Scale and polish: tartar, polishing, how often?

A scale and polish means removing tartar, the hard deposit that many people in Morocco call "calcaire" (limescale) on their teeth, and then polishing the teeth. You can brush your teeth every day and still need a scale and polish: this guide explains why, how the visit goes and what studies say about how often to have it. It is here to inform you; it does not replace an examination: every mouth is different.

Dental plaque and tartar: what is the difference?

Dental plaque is a soft, sticky layer of bacteria that builds up on the teeth throughout the day, especially along the gum line and between the teeth. It is often invisible, but a toothbrush used properly removes it.

Tartar is plaque that has not been removed and has hardened with the minerals in saliva. It forms a whitish, yellow or brown crust, often behind the lower front teeth and on the cheek side of the upper molars. It can also form under the gum, where you cannot see it.

"Limescale" on your teeth is tartar

In Morocco, people often say "calcaire" (limescale) for tartar. The picture is accurate: it is a hard mineral deposit, like in a kettle. The problem is that it is rough and holds plaque against the gum.

Why a toothbrush cannot remove tartar

Once it has hardened, tartar is stuck to the tooth: no brush, floss or mouthwash can lift it off. So-called "anti-tartar" toothpastes can slow the build-up of new tartar above the gum, but a literature review stresses that no benefit on gum inflammation or on decay has been shown from this effect (van Loveren and Duckworth, 2013, PubMed). Scraping tartar off yourself with a sharp object is not recommended: you could injure your gum.

Gingivitis and periodontitis explained simply

Gingivitis is inflammation of the gum caused by plaque: the gum becomes red, swollen and bleeds easily. According to the 2017 international consensus on the classification of gum diseases, it is above all this bleeding that defines gingivitis, and healthy gums can be restored after treatment (Chapple et al., 2018, PubMed). Gingivitis can therefore be reversed.

Periodontitis goes further: the inflammation gradually destroys what holds the tooth in place (the gum attachment and the bone around the root). Left untreated, it progressively destroys this support (Jervøe-Storm et al., 2024, PubMed); at an advanced stage, teeth can become loose. Even when treated and stable, a person who has had periodontitis keeps a higher risk of it coming back and needs close follow-up (Chapple et al., 2018, PubMed). Smoking and diabetes are recognised as factors that make periodontitis worse (Jepsen et al., 2018, PubMed).

A simple scale and polish treats visible tartar above the gum. With periodontitis, a deeper cleaning under the gum is needed (called scaling and root planing), often over several visits: it is the core of non-surgical treatment (Jervøe-Storm et al., 2024, PubMed).

How does a scale and polish work?

1. The examination: the practitioner looks for tartar, bleeding gums, decay or fragile fillings; if needed, they measure the depth between gum and tooth or ask for an X-ray.
2. The scaling: the tartar is removed tooth by tooth, top and bottom, front and back, then between the teeth.
3. The polishing: the surfaces are smoothed and stains are removed.
4. The advice: you are shown the areas where plaque stays and how to clean them.

Ultrasonic scaling

Scaling is most often done with an ultrasonic device: a thin tip vibrates very fast and breaks up the tartar, while a jet of water rinses and cools. Hand instruments (curettes) are used as well if needed. An expert review considers that ultrasonic devices and low-abrasive polishing powders cause less pain and discomfort than hand instruments alone (Bastendorf et al., 2020, PubMed). This is an expert opinion, not a comparative trial.

Tooth polishing

Tooth polishing comes after scaling. It is done with a small rubber cup or a small brush and a paste, or with a jet of air, water and fine powder. It removes stains (tea, coffee, tobacco) and makes the surface smoother, but it is not whitening.

Does a scale and polish hurt? Sensitivity and bleeding

A simple scale and polish is most often unpleasant rather than painful: vibrations, cold water, sharp sensations on sensitive areas. It is more uncomfortable when there is a lot of tartar, very inflamed gums or exposed roots. Say so if it hurts: the practitioner can adjust the power, take breaks or offer a local anaesthetic, especially for cleaning under the gum.

Sensitivity after the visit is common, especially to cold. A systematic review of deep cleaning under the gum (treatment of periodontitis) found root sensitivity in about half of patients after treatment; it increases for one to three weeks and then decreases (von Troil et al., 2002, PubMed). This finding is based on only two studies and concerns a deeper treatment than a simple scale and polish. If the sensitivity lasts or bothers you, talk to your dentist.

