Prevalence of Dental calculus – comprehensive project work on dentistry
INTRODUCTION
Background of the Study
The mouth like all other surfaces in the body, is a natural community of micro organisms which exists as structurally organized multispecies, complex biofilms, it is a well known fact that calculus is not an inducing agents for pathological changes to occur in gingival tissues (Ahmed, 2017).
Dental calculus or tartar is an adherent calcified mass that forms on the different surfaces of the teeth and dental appliances (Molokhia, & Nixon, 2002). The prevalence of dental calculus at any given time, worldwide, most children and adolescent students have experienced dental calculus (Amafule, 2010).
Dental calculus is classified based on location such as supragingival and subgingival calculus; it may also be classified according to source of mineralization, according to surfaces and according to degree and extent (Aghanshini, 2016). It is composed of inorganic components such as the calcium carbonate, phosphate mixed with food debris, while the organic components are polysaccharides complexes, desquamated epithelial cells, leukocytes and various types of micro organism (Jin, & Yip, 2002).
The chief cause of dental calculus is poor oral hygiene which gives rise to gum diseases, cavities and tooth loss, although the combination of soft starchy food changes the acidity of the oral environments, absents of oral hygiene leads to the buildup of micro organisms (Weyrich, Dobney, & Cooper, 2014). A number of theories have been put forward for calculus formation which includes booster mechanism, epitactic theory, inhibiting theory, enzymatic theory (Smith, 2017).
For students, there is a notion that female students maintain a good oral hygiene than the male students, the environmental alertness for female students have been deduced by psychologists to be expressed early and greater in their behavior than the male. The male are nonchalant about how the environment reacts to his behavior, while the female students show greater concern towards their oral health (AlOmari, & Hamasha, 2005).
Dental calculus can be controlled by chemical mineralization inhibition applied on the toothpaste, use of mouth rinse. It can also be prevented by the use of dental floss, proper tooth brushing, visit to the dental clinic twice yearly and good oral hygiene (Donald, 2007).
There are some treatment modalities used in the removal of dental calculus such as the use of manual instruments, ultrasonic scalers and so on (Sanai, 2014)
Statement of the problem
A visit to Model Secondary School, Amandim Olo, shows that most of the students attending the school are in the habit of not practicing good oral hygiene, which makes dental plaque difficult to be removed and this leads to the formation of dental calculus. Some of the factors that may lead to dental calculus are associated with ignorance about the importance of good oral hygiene since they are in the rural area, lack of health facilities, inadequate dental workers to give oral hygiene instructions (White, 2007).
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Objective of the study
The general objective of the study is to determine the prevalence of dental calculus among students attending Model Secondary school, Amandim Olo, Ezeagu local Government area, Enugu state.
Research questions
 What is the prevalence of dental calculus among students attending Model Secondary School, Amandim Olo?
 What type of dental calculus is common to the students?
 What age is mostly affected with dental calculus?
 What gender is mostly affected with dental calculus?
The Specific objective of the study is to:
 Determine the prevalence of dental calculus among the students
 Determine the type of dental calculus that is common to them
 Determine the age mostly affected
 Determine the gender mostly affected
Limitations and delimitations of the study
The researcher encountered the following problems in the course of this study.
 Inadequate time due to congested academic work
 Insufficient fund for the researcher because he depends solely on his parents for financial assistance
 Delays in obtaining permission from the school
 Low level of cooperation from the students who are experiencing oral health examination for the first time
However, a letter of introduction from Head of Dental Therapy department and courtesy visit to the Principal & assistance from some of the class teachers, the co – operation of the students was gained
Significance of the study
This study will be significant as it serve to provide information on the prevalence of dental calculus among students attending Model Secondary School, Amandim Olo, Ezeagu Local Government Area, Enugu state. The information will be used to plan preventive oral health programs and awareness for schools in the rural areas, especially in Ezeagu L.G.A. of Enugu state.
It will also serve as a data base for subsequent researchers who will have interest in carrying out further studies on dental calculus.
Scope of the study
The study was limited to the students attending model secondary school, Ezaegu Local Govt. Area, Enugu state.
Statement of hypothesis
Ho: Dental calculus is not significantly prevalence among students attending Model Secondary school, Amandim Olo, Ezeagu L.G.A.
