![]() Research suggests that subgingival calculus, at a minimum, may expand the radius of plaque induced periodontal injury. As a result, we are not entirely sure whether subgingival calculus is the cause or result of periodontal inflammation. 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". Subgingival calculus, in "low hygiene" populations, is extensive and is directly correlated with enhanced periodontal attachment loss. In these populations, supragingival calculus is associated with the promotion of gingival recession. 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. 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. Levels of supragingival calculus in these populations is minor and the calculus has little if any impact on oral-health. 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 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. A viable dental plaque covers mineralized calculus deposits. Dental calculus is calcified dental plaque, composed primarily of calcium phosphate mineral salts deposited between and within remnants of formerly viable microorganisms. Dental calculus, both supra- and subgingival occurs in the majority of adults worldwide.
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