 20 magnification under white or ultraviolet light. The surface area, thickness, and volume were calculated, and both linear least squares regression and nonlinear (Spearman's rank method) correlation coefficients were determined. Visible red LF digital readings showed better correlation to calculus volume than to surface area. Overall, the best performance was found for the KEY3 system (Spearman coefficient 0.59), compared to the Classic DIAGNOdent (0.56) and the DIAGNOdent Pen (0.49). These results indicate that while visible red LF systems vary somewhat in performance, their LF readings provide a useful estimation of the volume of subgingival calculus deposits present on teeth.

In this study, the dental calculus was characterized and imaged by means of swept-source optical coherence tomography (SSOCT). The refractive indices of enamel, dentin, cementum and calculus were measured as 1.625±0.024, 1.534±0.029, 1.570±0.021 and 1.896±0.085, respectively. The dental calculus lead strong scattering property and thus the region can be identified under enamel with SSOCT imaging. An extracted human tooth with calculus was covered by gingiva tissue as in vitro sample for SSOCT imaging.

A knowledge of fluoride uptake and distribution in tooth deposits and underlying tooth surfaces could provide useful information about availability and action of fluoride in the oral environment and oral fluids. Fluoride concentration and distribution were therefore measured in supra- and subgingival calculus and at the underlying enamel or cementum surfaces using a mechanical sampling technique and a fluoride electrode (Weatherell et al., 1985).In this study, twenty extracted teeth with supragingival calculus and twenty teeth with subgingival calculus removed from subjects aged 44 to 67 years old were used. Phosphorus distributions were also determined using a x-ray microanalyser.The results were as follows;1) Fluoride concenerations were highest at the surface of dental calculus. There was a lower level plateau for the interior, which rose again as the tooth surface was approached.2) Supragingival calculus tended to show a smoother profile compared with that of subgingival calculus.

Periodontal disease is one of the main chronic infectious diseases of oral cavity and the principal cause of tooth loss in humans. The main cause of periodontal disease is the bacteria in calculus or plaque to cause the gum inflamed. Therefore detection and removal of subgingival calculus remains important to all periodontal therapy. However, subgingival calculus within the periodontal pocket remains a complicated and potentially delicate structure to be detected and treated with current dental armamentaria, namely dental x-rays and the dental probe. In this study, an innovative subgingival calculus detection system employing autofluorescence imaging has been developed. Feasibility of such a system on the detection of subgingival calculus is investigated in vitro. Autofluorescence imaging is based on two-photon time correlated fluorescence technique by a femtosecond pulsed Ti-sapphire laser.

This study compared the relative amounts of Actinobacillus actinomycetemcomitans (Aa), Eikenella corrodens (Ec), and black-pigmented anaerobic rods, and the proportions of coccoid forms, nonmotile rods, motile rods, spirochetes, and total motile organisms in subgingival plaque samples from 2 groups of young adults with generalized moderate to severe periodontitis. Two groups of 12 untreated patients were selected based on the relative amounts of subgingival calculus detected. Subgingival plaque samples (2 sites/patient) were taken with a sterile curet, dispersed, and plated under anaerobic conditions on ETSA, ETSA-kanamycin, ETSA-clindamycin, and TSBV agar. Appropriate biochemical tests were performed to confirm suspected microorganisms. Phase-contrast microscopy also was used to count the relative numbers of coccoid forms, nonmotile rods, motile rods, and spirochetes in each of the samples. Patients with no clinically detectable subgingival calculus harbored significantly greater proportions (%) of coccoid forms and Aa and greater amounts (CFU/mg) of Aa than did patients with obvious amounts of subgingival calculus. Subjects with clearly detectable subgingival calculus possessed greater proportions of motile rods, total motile organisms, and black-pigmented anaerobic rods than did subjects with little or no subgingival calculus. Young adult patients with generalized moderate to severe disease and little or no detectable subgingival calculus may possess a subgingival microbiota with relatively higher numbers of Aa and coccoid forms, and a lower percentage of BPB, motile rods, and total motile organisms as compared to similar patients with greater amounts of subgingival calculus.