Ha: Dental calculus is significantly prevalence among students attending Model Secondary school, Amandim Olo, Ezeagu L.G.A.
LITERATURE REVIEW
The literature was reviewed under the following subheadings
Concept of dental calculus
Dental calculus is a hard deposit that is formed by mineralization of dental plaque on the surfaces of the natural teeth, and dental prosthesis (Aghanashians, 2016). It is derived from the word calcislimestone, white encrustation inside a cask also known as tartar, disambiguation, calcis odontholithiasis and fossilizes plaque (White, 2007). Levels of calculus and location of formation and population specific are affected by oral hygiene habits, access to professional care, diet, age ethnic group and time since last dental scaling and polishing, systemic disease and the use of prescription medication (White, 2007).
Dental calculus is a porous substance that can absorb a variety of toxic substances and retain significant level of conditioning which itself can damage tissues and these toxin are located on the periodontal surfaces causing periodontal disease (Grit, 2009). These hard deposits may form coronal or epical to the gingival margin, hence named accordingly as supragingival and sub gingival calculus and its ability to retain bacteria antigens makes it an important contributing factor in initiating and accentuating periodontal disease progression (Mukherjee, 2000).
When dental calculus is attached on the teeth, it cannot be removed with a toothbrush, flossing or the use of mouth wash. A visit to the dental clinic is the best as there are many techniques and instruments that could be used to identify and remove calculus deposits present on the tooth surfaces.
Organic calculus matrix can possibly attach itself to the root surface of the tooth, attachment by means of a secondary cuticles, attachments into microscopic irregularities of the cemental surface of the tooth root, attachment by penetration of the micro organisms of the calculus to matrix into the cementum of the tooth surfaces and attachment into the area of the cemental resorption (Kamath, 2014).
Dental calculus plays a vital role in aggravating the periodontal disease by action as reservoir for bacterial plaque and providing the protected covered niche for bacteria to proliferate (Saini, 2014).
Classification of dental calculus
According to Aballa (2016), Dental calculus is classified into the following
According to location
 Supragingival calculus
 Sub gingival calculus
According to degree
 Slight calculus
 Moderate calculus
 Heavy calculus
According to extent
 Localized calculus
 Generalized calculus
Based upon the location of dental calculus in relation to marginal gingival, it is classified into mainly two types (Dawes, 2006).
 Supra gingival calculus
 Sub gingival calculus
Supra gingival calculus
It is a light adherent calcified deposit that forms on the clinical crown of the teeth above the free gingival margin (White, 2007).
Supra gingival calculus is located coronal to the gingival margin and therefore its visible in the oral cavity, it is usually white or whitish yellow in color, hard with clay like consistency and easily detached from the tooth surface (Saini, 2014).
The two most common location for supra gingival calculus to develop are; the buccal surfaces of the maxillary molars and the lingual surfaces of the mandibular anterior teeth.
Other names for supra gingival calculus are;
Extra gingival calculus
Colonal gingival calculus (Willkins, 1989).
Supra gingival calculus is composed of more brushite and octa–calcium phosphate with less magnesium white lockite, it can be found in area of the mouth where there is poor oral hygiene or associated contributing factors such as kidney dialysis or genetic predisposition (Mukherjee, 2000).
Supragingival calculus examination
 Direct examination: May be seen directly or indirectly using mouth mirror
 Use of compressed Air: Small amount of calculus that have not been stained are frequently invisible when they are wet with saliva, with combinations of retraction light and dying with air, small deposits usually can be seen, an explorer may be used when visual examination is not definite (Corbert, 2012).
Sub gingival calculus
Sub gingival calculus is a calcified deposit that is formed on the root surfaces below the free marginal gingival and it is located on the anatomical crown epical to the margin of the gingival and extending to the clinical attachment on the root surfaces (Aballa, 2016).
It is usually dense, dark brown or greenish black and has a hard or a flint like consistency which is firmly attached to the tooth surface. Sub gingival calculus in “low hygiene” population is extensive and is directly correlate with enhanced periodontal attachment loss, it may expand to the radius of plaque induced periodontal injury and removal of sub gingival calculus, remains the corner stone of periodontal therapy (Jan, 2009).
