Tartar: how it forms and why it is important to remove it regularly

Dental tartar is one of the most common oral health problems, yet many people underestimate how seriously it can damage teeth and gums. Understanding how tartar forms and what happens when it is left in the mouth is essential for keeping your smile healthy over time.

How tartar develops: a process of gradual mineralisation

Tartar, technically known as dental calculus, is the result of the mineralisation of bacterial plaque. Plaque is a clear, sticky film made up of bacteria, food debris and saliva that constantly settles on the surfaces of the teeth.

When plaque is not removed effectively by daily oral hygiene, minerals in the saliva – mainly calcium phosphate – start to deposit on it, triggering a process of calcification. How quickly plaque mineralises varies widely from person to person, depending on oral hygiene, diet, age, general health conditions and medication.

Tartar comes in two main forms:

Supragingival tartar: visible above the gum line, it is yellowish or brownish in colour and tends to form where the salivary gland ducts open, such as the inner (tongue-side) surface of the lower front teeth and the outer surface of the upper first molars.

Subgingival tartar: forms in the periodontal pockets, below the gum line. Darker in colour, often greenish-black because of broken-down blood, it is particularly insidious because it is invisible and firmly attached to the root surface.

Why tartar is a silent enemy of oral health

What makes tartar dangerous is its porous, rough texture, which creates an ideal surface for even more bacterial plaque to build up. Tartar is in fact always covered by a layer of living bacterial plaque, which sets off a vicious circle that fuels inflammation.

Gum inflammation and gingivitis

The first stage of tissue damage is gingivitis, marked by red, swollen and bleeding gums. Bacteria in the tartar release toxins that trigger the immune system's inflammatory response, damaging the surrounding soft tissues.

Periodontal disease: the progression towards bone loss

If gingivitis is not treated, it can develop into periodontitis, a condition in which the destruction of the structures supporting the tooth cannot be reversed. Subgingival tartar, covered in plaque, builds up in the periodontal pockets and helps maintain a low-oxygen environment that favours harmful bacteria such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans.

The result is the gradual loss of the alveolar bone and periodontal ligament, leading to loose teeth and, in the most advanced cases, tooth loss. According to the WHO, severe periodontal disease is, together with advanced tooth decay, one of the main causes of tooth loss.

Root caries and lesions at the neck of the tooth

The plaque trapped by tartar produces acids that can demineralise the enamel and, above all, the root cementum exposed by gum recession. Root caries affect a tissue that is less resistant than enamel and can be difficult to treat because of their position.

Systemic implications: the link with general health

Scientific research has highlighted associations between periodontal disease and many systemic conditions; one of the mechanisms being studied is the passage of periodontal bacteria into the bloodstream through inflamed gums. The main associations concern:

• Cardiovascular disease: higher risk of atherosclerosis, heart attack and stroke
• Diabetes mellitus: a two-way relationship, with poorer blood sugar control
• Complications in pregnancy: higher risk of premature birth and low birth weight
• Respiratory disease: inhalation of oral bacteria into the lower airways
• Dementia: a possible association with cognitive decline and Alzheimer's disease

Professional removal: scaling

Once tartar has formed and hardened, it cannot be removed with a toothbrush or dental floss. It requires professional treatment: scaling (tartar removal).

Removal techniques: from manual to digital

Hand instruments: scalers and curettes remove tartar mechanically with controlled movements. This technique requires great manual skill and tactile sensitivity to avoid damaging the tooth surfaces and soft tissues.

Piezoelectric and magnetostrictive ultrasonic scalers: these are widely used in modern practice, and the EFP guideline considers both hand instruments and sonic or ultrasonic instruments valid, alone or in combination. Ultrasonic vibrations break up the tartar, while continuous irrigation washes away the debris and prevents overheating. The latest devices offer adjustable power and tips of different shapes, chosen according to the area being treated.

Laser technology: erbium lasers (Er:YAG, Er,Cr:YSGG) can be used to remove tartar, because their wavelength is absorbed mainly by water. However, the EFP guideline does not suggest their routine use in addition to conventional instrumentation, because additional benefits have not been shown.

Maintenance protocols: the ideal frequency

For people with healthy gums, the interval between professional sessions should be set by the dentist according to individual risk. For patients in supportive periodontal care, the EFP guideline recommends intervals of 3 to a maximum of 12 months, shorter when the risk is higher, for example with:

• A history of periodontal disease
• Risk factors (smoking, diabetes, genetic predisposition)
• Limited ability to clean their teeth at home
• Orthodontic appliances or complex prostheses

Find out how professional dental hygiene works at our clinic, how often it is recommended and why neglected tartar can lead to periodontitis.

