Why do I keep getting tartar build ups when I brush every day?

December 21, 2019

Tartar build ups are the result of poor oral hygiene and neglecting the cleanliness of the oral cavity. They not only hamper your appearance, but also make the mouth a diseased place, which may in turn lead to a series of events causing tooth loss.

What is tartar?

Tartar, or as it is called in theory – dental calculus, is a hard mineralized deposit on the teeth formed due to accumulation of calcium and phosphates on the surface of the teeth. They are formed by mineralization of plaque (the layer of microbial flora and organic deposits) on the surface of the teeth. These deposits can either be above the marginal gingival (supra-gingival) or below the gingiva (sub-gingival). Supra-gingival calculus is usually light in colour while sub-gingival calculus is dark in colour due to the presence of black pigmented bacteria and their cells are coated in a layer of heme obtained from blood when the gum bleeds.

It is most commonly found on the buccal (cheek) surface of maxillary molars and lingual surface of mandibular incisors probably due to the presence of the opening of the ducts of the parotid and sub lingual salivary glands.

Tartar is composed both of organic and inorganic constituents. The inorganic part ranging from 40-60% consists primarily of calcium phosphate crystals organized into four principal mineral phases: octacalcium  phosphate, hydroxyapatite, whitlockite and brushite. The inorganic part is composed of cellular (85%) and extra-cellular (15%) matrix. The cells are mostly bacterial but the presence of many species of yeast and fungi are also seen.

What does tartar do to teeth and gums?

The deposition of tartar is basically due to persistence of the layer of plaque and its mineralization. The surface of calculus is rough and provides a suitable place for the deposition of plaque which in turn gets mineralized and the vicious cycle continues. The presence of plaque and calculus irritates the gingiva and leads to a condition called gingivitis.

Gingivitis is the inflammation of the gums which causes swelling and bleeding of gums on brushing. When this inflammation increases, it involves other structures of the periodontium leading to a loss of the tissue connecting the teeth to the bone (periodontal ligament). This condition is then called periodontitis and includes features like loss of bone surrounding the teeth, mobility of teeth due to loss of periodontal attachment, pathological deepening of the gingival sulcus (periodontal pocket) and foul smell from the mouth. Teeth often appear discoloured, stained and give an unhealthy appearance.

What else can I do to prevent tartar build ups?

There are many ways in which a proper oral hygiene can be maintained and calculus deposition can be stopped. The first and foremost way is to mechanically control plaque by brushing, flossing and using interdental teeth cleaning aids. In addition to these, plaque can also be controlled by using chemical agents in toothpastes and mouthwashes.

Here are 5 Steps for plaque and tartar prevention

1) Brushing twice daily

As they say, prevention is better than cure. Tartar deposits can be stopped even before they begin by removing the layer of plaque that is deposited on the teeth. It takes a plaque cycle 24 hours to complete. Brushing thoroughly twice a day ensures that the plaque cycle is broken and there is no debris left on the surface of the tooth.

However, many people who brush twice daily also encounter tartar deposits. One cause of this might be an improper brushing technique. Teeth brushing twice daily should include proper brushing with the appropriate technique involving all the surfaces of the teeth for 2 minutes. People who have normal gums and no signs of gingival recession may use the Modified Bass technique for brushing their teeth while people who suffer from periodontal issues and show signs of root exposure due to gingival recession may opt for the Modified Stillman technique for brushing their teeth.

An easy way out is to use a powered toothbrush wherein the bristles may rotate in either circular or elliptical outlines. The advantages of using them include no need of following a brushing technique, an inbuilt timer which makes sure teeth are brushed for 2 minutes and better cleaning efficiency.

2) Use of appropriate toothpaste, proper flossing and use of interdental aids
Triclosan is an agent used in toothpastes for its anti-bacterial properties; it stops the bacteria from colonizing on the tooth surface. Pyrophosphates are agents employed in toothpastes to inhibit calculus formation.

A good dental floss enables access to even the remotest areas of the oral cavity. The loop method or the spool method may be used to floss the interdental areas in a back and forth motion.
Interdental cleansing aids such as proxa brushes and bottle brushes may be used food lodgment is a common complaint and cleansing is difficult.

3) Use of mouthwashes
Rinsing the oral cavity after brushing ensures protection of the oral cavity. The many chemical agents used in a mouthwash are chlorhexidine, triclosan, delmopinol, sanguinarine, etc. which help reduce plaque formation.

4) Regular dental checkups
It is essential that at least one visit be made to the dentists’ clinic every 6 months for review of the oral hygiene. The patient may undergo removal of the already present deposits of tartar by a process called scaling. Scaling may be done manually by hand instruments or by the use of ultra-sonic scaler tips which are also efficient in removing stains.

5) Diet and habit
Intake of sticky sugary foods must be limited since they are difficult to clean and provide a source of food for the bacteria to feed on. Consuming such materials in between meals poses an increased threat as they are not cleansed by the the other fibrous substances in the meal.
Smoking may increase chances of plaque build up. Smoking causes decreased oxygen flow to the gums which worsens gum condition. Tobacco also leads to gum diseases and is also responsible for oral cancers and precancerous lesions.

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