Does Teeth Scaling Damage Tooth Enamel?

What is dental plaque?

Dental plaque refers to dental plaque that is formed when oral microorganisms adhere to food residues, salivary glycoproteins, etc. on the tooth surface, and the biofilm (dental plaque) is secondarily hardened and calcified by minerals in the saliva (J Vet Dent, 1997). Teeth constantly repeat remineralization and demineralization, but if the biofilm on the teeth is not removed in time and left untreated, the calcium ions that should be attached to the enamel are absorbed by the biofilm, making it hard like a stone. Once dental plaque is formed, the teeth cannot recover through remineralization, and since the dental plaque does not allow oxygen to pass through well, anaerobic bacteria such as S. mutans can easily proliferate, and the acids they produce induce demineralization, causing tooth decay and inflammation in the gums, so the teeth cannot help but become weaker. So, it needs to be removed in time, but since tartar is difficult to remove with a toothbrush or interdental brush, dental treatment is necessary.

Dental plaque

Does scaling damage teeth?

Periodontal disease begins when oral bacteria in dental plaque attach to teeth (Clin Oral Implants Res 2006). Therefore, dental plaque removal is essential for maintaining oral health. In the past, plaque was directly scraped off with a manual scraping device such as Currete, but these days, it is mainly removed using an ultrasonic scaler (each has its own advantages and disadvantages, so there are cases where a manual hand scaler must be used as an auxiliary tool). Dental plaque can be divided into supragingival and subgingival plaque. Scaling is used to remove visible dental plaque, while root planing is used to remove subgingival plaque inside the gums. Ultrasonic scalers are more effective than manual scalers at removing hard and large dental plaque, and are known to cause less damage to enamel, but they are difficult to remove in detailed areas, fine dental plaque, or subgingival dental plaque.

Supragingival calculus(left) and subgingival calculus(right)

Principles and effects of scaling devices

A vibrating body that generates sound is called an acoustic source, and the sound energy generated from the sound source is transmitted in the form of waves with a certain frequency. The frequency of sound that humans can hear (audible frequency) is 20-20,000 Hz, and sound waves with a higher frequency are called ultrasonic waves (J Kor Orthop Assoc 2013).

A dental ultrasonic tartar remover is a medical device that rapidly vibrates the tip when the energy generated by ultrasonic waves is transmitted to the tip, breaking up tartar and cleaning the environment of the periodontal pocket (between the gums and teeth). The intensity of this vibration energy is called the vibration frequency and is expressed in Hz. 1 Hz is 1 cycle/sec, and although there are differences depending on the device, the vibration frequency of the tip is generally 18,000 - 60,000 Hz, and the heat generated during use is cooled using water. The action of ultrasonic waves and sprayed water creates small air bubbles that burst and create shock waves, which rupture the cell membranes of periodontal bacteria and kill them. The cavitation effect and the acoustic turbulence effect create a whirlpool within a certain space in the periodontal pocket, which effectively removes dental plaque and bacteria deep inside the gums (Korea Food and Drug Administration, 2015).

Dental ultrasonic tartar remover

Safety of Scaling

Ultrasonic and sonic scalers are clearly effective in removing plaque and have become indispensable equipment in dental treatment. However, there seems to be little research on their side effects.

Doctors say that ultrasonic scaling treatment does not cut the tooth enamel layer. No matter how hard you look for evidence on whether enamel can be broken at the maximum scaler specification of 60 kHz, it is not possible to find any evidence anywhere. Generally, it seems unlikely that ultrasonic scaling will wear away tooth enamel and expose dentin. However, this only applies to healthy teeth, and it does not mean that enamel is not worn at all.