Other names for sub gingival calculus are; sub marginal calculus, serumal calculus (Wilkins, 1997).
Sub gingival calculus examination
According to Masud (2014), sub gingival calculus can be observed and detached using the following;
 Visual examination: Dark edge of calculus may be seen just beneath the gingival margin
 Use of transillumination: subgingival calculus will show as dark opaque shadow like substances on the proximal surface of a tooth.
 Gingival tissue colour change: sub gingival calculus can reflect as dark area through a thin margin on the gingival
 Use of probe: in the sulcus pocket, the probe will give a rough sub gingival tooth surface which can be felt when there is a calculus
 Explorer: sub gingival explorers can be used , which must be properly adapted close to the root surfaces down to the pocket
 With Radiograph: thick highly mineralized calculus can be detected on the proximal surfaces using the radiographs
Differences between supra gingival calculus and sub gingival calculus
Features  Supra gingival calculus  Sub gingival calculus 
Definition  Defined as tightly adhering calculus deposits that forms on the crown of the teeth, coronal to the gingival margins  Calcified deposits that forms on the tooth surfaces below the free margin of gingivae 
Location  Forms coronal to the gingival margins  Deposits present apical to the crest of marginal gingivae 
Source  Delivered from the salivary secretion, thus salivary calculus  Derived from gingival exudates – seruminal calculus 
Distribution  Symmetrical arrangement on the tooth, more on facial surfaces of maxillary molar and lingual surfaces of mandibular anterior teeth  Related to pocket depth, heavier on proximal surfaces 
Colour  It is white, yellow in colour  Brown /greenish black in colour 
Consistency  Hard and clay like  Hard and firm/flint or glass like 
Composition  More brushite and octacalcium phosphate, less magnesium whitelockite  Less brushite and octa calcium phosphate. More magnesium whitelockite 
Visibility  Clinically visible  Not visible on routine clinical examination 
Attachment  Easily detached from the tooth  Firmly attached to the tooth surface 
Other contents  sodium content is less
salivary protein is present 
Sodium content increases with the depth of the pocket. Salivary proteins are absent 
(Sahithya, 2010).
Composition of dental calculus
Dental calculus consist of both organic and inorganic contents
Inorganic contents (70%90%)
Principle elements:
 Calcium – 39%
 Phosphorous – 19%
 Carbon dioxide – 1.9%
 Magnesium 0.8%
 Trace amounts of Na, Ba, Zn, Str, Br, Cu, Ag, Al, Fe, Fi.
Components:
 Calcium phosphate – 75.9%
 Calcium carbonate – 3.1%
 Magnesium phosphate – traces and other forms
Crystal forms:
 Hydroxyapitite (HA) – 58%
 Octa calcium phosphate (OCP) – 21%
 Magnesium white lockite (MWL) – 12%
 Brushite (BS) – 9%
Theories of dental calculus formation
Many theories where proposed to the better understand the mechanism of calculus formation. They are as follows
 Booster mechanism
 Epitactic concept
 Inhibition theory
 Transformation theory
 Bacterial theory
 Enzymatic theory
Booster mechanism theory
Major salivary ducts secretes saliva at a high Carbon (ii) oxide (co2) tension, about 54 to 65mmHg; but the pressure of co2 in atmospheric air is only about 0.3mmHg, as a result of large disparity in co2 tension, saliva emerging from the salivary duct loses co2 to the atmosphere. PH in saliva increases will increase when co2 escapes since PH in saliva depends largely on the ratio between bicarbonates and free carbonic acid. Phosphoric acid dissociation increases increases with rise in alkalinity, thus increasing the concentration of less soluble secondary and tertiary phosphate ions. This boost in phosphate ions concentration leads to a situation where solubility product of calcium phosphate is exceeded and crystals form (Russell & Fleisch 1970).
Epitactic theory
In saliva, the concentration of certain ions like calcium and phosphate is not high enough to precipitate but is ample enough to promote the the growth of hydroxyapatite crystals once an initial seed or nucleus is formed.