This study evaluated the ability of clinicians to detect residual calculus following subgingival scaling and root planing and compared the clinical detection to the microscopic presence and surface area occupied by calculus found on teeth extracted after instrumentation. Interexaminer and intraexaminer reproducibility in clinically detecting subgingival calculus was also determined. One hundred one extracted teeth with 476 instrumented tooth surfaces were evaluated stereomicroscopically for the presence of calculus and the percent surface area with calculus was determined by computerized imaging analysis; 57% of all surfaces had residual microscopic calculus and the mean percent calculus per surface area was 3.1% (0 to 31.9%). Shallow sites had greater surface area of calculus than moderate and deep sites. The difference was not significant. The interexaminer and intraexaminer clinical agreement in detecting calculus was low. There was a high false negative response (77.4% of the surfaces with microscopic...

The dental endoscope was developed to facilitate visualization of the subgingival environment as an aid in diagnosis and non-surgical root debridement. The purpose of this study was to determine whether endoscopy-aided scaling and root planing (SRP) resulted in a greater reduction of residual calculus compared to SRP alone in multirooted teeth.Twenty-four patients were enrolled and contributed 35 tooth pairs (70 teeth in total). Each tooth per pair was randomly assigned to receive endoscopy-aided SRP (test) or SRP alone (control). Both teeth were extracted immediately after treatment, washed with water, and stained with methylene blue. The percentage of residual calculus was determined via stereomicroscopy and digital image software by a single masked examiner.Overall, there was 1.16% (P = 0.097) less residual calculus at test versus control sites. At interproximal surfaces, test roots had 2.63% less residual calculus than control roots (P = 0.003), whereas test roots had slightly more residual calculus than controls at buccal/lingual surfaces (0.36%; P = 0.652). There were no statistically significant differences in residual calculus between groups at deeper probing depths or at sites with deep furcation invasions. Only at shallower interproximal sites with probing depthsor =6 mm was significantly less residual calculus seen in roots treated with endoscopy (P = 0.020). Treatment time decreased significantly as operator experience increased; however, no significant improvement in residual calculus levels was noted with greater experience.Within the confines of this study, the use of the endoscope as an adjunct to traditional SRP provided no significant improvement in calculus removal in multirooted molar teeth.

The purpose of this study was to evaluate the effectiveness of subgingival application of Carisolv™ gel as an adjunctive therapy to scaling and root planing (SRP) on calculus removal compared to conventional instrumentation. Forty-five teeth requiring extraction due to severe periodontal disease were randomized to the following treatments: 1) SRP alone; 2) placebo gel + SRP; 3) Carisolv™ gel + SRP. Either test or placebo gel was applied subgingivally for 1 min and then the root were instrumented until a smooth and calculus-free surface was achieved. Instrumentation time and the number of strokes required were recorded. After extraction, the efficacy of root surface instrumentation was measured by percentage of remaining calculus. There was no statistically significant difference (p>0.05) between the treatment groups regarding either time required for instrumentation or the percentage of residual calculus. The subgingival application of Carisolv™ gel prior to SRP did not provide any additional benefit to root instrumentation compared to scaling and root planing alone. O objetivo deste estudo foi avaliar a efetividade da aplicação subgengival do gel Carisolv™ em associação aos procedimentos de raspagem e alisamento radicular (RAR) na remoção do cálculo dental aderido à superfície radicular, quando comparado à terapia periodontal mecânica convencional. Foram utilizados 45 dentes indicados para a exodontia devido à doença periodontal avançada, os quais foram divididos em três grupos de tratamento: 1) RAR apenas; 2) placebo + RAR; 3) Carisolv™ + RAR. O tempo despendido e o número de movimentos realizados para a instrumentação das superfícies radiculares foram avaliados durante o tratamento. Em seguida, os dentes foram extraídos e avaliados quanto ao percentual de cálculo residual, por meio de um sistema computadorizado de análise de imagens. Não houve diferença estatisticamente significante (p>0,05) entre os grupos com relação ao tempo requerido para os diferentes tratamentos, assim como quanto ao percentual de cálculo residual. Os resultados indicaram que a aplicação do Carisolv™ não promoveu benefícios adicionais àqueles obtidos com a terapia mecânica convencional na remoção do cálculo subgengival.

