Mandel I D, Gaffar A
J Clin Periodontol. 1986 Apr;13(4):249-57. doi: 10.1111/j.1600-051x.1986.tb02219.x.
Although there is no doubt that gingivitis can develop in the absence of supragingival calculus, it is not clear to what extent the presence of mineralized deposit enhances gingival inflammation. Partial inhibition of plaque mineralization can be accomplished by chemical agents, but there has been no demonstration in humans of a reduction in gingivitis. It remains to be established what level of inhibition (if any) is required to have more than a cosmetic effect. Since the accepted scenario is that apical growth of supragingival plaque precedes the formation of subgingival calculus, there is no longer an issue of whether subgingival calculus is the cause or the result of periodontal disease. Subgingival mineralization results from the interaction of subgingival plaque with the influx of mineral salts that is part of the serum transudate and inflammatory exudate. This chronology, however, should not be the basis for relegating calculus to the ash heap. Morphologic and analytical studies point to the porosity of calculus and retention of bacterial antigens and the presence of readily available toxic stimulators of bone resorption. When coupled with the increased build up of plaque on the surface of the calculus, the combination has the potential for extending (beyond that of plaque alone) the radius of destruction and the rate of displacement of the adjacent junctional epithelium. The centrality of thorough scaling and root planing in the successful maintenance of periodontal health supports the view that subgingival calculus contributes significantly to the chronicity and progression of the disease, even if it can no longer be considered as responsible for initiation.
尽管毫无疑问，即使没有龈上牙石，牙龈炎也可能发生，但矿化沉积物的存在在多大程度上会加剧牙龈炎症尚不清楚。化学药剂可部分抑制菌斑矿化，但在人体中尚未证实能减少牙龈炎。要产生不仅仅是美观效果的抑制水平（如果有的话），仍有待确定。由于公认的情况是龈上菌斑的向根方生长先于龈下牙石的形成，所以龈下牙石是牙周病的病因还是结果已不再是问题。龈下矿化是龈下菌斑与作为血清渗出液和炎性渗出液一部分的矿盐流入相互作用的结果。然而，这种时间顺序不应成为将牙石弃之不顾的依据。形态学和分析研究表明牙石具有孔隙性，能保留细菌抗原，并且存在易于获得的骨吸收毒性刺激物。当与牙石表面菌斑的增加相结合时，这种组合有可能（超过单独菌斑的情况）扩大破坏范围和相邻结合上皮的移位速度。彻底的龈下刮治和根面平整对于成功维持牙周健康至关重要，这支持了一种观点，即龈下牙石对疾病的慢性化和进展有显著影响，即使不再认为它是疾病起始的原因。
