Hello Dr. Stegeman, I have a few patients who come every 3 months and every time they have semi-tenacious supra calculus, some with stain. They all have good homecare, brush with a power toothbrush, floss, and use rinse. As a hygienist I like to know as much as possible in the dental field to assure my patients. That being said, I'm stumped! I have no idea if it is diet, supplements, or bacteria. Please help me!!! Confused in IL, HIllary
As a fellow dental hygienist, I respect and appreciate that you are investigating other factors that may contribute to the rapid calculus formation of your patients, beyond oral hygiene instruction. A suggestion is to obtain a 24-hour food recall (ask the patient what they had to eat and drink yesterday) or for more accurate information, have the patient write down what they ate and drank for the past 3 days. One of my favorite food record forms can be found at http://www.tryon-nutrition.com/food_journal.pdf. With this information, you can analyze each meal and snack for fermentable carbohydrate intake and determine an average number of minutes of acid exposure. You may remember that there is generally 20 minutes of acid exposure for liquids and 40 minutes for solids. Two hours/day is considered high. Frequent consumption of carbohydrates can influence supragingival plaque biofilm formation. In addition, identifying foods that stick to the tooth surface also attracts and enhances plaque biofilm. Therefore, providing the patient with alternate meal or snack ideas may prove to be very helpful.
In regards to the stain, taking a liquid iron supplement or a high consumption of tea and/or coffee may contribute to the stain. Finally, there is no evidence to support the use of supplements and plaque biofilm or calculus formation. Best of luck with finding a solution, Hillary!