Calculus (dental) - Clinical Significance

Clinical Significance

Plaque accumulation causes the gingiva to become irritated and inflamed, and this is referred to as gingivitis. When the gingiva become so irritated that there is a loss of the connective tissue fibers that attach the gums to the teeth and bone that surrounds the tooth, this is known as periodontitis. Because dental plaque is the sole cause of periodontitis, it is referred to as the primary aetiology. Plaque that remains in the oral cavity long enough will eventually calcify and become calculus. Calculus is detrimental to gingival health because it serves as a trap for increased plaque formation and retention; thus, calculus, along with everything else that causes a localized build-up of plaque, is referred to as a secondary etiology of periodontitis.

Calculus can form both along the gumline, where it is referred to as supragingival ("above the gum"), and within the narrow sulcus that exists between the teeth and the gingiva, where it is referred to as subgingival ("below the gum"). Calculus formation can result in a number of clinical manifestations, including bad breath, receding gums and chronically inflamed gingiva.

When plaque is supragingival, the bacterial content consists mostly of aerobic bacteria and yeast, or those bacteria which utilize and can survive in an environment containing oxygen. Subgingival plaque, however, is composed mainly of anaerobic bacteria, or those bacteria which cannot exist in an environment containing oxygen. Anaerobic bacteria are especially dangerous to the gingiva and the gingival fibers that attach the teeth to the gums, leading to periodontitis. Calculus tartar paste is commonly exhibited by humans. Almost all individuals with periodontitis exhibit considerable subgingival calculus deposits. These anaerobic bacteria have been linked to cardiovascular disease and mothers giving birth to pre-term low weight babies, but there is no conclusive evidence yet that periodontitis is a significant risk factor for either of these two conditions.