Treatment of Excessive Calcium Deposits on Teeth (Dental Calculus)
Professional mechanical removal through scaling and debridement by a dental professional is the definitive treatment for dental calculus, as chemical agents can only prevent formation but cannot remove existing mineralized deposits. 1, 2
Understanding Dental Calculus Formation
Dental calculus is mineralized bacterial plaque composed primarily of calcium phosphate mineral salts deposited between remnants of microorganisms. 2 The formation occurs when:
- High salivary pH and elevated concentrations of calcium, phosphorus, magnesium, and urea promote precipitation of calcium-phosphorus and calcium oxalate crystals 1
- Bacterial biofilm mineralizes when exposed to these ions from saliva or crevicular fluid 3, 2
- Most common locations are buccal surfaces of maxillary molars and lingual surfaces of mandibular anterior teeth, where salivary ducts open 4, 5
Primary Treatment: Professional Removal
Supragingival calculus (above the gumline):
- Requires professional scaling to mechanically remove hardened deposits 2
- Cannot be removed by brushing or chemical agents once mineralized 6, 2
Subgingival calculus (below the gumline):
- Requires professional subgingival debridement and root surface detoxification 2
- Removal is the cornerstone of periodontal therapy and essential to prevent periodontal disease progression 2
- In populations without regular professional care, subgingival calculus is directly correlated with enhanced periodontal attachment loss 2
Prevention of Recurrence
Chemical mineralization inhibitors in toothpastes can delay future calculus formation but do not remove existing deposits: 6, 2
- Zinc ions (zinc chloride or zinc citrate) inhibit crystal growth 6
- Pyrophosphates alone or combined with copolymer prevent mineralization 6
- Triclosan with copolymer reduces plaque substrate for calculus formation 6
- These agents keep deposits in an amorphous non-hardened state to facilitate removal with regular brushing 2
Important limitation: Chemical additives do not reach deeper periodontal pockets and are only effective for supragingival calculus prevention 6
Maintenance Protocol
For patients with regular access to dental care: 2
- Professional cleanings at intervals determined by individual calculus formation rate
- Daily brushing with anti-calculus toothpaste containing zinc or pyrophosphates 6
- Flossing to remove plaque before mineralization occurs 1
For patients with chronic kidney disease or dialysis: 1
- More frequent professional cleanings due to elevated salivary calcium, phosphorus, and alkaline pH that accelerates calculus formation 1
- These patients have significantly higher dental calculus formation rates than healthy controls 1
Critical Pitfalls to Avoid
- Do not rely on chemical agents alone to treat existing calculus—they only prevent new formation, not remove established deposits 6, 2
- Do not delay professional removal in patients with subgingival calculus, as it harbors bacterial biofilm on rough surfaces and promotes periodontal disease 6, 2
- Do not assume calculus is purely cosmetic—subgingival deposits may expand the radius of plaque-induced periodontal injury and contribute to attachment loss 2
- In patients with systemic conditions (chronic kidney disease, metabolic disorders), address underlying metabolic imbalances that accelerate calculus formation 1