The term epitactic refers to crystals formation through seeding by another compound which is similar to hydroxyapatitic crystals leading to precipitation of calcium salts from the metastable solution of saliva. Seeding agents provoke small foci calcificationen large and coalesce to form the calcified mass. Intercellular matrix or plague plays an important role. Calcification will be initiated by a chelation/protein complex which removes calcium from saliva by chelation process and binds with the nuclei that stimulates subsequent deposition of minerals (Russell & Fleisch 1970).
Inhibition theory
This theory assumes about calcification as occurring only at specific sites because of existence of an inhibiting mechanism at non calcifying sites. According to this theory, the sites where calcifications occurs, the inhibition is apparently altered or removed. Pyrophosphate is thought to be one possible inhibiting substance and other possible inhibiting substances including polyphosphates. Alkaline pyrophosphate is the enzyme involved in controlling mechanism which hydrolyzes the pyrophosphate to phosphate and this pyrophosphate prevents the initial nucleus from growing and inhibits their calcification possibly by poisoning the growth centers of the crystals (Russell & Fleisch 1970).
Transformation theory
Most noticeable hypothesis states that hydroxyapatite need not arrive exclusively via epitaxis or nucleation. Octacalcium phosphate is formed by the transformation of amorphous noncrystaline deposits and brushite and then transformed to hydroxyapatite (Fleisch, 1968).
Bacteriological theory
According to this theory, the primary cause of calculus formation is oral micro organisms and their involvement in attachment to the tooth surface. Leptotrochia and actinomyces has been considered most often as the causative micro organisms.
Enzymatic theory
According to the theory, calculus formation is the resultant of the action of phosphatasses derived from either oral tissues or oral micro organism on some salivary phosphate containing complex, most probably phosphoric esters of the hexophosphoric group (Sahithya, 2000)
Stages of dental calculus formation
According to Itodo (2016), dental calculus results from the deposition of minerals into a plaque organic matrix. Dental calculus formation occurs in these basic steps.
Organic matrix: mineralization first occurs within the intermicrobial matrix. The filamentous micro organism provides the matrix for the deposition of minerals. A calculus like deposit has been observed on the teeth of germ free animals that have no bacterial plague. It may indicate that other organic substances such as the pellicle may mineralize.
Pellicle formation: the pellicle is composed of micro proteins from the saliva, its thickness and contour varies on the tooth surface. It begins to form within minutes after all deposits have been removed from tooth surface.
Plaque maturation: microorganisms settle in the pellicle layers colonies are formed. Originally, the colonies consist primarily of cocci and rod shaped organisms. By the fifth day, the plague is mostly made up of filamentous organisms. The colonies grows together to form plague layer.
Mineralization: mineralization foci center forms within 24 hours, more mineralization center grow large enough to touch and unite.
Sources of minerals: the source of element for supra gingival calculus is the saliva, while gingival sulcus fluid and the inflammatory exude supply the minerals for sub gingival deposits. Because the amount of sulcus fluid and exudates increases with increase in inflammation, more minerals are available for mineralization of sub gingival plague.
Crystal formation: mineralization consists of crystal formation namely hydroxyapatite, octacalcium phosphate, white lockite and brushite. The crystals form in the intercellular matrix and on the surface of bacteria and finally within the bacteria.
Mechanisms of mineralization: the mineralization process is considered the same for both supra and subgingival calculus. The process of which mineral, mainly calcium and phosphate becomes incorporated from the saliva or gingival sulcus fluid into the plague matrix is still not completely understood.
Epidemiology of Dental calculus
Geol et al, (2000) conducted a study on the calculus prevalence among children of two age groups, at putur municipality, an area located in Karnataka state, India. The two age groups are 56 and 1213 years old of school children. A sample size of 200 subjects was taken from each group and chister sampling method was used to select those which were to be included in the data frame. Data collection was done using the basic oral health survey (WHO) from the deciduous dentition alone was considered for those aged 1213 years. A total 427 subjects from 7 schools were studied; results indicated that none of the 5years old subjects had calculus on the teeth while 4778% of 1213 years old subjects exhibited the presence of dental calculus.
Prevalence of dental calculus was significantly higher among 1213 years old subjects compared to the 56years subjects; however, this finding is in agreement with the observation of Soumi, who reported that occurrence of dental calculus increases with age from infancy to teenage. Although 1213years old female subjects exhibited lower prevalence of calculus as compared to their male, and this difference was not statistically significant (Suomi, 2002).
