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Did the ultrasonic scaler damage my veneers?

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Dr. Hall,
I have had three cleanings with a magnetostrictive ultrasonic cleaner and had both upper lateral incisors with veneers fracture within days of the clean. How common is this? Is one type of scaler more likely to fracture teeth than others. What companies manufacture this equipment?
– Peter Andrew Grant

(See Dr. Hall’s answer below.)


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Comment by Dr. Hall,
There are two types of ultrasonic scalers – piezoelectric and magnetostrictive. The company that makes the most popular magnetostrictive scaler is Dentsply and the machine is called a Cavitron. It is the original ultrasonic scaler and has been around for decades. While in some ways it is gentler than the piezoelectric scaler, it is more technique sensitive in that it has greater potential for damaging your teeth or your dental work. In the hands of the right hygienist, it should not cause any problems with your veneers. I addressed this in my post, Is the Cavitron safe for porcelain veneers.

What I address in that post is the possibility of chipping the margins of the veneer. But you had your veneers crack, or rather fracture. To get that to happen, I’m guessing that the hygienist would have to use the tip of the scaler on the surface of the porcelain, which would be a big no-no. These ultrasonic scalers are great tools when used properly. When not used properly it might be more appropriate to call them weapons.

Photo of a tooth showing half of the porcelain veneer fractured off.

A fractured porcelain veneer. Image courtesy of No.1 Dental Clinic, Hồ Chí Minh City, Vietnam

I wouldn’t stay in a dental office where the hygienist caused damage like this. He or she needs to be in complete control of the instrument and aware of the damage it could cause. Other significant damage from an improperly used ultrasonic scaler would be creating nicks or rough areas in the roots of the teeth which will end up attracting plaque and calculus and, over the years, could lead to gum disease or decay.

For a comparison of piezoelectric and magnetostrictive scalers, I cite a study published in the Journal of Clinical Periodontology comparing piezoelectric and magnetostrictive scalers which concluded that the magnetostrictive scaler, while it took longer, left the root surface smoother.

Another excellent article that interprets these results in a more understandable way is found in a site for dental hygienists.

See also my page that has a list of things a dental hygienist needs to do to properly care for your porcelain veneers. My advice, if you have veneers, is to have even your maintenance done at an office that has an emphasis on esthetic dentistry because they will train their hygienists in these points.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

The post in my tooth broke. Now what do I do?

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Dr. Hall,
I have a three-piece bridge and the post in one tooth broke off. What kind of dentist can do this so I can get another post put in? These are my front teeth.

This bridge was only put in a couple of years ago and is on teeth numbers 7, 8, and 9. Number 8 is the false tooth. Number 7 needed a root canal and there wasn’t much left of the tooth, so my dentist put a post in there to help hold the bridge. But now that tooth has broken off at the gumline right through the post, and the bridge is being held on by only the one tooth.
– Joan

(See Dr. Hall’s answer below.)


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Joan,
The first question that comes to my mind when you tell me you want to replace the post that broke in your tooth is “What is going to keep the replacement post from breaking?”

I wrote a blog post about five years ago about removing metal posts from teeth. Both the person who asked me and the case I treated were dealing with possible sensitivity to the metal in the posts. That’s a very different situation than yours. They just wanted to get rid of the metal. You’re wanting to repair a break.

You’re dealing with several difficult problems here. First of all, with the post broken off at the gumline, there is nothing there to grab, which is going to limit the techniques that could be used to remove it. Sometimes an ultrasonic scaler instrument can be held to the post, which, given enough time, may loosen the cement and enable the dentist to twist it out of the tooth. But in your case, in order to grab the post to be able to twist it, the dentist would have to drill away a fair amount of tooth structure around the post. And this is tooth #7, which is the right lateral incisor—the smallest front tooth. Drilling around the post to be able to grab it would leave you with an even weaker situation for the new post because there would be that much less tooth to give retention to the post.

Second, in order to do any of this, the dentist would have to cut this crown off the bridge to be able to get enough access to the post. Once that is done, he or she may as well grind the entire bridge off because you would need an entirely new bridge That is one of the disadvantages of replacing a missing tooth with a bridge instead of an implant—if anything happens to any one of the teeth involved, the whole bridge needs to be replaced. Repair options are limited here.

Third, there is no reason to expect a new post to last any longer than the old one, and it would probably not last as long. I’m guessing that you have a bite that puts a lot of lateral stress on your front teeth.