Objective: A radiographic investigation into the relationship between tobacco smoking and subgingival dental calculus was conducted in an adult population, including 48 current smokers, 57 former smokers, and 125 non-smokers. Material and Methods: Assessment of subgingival calculus was based on a full set of radiographs. Mesial and distal root surfaces were assessed as to presence or absence of radiopaque deposits apical to the cemento-enamel junction. The severity of subgingival calculus deposition, labeled subgingival calculus load, was estimated from both the total number and the proportion of proximal sites affected. Results: The overall prevalence of individuals exhibiting at least one subgingival calculus positive site was 43%, ranging from 15% in age stratum 20–34 years to 72% in age stratum 50–69 years. The prevalence among current smokers, former smokers, and non-smokers was 71%, 53%, and 28%, respectively. The differences between smoking groups were statistically significant (p

The aim of the present study was to compare the ability of the diode laser to detect residual calculus with that of an explorer.The root surface of 40 extracted human teeth, each partially covered with subgingival calculus, was instrumented with curets under simulated clinical conditions in a manikin. The samples were randomly assigned to two study groups. In group A, the root surface was treated with an explorer until it appeared free of mineralized deposits upon examination. The samples in group B were instrumented until the relative intensity of fluorescence as induced with diode laser radiation was below a threshold value of 5. The root surface of each sample was then examined for residual calculus using standardized digital images. The statistical analysis was performed with a non-paired t test at a level of significance of 5% (P0.05).The root surface of single-rooted teeth showed residual calculus on 0.19 +/- 0.37 x 10(7) microm2 in the laser group and on 0.11 +/- 0.26 x 10(7) microm2 in the explorer group (P = 0.19). For multirooted teeth, the mean calculus-covered area was 0.50 +/- 0.48 x 10(7) microm2 for the teeth evaluated with an explorer and 0.27 +/- 0.43 x 10(7) microm2 for the diode laser group (P = 0.02).The present findings indicate that the detection of subgingival calculus is significantly improved using 655 nm diode laser radiation compared to an explorer for molars but not for single-rooted teeth.

Objective: To critically analyse the formation, composition, ethnic variations and pathogenic potential of subgingival calculus in comparison with supragingival calculus. Data sources: Using CD-ROM and index medicus, scientific papers relating to subgingival calculus or subgingival and supragingival calculus written in the English language since 1960 were considered, with the emphasis on more recent articles. Study selection: Studies were selected for their relevance and contemporary nature re:composition and formation of dental calculus and comparisons of ethnic groups with regard to dental calculus, especially subgingival calculus. Some similar studies were not included. Data extraction: Abstracts of studies were kept brief unless particularly important to the review. Population, methodology, statistics and accurate conclusions were used as important guides to the quality and validity of studies. Data synthesis: Similarities and differences between supragingival and subgingival calculus in composition and formation were shown. Different morphological types of subgingival calculus were demonstrated. There was evidence for an association between calculus formation and ethnicity with regard to supragingival and subgingival calculus, and an association between subgingival calculus composition and ethnicity was indicated. Conclusions: An association between ethnicity and subgingival calculus formation and composition was found. Further research into the reasons for these ethnic differences in dental calculus and the role of the mineral constituents especially of subgingival calculus would be valuable.

The diagnostic evaluation of supra- and subgingival calculus has remained an important research problem for over 40 years. The measurement of calculus remains an important objective in both research and office settings. As might be expected, the most important advances in diagnostic methods for calculus assessment have been derived from cross-fertilization from other technical disciplines including engineering, optics and computer science fields. With the new methods described herein, clinicians and researchers can look forward to important advances in our understanding of the impact of supragingival and subgingival calculus on oral health status and periodontal disease progression and in the development of treatment modalities for improved calculus control, benefiting patients and clinicians alike.

The aims of the present study on 40 patients were to quantitate by the Volpe-Manhold method, the amount of supragingival (SPR) calculus, to determine qualitatively the amount of subgingival calculus (SBG), and to determine the association between supragingival and subgingival calculus on vestibular and lingual surfaces of all the teeth except third molars. Kappa values for intraexaminer reproducibility varied between 0.863 and 0.738. There was marked site-specificity of SPR calculus scores, with the highest values by far on the lingual aspects of the lower anterior teeth: central incisor, lateral incisor, and canine, respectively. Although the grades for SBG calculus were higher on the lingual surfaces than on the vestibular surfaces of 25 of the 28 teeth, there was much less site-specificity than for SPR calculus. For the teeth as a whole, there were significant associations (P0.001), as tested by chi-square or Fisher's exact test, between SPR and SBG grades on both vestibular and lingual surfaces, between SPR grades on vestibular and lingual surfaces, and between SBG grades on vestibular and lingual surfaces. However, for individual teeth, or groups of similar teeth, only a few of the above associations were statistically significant.