A cross sectional study was carried out in Nigeria: Ileife (urban) and Ashipa (rural) located in the SouthWest of Nigeria. The number of subject was 205(age 8 10 12) in Ileife and 51(age 8 10 12 1575) in Ashipa. The purpose of this study was to clarify the distribution of calculus score (ClS, OHIs) among the Nigerians by age and it was observed that CIS was higher in rural area. This evidence is expected as a consequence of using traditional twig (Pako or chewing stick) for tooth brushing because 73.1% of the urban children were using toothbrush, the changing pattern of CIS of the rural people was of high level in the children of 812 years of age & decreased to the bottom level in 20s after the lower score.
According to Itodo (2016), the result of clinical examination of students attending HIS Grace High school, Awkunano, using calculus index indicated that 120(66.67%) had no traces of calculus as they fell within “0” index and 60(33.33%) had traces of supra gingival calculus (mild) as they fell within “1” index. This result shows that calculus was not prevalent among the students. This is agreement with Ezeobi (2015) who reported that dental calculus was not prevalent among students of girl’s high secondary school Uwani, Enugu.
According to Ibekwe (2016), the result of clinical examination of students attending Trans Ekulu girl’s secondary school Enugu, using calculus index indicated that 60(33.33%) had traces of supra gingival calculus (mild) as they fell within “1” index, their group index was 0.5. Females take care of their oral cavity more.
Calculus index (CIS)
Calculus index is one of the most common methods for accessing dental calculus prevalence as well as oral cleanliness by estimating the tooth surface covered with debris (Ibekwe 2016)
The procedures for calculus index are
 Purpose – To measure existing calculus as an indication of oral cleanliness.
 Selection of teeth and surfaces.
 Divide the dentition into sextants, posterior sextants being distal to the canine
 Score only the fully erupted permanent teeth, a tooth is considered fully erupted when it has reached the occlusal plane.
 Exclude third, teeth with full crown restoration and tooth reduced in height because of severe dental caries trauma.
 Select the tooth surfaces, labial, lingual or palatal, buccal and occlusal surfaces in each sextant that is covered with the greatest amount of calculus
 Include half the circumference of the selected tooth.
 Procedures
 Evaluation: evaluate each sextants to record the calculus
 Sequence: proceed in routine order from maxillary right anterior and left sextants to the mandibular left anterior and right sextants
 Record the calculus score
Examination
Use an explorer to supplement visual examination for supra gingival calculus deposits identify sub gingival deposits by exploring and probing. Record only definite deposits of hard calculus
Criteria
0 = no calculus
1 = supra gingival calculus covering more than one third of the exposed tooth surface being examined
2 = supra gingival calculus covering more than one third but not more than two third of the exposed tooth surfaces or the presence of individual fleeks of sub gingival calculus round the cervical portion of the tooth.
3 = supra gingival portion of the tooth. Twothird of the exposed tooth surface, or a continuous heavy bind of sub gingival calculus around the cervical portion of the tooth.
Scoring
Calculus for an individual
 Determine the calculus index (CI)
 Divide total score by number of sextants
 Each selected surface has a severity score of 0 to 5
 The total score of calculus ranges from 0 to 36 (12 scores multiplied by maximum severity of 3)
Calculus index (CI) ranges from 06
Rating  Scores 
Excellent  0 
Good  0.1 – 1.2 
Fair  1.3 – 3.0 
Poor  3.1 – 6.0 
A suggested nominal scale for calculus index (CI) is equal to the total CI score divided by number of sextants
CI = Total calculus score
Number of sextant
RESEARCH METHODOLOGY
The method that was used in this study was discussed under the following subheadings;
Research design
The research design for the study was a cross sectional survey of the students attending Model Secondary school, Amandim Olo, Ezeagu L.G.A, Enugu state.