As all mechanized equipment has its drawbacks, scalers also have the risk of mechanical damage to teeth depending on the contact time, tip angle, and pressure of the device. Scaling treatment does not damage the teeth including the enamel only when the side of the scaler is used, the scaler is continuously moved, the scaler is stayed on one tooth for less than 15 seconds, and no or minimal pressure is applied (Caiafa 2007; Holmstrom 2013b; McMahon 2013; Niemiec 2013). This is clearly an area that requires training, which is why it is important to have the procedure performed by a well-trained dental hygienist. On the other hand, this means that the scaling device already has such power that it can damage the teeth if performed by a less skilled person.

The tip of the scaler generates different amounts of energy depending on its location, and if used incorrectly, enamel can be seriously damaged.

And since everyone has different enamel thickness, tooth surface condition, and tooth composition ratio, it is difficult to apply the safety of the scaler to everyone. Children whose teeth structure is not complete, those with early caries symptoms, those whose enamel has worn away due to aging and the gums are exposed, those with fine cracks (crack lines), those with resin treatment, and those with cervical lesions in particular may be damaged even when ultrasonic scaling is performed.

Non-carious cervical lesions causing hypersensitivity such as numbness

Things to keep in mind when receiving scaling treatment

Since scaling has been covered by health insurance since 2013, the number of patients receiving scaling has increased significantly. The fact that patients who have received scaling often complain of hypersensitivity such as numbness means that scaling is performed on lesions that can be seen with the eyes, and there are many cases where hemorrhoids are removed as a result. Since scaling is performed by dental hygienists, not doctors, there is no separate medical history check and there is no way to select a skilled practitioner. However, if periodontal disease has occurred due to tartar, the risk of it is much more urgent than the risk of tooth damage, so it is best to receive treatment as soon as possible. Before receiving the treatment, tell as much as possible about your dental history and any discomforts you have.

 

Insurance coverage for scaling procedures

In Korea, scaling is not a treatment but a preventive treatment, so it is covered by health insurance once a year from January to December every year for those over 19 years of age. If you get scaling done at a local dental clinic (clinic), it will cost about 15,000 won. When I got it done in my neighborhood in December last year, I paid 15,300 won. This is applied differently depending on the medical institution, so if you get it done at a hospital, it will cost about 24,700 won, and if you get it done without insurance, it will cost about 50,000-60,000 won. If you do not have any special periodontal disease and do not have much tartar, scaling will not be painful and will be over quickly (it took me about 5 minutes), and there will be almost no swelling or gum swelling after the treatment, but it is impossible for the teeth and gums to be completely irritated, so avoid spicy, salty, hot, or cold foods after the treatment. 

※ Additional

I got scaling again this year after 2 years. My gums are receding and I have numbness on the top of my teeth. Last time at the dentist, they scaled the receding gums and I thought I would die because of the numbness.. This time at the dentist, they said that the receding gums are where the enamel is damaged and the yellow dentin is visible or exposed, so if scaling is done here, not only will the numbness be a problem, but the teeth may actually be receding.

If you have sensitive teeth on top due to gum damage caused by excessive brushing, you should inform your dental hygienist before scaling.

On YouTube, dentists demonstrate scaling devices with their bare hands and compare them to teeth being ground with a tooth-removing tool, saying that scaling devices absolutely do not damage teeth. However, I think it is difficult to detect the degree of damage with the naked eye unless you look at it through a microscope. Even if there is damage to the teeth that is not visible to the eye, scaling once or twice is not a problem, but when looking at it in the long term, twice a year for several decades throughout life, even small damage cannot be ignored.

In addition, there are teeth like mine whose enamel has already been damaged. Scaling should not be done carefully or in these areas, but the scaling methods and skills of dental hygienists who do scaling work are like heaven and earth. There is no way to detect it before the teeth are removed, so it is a hit or miss.

So I don't think it is good to scale too often. I think it's better to have regular dental checkups, but rather than frequent scaling, it's better to take care of your teeth diligently with a sonic toothbrush (I've never seen a dentist recommend a sonic toothbrush. Is it because dentists wouldn't make money if everyone used sonic toothbrushes?) and floss. I got my teeth scaled after two years, and they said I didn't have much tartar.