Dental calculus: the stuff brushing cannot remove

There is a point at which the problem in your mouth stops being something you can do anything about.

Plaque is soft. You can brush it off, floss it out, and keep on top of it entirely at home. Left alone for a couple of days, it takes up minerals from your saliva and sets hard, and at that moment it becomes calculus.

After that, no toothbrush will move it. Not a better brush, not an electric one, not brushing harder or longer. It is bonded to the tooth and it comes off with an instrument or not at all.

That single fact is the whole reason professional cleans exist.

What it looks like and where it hides

The part you can see is usually a yellow or brown crust, most often on the inside of the lower front teeth and around the outside of the upper back teeth. Those are the spots nearest the salivary glands, which is why they set first.

The part that matters is the part you cannot see, under the gum line. That is where calculus does its actual damage, and it is why "my teeth look fine" is not evidence of much.

Why it is worse than the plaque it came from

Calculus is rough and porous, where enamel is smooth.

That has two consequences. It gives fresh plaque an excellent surface to cling to, so build-up accelerates once it starts. And it soaks up colour from coffee, tea, wine and smoking, which is why it stains far more readily than your teeth do.

So the deposit is not just sitting there. It is actively making the next stage worse.

What it does to gums

Below the gum line, calculus holds bacteria hard against the gum where nothing can disturb them.

The gum responds with inflammation. That is gingivitis, and it is the reason for the pink in the sink when you brush. At that stage it is very reversible.

If it continues, the gum starts to detach from the tooth, opening a space that a brush cannot reach at all. Inside that space, the process works on the bone and fibres that hold the tooth in place. That is periodontitis, and unlike gingivitis it does not fully reverse. Gum disease is the leading cause of tooth loss in adults, ahead of decay.

The unfair part is that it is usually painless until teeth start to feel loose, which is late.

There is more on this here: what your mouth says about the rest of your health.

Removing it

A scale and clean. Ultrasonic instruments break the deposits up with high-frequency vibration and water, and hand instruments take care of the finer work and anything below the gum line. The teeth are then polished smooth, which slows the next lot down.

For most people this is comfortable and more odd than painful. Where there is a lot of build-up, or it extends deep below the gum, we can numb the area. Gums that are already inflamed are more tender, which is an argument for coming more often rather than putting it off further.

If gum disease has gone beyond the early stage, deeper cleaning of the root surfaces may be needed. That is a bigger appointment, done numb.

Do not try this at home

Home scrapers are sold, and they are a bad idea.

The instruments are sharp, the enamel is easy to scratch, the gum is easy to cut, and you cannot see below the gum line at all. What you are most likely to achieve is a scratched tooth surface that collects plaque faster than before.

Tartar-control toothpaste is worth using, but understand what it does. It slows new build-up. It does not dissolve what is already there.

Slowing it down

You cannot stop calculus entirely. You can change how fast it forms.

• Brush twice a day, angled into the gum line. That junction is the spot most people miss and the spot where this all starts.
• Clean between the teeth daily, with floss or interdental brushes. The contact points are where the brush cannot reach.
• Do not scrub. Hard brushing does not remove tartar and does wear enamel and push gums back.
• Cut down on grazing, since every eating episode feeds the plaque.
• Stop smoking if you can. It increases build-up and it hides the bleeding that would otherwise warn you about your gums.

Some people just form it faster

Worth saying plainly, because people take this personally.

The mineral content of saliva varies from person to person, and some people build calculus quickly no matter how well they clean. That is not a failure of effort.

If that is you, the answer is a shorter interval between cleans, not more scrubbing at home. Six months suits most people. Some do better at three or four, and that is a normal recommendation rather than an upsell.

The bottom line

There is a part of this you can do and a part you cannot, and the line between them is a couple of days.

Your job is stopping plaque from setting. Ours is removing what did anyway, including the part under the gum that you have no way of reaching.

A full check-up and clean is a fixed $249, which covers the exam, the scale and clean, fluoride and any bitewing x-rays you need. We claim your health fund on the spot, and many funds cover it in full.