Tartar is mineralised plaque that forms on the surface of the teeth, usually as a result of poor oral hygiene. Plaque is made up of bacteria, food debris and saliva proteins. If plaque is not regularly removed by brushing and cleaning between teeth, it can harden and become tartar. Tartar is rough and can cause gum irritation, lead to gingivitis and contribute to the development of other oral health problems, such as periodontitis.

How common is tartar buildup?

Tartar is a very common oral health problem. Almost all adults have tartar buildup at some point in their lives, and the incidence increases with age. Here are some important facts to help you understand how common tartar is:

Adults: Most adults will get tartar at some point. The risk increases with age as plaque builds up over time, and possibly oral hygiene can also deteriorate, for example as fine motor skills in the hands deteriorate.

Adolescents and children: Although tartar is more common in adults, it can also occur in adolescents and children, especially if oral hygiene is poor.

Risk groups: Certain groups of people are more prone to developing tartar. These include smokers, diabetics, people with dry mouth, and people with certain types of eating habits (e.g. high consumption of sugary and starchy foods).

Tooth location: Plaque is usually more likely to form on the mandibular incisors and maxillary molars, as the salivary glands are located close to these teeth and saliva can contribute to plaque mineralisation.

How can I prevent the formation of tartar?

Regular and careful oral hygiene is the best way to prevent tartar. Tartar cannot be completely prevented, but the amount and effects can be significantly reduced through good daily oral hygiene and professional cleanings.

Regular brushing: brush your teeth twice a day for at least two minutes at a time with a fluoride toothpaste. Use a soft toothbrush and brush thoroughly on all tooth surfaces, including the gum line.

Use a floss, brush or other interdental cleaning tool daily to remove plaque between teeth where the toothbrush cannot reach.

Healthy diet: avoid sugary and starchy foods and drinks that contribute to plaque formation. Eat healthy foods, such as fruit and vegetables, that promote saliva production and help keep your mouth clean.

Regular dental visits: go to your dentist regularly for check-ups and cleanings. A dental hygienist can remove tartar that you cannot remove yourself at home.

Complementary treatment: regular use of the Lumoral antibacterial treatment reduces the amount of bacteria in your mouth and helps prevent plaque and tartar build-up.

Why do you need to remove tartar?

‘When the tooth surface is rough due to tartar, it is easy for new bacteria to accumulate on the surfaces of the teeth. These bacteria, together with tartar, irritate the gums and cause gingivitis. You cannot remove tartar yourself at home, but dentists and dental hygienists give patients an anti-infective treatment to remove tartar and reduce the amount of bacteria in the gum pocket.’ Viivi Soikkeli, dental hygienist at Hampaasi Dental Clinic in Helsinki, Finland, explains.

Lumoral antibacterial treatment is used as a complement to mechanical tooth cleaning.

‘Lumoral treatment is based on the fact that it effectively reduces the amount of plaque in the mouth, while also reducing the build-up of plaque and tartar,’ says Soikkeli.

Studies have shown that regular antibacterial treatment as an adjunct to conventional non-surgical standard treatment reduces gum inflammation and improves oral hygiene and the healing of deep pockets in chronic periodontitis compared to conventional treatment.

Antibacterial treatment has also been shown to prevent and help reduce inflammation in the tissues surrounding implants. It is suitable for everyone, but light-activated antibacterial treatment is considered most effective for patients who need to improve their oral hygiene.

Unlike conventional antibacterial mouthwashes, which affect the whole mouth and also remove the good bacteria that we need, Lumoral treatment targets only plaque, reducing bacterial and tartar build-up.

‘I recommend Lumoral especially to customers who have a lot of tartar,’ says Soikkeli.

Dental and oral bacteria have been linked to numerous chronic diseases throughout the body. Recent research indicates that thorough brushing and regular dental visits can also play a role in preventing strokes (1).

According to statistics from the World Stroke Organization (WSO), over 13 million people globally suffer from strokes each year, with one in four individuals experiencing a stroke in their lifetime. Surprisingly, up to 90% of these cases could be prevented through lifestyle changes such as adopting a healthier diet, increasing regular exercise, quitting smoking, and even improving oral hygiene practices (2).

