Question

I (f., 72) brush my teeth regularly and go to the dentist twice a year for a thorough cleaning. However, in the weeks following the last thorough cleaning by the dental assistant using scrapers and other instruments, small pieces have broken off several of my teeth. Doesn't the thorough cleaning of my teeth, which have obviously become fragile, further weaken them? And is a total, precautionary dental x-ray every two years sensible and harmless? T. B. in O. 

Short answer

As brushing your teeth at home can never achieve complete cleaning, tartar builds up over time. This can only be removed by professional teeth cleaning. When carried out professionally, neither healthy teeth nor fillings, crowns or the like are weakened. Fillings and teeth are subject to a natural ageing process, which can lead to a part of the tooth breaking off. 

The bacterial film (plaque), which forms on the tooth surfaces within a few hours of brushing, thickens undisturbed and, if it is not removed by brushing, it becomes hard tartar. The composition of the saliva determines how quickly tartar build-up sets in. 

Tartar adheres strongly 

Regular, perfect cleaning of the tooth surfaces and interdental spaces would theoretically prevent the formation of tartar. However, as no one can achieve this perfection at home, tartar will form to varying degrees, even in people who clean their teeth regularly and well. Once tartar has formed, it can no longer be removed by simply brushing your teeth. Regular professional help from a dentist or dental hygienist is therefore necessary to prevent tartar from damaging the gums and bones. Manual scrapers or mechanical instruments that vibrate at very high frequencies are used for this purpose. It goes without saying that these instruments must be used professionally. When used correctly, neither healthy teeth nor fillings, crowns or the like are damaged. It is not possible to cause or subsequently trigger tooth fractures with these instruments. 

Pre-existing damage 

A part of a tooth can break off spontaneously or even eating a soft food (e.g. a croissant) can be enough to trigger a tooth fracture. However, this spontaneous breakage only occurs if the tooth is already damaged. The most common cause of pre-damage is teeth grinding. Other possible causes include larger fillings. Fillings, like natural teeth, are subject to an ageing process in the mouth. After years, it is quite possible that an older filling or part of a tooth may eventually break and be lost due to gradual cracking. 

Does X-ray control make sense? 

Taking control x-rays every two to three years is sensible and appropriate. The benefits far outweigh the theoretical disadvantages. Caries formation can increase very quickly, especially in older people, due to reduced saliva production (dry mouth). Regular (twice a year, or more frequently in difficult situations) check-ups with a dental hygienist or dentist are also advisable in order to detect damage before it occurs. 

Author: Dr. med. dent. Jürg Eppenberger
Published in: Neue Luzerner Zeitung on December 10, 2012