Description of the study area
The study area was carried out at Model Secondary school, Amandim Olo, Ezeagu LGA, Enugu state. The school was established in 1990 with 18 students, it is a government school. The name of the principle of the school is Mr Okafor Micheal, The school has 5 blocks, 1 is the library, 2 blocks are dilapidated class rooms, and 2 others are class rooms and also contain the office of the principle and other teachers. The school is located opposite the palace of the king of the community of Amandim Olo. The school has a total number of 280 students, it also have a total number of 17 teachers and 2 security men. (Source: Mr Okafor Micheal, Principal, personal communication)
Population of the study
The total number of students attending Model Secondary School, Amandim Olo is 280 students, 17 teachers and 2 security men. (Source: Mr Okafor Micheal, Principal, personal communication)
Sample size and sample techniques
A sample size of 180 students attending Model Secondary School, Amandim Olo was used for the study. Proportional stratified sampling technique was used to divide the classes into strata of JSS1 to SS3. Then simple random sampling technique was used to select 30 students from each class.
Instruments for data collection
Data was collected using clinical examination to check their oral cavity; their oral cavity was examined using mouth mirror, calculus probe, and college tweezers. Chemical sterilization was done using hypo and methylated spirit. Findings was recorded on a data sheet specifically designed for this purpose
Validity and Reliability of Instruments used
To ensure validity and reliability of instruments, it was subjected to the close supervision of the supervisor who made it compulsory that a pilot test is carried out on 10 students in order to get acquainted with the procedures involved in calculus index.
Method of data collection
An introductory letter was obtained from the H.O.D, Dental therapy department, FCDT&T, Enugu and was presented to the principal for easy access and cooperation of the students and teachers.
The students were assembled in the school hall where the selection and data collection was carried out, with the help of 2 final year Dental therapy students.
The selected students were examined using the examination instruments including mouth mirror, calculus probe, and college tweezers. Calculus detected on the teeth surfaces were recorded according to the calculus index on the data sheet, each tooth were specifically represented and its data recorded, age of students, class of the students and gender of the students were also recorded specifically on the data sheet.
Method of data analysis
Data collected was grouped according to class, age, gender of the students. They were analyzed using simple frequency table. Data was presented in figures and easy forms for easy understanding.
Test of hypothesis
Hypothesis was tested using dental calculus index (CI) which was used to determine the prevalence of dental calculus among the students. Dental calculus index is mathematically represented as follows;
Calculus index = Total score of calculus
Number of sextants
Interpretations are presented below.
Note: the calculus index does not give room for approximation as such,
0 – 0.4 falls under 0
0.5 – 1.4 falls under 1
1.5 – 2.4 falls under 2
2.5 – 3 falls under 3
Data analysis and presentation
The data collected between June to September 2018 has been subjected to different analytical procedures to enable the researcher determine the extent to which the research questions has been answered.
Table1. Classes of students
CLASS  FREQUENCY/ NO OF STUDENTS  PERCENTAGE 
JSS1  30  16.67% 
JSS2  30  16.67% 
JSS3  30  16.67% 
SS1  30  16.67% 
SS2  30  16.67% 
SS3  30  16.67% 
TOTAL  180  100% 
Table 1 above shows the classes of the students that participated in the research ranging from JSS1 to SS3, equal number of 30 (16.67%) were selected from each classes.
Table2. Age range of the students
AGE RANGE  FREQUENCY  PERCENTAGE FREQUENCY  
1012 YEARS  9  5%  
1315 YEARS  62  34.4%  
1618 YEARS  75  41.6%  
1921 YEARS  34  18.9%  
TOTAL  180  100%  
Table 2 above shows the age range of the students between 1012years is 9(5%), 1315years is 62(34.4%), 1618years is 75(41.6%) and 1921years is 34(18.9%). From the data above, the frequency of age group of 1618years proves to be the more in numbers 75(41.6%), while the age group of 1012years proves to be the lowest with 9(5%)
Table 3. Gender of the students


Table 3 above shows the gender of the students that participated in the study, in which males are 108(60%) and the females are 72(40%)
Table4. Dental calculus index
DENTAL CALCULUS INDEX  FREQUENCY  PERCENTAGE 
0  7  3.9% 
1  135  75% 
2  38  21.1% 
3  0  0 
TOTAL  180  100% 
Table 4 above shows the value of Calculus index among the student after clinical examination, 7(3.9%) falls within calculus index of “0”, 135 (75%) falls within calculus index “1” and 39(21.7%) falls within calculus index of “2”
Interpretations are presented below.
