J Clin Periodontol 1999; 26: 541–547 Copyright C Munksgaard 1999

Printed in Denmark . All rights reserved

ISSN 0303-6979

Tobacco smoking and Jan Bergström

School of Dentistry, The Karolinska Institute,
Stockholm, Sweden

supragingival dental calculus

Bergström J: Tobacco smoking and supragingival dental calculus. J Clin Peri-
odontol 1999; 26: 541–547. C Munksgaard, 1999.

Abstract. Supragingival calculus is frequent in all ages from adolescence to old

age. The influence of tobacco smoking on the occurrence and severity of supragin-
gival calculus has received surprisingly little attention. The present investigation
conducted in a population of 258 dentally aware individuals in the age range
20–69 years, was initiated to elucidate the relationship between tobacco smoking
and supragingival calculus, taking into account possible confounding factors such
as age, gender, oral hygiene and gingival inflammation. The calculus deposition
was bilaterally assessed on the lingual surfaces of the mandibular anteriors and the
vestibular surfaces of the maxillary premolars and molars. The overall prevalence
of supragingival calculus was 69% ranging from 59% in age group 20–34 years to
84% in age group 50–69 years. The prevalence rates for current smokers, former
smokers, and nonsmokers were 86%, 66%, and 65%. The differences between
smoking groups were statistically significant (p∞0.05). The influence of smoking
was independent of age, plaque and gingival inflammation. In former smokers who
had stopped smoking in the distant past, the occurrence and severity of supragin-
gival calculus were very close to those in individuals who had never smoked, sug-
gesting that the effect of smoking is reversible. The observations indicate a strong
Key words: calculus; dental plaque; gingivitis;
and independent association between tobacco smoking and supragingival calculus smoking; tobacco
deposition. The avoidance of excess deposition of supragingival calculus, there-
fore, is a further argument for reducing smoking in the population. Accepted for publication 3 November 1998

