Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

July 18, 2016

Would I let a rough hygienist clean my teeth?


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Dr. Hall,
All of my top teeth (except the molars) have porcelain crowns. I was advised years ago not to have a Cavitron used to clean the crowns. I recently had my teeth cleaned by a new hygienist who became very upset when I asked her not to use the machine. She scaled my crowns with so much force that it was painful and I really worried she would break them. The 4 center teeth do not have a metal lining behind the porcelain and I treat them very carefully. Which is the lesser of two evils – the Cavitron or a brutal hygienist scaling my porcelain crowns with hand instruments? Could there really be that much plaque on a porcelain surface?
– Elizabeth from Massachusetts

Elizabeth,
I’m getting a lot of these Cavitron questions lately. I think that’s because their use is getting more popular with dental hygienists.

The Cavitron by itself won’t hurt your porcelain crowns or other porcelain restorations. See my earlier post on this: Is the Cavitron safe for use with porcelain veneers? We used to give a blanket prohibition against using the Cavitron with porcelain crowns or veneers, but our observation of the care being used by dental hygienists has caused us to soften that. Used properly, there is no risk of damage from the Cavitron to crowns or any other restorations.

What bothers me most about what you told me is that your hygienist became upset when you asked her not to use the Cavitron. I talked to my own hygienist about this Cavitron issue and she said she gets a number of requests from patients to not use the Cavitron in certain places, or other requests, and she honors those requests. This haughty attitude and lack of sensitivity to the patient is not good. It’s kind of like you are in the way of her doing her job. She doesn’t seem to connect that you are paying for her services. Hygienists and dentists get a number of special requests like this from patients, and I believe the proper response is to honor those when possible. Yes, you may have made more work for her, but serving the patient is her job.

To answer your question, yes, the hygienist can do damage even without the Cavitron. Heavy scaling can nick the margins. If I were in your position, I wouldn’t let this hygienist touch my teeth any more, whether she used a Cavitron or a hand scaler or a toothpick. If that meant switching dentists, I would do it, and let the dentist know the reason. From what you’ve told me, I have serious questions about how much she cares about her patients, which for me is the first requirement of quality care. In rough hands, a Cavitron can do significant damage not just to restorations but even sometimes to your teeth.
– Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

May 27, 2008

Will the dental hygienist damage my porcelain veneers?

Dr. Hall,

I have a question would like you to help me. I have 8 veneers on the fronth teeth and I am wondering will the veneers loosen or break when a hygenist use dental tools to clean along the gumline during regular cleaning? Thank you and I look forward to hear from you.
Sincerely,
Vu from Ontario

Vu,
This is a good question. No, the hygienist won’t pull the porcelain veneers off or break them. They’re too strong for that. But yes, you do need to be concerned about possible damage that a dental hygienist can do to your porcelain veneers–she or he could chip them or dull the surface. It’s safest to have your cleaning done in the office of an expert cosmetic dentist, but if you have this checklist of “no-no’s” to give the hygienist, and you’re up front about what you want the hygienist to do and not do, you could have your veneers cleaned in any office:

  1. Power polishing equipment will ruin the surface. Some hygienists like to use Dentsply’s Prophy Jet. It’s a power polishing unit that sprays a mixture of sodium bicarbonate and water on your teeth and gets them really clean very quickly. Your porcelain veneers will look great at the end of the appointment, but the glaze will be completely gone and they will begin to stain as soon as you get home. This is the worst thing a hygienist can do to your porcelain veneers. There are other brands of power polishers that will also harm your veneers.
  2. An ultrasonic scaler can also damage the veneers right on the margins. It can cause little chips on the edges that will then become places where stain and plaque can accumulate and where decay will later start.
  3. Heavy duty manual scalers can also chip the margins, if they are used right on the margins of the veneers. Sometimes your hygienist needs to use these scalers, but she or he just needs to be careful not to be scraping hard right on the margins.
  4. Also, coarse polishing pastes with coarse pumice can scratch the veneers a little, and can scratch the luting composite at the margins a lot. Hygienists should only use fine or ultra-fine polishing pastes, preferably with an aluminum oxide grit–no pumice.
  5. And finally, some dental hygienists like to give fluoride treatments even to adults. Beware, if you have porcelain veneers, that they don’t use acidulated fluoride, which will etch the surface of the porcelain and remove the glaze, similar to what power polishing equipment does. They should use a neutral fluoride gel.

I hope that’s helpful.

For more information, see:
Our page on taking care of porcelain veneers.
We recommend for people with porcelain veneers that they use Supersmile whitening toothpaste daily, because it is so effective at removing stains but yet it is gentle on cosmetic dental work.
Our page on general cosmetic dentistry maintenance, with tips on taking care of various cosmetic dental work.
Click here for a cosmetic dentist referral.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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