The Role of Calculus in Periodontal Disease

University of Technology, Jamaica

College of Oral Health Sciences

Periodontics IV
DMD3027
Dr Brady

July 26, 2022

Bethany Pinnock
1904475
Doctor of Medical Dentistry Year 3
 In a paper done by Donald J White, he described dental calculus as calcified dental
plaque, composed primarily of calcium phosphate mineral salts deposited between and within
remnants of formerly viable microorganisms (White, 1997). It can be found on the tooth surfaces
as well as the surfaces of dental prostheses such as dentures and orthodontic appliances. This
paper seeks to explain in detail what dental calculus is and the part it plays in the perpetuation of
diseases of the periodontium.

Calculus can be found either coronal to the gingival margin (supragingival) or below the
margin (subgingival). Supragingival calculus is usually a hard, white/ white yellow coloured
mass. It is mostly prevalent in regions that are close in proximity to salivary duct openings or on
teeth out of occlusion. Subgingival calculus is described as being hard and darkly coloured (dark
brown/green-black). This type is found within the periodontal pocket, on subgingival restorations
but does not contact the junctional epithlium. Calculus is made up of inorganic material which is
70-90% of calcium phosphate and other salts and elements and the remaining 10-30% is organic
material which consists of a mixture of protein–polysaccharide complexes, epithelial cells,
leukocytes, and other microorganisms. Composition will vary slightly due to the orgin of the
calculus as subgingival calculus develops from plasma/ gingival crevicular fluid and
supragingival is from salivary fluid.

Dental calculus, as stated before is mineralized dental plaque. Attachment may occur in
four (4) different ways: the firm attachment of bacteria to the acquired pellicle of the teeth,
mechanical interlocking into a surface irregularity (cracks,caries), adaptation of the calculus to
unaltered cementum and the penetration of calculus into the cementum. This plaque layer is then
mineralized due to the precipitation of minerals from the surrounding crevicular fluid or salivary
fluid over a span of 1 - 14 days. During calcification, calcium ions are bound to the
carbohydrate-protein complexes and form calcium phosphate salts. Crystals begin to form within
the matrix and progress to forming on the bacterial surfaces and finally within the bacteria itself.

The role that calculus plays in periodontal diesease is similar to that of an overhanging
restoration; it serves as a site for plaque attachment. It is the perfect attachment site for bacterial
plaque as calculus is hard, firmly attached to the surfaces they sit on (teeth, prostheses) and is not
easily removed for those reasons. It also creates additional attachment sites for plaque to adhere
to. Calculus would therefore be in close proximity to tissues of the periodontium for long
periods, allowing for continued inflammation and degradation of periodontal tissues as the body
reacts to the bacterial load that resides on or close to its tissues. Both subgingival and
supragingival calculus contribute to the accentuation of periodontal disease in this way.
Therefore, dental calculus is not a main etiologic factor in the proliferation of periodontal
disease, but is an indirect contributor to the destruction of the surrounding periodontal tissues by
harbouring bacterial plaque (main etiologic factor). For this reason, gross debridement and
scaling and root planing in an effort to remove supragingival and subgingival plaque and
calculus are effective methods in the treatment of periodontal disease. These methods aim to
remove the microbiota (directly and indirectly) responsible for the development of periodontal
disease, thus allowing the tissues to return to a healthy state.

Word Count: 552

 References

Gakhar, A. (2015, April 29). Dental Calculus [PowerPoint slides]. SlideShare.

https://www.slideshare.net/abhishekgakhar11/dental-calculus

Newman, M. G., Takei, H., Carranza, F. A., & Klokkevold, P. R. (2018). Newman and Carranza's
clinical periodontology. Saunders.

White, D. J. (1997). Dental calculus: Recent insights into occurrence, formation, prevention,
removal and oral health effects of supragingival and subgingival deposits. European
Journal of Oral Sciences, 105(5), 508-522.
https://doi.org/10.1111/j.1600-0722.1997.tb00238.x