Supragingival calculus refers to min-
eralized tooth surface deposits which
are localized coronally to the gingival
margin and clinically visible to the
naked eye. The deposits occur predomi-
nantly on the lingual surfaces of man-
dibular incisors and the vestibular sur-
faces of maxillary molars, both predo-
minating localizations being situated in
the close vicinity of the orifices of the
submandibular/sublingual and parotid
glands, respectively (Schroeder 1969,
Corbett & Dawes 1998). Supragingival
calculus is formed mainly as a result of
mineralization of bacterial plaque ac-
cumulation and, therefore, often re-
ferred to as mineralized plaque. Supra-
gingival calculus may vary in quantity
as a function of age, oral hygiene stan-
dard, dental care attendance and poss-
ibly diet (Schroeder 1969, Gaare et al.
1989, White 1997). Certain medi-
cations, such as immunosuppressants
and tranquilizers, may influence its oc-
currence and quantity (Sutton & Smal-
es 1983, Turesky et al. 1992, Breuer et
al. 1996). Whether or not tobacco
smoking exerts an influence on the oc-
currence and severity of supragingival
calculus has received but little attention
and available results are equivocal.
Comparably elevated calcium levels in
48-h plaque of young adult smokers
suggest a smoking associated influence
on the early stages of supragingival cal-
culus formation (Macgregor et al.
1985). In a further investigation, how-
ever, the same researchers were unable
to reach conclusive evidence as to
whether or not the calcium content in
the saliva of smokers was higher than
that of non-smokers (Macgregor &
Edgar 1986). Comparably higher levels
of calcium in plaque and saliva in peri-
odontitis-affected individuals have been
observed, a finding that, it was specu-
lated, might reflect an influence of
smoking (Sewón et al. 1990, 1995). This
assumption, however, needs further
documentation.
Epidemiological studies have re-
ported more calculus concomitant with
an inferior periodontal health condition
in smokers as compared to non-
smokers (Alexander 1970, Ainamo
1971, Sheiham 1971). The interpreta-
tion of epidemiological studies, how-
ever, is rendered difficult due to the fact
that the evaluation is usually based on
composite indices which do not differ-
entiate between supragingival and sub-
gingival calculus deposits. It is difficult,
therefore, to determine whether a given
index value refers to supragingival cal-
culus, which is mainly a function of sal-
iva reflecting the supragingival oral en-
vironment, or to subgingival calculus,
which is rather the result of periodontal
inflammation reflecting the subgingival
oral environment. It may be presumed
that calculus index values found in ado-
lescent and young adult populations
542 Bergström
Table 1. Study population according to age, gender and smoking
Current smoker Former smoker
Age (years) men women men
20–34 12 3 6
35–49 13 6 13
50–69 15 1 27
total 40 10 46
mainly represent supragingival calcu-
lus. In middle age and old age popula-
tions, indices are more likely to repre-
sent a mixture of both supragingival
and subgingival calculus deposition.
Thus, although clinical and epide-
miological observations, predominantly
based on relatively young age popula-
tions, suggest that tobacco smoking
might contribute to the formation and
deposition of calculus in humans, avail-
able information does not clarify
whether the association between smok-
ing and calculus holds true for supra-
gingival or subgingival calculus or for
both categories. In order to further
elucidate the possible influence of to-
bacco smoking on calculus prevalence
and severity, the present investigation
was conducted in a population of den-
tally-aware individuals with compar-
ably low levels of periodontal mor-
bidity. In this first part of the investiga-
tion, focus was placed on the
supragingival category.
Material and Methods
Study population
The total population investigated com-
prised a total of 258 individuals in the
age range 20–69 years, 191 men and 67
women. From a dental health behav-
iour point of view, the population is
characterized by a high standard of
dental awareness as previously found by
above average standards of dental at-
tendance and oral hygiene (Berg-
ström & Eliasson 1985). The oral health
