Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
, 105 (5 Pt 2), 508-22

Dental Calculus: Recent Insights Into Occurrence, Formation, Prevention, Removal and Oral Health Effects of Supragingival and Subgingival Deposits

Affiliations
Review

Dental Calculus: Recent Insights Into Occurrence, Formation, Prevention, Removal and Oral Health Effects of Supragingival and Subgingival Deposits

D J White. Eur J Oral Sci.

Abstract

Dental calculus, both supra- and subgingival occurs in the majority of adults worldwide. Dental calculus is calcified dental plaque, composed primarily of calcium phosphate mineral salts deposited between and within remnants of formerly viable microorganisms. A viable dental plaque covers mineralized calculus deposits. Levels of calculus and location of formation are population specific and are affected by oral hygiene habits, access to professional care, diet, age, ethnic origin, time since last dental cleaning, systemic disease and the use of prescription medications. In populations that practice regular oral hygiene and with access to regular professional care, supragingival dental calculus formation is restricted to tooth surfaces adjacent to the salivary ducts. Levels of supragingival calculus in these populations is minor and the calculus has little if any impact on oral-health. Subgingival calculus formation in these populations occurs coincident with periodontal disease (although the calculus itself appears to have little impact on attachment loss), the latter being correlated with dental plaque. In populations that do not practice regular hygiene and that do not have access to professional care, supragingival calculus occurs throughout the dentition and the extent of calculus formation can be extreme. In these populations, supragingival calculus is associated with the promotion of gingival recession. Subgingival calculus, in "low hygiene" populations, is extensive and is directly correlated with enhanced periodontal attachment loss. Despite extensive research, a complete understanding of the etiologic significance of subgingival calculus to periodontal disease remains elusive, due to inability to clearly differentiate effects of calculus versus "plaque on calculus". As a result, we are not entirely sure whether subgingival calculus is the cause or result of periodontal inflammation. Research suggests that subgingival calculus, at a minimum, may expand the radius of plaque induced periodontal injury. Removal of subgingival plaque and calculus remains the cornerstone of periodontal therapy. Calculus formation is the result of petrification of dental plaque biofilm, with mineral ions provided by bathing saliva or crevicular fluids. Supragingival calculus formation can be controlled by chemical mineralization inhibitors, applied in toothpastes or mouthrinses. These agents act to delay plaque calcification, keeping deposits in an amorphous non-hardened state to facilitate removal with regular hygiene. Clinical efficacy for these agents is typically assessed as the reduction in tartar area coverage on the teeth between dental cleaning. Research shows that topically applied mineralization inhibitors can also influence adhesion and hardness of calculus deposits on the tooth surface, facilitating removal. Future research in calculus may include the development of improved supragingival tartar control formulations, the development of treatments for the prevention of subgingival calculus formation, the development of improved methods for root detoxification and debridement and the development and application of sensitive diagnostic methods to assess subgingival debridement efficacy.

Similar articles

  • [Tartar and Periodontal Disease--A Cofactor in Etiopathogenesis]
    L Checchi et al. Dent Cadmos 59 (8), 80-4, 87-90, 93-5. PMID 1864421.
    Calculus may be considered as an aggregate of calcified deposits or deposits that are going to calcify in the oral cavity. From a topographical point of view calculus is …
  • Calculus Revisited. A Review
    ID Mandel et al. J Clin Periodontol 13 (4), 249-57. PMID 3519689. - Review
    Although there is no doubt that gingivitis can develop in the absence of supragingival calculus, it is not clear to what extent the presence of mineralized deposit enhanc …
  • Nonsurgical Periodontal Therapy
    CH Drisko. Periodontol 2000 25, 77-88. PMID 11155183. - Review
    Regular home care by the patient in addition to professional removal of subgingival plaque is generally very effective in controlling most inflammatory periodontal diseas …
  • Rationale of Mechanical Plaque Control
    E Westfelt. J Clin Periodontol 23 (3 Pt 2), 263-7. PMID 8707987. - Review
    Patients who have received extensive periodontal treatment also demonstrate a high susceptibility to periodontal disease. Maintenance of periodontal health following ther …
  • Prevention and Treatment of Periodontal Diseases in Primary Care
    DC Matthews. Evid Based Dent 15 (3), 68-9. PMID 25343386.
    There is a need for high-quality research carried out within an appropriate governance framework to improve the evidence base in the following areas: barriers and facilit …
See all similar articles

Cited by 40 PubMed Central articles

See all "Cited by" articles

MeSH terms

Substances

LinkOut - more resources

Feedback