My experience with patients that have heavy biting forces and teeth that have broken off at the gumline is that they will also break off dental work. I’ll give you my recommendation, with the disclaimer that I haven’t seen your case myself and don’t know everything about it, so I would defer to a qualified dentist who has examined you in person. But my guess is that in order to get a stable situation for your front teeth, you will need two dental implants—one to replace the missing tooth, and one to replace this lateral incisor (#7) that has broken off at the gumline. You could try to save #7 and go with a longer 4-unit bridge from the right canine to the left central incisor, but that will give additional stress to those two teeth, and given your history of breaking things off, would be too risky, in my opinion, again with the disclaimer that I haven’t actually examined you and don’t know the whole history here.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

Why the Peroxide Rinse?

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Hello Dr. Hall,
I had a recent dental cleaning and there were several protocols in place to screen for COVID. One of the things that surprised me was that the hygienist requested that I rinse with peroxide before she cleaned my teeth. I asked if it was related to COVID, and she said yes. She actually said she has been requesting this of patients for over 15 years, even during ‘normal’ times. How effective is this in preventing the spread of viruses? Are all dentists doing this?

Thanks,
Jamie from Colorado

(See Dr. Hall’s answer below.)


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Jamie,
The concern is over aerosols that are generated during a dental appointment. Especially if your hygienist uses an ultrasonic scaler, aerosols are generated that escape into the air of the dental office and can circulate throughout the office. They can remain suspended in the air for several hours. Everyone in the office can then inhale them.

There are several ways of reducing infectious aerosols produced by dental treatment. One way is the use of high-volume suction equipment. When the dentist does procedures, usually the dental assistant will be tasked with holding the high-volume suction close to the field of operation. While that doesn’t provide perfect protection against infectious aerosols, it has been shown to reduce them by about 95%. This method, however, is usually not practical for dental hygiene appointments because there is normally not a dental assistant present.

Recent advertisements to dentists have promoted suction devices with wide openings of a foot or more in width that can be placed near the operatory field. Here is a screen shot of an advertising that I recently received for one of these devices.
A photograph of a dentist working on a patient with a Rhondair suction resting on the patient's chest

This device will capture aerosols into a box with a filter. While a nice idea, my worry would be that the clear shield could get in the way. I noticed the photograph doesn’t have a dental assistant present, and while the dentist, using quality magnification, could maybe work around the shield, I have difficulty picturing how the assistant would.

Another effective option is, rather than reducing the aerosols, to make them less infectious. This is where the pre-operative rinse comes in. In recent years, dental hygiene schools have been teaching hygienists to use a pre-operative rinse before each appointment, but only a small minority of hygienists have actually been doing that. However, with COVID-19, I believe the use of those rinses may be near 100%. In some states, they have actually become mandatory.

There are several anti-microbial rinses that are used. I believe that the peroxide rinse is the most effective because of its quick action to kill oral micro-organisms. The peroxide used is a little more concentrated than you would buy over the counter. What is sold to the public is a 3% peroxide. For dental appointments, while the American Dental Association recommends at least a 1.5% concentration, a number of offices are using rinses with about 4 or 5%. A swish for a few seconds is fairly effective at killing bacteria and viruses. The aerosols then that are generated during your cleaning or other dental treatment will then be much less infectious.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

Will my electric toothbrush loosen the post in my tooth or the crown?

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Hi Dr. Hall
On your page about how to remove a post in a tooth you mention that an ultrasonic tip can be used to help remove a post. I have a crown on a post and want to use an electric toothbrush. Is there any chance that an electric toothbrush can cause the crown falling off or post loosen up due to the vibrations?
– Anna

Anna,
Many of today’s electric toothbrushes use sonic vibrations through the bristles to help loosen plaque. I don’t believe these are strong enough to loosen anything that is cemented in your mouth.

The ultrasonic tip that a dentist would use to help remove a dental post cemented in a tooth would be the tip of an ultrasonic scaler—a powerful tool used by dental hygienists to help clean teeth. The tip is rigid and imparts the full strength of the ultrasonic vibrations to whatever it touches. When used to remove a post, it has to be pressed firmly on the post for an extended period of time.

By contrast, the vibrations of a sonic or ultrasonic toothbrush are transmitted through the soft bristles and thus are very gentle.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

Is the Cavitron safe for use with porcelain veneers?

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Dr. Hall,
I just had my first dental cleaning with my new veneers….placed by a cosmetic dentist recommended on your website. The tool used to clean was called a “cavitron.” It seemed to shoot out a lot of water while cleaning the teeth. I’m assuming that this is safe because this is a very good dentist, but after reading your website, I got nervous. Can you let me know if the cavitron is ok, not too harsh on the porcelain…
Thank you for this excellent website.
– Anna from Connecticut

Anna,
Yes, the Cavitron is an ultrasonic scaler, and in my advice for care of porcelain veneers I have written a caution about that, that an ultrasonic scaler can chip the margins of porcelain veneers. It’s not the water that is the cause for concern, but the metal tip that vibrates at an ultrasonic frequency. But thanks to your bringing this to my attention, I have gone over this advice to update it. After some additional years of experience with these machines, I’m going to soften that advice somewhat. Ultrasonic scalers like the Cavitron have gotten very popular with dental hygienists and I believe that most quality offices are now using them. I believe that if hygienists are skillful in using them, are smooth in their motions and don’t dwell on the margin area, that they are fine. So where I used to list ultrasonic scalers as unsafe to use with porcelain veneers I’m going to say now that in the hands of a good hygienist you should be fine.