condition in general was also of a high
standard as seen from, e.g., a great
number of retained teeth (Eliasson &
Bergström 1997). The participation rate
was 80%. The proportions of current
smokers, former smokers and non-
smokers were 20%, 23% and 52%, re-
spectively, whereas in 5%, information
on smoking was missing or uncertain.
The present analyses were based on 243
individuals with an unambiguous
smoking diagnosis. The frequency dis-
tribution of the study population ac-
cording to age, gender and smoking is
Non-smoker
women men women
8 39 21
5 26 13
2 27 6 2
15 92 40
presented in Table 1. The mean (SD)
number of retained teeth in current
smokers, former smokers and non-
smokers was 28.0 (2.5), 27.8 (2.8) and
28.7 (2.6), respectively. The study popu-
lation, furthermore, included 37 indi-
viduals (14%) with self-reported regular
use of medical drugs. The study was ap-
proved by the local ethical committee of
The Karolinska Institute.
Assessment of supragingival calculus
Supragingival calculus was assessed on
(1) the lingual surfaces of the mandibu-
lar anterior regions and (2) the vestibu-
lar surfaces of the maxillary premolar
and molar regions. Assessment was
made bilaterally on left and right hand
sides of the dentition, and the occur-
rence of deposits in each region was di-
chotomously judged by inspection and
probing as present (score 1) or absent
(score 0). The arithmetic mean of scores
across the 2π2 bilateral regions formed
the supragingival calculus mean score
of the individual.
Assessment of plaque and gingival
inflammation
Supragingival plaque was assessed ac-
cording to the plaque index system of
Silness & Löe (1964). Assessment was
made on all buccal, distal, lingual and
mesial tooth surfaces in the individual
following erythrosin staining. The mean
of all assessments formed the plaque
index of the individual. Gingival in-
flammation was assessed according to
the gingival index of Löe & Silness
(1963). The marginal gingivae along the
buccal, distal, lingual and mesial as-
pects of all teeth were assessed and the
mean of all assessments formed the gin-
gival index of the individual.
Statistics
Data are presented as means and stan-
dard deviations (SD) or standard errors
of the mean (SEM). Statistical signifi-
cance of differences between means was
Other Total
men women men women
3 1 60 33
8 0 60 24
1 71 10
13 2 191 67
tested by means of 1-factor ANOVA.
Significant variables were run together
with other significant factors as co-vari-
ables in a 2-factor ANOVA. Post hoc
multiple comparisons were performed
according to Scheffe’s test. For pro-
portions, significance was tested using
the c2 distribution. Odds ratios (OR)
and their 95% confidence intervals (CI)
were calculated according to Fleiss
(1981). Multivariate testing was per-
formed using multiple regression analy-
sis. Variables with a non-normal distri-
bution were log or square-root trans-
formed. Age was included as 3 strata
representing 20–34, 35–49 and 50–69
years, respectively. Stratification with
regard to plaque index was done ac-
cording to (1) 0.00–0.40 (nΩ43); (2)
0.41–0.70 (nΩ65); (3) 0.71–1.00 (nΩ83);
(4) 1.01–2.00 (nΩ46). Stratification with
regard to gingival index was done ac-
cording to (1) 0.00–0.40 (nΩ64); (2)
0.41–0.80 (nΩ76); (3) 0.81–1.20 (nΩ73);
(4) 1.21–2.10 (nΩ44). Smoking ex-
posure of current and former smokers
was expressed in terms of smoking dur-
ation, i.e., number of years of smoking,
and life-time exposure, i.e., the product
of consumption (cigarettes per day) and
smoking duration (years). Smoking
duration was stratified according to (1)
1–10 (nΩ54); (2) 11–20 (nΩ36); (3) >21
years (nΩ29). Life-time exposure was
stratified according to (1) 1–30 (nΩ18);
(2) 31–250 (nΩ52); (3) ±250 cigarette-
years (nΩ44).
Results
Prevalence of supragingival calculus
The overall prevalence of supragingival
calculus in the total study population
was 69%, ranging from 59% in age
group 20–34 years to 84% in age group
50–69 years (Table 2). The differences
between age strata were statistically sig-
nificant (c2Ω12.9, pΩ0.001). The preva-
lence of mandibular supragingival cal-
culus was identical to that of the overall
prevalence. The prevalence of maxillary
supragingival calculus was 21%, rang-
ing from 16% in age group 20–34 years
 Smoking and dental calculus 543