Note: the calculus index does not give room for approximation as such,
0 – 0.4 falls under 0
0.5 – 1.4 falls under 1
1.5 – 2.4 falls under 2
2.5 – 3 falls under 3
Table5. Calculus index in relation to sex
DENTAL CALCULUS INDEX  FREQUENCY  %  NO. OF FEMALES  %  NO. OF MALES  % 
0  7  3.9%  3  1.7%  4  2.2% 
1  135  75%  54  30%  81  45% 
2  38  21.1%  15  8.3%  23  12.8% 
3  0  0  0  0  0  0 
TOTAL  180  100%  72  40.0%  108  60% 
Table 5 above shows the calculus index of the students in relation to their gender. 7(3.9%) fell within calculus index “0” of which 3(1.7%) are females and 4(2.2%) are males; 135(75%) fell within the calculus index of “1” of which 54(30%) are females and 81(45%) are males; 38(21.1%) fell within the calculus index of “2” of which 15(8.3%) are females and 23(12.8%) are males. This table shows that none fell under the calculus index of “3”. Calculus is always more in males than their female counterpart.
Table6. Calculus index in relation to age
CALCULUS INDEX  FREQUENCY  %  1012  %  1315  %  1618  %  1921  % 
0  7  3.9%  1  0.5%  1  0.5%  2  1.1%  3  1.7% 
1  135  75%  7  3.8%  43  23.9%  65  36%  20  11.1% 
2  38  21.1%  1  0.5%  18  10%  8  4.4%  11  6.1% 
3  0  0  0  0  0  0  0  0  0  0 
TOTAL  180  100%  9  4.8%  62  34.4%  75  41.6%  34  18.9% 
In the table above, a total of 7(3.9%) students that were examined fell into the calculus index of “0” of which 1(0.5%) was within the age of 1012years, 1(0.5%) were within the age group of 1315years, 2(1.1%) were within the age range of 1618years, 3(1.7%) were within the age range o 1921years. 135(75%) that were examined fall into the calculus index of “1” of which 7(3.8%) were within the age range of 1012years, 43(23.9%) were within the age range of 1315years, 65(36.1%) were within the age range of 1618years, 20(11.1%) were within the age range of 1921years. 38(21.1%) that were examined fell into the calculus index of “2” of which 1(0.5%) were within the age range of 1012years, 18(10%) were within the age range of 1315years, 8(4.4%) were within the age range of 1618years, 11(6.1%) were within the age range of 1921years.
Table7. Frequency of dental calculus
DENTAL CALCULUS OCCURRENCE  FREQUENCY  %  NO. OF FEMALES  %  NO. OF MALES  % 
PRESENT  173  96.1%  69  38.3%  104  57.9% 
ABSENT  7  3.9%  3  1.6%  4  2.2% 
TOTAL  180  100%  72  39.9%  108  60.1% 
Table 3 above shows the occurrence of dental calculus among the students. Dental calculus was present in 173(96.1%) students which comprises of 69(38.3%) females and 104(57.9%) males. Dental calculus was absent among 7(3.9%) students which comprises of 3(1.6%) females and 4(2.2%) males
Table 8. Type of dental calculus common among the students
TYPE OF DENTAL CALCULUS  FREQUENCY  %  NO. OF FEMALES  %  NO. OF MALES  % 
SUB GINGIVAL CALCULUS  50  27.8%  16  9.2%  34  19.6% 
SUPRA GINGIVAL CALCULUS  122  67.8%  53  30.6%  70  40.5% 
TOTAL  173  96.1%  69  38.3%  104  57.9% 
In table 7 above, a total of 50(28.9%) students that were examined, have sub gingival calculus. 16(9.2%) were females and 34(19.6%) were male students. A total of 122(75.5%) students that were examined has supra gingival calculus in which 53(30.6%) students were females and 70(40.4%) students were males.
Result of test of hypothesis using calculus index
Ho: Dental calculus is not significantly prevalence among students attending Model Secondary school, Amandim Olo, Ezeagu L.G.A.
