Calculus formation happens in a sequence of three steps including pellicle formation, biofilm formation, and mineralization. The first step in calculus formation is the development of a pellicle. A pellicle is an organic substance made of mucoproteins that quickly forms within minutes of being detached from the tooth surface. The next step is biofilm maturation where the biofilm forms in layers. Microorganisms grow and colonize on the growing pellicle. There are many morphologic forms of bacteria in the biofilm, but in the first few days Gram-positive cocci and rods dominate. The length of time that the biofilm is composed primarily of cocci differs depending on if the patient is a slow biofilm former or a fast biofilm former. Slow biofilm formers make biofilm with predominantly cocci in it longer than fast biofilm …show more content…
After roughly 4 to 7 days there are many filamentous organisms present and an increase in the amount of Gram-negative spirochetes and vibrios. Once the biofilm has been developing for approximately 7 to 21 days, there is an increase in the prevalence of spirochetes and vibrios as well as many anaerobic organisms. The microorganisms form a cohesive layer in a palisade arrangement on the tooth surface. The last stage in calculus formation is mineralization beginning with the development of mineralization foci. This process is initiated within 24 to 72 hours in the intermicrobial matrix first, although it takes about 12 days for the primary deposits to become a mature crystalline hydroxyapatite. Like with the biofilm, depending on the patient, this process ranges from 10 days for rapid formers to 20 days for slow formers. Calculus is rough and forms in incremental lines because it grows in layers. The source of elements to make the supragingival calculus is the saliva in the mouth. Contrarily, the source of elements to make the subgingival calculus is the gingival sulcus fluid and