Table 2. Prevalence (%) of supragingival calculus according to age, gender and localization supragingival calculus mean score and
Localization age was statistically significant (1-factor
ANOVA FΩ4.6, pΩ0.010). The associ-
mandible maxilla total
ation remained statistically significant
Age (years) men women total men women total men women total after adjustment for smoking and
20–34 65 48 59 22 6 16 65 48 59 plaque index (2-factor ANOVA FΩ4.6,
35–49 66 67 66 29 4 22 66 67 66 pΩ0.010 and FΩ7.7, pΩ0.001, respec-
50–69 83 90 84 27 10 25 83 90 84 tively).
total 72 61 69 26 6 21 73 61 69 The mean (SD) supragingival calcu-
lus mean score for current smokers, for-
mer smokers and non-smokers was 0.60
Table 3. Prevalence (%) of supragingival calculus according to age, smoking and localization (0.33), 0.40 (0.33) and 0.42 (0.36), re-
spectively. The association between
Smoking status
smoking and supragingival calculus
current former non mean score was statistically significant
Age (years) mandible maxilla mandible maxilla mandible maxilla (1-factor ANOVA FΩ6.0, pΩ0.003),
20–34 87 20 64 7 57 17
with significant post hoc comparisons
35–49 84 37 72 22 59 15 between current and former smokers,
50–69 88 44 76 21 88 15 and current smokers and non-smokers
total 86 34 66 18 65 16 (Scheffe FΩ3.7, p∞0.05 and 5.9,
p∞0.01, respectively). The association
between supragingival calculus mean
score and smoking remained statisti-
Table 4. Multiple regression with supragingival calculus mean score as dependent variable
(R2Ω0.30) cally significant after adjustment for
age (2-factor ANOVA FΩ6.1, pΩ0.003).
Coefficient SE t-value p The relation between supragingival cal-
intercept ª0.309 culus mean score, age and smoking is
plaque index 0.25 0.063 3.91 0.0001 illustrated in Fig. 1.
gingival index 0.20 0.054 3.76 0.0002 Supragingival calculus mean score
age (years) 0.008 0.002 3.48 0.0006 increased with increasing levels of
smoking 0.167 0.047 3.03 0.0028
plaque index from a mean (SD) of 0.24
(0.25) in individuals with a low level to
0.63 (0.36) in individuals with a high
to 25% in age group 50–69 years. The current smokers, the prevalence of man- level (Fig. 2). The association between
differences between age strata were not dibular supragingival calculus varied supragingival calculus mean score and
statistically significant. The prevalence between 80 and 90% in all age groups, plaque index after adjustment for age
rate of maxillary supragingival calculus whereas in former smokers and non- was statistically significant (2-factor
was significantly lower in women as smokers it tended to increase with age. ANOVA FΩ8.9, pΩ0.000). The relation
compared to men (c2Ω10.8, pΩ0.001). The prevalence of maxillary supragin- between supragingival calculus mean
The bilateral occurrence of mandibular gival calculus increased with increasing score, plaque index and smoking is il-
supragingival calculus was total, all in- age in current smokers, whereas no lustrated in Fig. 3. The association be-
dividuals exhibiting deposits either in clear trend was seen in neither former tween supragingival calculus mean
both regions or not at all. Concerning smokers nor nonsmokers. The relative score and smoking after adjustment for
maxillary supragingival calculus 3 indi- risk (odds ratio) for mandibular and plaque index was statistically significant
viduals only (1%) exhibited unilateral maxillary supragingival calculus, re- (2-factor ANOVA FΩ6.0, pΩ0.003).
deposits, hence a 99% symmetric occur- spectively, to be associated with smok- Supragingival calculus mean score,
rence. All individuals exhibiting maxil- ing was ORΩ3.3 (CIΩ1.6–6.6) and furthermore, increased with increasing
lary calculus but one (98%) scored posi- ORΩ2.7 (CIΩ1.5–4.8). levels of gingival index from a mean
tive for mandibular calculus. (SD) of 0.25 (0.31) in individuals with a
The influence of smoking on the low level to 0.69 (0.34) in individuals
Supragingival calculus mean score
prevalence rate is demonstrated in Table with a high level (Fig 2). The associ-
3. Mandibular supragingival calculus The mean (SD) supragingival calculus ation between supragingival calculus
was present in 86% of current smokers, mean score for the total population mean score and gingival index after ad-
66% of former smokers, and 65% of under study was 0.45 (0.35), 0.49 (0.36) justment for plaque index was statisti-
non-smokers. The differences between for men and 0.33 (0.29) for women. The cally significant (2-factor ANOVA FΩ
smoking groups were statistically sig- gender difference was not statistically 6.8, pΩ0.001). The relation between
nificant (c2Ω8.3, pΩ0.016). The corre- significant after adjustment for age (2- supragingival calculus mean score, gin-
sponding maxillary prevalence rates factor ANOVA FΩ3.1, pΩ0.078). gival index and smoking is illustrated in
were 34%, 18% and 16% in current Supragingival calculus mean score in- Fig. 4. The association between supra-
smokers, former smokers, and non- creased with increasing age from a gingival calculus mean score and smok-
smokers, respectively. The differences mean (SD) of 0.37 (0.35) in age group ing after adjustment for gingival index
between smoking groups were statisti- 20–34 years to 0.53 (0.31) in age group was statistically significant (2-factor
cally significant (c2Ω7.7, pΩ0.021). In 50–69 years. The association between ANOVA FΩ4.4, pΩ0.013).
544 Bergström