Ha: Dental calculus is significantly prevalence among students attending Model Secondary school, Amandim Olo, Ezeagu L.G.A.
Summation of individual CI = 196.8 (See appendix 1)
Group CI = summation of individual CI
Total number of students examined
Group CI = 196.8
180 = 1.0
Result of the CI of the students shows a value of “1.0”, this means that Dental calculus is not prevalent among the studenT
DISCUSSION, CONCLUSION AND RECOMMENDATION
Discussion
The research work was carried out between June to September 2018, 180 students were selected from six classes, which is from jss1 to ss3. 30 students (16.67%) were equally selected from each class respectively. The age analysis shows that 9(5%) were between the age of 1012years, 62(34.4%) were between the age of 1315years, 75(41.6%) were between the age range of 1618years, 34(18.9%) were between the age of 1921years.
The result of the clinical examinations using calculus index indicated that 7(3.9%) students falls within the “0” index, and 135(75%) students had traces of supra gingival calculus as the fell In the “1” index. 38(21.1%) students has traces of both sub gingival and supra gingival calculus as they fall into the “2” calculus index. This result shows that dental calculus was not prevalent among the students. This finding is in agreement with Ezeobi (2016) who also reported that dental calculus was not prevalent among the students of Queens Model Secondary school, Enugu. Result showed that students that fell into calculus index of “0” are 60(33.33%) while those with traces of calculus fell into the calculus index of “1” are 120(66.67%). Their group CI is 0.5 which shows that there is no prevalence of dental calculus among the students.
The sex analysis shows that 84(46.67%) are males and 96(53.33%) are females, in comparisom of oral health between male and female counterpart, calculus index “0” shows that 59(32.78%) are males while 76(42.22%) are females. Female students are proven to havenless deposits than male students.
Conclusion
The findings from this study of the students attending Model secondary school, Amandim Olo, ezeagu LGA, Enugu state, using calculus index showed that dental calculus was not prevalent because the calculus index score of the group is 1.0, it is clear that calculus removal and prevention is important to achieve a smooth and plaque free tooth surface. There is need for oral health awareness in secondary school in rural areas for proper utilization of dental care.
Recommendations
 Oral health education should be carried out regularly in secondary school
 There is need for teachers to put more effort to achieve high level of education among the students
 Parents and guardians should be educated on diet counseling as they are in good position to educate their young ones
 Dental health educators should be sent to various rural areas to create oral health awareness among students at least twice every month.
Suggestion for further studies
 Prevalence of dental caries among the students
 Need for routine scaling and polishing among the students
 Relationship between dental calculus and oral hygiene status
Test of hypothesis
From the calculus index table attached, the frequency and calculus score for each class of respondent is stated below.
CLASS  FREQUENCY  CALCULUS SCORE 
JSS1  30  46.1 
JSS2  30  30 
JSS3  30  31 
SS1  30  33 
SS2  30  32.2 
SS3  30  24.5 
TOTAL  180  196.8 
Prevalence of dental calculus using c1
Group CI = summation of individual CI
Total number of students examined
Group CI = 196.8
180 = 1.0
From the nominal scale for dental calculus index above, this shows that “1.0” lies under 0.1 – 1.2 calculus index which is rated as “good”. We accept the null statement which states that dental calculus is not prevalent among students attending Model Secondary school, Amandim Olo, Ezeagu LGA.
DEFINITION OF TERMS
ANALYSIS: process of breaking down a subject and studying
it.
DENTAL CALCULUS: This is hard, stone like chalky concretion, varying in colour, from creamy yellow to black that forms on the teeth on the dental prosthesis through calcification of dental plaque.
DENTINE: This is yellowish tissue that makes up the bulk of a
Teeth. It is harder than bone but softer than the enamel.
DENTAL PLAQUE: Thin film of bacteria in a sticky glycol protein
matrix which stick to the teeth surface
ENAMEL: This is a hard tissue covering the tooth or crown
PREVALENCE: A term which means being widespread. It is
distinct from incidence. Prevalence measures
Individuals affected by the disease
SURVEY: careful examinations or study
SIGNIFICANCE: quality of having meaning
WHITELOCKITE: This is a mineral and unusual form of calcium
Phosphate
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