In his recent doctoral dissertation in forensic medicine at the University of Tampere, Medical Licentiate Olli Patrakka examined the significance of oral bacteria, particularly viridans group streptococci, in stroke development. While these bacteria are normal mouth microbes, they can lead to serious illnesses like heart valve inflammation when entering the bloodstream, such as through inflamed gums during teeth brushing. (3).

Olli Patrakka suggests that these bacteria, attaching to tooth surfaces and initiating plaque formation, may similarly contribute to stroke and atherosclerosis development when entering arterial walls via the bloodstream during dental procedures or infections.

Poor oral hygiene is a risk factor for strokes

According to Patrakka, dental bacteria are present in the blood clots of stroke patients in about four out of five cases, with similar results yet to be reported. Blood clots were collected from stroke patients undergoing acute care in Tampere, Finland, for the study, along with samples from patients with symptomatic carotid artery stenosis used as endarterectomy tissues. (3).

Epidemiological studies have identified poor oral hygiene as an independent risk factor for strokes. Patrakka suggests that the inflammatory reaction induced by dental bacteria in atherosclerotic plaques could explicitly explain this connection.

The dissertation's findings are significant as they present new opportunities for stroke patient treatment development, Patrakka says. He also believes that the development of a vaccine may also be now feasible.

Patrakka stresses that while further research is necessary to establish causality, the study supports the importance of oral health, particularly in individuals at risk of srokes. He emphasizes that considering the inflammation caused by streptococcal bacteria in the mouth is crucial in stroke prevention as part of routine dental care. Moreover, investigating the potential benefits of timely antimicrobial treatment or bacterial vaccines in the future is essential.

Periodontitis is the root cause of many ailments

Studies show dental plaque bacteria are responsible for about 95 per cent of oral diseases. One of the most common oral diseases is periodontitis, a severe gum disease caused by dental plaque. Early signs of this disease include red gums, gum bleeding, and bad breath. (4)

In patients with periodontitis, the fibres that attach the tooth to the gum are destroyed, forming a periodontal pocket between the gum and the tooth. This pocket may expand around the entire tooth. If the infection is not treated promptly and oral hygiene is not improved, it can progress to destroy more extensively the supporting tissues of the teeth and, ultimately, the jawbone. (4)

Thorough oral hygiene is crucial for the prevention and treatment of oral infections. According to the Oral Health Foundation one-in-four (26%) British adults regularly brush their teeth only once a day raising concerns about the number of people willing to skip twice-daily brushing. (5)

The charity is especially worried by the number of people who regularly fail to brush their teeth last thing at night, when the health of the mouth is most likely to deteriorate.  Insights from the research show that one-in-four (25%) do not brush their teeth in the evening before they go to bed. (5).

Deficiencies in oral hygiene are directly reflected in the statistics of oral infectious diseases. More than 45% of adults in the UK are currently being affected by gum disease. Meanwhile, 10% are living with the most severe form, which can lead to tooth loss. (6)

Thorough mechanical brushing of teeth and cleaning of the interdental spaces are crucial because even asymptomatic oral inflammations can affect the body's overall health. According to statistics, individuals with healthy mouths even live longer, research shows (7).

– Every missing tooth reduces life expectancy. This is talked about far too little, says Tommi Pätilä, a heart and transplant surgeon at HUS New Children's Hospital in Helsinki, Finland.

Pätilä is also one of the developers of the antibacterial Lumoral method. Lumoral is a medical device designed to improve oral hygiene and oral health. The antibacterial oral care method is especially suitable for patients with difficult-to-treat gum diseases such as periodontitis who do not get adequate results from traditional oral hygiene methods such as brushing teeth and cleaning interdental spaces. (8, 9, 10).

The effectiveness of the novel oral health enhancing device relies on antimicrobial photodynamic therapy (aPDT), also referred to as photoantimicrobial chemotherapy. While this technology is already prevalent in dental clinics, the advent of a home-use device allows for more frequent application of this antibacterial treatment. (11)

aPDT technology itself utilizes light energy and a photosensitizer to generate an antimicrobial effect that eliminates problem-causing plaque bacteria from the mouth. Due to its targeted approach aPDT does not lead to bacterial resistance. (11)

The importance of interdisciplinary collaboration

According to Pätilä, the recent medical dissertation at the University of Tampere holds significance as it integrates oral health into overall body health. Enhancing collaboration between doctors and dentists is crucial and needs improvement across various European countries. While many medical doctors already evaluate their patients' oral health at clinics and refer them for additional treatment when needed, closer collaboration is essential.