Bleeding during the visit is common when the gums are inflamed, and they may still bleed when you brush for a few days. Do not stop brushing your teeth: removing plaque is what allows the gums to heal. See your dentist if the bleeding is heavy, if it happens for no reason, or if it comes with fever, swelling or strong pain.

How often should you have a scale and polish?

You often hear "a scale and polish every six months". The evidence is more nuanced. A Cochrane review (a reference systematic review) compared, in adults without severe periodontitis who were already seeing a dentist regularly, a scheduled scale and polish every 6 or 12 months with no scheduled scale and polish (Lamont et al., 2018, PubMed):

These results come from only two studies (1,711 adults, in the United Kingdom). They do not say that a scale and polish is useless: a fixed schedule, the same for everyone, has not shown a clear benefit in people at low risk. When there is tartar, gingivitis or periodontitis, professional cleaning is part of the treatment.

In practice, how often depends on your risk: how fast tartar builds up again, the state of your gums, a history of periodontitis, smoking, diabetes, braces. Some people need a scale and polish several times a year, others less often. Your dentist suggests a schedule after examining you and can change it.

Scale and polish and braces

Fixed braces trap plaque, and the gums easily become inflamed around the brackets. According to the D.U. courses in orthodontics, teeth are not moved on inflamed gums: the forces of the braces combined with inflammation cause a loss of support that cannot be reversed. The gums are therefore examined before starting, and care continues during and after treatment. For a person who has had gum disease, the courses call for periodontal follow-up every two months during treatment.

A systematic review observed a temporary increase in certain bacteria under the gum after fixed braces were fitted, with a return to starting levels a few months later (Guo et al., 2017, PubMed); most of the 13 studies included had no comparison group. A scale and polish can be done before the braces are fitted, during treatment and after they are removed. The retainer wire bonded behind the lower teeth also traps plaque and tartar: it needs to be checked. See also the page on braces.

Myths about scale and polish

"A scale and polish damages the enamel"

Scaling targets tartar, not enamel. To be honest, though: a laboratory study on 120 tooth surfaces showed that ultrasonic devices leave microscopic marks, deeper on cracked enamel, early decay or a resin filling (Kim et al., 2018, PubMed). This is why the practitioner examines the teeth first, adjusts the device and does not use the instrument more than necessary. This risk is no reason to keep tartar, which keeps the gums inflamed.

"A scale and polish makes gaps between the teeth"

A scale and polish does not move teeth. But tartar can fill the spaces between the teeth and hide gums that have already receded; once it is removed, these spaces become visible, and swollen gums shrink as they heal. It feels as if the teeth have moved apart, when the space was already there. If a tooth really is loose, it is a sign of loss of support that should be examined.

Preventing tartar at home

• Brush your teeth twice a day, for about two minutes, with a fluoride toothpaste, paying special attention to the gum line.
• Clean between your teeth every day, with dental floss or interdental brushes in the size your dentist recommends. A Cochrane review concludes that floss or interdental brushes, in addition to a toothbrush, may reduce gingivitis or plaque more than brushing alone, and that interdental brushes might work better than floss (Worthington et al., 2019, PubMed); the evidence is of low certainty and the studies were short.
• Do not stop brushing gums that bleed: brush them gently but thoroughly.
• If you wear braces, follow the brushing method the team shows you.

In practice

1. Tartar ("calcaire") does not come off with a toothbrush: only a scale and polish at the dentist removes it.
2. Bleeding gums are a sign of inflammation: keep brushing and get them examined.
3. Mention sensitive teeth, diabetes, smoking or a history of gum disease before the visit.
4. After the visit, temporary sensitivity is possible; see your dentist if it lasts or bothers you.
5. Ask your dentist for a check-up schedule that fits your risk, rather than a fixed rule.
6. Brush your teeth twice a day and clean between your teeth every day.

Frequently asked questions

How long does a scale and polish take?

It depends on the amount of tartar and the state of your gums: a simple scale and polish is usually done in one visit, while deep cleaning under the gum may take several.

Does a scale and polish make teeth whiter?

It removes tartar and surface stains (tea, coffee, tobacco), which gives your teeth back their natural colour, but it does not change the shade of the tooth itself and it is not whitening.

Can I have a scale and polish during pregnancy?

Gums often bleed more during pregnancy, and a gum examination is useful; tell your dentist you are pregnant, and they will decide with you on the right timing and care, in contact with your doctor if needed.

Do I need a scale and polish before getting braces?

The gums must be healthy before teeth are moved: if there is tartar or inflammation, these are treated first, then care continues throughout treatment and after the braces are removed.