Several studies have found incomplete calculus removal during periodontal treatment with traditional hand curets, sonic, and ultrasonic instruments. This study evaluated the speed and effectiveness of subgingival calculus removal with new diamond-coated ultrasonic tips on single-rooted teeth. Single session subgingival scaling and root planing was performed on 80 teeth with 5 to 12 mm probing depths in 15 patients. Each patient provided groups of 4 teeth that were randomly treated with either hand curets (HAND); standard smooth ultrasonic tip (US); or fine grit (FINDIAM) or medium grit (MEDDIAM) diamond-coated ultrasonic tips. The time taken to reach the therapeutic endpoint of a clean, smooth root surface in a defined region on each tooth with each instrument by the 3 therapists with differing experience levels was recorded. The teeth were then atraumatically extracted, stored in a surfactant, photographed at 10X, and the percent of calculus present in the area of the pocket or on a comparable control surface calculated by histometric point counting. ANOVA and paired t tests showed that mean percent remaining calculus on treated versus control surfaces was HAND 4.6 +/- 5.3 versus 57.5 +/- 28.2, US 4.7 +/- 6.4 versus 54.4 +/- 25.9, FINDIAM 4.3 +/- 5.2 versus 37.5 +/- 22.1, and MEDDIAM 3.4 +/- 4.2 versus 50.7 +/- 20.1, respectively (all P < 0.01). The mean time in seconds to reach the clinical endpoint ranged from HAND 289 +/- 193, US 194 +/- 67, FINDIAM 167 +/- 71, to MEDDIAM 147 +/- 92. All powered instruments were significantly faster than HAND (P < 0.05), but did not differ from each other. On a 0 = "smooth" to 3 = "rough" scale, most often HAND resulted in "smooth" surfaces (10/20), the powered tips of all types "slight" surface roughness (10/20 each), and US the most "moderate" roughness (7/20). There were no differences in percent calculus remaining, surface roughness, or time spent among the 3 treating clinicians despite their varying experience levels. The results of this study showed that percent calculus remaining was

The aims of this study were twofold: firstly, to evaluate the relationship of supra- or subgingival calculus and bleeding on probing (BOP) in sextants coded 2 in the Community Periodontal Index of Treatment Needs (CPITN); and secondly, to compare the differences in four investigations in Taiwan, Hong Kong, Japan and Norway. In a national survey, a total of 2658 Chinese dentate adults were examined by using modified CPITN in the Taiwan area from 1985 to 1987. Sextants given Code 2 were divided into four subclassifications: supragingival calculus with bleeding (I+), supragingival calculus without bleeding (I-), subgingival calculus with bleeding (II+) and subgingival calculus without bleeding (II-). The results showed that of the 9394 sextants given Code 2, the highest percentage (70%) were characterized by the presence of subgingival calculus with bleeding and the lowest percentage (4%) by supragingival calculus with bleeding. The ratio of sextants coded 2 with only supragingival calculus versus subgingival was 1:6.2. The bleeding to nonbleeding ratio of sextants coded 2 in this study was similar to the Hong Kong study. However, differences among Taiwan, Japan and Norway were found. The results indicated that sextants with subgingival calculus had a higher tendency to BOP, with a ratio of 4:1. Those with supragingival calculus had a ratio of 3:7. We conclude therefore, that it is essential to scale teeth to remove subgingival calculus for determination of the necessity of periodontal treatment.

Aim: The aim of this study was (1) To investigate the viability of bacteria within supragingival and subgingival calculus, (2) To examine motility of bacteria, and (3) To identify bacterial morphotypes in calculus. Materials and Methods: Supra and subgingival calculus were harvested from 30 subjects having clinical evidence of chronic inflammatory periodontal disease and were divided into two groups . Samples from both groups were immediately transported to the Department of Microbiology for gram staining, acridine orange staining, bacterial culture and to the Department of Oral Pathology for dark field microscopy. Results: Gram staining revealed presence of bacteria within the samples. Dark field microscopic examination revealed presence of filamentous organisms, spirochetes, and motile short bacilli. Acridine orange fluorescent stain showed that the viable bacteria appeared apple green. Bacterial culture revealed presence of a variety of aerobic organisms. Conclusion: From the results, it appeared that viable bacteria were present within calculus especially within internal channels and lacunae.