Advanced prevention: evidence-based strategies

Next-level oral hygiene at home

Strategic brushing: the modified Bass technique, with the bristles angled at 45° to the gum line and short vibrating movements, is one of the most widely taught techniques for cleaning the gum line. According to the Cochrane review, electric toothbrushes reduce plaque and gingivitis more than manual ones, in both the short and the long term; the strongest evidence is for rotating-oscillating brushes.

Interdental cleaning: used in addition to a toothbrush, floss and interdental brushes can reduce gingivitis and plaque; interdental brushes have on average proved more effective than floss, and the EFP guideline recommends them where the space allows. The size of the brush should be chosen for each individual space between the teeth.

Water flossers: pulsating water-jet devices reach areas that are hard for traditional tools, but according to the Cochrane review the evidence on their effectiveness is limited and inconsistent.

Salivary biomarkers: predictive diagnostics

Research is studying molecular saliva tests that measure:

• Levels of specific periodontal bacteria
• Inflammatory markers (IL-1β, MMP-8)
• Alkaline phosphatase activity (linked to mineralisation)
• Saliva pH and buffering capacity

In future, these tests may help to assess each person's risk and tailor maintenance intervals; for now, they are still being studied.

Modulating the oral microbiome: probiotics and prebiotics

Research is exploring the use of selected probiotic strains (Lactobacillus reuteri, Streptococcus salivarius K12) to have a positive effect on the oral microbiome, reducing harmful bacteria and gum inflammation. Results are still limited: the EFP guideline does not suggest using them in addition to periodontal treatment.

Why personalisation matters: not all tartar is the same

The speed at which tartar forms varies considerably from person to person, depending on factors such as saliva composition, diet, age, general health conditions and medication. Some patients build up a lot of tartar despite meticulous hygiene, while others accumulate very little even with less-than-ideal hygiene.

Each patient's individual risk profile should guide the prevention strategy and how often they are recalled for professional cleaning. A personalised approach based on clinical, radiographic and biomarker assessment is the future of oral prevention.

When professional experience makes the difference

Removing tartar requires technical skill, clinical experience and advanced equipment. Choosing a qualified professional affects not only how effective the treatment is, but also the patient's comfort and the preservation of the tissues.

Dr Nihad Pljevljak, who trained at Sapienza University of Rome and holds a PhD in Oral and Dental Diseases, is a point of reference for anyone looking for excellence in preventive and therapeutic dentistry. His ten years of experience and continuous training in the latest technologies allow him to offer personalised treatment aimed at the best possible results.

At Nea Bios Dental Clinic in Rome EUR Laurentina, Via Cesare Pavese 135, Dr Pljevljak, registered with the Rome Order of Physicians and Dentists (Ordine dei Medici Chirurghi e Odontoiatri di Roma), has built a reputation for reliability, also treating high-profile patients in the EUR area.

Your smile deserves professional care

Don't wait for tartar to damage the health of your teeth and gums. Prevention is always the most effective and economical strategy.

Call the Nea Bios Dental Clinic reception Monday to Friday, from 9.00 to 13.00 and from 14.00 to 18.00, to book your check-up and scaling. Dr Nihad Pljevljak's team is on hand to answer any questions and tailor your oral health plan.

Investing in prevention today means protecting your smile for tomorrow.

Sources

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2. World Health Organization. Oral health. Fact sheet. 2025. WHO
3. Genco RJ, Sanz M. Clinical and public health implications of periodontal and systemic diseases: An overview. Periodontol 2000. 2020;83(1):7-13. PubMed
4. Sanz M, Herrera D, Kebschull M, et al. Treatment of stage I-III periodontitis-The EFP S3 level clinical practice guideline. J Clin Periodontol. 2020;47 Suppl 22:4-60. PubMed
5. Yaacob M, Worthington HV, Deacon SA, et al. Powered versus manual toothbrushing for oral health. Cochrane Database Syst Rev. 2014;(6):CD002281. PubMed
6. Worthington HV, MacDonald L, Poklepovic Pericic T, et al. Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries. Cochrane Database Syst Rev. 2019;4(4):CD012018. PubMed