Fig. 1. Supragingival calculus mean score according to age and smok- Fig. 3. Supragingival calculus mean score according to plaque index
ing. and smoking.

Fig. 2. Supragingival calculus mean score. Mean and SEM according Fig. 4. Supragingival calculus mean score according to gingival index
to plaque index and gingival index. and smoking.

Supragingival calculus mean score

significantly increased with increasing
smoking exposure in terms of smoking
duration and lifetime exposure in cur-
rent and former smokers combined
(‘‘ever smokers’’, 1-factor ANOVA FΩ
8.4, pΩ0.000 and FΩ4.8, pΩ0.009, re-
spectively) but, due to the limited num-
ber, not in current smokers alone. The
influence of exposure remained signifi-
cant after adjustment for age and
plaque index. The relation between life-
time exposure and supragingival calcu-
lus mean score is illustrated in Fig. 5.
Supragingival calculus mean score
did not significantly differ between the
37 individuals reporting regular use of
medication and those not on medi-
cation (1-factor ANOVA FΩ1.4, pΩ Fig. 5. Supragingival calculus mean score. Mean and SEM according to life-time smoking
0.236). exposure in current and former smokers.

Multiple regression analysis
A multiple regression analysis with age,
gingival index, plaque index and smok-
ing (dummy variable) as independent
variables entered in one block, and
supragingival calculus mean score as
the dependent variable suggested that
supragingival calculus mean score
could be predicted from these variables,
accounting for 30% of the variance in
the dependent variable (FΩ24.8, pΩ
0.000, R2Ω0.30, Table 4). A forward
stepwise approach confirmed that
plaque index was the strongest predic-
tor (data not shown). The addition of
gender, smoking exposure variables,
and medication did not materially in-
crease the explanatory value.
Discussion
The present investigation was under-
taken in order to evaluate the influence
of smoking on the prevalence and sever-
ity of supragingival calculus in a popu-
lation, the dental awareness of which
generally is of a high standard (Berg-
ström & Eliasson 1985, 1986). This was
confirmed by the present observation of
low plaque index levels in the vast ma-
jority of individuals, more than 80% ex-
hibiting plaque index levels less than
1.0. The high standard of oral cleanli-
ness, moreover, was independent of
smoking status.
The clinical assessment was limited
to the two predominant dental regions
of supragingival calculus deposition,
viz., the lingual surfaces of the man-
dibular anteriors and the vestibular sur-
faces of the maxillary premolars and
molars. The assessment within each re-
gion was based on a dichotomous de-
termination as to presence or absence,
only. Although there exist several
methods and indices for the (semi-)
quantitative evaluation of supragingival
calculus (Volpe 1974), no attempt was
made to quantitate the amount of de-
posits encountered, since it was a priori
known that most individuals exhibited
limited amounts both in the mandible
and, particularly, in the maxilla. For
comprehensive studies, dichotomous
methods may be as appropriate as se-
verity scales (Barbano & Clemmer
1974). The arithmetic mean across the
2π2 bilateral assessments, labelled
supragingival calculus mean score,
served as a quantity (severity) measure.
It would have been desirable if the as-
sessment had included more detailed in-
formation about quantity, such as the
frequency of surfaces harboring de-
posits, and a site-specific approach as
applied in some recent studies might
have provided additional information
about quantity and extension
(Corbett & Dawes 1998).
The overall prevalence of supragin-
gival calculus for the entire population
under study was close to 70%. This may
be compared with a prevalence rate of
approximately 90% in a Norwegian
population of males with an above aver-
age education and maximum exposure
to dental care (Ånerud et al. 1991).
Both of these prevalence rates suggest
that supragingival calculus is a com-
mon characteristic also in dentally con-
scientious individuals. The prevalence
of mandibular calculus was 3–4 fold
that of the maxillary category. This
mandibular to maxillary prevalence
ratio seems to be of the same order of
magnitude as that reported by Ånerud
et al. (1991).
The deposition of supragingival cal-
culus typically appeared in a bilaterally
symmetric manner in the mandible as
well as the maxilla. A symmetrical pat-
tern of supragingival calculus occur-
rence has been decribed previously
(Schroeder1969, Ånerud et al. 1991,
Corbett & Dawes 1998) and may not be
surprising, particularly not for the
mandibular region since the orifices of
the submandibular/sublingual glands
are in close proximity to the lingual sur-
faces of the anterior teeth investigated.
Although a comparably infrequent
finding, maxillary supragingival calcu-
lus also appeared in a symmetric man-
ner. In contrast to the situation in the
mandible, however, the maxillary sym-
metry was mainly due to bilateral ab-
sence of calculus.
The major observation of the present
investigation was a positive association
between smoking and supragingival cal-
culus. Prevalence as well as severity
