Introduction

Tartar, also known as dental calculus, is a hard deposit of plaque that accumulates on the teeth's surface over time, which, if left untreated, can cause severe gum disease. Tartar is mainly composed of calcium phosphate, a mineral derived from saliva. Interestingly, it provides multiple understandings of prior human behaviours and corresponding health effects. For instance, activities such as tobacco use may substantially influence oral as well as overall health.¹ Many factors are crucial in determining tartar formation, such as bacterial biofilm, saliva composition, hygiene habits, and diet. Diets rich in fats and sugars increase the risk of tartar deposition, while high-protein diets seem to protect oral health.

However, tartar appears to originate differently among individuals; in fact, some of them develop it rapidly, although they have good oral hygiene, forcing them to require more frequent dental visits.² Age plays a crucial role in tartar formation; indeed, adults are more likely to have general oral issues, including tartar formation, especially due to prolonged plaque retention and life habits.³ In contrast, children develop tartar less frequently, though during adolescence they become more susceptible, probably due to an increase in sex hormones. Therefore, education about correct hygiene habits should be prioritised before they reach puberty, contributing to better oral health in adulthood.⁴

Factors influencing tartar formation in children vs. adults

Biological and developmental factors

One of the factors that can determine tartar formation is saliva, whose composition and properties have an important impact on its development. Saliva is made up of components like proteins, electrolytes, mucins and bacteria that play a significant role in regulating oral health due to its moisturising, stabilising and antimicrobial properties. However, residual bacterial plaques on the teeth surface, which can be due to a lack of oral hygiene for a long time, undergo calcification upon contact with elevated salivary pH and an excessive flow rate, increasing the risk of tartar accumulation.² Therefore, after tooth eruption or teeth cleaning, generally, there is a rapid absorption of the pellicle proteins onto the enamel, leading to bacterial adhesion and biofilm development. The biofilm keeps maturing till it forms plaque. Right after, the contact with salivary mineralising agents contributes to plaque mineralisation, calcium phosphate precipitation and final tartar formation.⁵

Plaque accumulation and tartar development

As mentioned, bacteria produce biofilm layers on the teeth's surface, which, if left unwashed for days, begin to mineralise, so tartar builds up.⁶ Tartar builds up in both supragingival (above the gingiva) and subgingival (below the gingiva) environments, depending on the bacterial composition of the oral cavity. In supragingival plaque, tartar derives from salivary secretions harbouring a diverse range of bacteria, whereas in the subgingival plaque, it originates from gingival crevicular fluid and promotes anaerobic bacteria growth, like Porphyromonas gingivalis and Treponema denticola, which are strongly related to periodontitis.⁵ However, the oral microbiome changes over the years depending on the stages of tooth eruption. 

Predentate infants (0-6 months) primarily host maternal bacteria. The primary dentition stage (6 months - 6 years) introduces new bacterial niches. The mixed dentition stage (6-12 years) presents with both primary and permanent teeth. This transition influences oral microbiome composition, leading to an increased risk of plaque and tartar development. While in the permanent dentition stage (12+ years), the microbiome stabilises. Though if proper oral hygiene is lacking, plaque can still accumulate, promoting tartar formation.⁷

Furthermore, the risk of tartar is higher in these stages, especially in children with orthodontic devices, as they make it easier for plaque to accumulate and subsequent difficulties in its removal. Food particles may get stuck in between, making oral hygiene more challenging, with consequent unremoved plaque, which hardens into tartar.⁸

Dietary and lifestyle factors

Oral hygiene practices

Correct oral hygiene practices are fundamental to control bacterial plaque, which is responsible for caries and other periodontal diseases. Although factors like age, sex, and socio-economic status influence oral health, habits such as the proper use of a toothbrush and floss can play a crucial role in removing plaque accumulation, thus preventing the subsequent tartar formation. However, a study demonstrated that there is a strong correlation between children and their parents regarding oral hygiene habits. For instance, parents who visit the dentist only when a problem occurs have children with the same behaviour. On the other hand, parents who go every 3-6 months to the dentist have children accustomed to the same routine. Additionally, the frequency of brushing and the use of flossing, whether or not, are nearly the same between children and parents. Thus, establishing family education appears to be fundamental to prevent oral issues.⁹

Age and gender

Age is significantly related to an increased buildup of tartar. When people age, they might have reduced motor skills, so it may be harder for them to properly take care of their teeth.

Also, gender-based variances in the tartar amassment imply that males might be somewhat more susceptible than females, who clean their teeth with more consistency.

Diet 

Diet has a significant impact on tartar formation. Specifically, sugary and starchy foods usually work as a base for plaque formation. In addition, certain acidic foods and beverages may erode tooth enamel, possibly leading to plaque amassment. 

In contrast, vegetables and fruits increase saliva production, which in turn helps clean teeth naturally while lowering the odds of tartar. 

Smoking

Smoking represents another important risk factor in tartar amassment, modifying saliva composition and immune response as well as oral microbiota. Research reveals tobacco use has associations with multiple kinds of gum issues, like the amassing of large tartar, especially among younger people.¹⁰

Prevention and management of tartar

To prevent and handle dental calculus, some recommendations should be followed, such as routine dental appointments, good oral hygiene practices at home, and care from a dentist in their practice. It is very important for children to visit the dentist early to form good behaviours, along with keeping hard deposits from fully developing. This could be beneficial as well for adults, who gain advantages from consistent expert cleanings to take care of the built-up hard deposits.⁶

Moreover, using fluoride toothpaste along with mouthwash is very important in lessening plaque accumulation and mineralisation, with further prevention of oral diseases like cavities or tartar. In addition, if accompanied by interdental cleaning devices like floss and water flossers, getting to spots past the toothbrush promotes better oral health.¹¹

Otherwise, professional practices in managing tartar deposits include scaling and root planing, especially in adults. These together get rid of tartar from under the gums and make root surfaces smooth, which helps the gums reattach and also reduces bacterial growth.⁶

On the other hand, children usually receive regular cleanings. They also get protective actions, including:¹¹

• Fissure sealants act as a physical barrier that protects the deep grooves and pits of teeth, preventing bacteria and food particles from accumulating
• Extra fluoride treatments like fluoride tablets, toothpaste, mouthwashes, and fluoride varnish therapy, which are completely safe, effective, and efficient for protecting teeth as they grow

These combined strategies certainly guarantee a thorough approach for maintaining optimal oral health and considerably lowering the chance of periodontal diseases in the long term.

Summary

Tartar formation is different between children and adults. Its development is influenced by several factors, including oral hygiene habits, age, diet, and lifestyle. Although it is not usual for children to have tartar, during puberty, their hormones shift, making some of them more likely to build up tartar. Moreover, when people age, they may have less capacity to maintain oral hygiene. When combined with unhealthy diets or tobacco use, this leads to increased tartar buildup and a higher risk of gum disease. Maintaining a proper oral care routine from childhood is essential to keep healthy teeth in adulthood. Regular brushing, flossing, and professional dental check-ups are key to preventing plaque accumulation and tartar formation. Additionally, it is highly recommended that parents teach their children good hygiene practices, as early education can set up the foundation for healthier mouths in adulthood. Overall, coherently approaching oral hygiene, starting from family education to professional cleanings and fluoride treatments, can remarkably reduce the risk of tartar buildup and other correlated oral diseases. Once again, encouraging good dental care habits from childhood and maintaining them over the years represents the key to ensuring long-term oral health.