These ultrasonic scalers are powerful and they not only have the potential to nick the margins of porcelain restorations, but they can nick the cementum of teeth, causing a roughness that will attract plaque and calculus. But I have had the opportunity to observe closely in the past few years at three dental offices where the hygienists have used ultrasonic scalers, and they have all been excellent with them, to where I really don’t think there is a risk of damaging the porcelain.

The two absolute no-no for dental hygienists in maintaining porcelain veneers are no Prophy Jet and no acidulated fluoride treatments. The Prophy Jet sprays an abrasive at the teeth at high pressure and it will destroy the glaze on porcelain veneers. This isn’t a risk, it’s a certainty. And acidulated fluoride will etch the surface of the veneers causing similar though milder damage.

Dr. Hall

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

Confused about the use of ultrasonic toothbrushes on bonding and porcelain veneers

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I’m confused. Your site says not to use ultrasonic cleaning devices for bonded teeth, yet you’re selling an ultrasonic toothbrush. Please respond accurately with factual information – does ultrasonic toothbrushes cause any harm to dental restoration – not just abrasion, but do the vibration cause a loosening of the bond (over time or otherwise). Please explain.
– Helen from Florida

Helen,
Thanks for your question. I looked on the website to see where this confusion might be coming from, and I see where it is put in a fuzzy way and confusing. I have gone back to clarify a couple of the pages and hopefully that will help.

When I tell people not to let a dental hygienist use ultrasonic cleaning devices on their bonded teeth, I am referring to equipment like the Cavitron that has a metal tip that vibrates at ultrasonic speeds. This metal tip can nick the margins of bonding and also of porcelain veneers. In several places on the site I reference these as ultrasonic scalers, but in one place I call them ultrasonic cleaning devices. That’s too broad a term, and I’ve corrected that instance to make it clear I am talking about these ultrasonic scalers.

There are two differences in trying to apply this concept to toothbrushes. The first is that the bristles of these electric toothbrushes are soft and so are incapable of nicking anything solid like dental bonding or porcelain veneers. Rather, they clean and polish, which is a beneficial result. And the second is that the toothbrushes are almost always “sonic” toothbrushes, not “ultrasonic”, which means that they vibrate at slower sonic speeds, which also makes them more gentle.

And there is a dentist who has posted something on the Internet claiming that sonic toothbrushes loosen dental bonding. However, this is without any factual basis. He is the only one saying this, and, in fact, the University of Missouri at Kansas City did a study they published in 1998 which proves that this is a fallacy. They brushed teeth for two years with a sonic toothbrush and could not find any weakening of bond strength. This confirms my own observations.

And don’t misinterpret this to be a condemnation of ultrasonic scalers in the hands of a skilled dental hygienist. While they can be misused and can nick the root surfaces of teeth, when used properly they are a great aid and produce a superior result. My dental hygienist uses this every time I come in for a cleaning, and it leaves my tooth surfaces smooth and spotless.

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About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

A sonic toothbrush is fine for porcelain veneers.

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I’ve read that sonic toothbrushes should be avoided on veneers as the vibrations could affect the bond between the veneer and the natural tooth. Is this true? Do you think and electric brush without sonic technology is better for veneers?
– mari

Marilyn,
That is not true, that a sonic toothbrush will weaken the bond of porcelain veneers or make them loose.

I looked on the Internet to see where you might have found this erroneous information. I found a website of a dentist in Nebraska who is giving that advice about caring for your porcelain veneers – but my guess it that comes from his own reasoning, because the research does not substantiate that.

The University of Missouri at Kansas City did a study that was published in 1998 where they brushed teeth with porcelain veneers on them for two years with a sonic toothbrush and found that there was no loss of bond strength.

The Sonicare toothbrush is an excellent toothbrush, great at removing plaque. Oral B also makes an excellent sonic toothbrush, as does Supersmile. Any one of them is fine for use with porcelain veneers. Click here to read our page on sonic toothbrushes.

Dr. Hall

Read more about the post-operative care of porcelain veneers.

About David A. Hall

Dr. David A. 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 advanced internet marketing for dentists.

Will the dental hygienist damage my porcelain veneers?

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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 A. 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 advanced internet marketing for dentists.

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