were greater in smokers than in individ-
uals currently not smoking tobacco.
The association with smoking was quite
evident, a current smoker running a 3-
fold increased risk of exhibiting supra-
gingival calculus as compared to a non-
smoker. The influence of smoking was
associated neither with plaque nor with
age, which strongly suggests an inde-
pendent influence. Furthermore, there
was a clear trend towards increased se-
verity in response to increasing levels of
exposure, although the data base was
not large enough to allow statistical sig-
Smoking and dental calculus 545
nificance in currrent smokers alone.
Interestingly, former smokers who had
quit in the distant past, very much re-
sembled nonsmokers both with regard
to prevalence and severity, indicating a
normalization of supragingival calculus
deposition rate following cessation of
the habit. Taken together, the trend of
a dose-response relation and the attenu-
ation of the impact following cessation
make an important argument in favour
of a direct causal role for smoking in
promoting supragingival calculus depo-
sition. The present observations of an
association between supragingival cal-
culus and smoking are the first in an
adult population covering a wide age
range, and controlling for possible con-
founding. They confirm and further
elucidate trends found in earlier studies
of young age populations (Brandt-
zaeg & Jamison 1964, Alexander 1970,
Kristoffersen 1970, Ainamo 1971). The
reason why smoking is associated with
an elevated risk for supragingival calcu-
lus deposition remains incompletely
understood. It may exert its influence
systemically via the saliva or locally via
a conditioning of tooth surfaces render-
ing them more susceptible to depo-
sition, or both. Whether or not smok-
ing exerts an influence on salivary flow
rate is controversial (Pangborn &
Sharon 1971, Macgregor & Edgar
1986). It may be speculated that smok-
ing causes a modification of the saliva
resulting in elevated levels of calcium
and possibly phosphorus. An elevated
calcium content, in turn, may promote
the calcification of plaque as proposed
by Mandel (1974a, b). This assumption
is supported by the findings that the
concentration of calcium and the ratio
of calcium to phosphorus are elevated
in early plaque of smokers (Macgregor
et al. 1985). In accord with earlier docu-
mentation (Bastiaan & Waite 1978,
Bergström 1980, Macgregor et al.
1985), the present observations indi-
cated there was no influence from
smoking on the plaque level. It seems
likely, therefore, that smoking primarily
affects the mineralization rate rather
than the formation rate of supragin-
gival plaque. It is envisaged that a num-
ber of plaque mineralizing factors may
be modified by smoking (Mandel 1991).
Further exploration, therefore, is
needed to uncover the precise mechan-
isms responsible for the association be-
tween smoking and supragingival calcu-
lus deposition.
The single most important factor for
546 Bergström
supragingival calculus prevalence and
severity was plaque index. This obser-
vation generally agrees with previous
cross-sectional epidemiologic and clin-
ical observations (Alexander 1970, Ain-
amo 1971, Sheiham 1971). A close re-
lationship between plaque and supra-
gingival calculus is plausible since the
bacterial soft matter of plaque probably
serves as a matrix for salivary minerals
to become embedded in over time
(Scheie 1989).
The influence of age on occurrence
and severity of supragingival calculus
was evident. This observation agrees
with several previous studies suggesting
an increasing likelihood of supragingival
deposition with the increase of age
(Schroeder 1969, Sheiham 1971, Ånerud
et al. 1991). The reasons for this are not
completely understood. It has been sug-
gested that saliva quality as well as quan-
tity may change with age favouring the
mineralization properties. A recent
large-scale study in the elderly, however,
suggests that salivary flow rate does not
change with increasing age (Österberg et
al. 1992). Whereas the prevalence of
mandibular calculus was comparable in
both genders, the maxillary prevalence,
interestingly, was significantly lower in
women. The reason for this gender dif-
ference is not known since neither smok-
ing habits nor plaque levels were gender
related, and the age difference was ac-
counted for. A comparably lower preva-
lence of supragingival calculus in women
has previously been reported in Ameri-
can adults (Beiswanger et al. 1989).
There was a positive association be-
tween supragingival calculus and gingi-
val index which was independent of
plaque, a finding that suggests that at
least in individuals with low plaque
levels supragingival calculus may con-
tribute to gingival inflammation. This
finding was somewhat unexpected in
view of the strong association of calcu-
lus deposition with smoking, and the
fact that smoking often but not always
is associated with a depressed clinical
gingivitis expression (Bergström 1990,
Lie et al. 1998). It seems that the gingi-
vitis depressive influence of smoking is
counteracted by the calculus promoting
one. As discussed by Mandel & Gaffar
(1986), the rôle of supragingival calcu-
lus in gingivitis induction is ambiguous
