Clinical trials of anticalculus agents in dentifrices published since 1989 have been reviewed. There are several methods for assessment of the growth of calculus, but the most widely applied is the Volpe-Manhold scoring method .
The crystal growth inhibitors, pyrophosphate and zinc citrate, have received the greatest attention in trials of anticalculus agents. Prolongation of their activity in the mouth after teeth were brushed with the toothpaste has been sought by the use of materials which themselves have substantivity, or by the inclusion of other agents which will convey substantivity to the active ingredient. The copolymer of polyvinylmethyl ether and maleic acid anhydride has been found to increase the anticalculus efficacy of pyrophosphates, and it appears also to increase the retention of an antimicrobial, Triclosan, in plaque.
The anticalculus activity of zinc is enhanced when combined with the antimicrobial Triclosan. Trials have demonstrated a retention of anticalculus and anticaries activity when fluorides are incorporated with pyrophosphate or zinc citrate in a dentifrice. Thus, dentifrices can be formulated to offer "total" oral health care.
The newer dentifrice preparations containing an anticalculus agent with baking soda have been the subject of several trials which suggest that baking soda does not interfere with the activity of the anticalculus agents.
The association between calculus and disease is far from clear, but there is evidence that calculus, both sub- and supragingivally, may be linked to gingival recession in heavy-calculus-formers. More research is needed to clarify the role of supragingival calculus in periodontal diseases.
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