This 5-year longitudinal study monitored 167 subjects at ages 14.3, 16.0 and 19.6 years. The aims were (1) to determine loss of attachment greater than or equal to 1 mm in the study group over the 5-year period; (2) to relate baseline levels of oral deposits and gingivitis to the 5-year increment of loss of attachment; (3) to determine whether subjects who had developed loss of attachment greater than or equal to 1 mm by age 16 years were more susceptible to further development of loss of attachment; (4) to evaluate loss of attachment indices. Loss of attachment, plaque, subgingival calculus, gingival bleeding and gingival colour change were measured. At baseline, 3% of subjects had loss of attachment greater than or equal to 1 mm and less than 1% of sites were involved. By age 19 years, 77% had loss of attachment greater than or equal to 1 mm, and 31% of sites were affected. There was a significant correlation between the presence of subgingival calculus at baseline and the 5-year increment of loss of attachment (Pearson's r = 0.26 p less than 0.001). Subjects who had developed loss of attachment by age 16 years still had significantly more sites affected at the more severe 2 mm level 3 years later than their peers (p less than 0.05). The results suggest that a flexible approach is needed in selecting indices of loss of attachment for epidemiological investigations.

This study evaluated clinically the effectiveness of hand versus sonic subgingival scaling and root planing in the removal of calculus by visually examining the root surface at the time of periodontal flap surgery. Consideration was given to the method of instrumentation, probing depth, number of roots, and type of tooth surface. Eleven patients with moderate to advanced periodontal disease were evaluated. Four subjects were scaled and root planed with the Titan-S only, four with curettes only, and three with the Titan-S + curettes. At reevaluation 3 to 6 weeks after scaling and root planing, the decision to perform periodontal flap surgery was made based upon probing depth, bleeding upon probing, previous access to the root surface, furcation involvement, and the patient's level of oral hygiene. A full thickness mucoperiosteal flap was elevated to gain access to the root surface and measure the distance from the cementoenamel junction to the residual calculus. A total of 690 surfaces were evaluated surgically. The percentage of surfaces with residual calculus for each method of instrumentation was: Titan-S only (31.9%), curettes only (26.8%), and Titan-S + curettes (16.9%). Overall, 15.7% of the surfaces probing 0 to 3 mm, 29.3% of the surfaces probing 4 to 5 mm, and 44.4% of the surfaces probing 6 to 12 mm had residual calculus.(ABSTRACT TRUNCATED AT 250 WORDS)

The mid and far FTIR spectra of supragingival and subgingival calculus were measured, respectively. From the subtraction spectra of the two types of calculus, the protein components of calculus have been obtained. The results of photoacoustic spectroscopy indicated the presence of protein layer on the surface of early calculus.

The Cu concentration as well as the Ca, Mg, Fe, Pb, Zn, and F concentrations were determined in subgingival calculus and the relation of Cu to Zn, Ca, Mg and Fe described. Samples of human subgingival calculus of 60 pieces from 60 subjects were ashed in an acid solution and the cation concentrations were determined with atomic absorption spectrophotometry. The F content was analyzed with an ion-selective electrode. The data was analyzed using the multiple linear regression analysis. The mean +/-SD of the Cu concentration in the subgingival calculus was 48.4+/-59.0 micrograms/g. Four elements, Zn, Ca, Fe and Mg, explained 41.1% of the Cu content. Zn explained 25.5% and the correlation was positive, whereas Ca (10.4%) had a negative correlation with the Cu content. The results showed such a high Cu content that it could affect the mineralization of calculus.

