From a mechanistic viewpoint it is reasonable to anticipate an inverse clinical relationship between calculus and caries. Calculus formation is essentially a mineralisation process. The development of a caries lesion is the result of the net demineralisation of tooth enamel by plaque acid. These processes both involve crystalline calcium phosphate phases in contact with liquid, saliva and/or plaque fluid, containing their constituent ions. The oral environment also contains other salivary constituents and bacteria, which either inhibit or promote crystal growth or dissolution.An inverse relationship would mean that the absence of calculus could be a useful predictor of caries. Historically, however, any calculus-caries relationship has often been obscured by other factors. Firstly, the prevalence of both calculus and caries increases with increasing age [1, 2] and, second, both conditions are expected to correlate positively with poor oral hygiene [3][4][5]. These trends could be the reason why Schroeder [1] found no consistent relationship between clinical observations of calculus and caries experience in the first major review of the topic.The main purpose of this chapter is to review data from several clinical trials sponsored by Unilever, in which both caries and supra-gingival calculus were assessed concomitantly, in order to assess the strength of any empirical relationship between the two conditions. These data are presented in the following section 1.2, together with the results of other relevant published studies. To provide background information against which to judge the findings derived from the clinical data, calculus formation and caries are then briefly described Chapter 1