and its possible contribution to the in-
flammatory response of the gingiva
should be further approached in longi-
tudinal studies.
Some types of medication may in-
fluence supragingival calculus depo-
sition (Sutton & Smales 1983, Turesky
et al. 1992). In particular, b-blocking
agents are reported to be associated
with decreased levels of supragingival
calculus (Breuer et al. 1996). Medi-
cation was therefore introduced as a
possible confounder in the present
study. No influence was detected, how-
ever, from self-reported unspecified
medication on supragingival calculus.
In conclusion, the present investiga-
tion has demonstrated that supragin-
gival calculus present in about 70% of
adults with regular dental care habits,
may be considered a natural character-
istic of the oral ecology also in dentally
conscientious individuals. Importantly,
the observations indicate that supragin-
gival calculus deposition is strongly as-
sociated with tobacco smoking. The as-
sociation was independent of both
plaque and age. In former smokers who
had stopped smoking in the distant
past, prevalence and severity were no
different from individuals who had
never smoked, suggesting that the con-
tribution of supragingival calculus due
to smoking is reversible. The avoidance
of excess deposition of supragingival
calculus is therefore a further argument
for reducing smoking in the population.
Zusammenfassung
Tabakrauchen und supragingivaler Zahnstein
Supragingivaler Zahnstein ist in jedem Alter
vom Heranwachsenden bis zum hohen Alter
häufig. Der Einfluß von Tabakrauchen auf
das Vorkommen und auf die Menge des su-
pragingivalen Zahnsteins hat überraschen-
derweise wenig Beachtung gefunden. Die vor-
liegende Studie, die in einer Population von
258 zahnbewußten Individuen im Alter von
20 bis 69 Jahren durchgeführt wurde, wurde
initiiert, um die Beziehung zwischen Tabak-
rauchen und supragingivalem Zahnstein un-
ter Berücksichtigung von möglichen Ein-
flußfaktoren wie Alter, Geschlecht, orale Hy-
giene und gingivale Entzündung zu erklären.
Die Zahnsteinauflagerung wurde bilateral
auf den lingualen Oberflächen der unteren
Frontzähne und den vestibulären Oberflä-
chen der oberen Prämolaren und Molaren er-
faßt. Die allgemeine Prävalenz des supragin-
givalen Zahnsteins war 69% mit einer Streu-
ung von 59% in der Altsgruppe 20–34 Jahre
bis zu 84% in der Altersgruppe 50–69 Jahre.
Die Prävalenz der gegenwärtigen Raucher,
ehemaliger Raucher und Nichtraucher war
86%, 66% und 65%. Die Differenzen zwi-
schen den Rauchergruppen war statistisch si-
gnifikant (p∞0.05). Der Einfluß des Rau-
chens war unabhängig vom Alter, Plaque
und gingivaler Entzündung. Bei ehemaligen
Rauchern, die mit dem Rauchen vor längerer
Zeit aufgehört hatten, war das Auftreten und
die Menge des supragingivalen Zahnsteins
sehr ähnlich zu den Personen, die niemals ge-
raucht hatten. Damt wurde unterstrichen,
daß der Effekt des Rauchens reversibel ist.
Die Beobachtungen zeigen eine enge und un-
abhängige Verbinding zwischen Tabakrau-
chen und supragingivaler Zahnsteinablage-
rung. Die Vermeidung exzessiver supragingi-
valer Zahnsteinbildung ist deshalb ein
weiteres Argument gegen das Rauchen in der
Bevölkerung.
Résumé
Tabac et tartre sus-gingival
Le tartre sus-gingival est fréquent à tous les
âges, de l’adolescence à la vieillesse. Il est
étonnant que l’influence du tabac sur la pré-
sence du tartre sus-gingival et sur sa sévérité
n’ait pas attiré plus d’attention. La présente
étude, menée dans une population composée
de 258 sujets, âgés de 20 à 69 ans et s’inté-
ressant à leurs dents, a été entreprise pour
éclairer la relation entre le tabac et le tartre
sus-gingival, en tenant compte des facteurs
de confusion possibles, tels que l’âge, le sexe,
l’hygiène bucco-dentaire et l’inflammation
gingivale. L’accumulation de tartre a été
enregistrée des deux côtés sur les faces lin-
guales des dents antérieures inférieures et sur
les faces vestibulaires des prémolaires et mo-
laires supérieures. La prévalence globale du
tartre sus-gingival était de 69%, allant de
59% dans le groupe d’âge de 20–34 ans à 84%
dans le groupe d’âge de 50–69 ans. La préva-
lence chez les sujets fumant actuellement,
chez les sujets ayant fumé antérieurement et
chez les non-fumeurs était respectivement de
86%, 66%, et 65%. Les différences entre ces
groupes étaient statistiquement significatives
(p∞0.05). L’influence du tabac était indépen-
dante de l’âge, de la plaque et de l’inflamma-
tion gingivale. Chez les sujets ayant fumé an-
térieurement, mais ayant cessé de fumer de-
puis longtemps, la présence et la sévérité du
tartre sus-gingival était très proche de celle
des sujets n’ayant jamais fumé, ce qui sem-
blerait indiquer que l’effet du tabac est réver-
sible. Ces observations indiquent une asso-
ciation forte et indépendante entre le tabac
et l’accumulation de tartre sus-gingival. La
possibilité d’éviter l’accumulation excessive
de tartre sus-gingival constitue donc encore
un argument pour réduire le tabagisme dans
les populations.
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Address:
Jan Bergström
Department of Periodontology
The Karolinska Institute
Box 4064, Alfred Nobels Allé 8
S-141 04 Huddinge
Sweden