Diabetes serves as a prime example of a disease where the importance of underlying inflammations is widely acknowledged. However, heightened collaboration is necessary to accelerate diagnoses and even prevent several common diseases.

Olli Patrakka's interest in oral bacteria stemmed from his responsibilities as a pathologist. Has the interest of young doctors in the impact of dental infections on general health increased?

– It hasn't increased significantly, but it should. In my basic medical training about five years ago, there was minimal discussion of the impact of dental infections on overall health. While the topic is relatively new, it's crucial that awareness and scientific evidence grow over time.

Patrakka underscores the importance of general practitioners recognizing when a dental issue necessitates a referral to a dentist. This could streamline the treatment of oral infections and potentially aid in achieving a balance in treating various general diseases.

– My research contributes to the growing evidence that oral health significantly influences overall health. The blood vessels of the tooth pulp directly connect to the systemic circulation. Therefore, if teeth are in poor condition, bacteria and their byproducts can circulate directly into our bodies.

References:

1. Shahi S, Farhoudi M, Dizaj SM, Sharifi S, Sadigh-Eteghad S, Goh KW, Ming LC, Dhaliwal JS, Salatin S. The Link between Stroke Risk and Orodental Status-A Comprehensive Review. J Clin Med. 2022 Oct 2;11(19):5854. doi: 10.3390/jcm11195854. PMID: 36233721; PMCID: PMC9572898.
2. Sen S, Giamberardino LD, Moss K, Morelli T, Rosamond WD, Gottesman RF, Beck J, Offenbacher S. Periodontal Disease, Regular Dental Care Use, and Incident Ischemic Stroke. Stroke. 2018 Feb;49(2):355-362. doi: 10.1161/STROKEAHA.117.018990. Epub 2018 Jan 15. PMID: 29335336; PMCID: PMC5780242.
3. https://trepo.tuni.fi/bitstream/handle/10024/154588/978-952-03-3315-7.pdf?sequence=2&isAllowed=y
4. Saini R, Saini S, Sharma S. Biofilm: A dental microbial infection. J Nat Sci Biol Med. 2011 Jan;2(1):71-5. doi: 10.4103/0976-9668.82317. PMID: 22470238; PMCID: PMC3312703.
5. Mehrotra N, Singh S. Periodontitis. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541126/
6. Oral health: What is gum disease? | British Dental Journal, Published 10 March 2017, Issue Date10 March 2017, DOI: https://doi.org/10.1038/sj.bdj.2017.196
7. Friedman PK, Lamster IB. Tooth loss as a predictor of shortened longevity: exploring the hypothesis. Periodontol 2000. 2016 Oct;72(1):142-52. doi: 10.1111/prd.12128. PMID: 27501497.
8. Pakarinen S, Saarela RKT, Välimaa H, Heikkinen AM, Kankuri E, Noponen M, Alapulli H, Tervahartiala T, Räisänen IT, Sorsa T, et al. Home-Applied Dual-Light Photodynamic Therapy in the Treatment of Stable Chronic Periodontitis (HOPE-CP)—Three-Month Interim Results. Dentistry Journal. 2022; 10(11):206. https://doi.org/10.3390/dj10110206
9. Nikinmaa S, Alapulli H, Auvinen P, Vaara M, Rantala J, et al. (2020) Dual-light photodynamic therapy administered daily provides a sustained antibacterial effect on biofilm and prevents Streptococcus mutans adaptation. PLOS ONE 15(5): e0232775. https://doi.org/10.1371/journal.pone.0232775
10. Nikinmaa S, Moilanen N, Sorsa T, Rantala J, Alapulli H, Kotiranta A, Auvinen P, Kankuri E, Meurman JH, Pätilä T. Indocyanine Green-Assisted and LED-Light-Activated Antibacterial Photodynamic Therapy Reduces Dental Plaque. Dentistry Journal. 2021; 9(5):52. https://doi.org/10.3390/dj9050052
11. Jao Y, Ding SJ, Chen CC. Antimicrobial photodynamic therapy for the treatment of oral infections: A systematic review. J Dent Sci. 2023 Oct;18(4):1453-1466. doi: 10.1016/j.jds.2023.07.002. Epub 2023 Jul 11. PMID: 37799910; PMCID: PMC10548011.