The aim of this study was to consider the validity of measurements of loss of attachment on buccal surfaces in studies of early periodontitis and in particular to monitor the development of loss of attachment greater than or equal to 1 mm on buccal surfaces over a 2-year study period in 229 subjects initially aged 14.3 years and to relate this loss of attachment to gingival status and oral cleanliness at baseline. 3 subgroups were considered: the first comprised 83 subjects who developed no loss of attachment over the 2-year study period; subgroup 2 comprised 56 subjects who developed loss of attachment greater than or equal to 1 mm on buccal surfaces only; subgroup 3 comprised 75 subjects who developed loss of attachment greater than or equal to 1 mm on at least 1 buccal surface and on at least 1 mesio-buccal surface over the study period. The mean number of buccal sites with plaque, subgingival calculus, gingival colour change and gingival bleeding at baseline was lower in subgroup 2 than subgroup 3, the differences being significant for the latter three variables. The data failed to reject the null hypothesis of no differences between subgroups 2 and 1. It was concluded that the buccal loss of attachment greater than or equal to 1 mm found in subgroup 2 at age 16 years was associated with few oral deposits and little gingival inflammation and could probably be related to toothbrushing practices.(ABSTRACT TRUNCATED AT 250 WORDS)

Significant positive correlations between protease activities in saliva and supragingival/subgingival calculus indices, periodontal pocket depth, or P-M-A index were confirmed. When the partial correlation was calculated, the subgingival calculus index correlated well with the sediment protease at pH 8.5, and the supragingival calculus index showed a significant correlation with the supernate protease at pH 4.5.

The concentrations of Ca, Mg, Mn, Sr and Zn in supra- and subgingival calculus collected from mandibular anterior teeth mainly of the same persons were analyzed with atomic absorption spectrophotometry. The results showed highly significantly (P less than 0.001) greater Zn and Sr concentrations in subgingival samples. The mean value of Zn was 5.4 times higher in subgingival calculus than in supragingival calculus. In contrast, the concentration of Mn was significantly (P less than 0.01) higher in supragingival calculus. The difference in the concentration of Mg in supra- and subgingival calculus was highly significant (P less than 0.001) only when samples from the same person were compared. The concentration of Ca was very similar in both types of calculus and individual variations were very small.

Ten teeth of betel chewing P'wo Karen, a hilltribe group of northern Thailand, were available for this morphologic study. The structural composition of the black layer on these teeth was studied by light microscopy, microradiography and by electronmicroscopy. Principally, the black layer on the teeth of betel chewers was identical with subgingival calculus which had been colored by specific polyphenols contained in the betel nut. However, a pellicle-like layer forming initially on enamel crystals was also observed. From the morphologic aspect of the black layer a specific anticariogenic property cannot be attested. Further studies on the chemical composition of this black layer may elucidate its probable anticariogenic and its carcinogenic properties relative to oral submucous fibrosis.

THE ULTRASTRUCTURE of nondecalcified supragingival and subgingival calculus was studied in mature deposits. To facilitate sectioning of the embedded material, a thin reinforcing film of plastic was painted on the block. A new film was applied for each section. Light microscopy showed that supragingival calculus was heterogeneous with islets of calcified material within the covering plaque and with noncalcified areas within the calculus. Under transmission electron microscopy supragingival calculus was heterogeneous, dominated by microorganisms, small needle-shaped crystals and large ribbon-like crystals. In the covering soft plaque small crystals were often scattered in the intermicrobial matrix. In the supragingival calculus itself noncalcified microorganisms were surrounded with densely packed small crystals. There were also rosettes and bundles of large crystals. Subgingival calculus was homogeneous in light microscopy. The covering plaque contained no calcified material and only calcified material was seen within the calculus itself. Transmission electron microscopy of subgingival calculus revealed crystals of small size only. Subgingivally very few noncalcified microorganisms were seen within the calculus. The bacterial cell wall seemed to be the structure that was last calcified, both supragingivally and subgingivally.

A survey of the oral conditions of 1347 Navajo Indian children between the age of 3 and 20 years was conducted. The data recorded were, the gingival condition about each tooth, deposits, abrasion and dental caries. The prevalence, severity and incidence rate of gingivitis were found to be remarkably similar to that of a group of Alabama school children. The main differences were a high incidence of subgingival calculus at an early age, a high incidence of abrasion, a different intra-oral pattern of gingival disease and a low caries rate. The diet was studied of the Navajo Indians residing in the remote areas which were visited during a family to family survey. The mode of life, general health, climatic conditions are discussed with possible reference to the oral health findings.