Calculus as a Risk Factor for Periodontal Disease: Narrative Review on Treatment Indications When the Response to Scaling and Root Planing Is Inadequate

Abstract

Background: Based on the 2018 classification of periodontal disease, a series of articles have been published describing the decision points of periodontal therapy and how the findings collected at those decision points can be used as guidelines for periodontal therapy. The articles are reviewed with a focus on the finding of inadequate calculus removal at the decision points and how that finding impacts treatment outcomes. Methods: A narrative review of the literature discussing the influence of calculus on inflammation was performed and the effects of inadequate removal of calculus during periodontal therapy were analyzed in light of the 2018 classification of periodontal disease, the decision points of periodontal therapy, and the guidelines of periodontal therapy. Results: The published literature supports that calculus is a major risk factor for periodontal inflammation. Recent studies indicate that the pathologic risk of calculus goes beyond the retention of biofilm and may represent a different pathophysiologic pathway for periodontal disease separate from the direct action of biofilm. The inadequate removal of calculus is a factor in the failure of periodontal therapy. Conclusions: The inadequate removal of calculus plays an important role in the frequent failure of non-surgical periodontal therapy to eliminate inflammation.

Feline tooth resorption in a case-control study based on a subpopulation of 944 dentally examined cats from a Finnish questionnaire survey of over 8000 cats

“…Dental calculus causes gingivitis in cats, as reported by Thengchaisri et al (2017). In addition, dental calculus is most often essential in development of periodontitis (Harrel, 2022). However, in our data there were cats in which the owner had reported periodontitis but no dental calculus.…”

Comparison of the Links between Tobacco Smoking, Use of Smokeless Tobacco and Periodontal Health: A Scoping Review

“…Previous research has identified tobacco smoking as a contributing factor to the development of subgingival calculus [44]. Subgingival calculus serves as a local pathogenic element in the context of periodontitis [45]. Sterile calculus has the potential to induce widespread inflammation and the generation of granulation tissue [46].…”

A Journey into the Evolution of Human Host-Oral Microbiome Relationship through Ancient Dental Calculus: A Scoping Review

“…Although susceptibility to periodontal disease and caries is strongly linked to the subject's habits, the build-up of dental plaque and dental calculus, both supra-and subgingival, is a risk factor [52]. Moreover, the composition of the oral microbiome with specific signatures can significantly modulate the state of oral health or disease by interacting with the host [53]. For this reason, and because of the great importance that oral microbiome has at a systemic level as well, modern medicine and dentistry are trying to shed light on such an influence and the mechanisms related to the microbiome-host interaction [54].…”