The Nokia Rubber Workers' Sickness Fund (Nokian Kumiväen Sairauskassa) has entered into a partnership agreement with Finnish health technology company Koite Health Oy, deciding to increasingly focus on the oral health of its insured members. The fund will now reimburse the costs of Lumoral treatment for its insured members, providing a valuable additional benefit for maintaining oral health.

Lumoral is an innovative Finnish health technology solution that supports users' oral health by treating and preventing infections of the teeth and gums. The fund sees its solution as an important step towards preventive healthcare.

– The decision is based on thorough consideration and discussions with the fund's board. The board recognized the opportunities offered by the Lumoral device and unanimously decided to approve it as part of the benefits offered by the sickness fund, says Piia Virolainen, CEO of the Nokia Rubber Workers' Sickness Fund.

Piia Virolainen, CEO of the Nokia Rubber Workers' Sickness Fund.

Studies show that poor oral health is one of the major risk factors behind many common diseases, as inflamed gums and damaged tooth surfaces provide a direct route for bacteria.

– Oral infections are remarkably common globally, and they contribute to the onset of serious conditions such as cancer, diabetes, heart, lung, and kidney diseases, says Tommi Pätilä, a heart and organ transplant surgeon at HUS Children's Hospital, in Helsinki. Pätilä is also one of the developers of the Lumoral method.

– As the population ages, we are inevitably heading towards difficult times in healthcare and its financial management. Oral infections significantly increase the need for hospitalization and its complications. Therefore, investing in oral care and its comprehensive understanding – especially in the prevention of dental diseases – pays off multiple times in the future, Pätilä continues.

Oral diseases are a significant expense

According to Virolainen, the decision will practically mean that regular Lumoral treatment, including Lumorinse tablets, will be covered for the health fund's insured members as part of the fund's dental benefit.

– Regular Lumoral treatment has an impact on oral health, but it also affects the overall well-being of its users. The Nokia Rubber Workers' Sickness Fund is constantly striving to improve the well-being and health of its insured members. The reimbursement of Lumoral device and Lumorinse tablets is one step towards this goal, emphasizes Virolainen.

Virolainen states that the Nokia Rubber Workers' Sickness Fund reimburses the most research and treatment costs. The next highest reimbursement is for insured members' dental treatment costs.

– Dental diseases can lead to significant costs, making our fund's dental benefit a highly valued and frequently utilized resource among our insured members. Quick access to dental care, without the inconvenience of waiting, is considered essential by our insured members, Virolainen adds.

According to Lumoral Area Manager Riikka Nisula, local dental clinics have eagerly welcomed the decision of the Nokia Rubber Workers' Sickness Fund to reimburse Lumoral and Lumorinse tablets because prevention and enhancing self-care support professional treatment.

The antibacterial Lumoral treatment effectively removes harmful bacteria from the surfaces of the teeth and gum lines. Home-administered Lumoral treatment has been found to be significantly more effective and better tolerated than chlorhexidine-based mouthwashes, which are commonly used today.

Nisula emphasizes that the antibacterial treatment is carried out as an additional treatment to mechanical teeth cleaning and does not replace the need to brush teeth and clean between teeth. So why is additional treatment to enhance mechanical oral hygiene needed?

According to studies, brushing teeth removes only 65% of plaque. Residual plaque remains in the mouth after even the most effective teeth brushing. Lumoral helps to remove this residual plaque. With regular Lumoral treatment, the tooth surfaces are properly cleaned.

Antibacterial treatment has also been shown to prevent and treat infections of the tissues surrounding implants. The treatment is suitable for everyone, but light-activated antibacterial treatment is seen as most effective for patients who need enhanced oral hygiene.

The Nokia Rubber Workers' Sickness Fund is a so-called supplementary fund that reimburses insured members for additional benefits according to its rules. The fund has about 1,200 insured members. Altogether, there are about 110 health funds operating in Finland, whose insured members consist of employees and/or office personnel. In many funds, retirees can continue to be insured by the fund, and in some funds, family members are also entitled to reimbursements.

For more information:  

Sakari Nikinmaa
CEO, Koite Health
+358 40 8222 034, sakari@koitehealth.com

Piia Virolainen
CEO, Nokian Kumiväen Sairauskassa
+358 50577015,5 toimisto@nokiankumivaensairauskassa.fi