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Acoustic Microstreaming: Detection and
Measurement Around Ultrasonic Scalers*
B.S. Khambay and A.D. Walmsley
Background: Acoustic microstreaming (AMS) may be useful to
the clinician when using the ultrasonic scaler to remove particulate
matter from the teeth. The aim of this study was to detect and mea-
sure the effects of AMS produced by ultrasonic scalers.
Methods: For the study, an ultrasonic generator was selected with
4 differently shaped scaling tip inserts (TFI-3, TFI-9, TFI-1, and P-
12). A plaque substitute (0.2 mm thick soft cream cheese) was
coated onto a microscope slide and immersed in water. The ultra-
sonic scaler tip was placed in the water and orientated either per-
pendicular or parallel to the slide. The instrument was operated both
contacting the slide under a load of 0.3 N and non-contacting at
various distances from the slide surface. This was repeated with the
tip parallel to the slide. The area of medium removed was quantified
by digital image analysis.
Results: It was found that AMS removed the plaque substitute
from around the tip. The TFI-9 insert significantly removed more
material with increasing displacement amplitude (P <0.05).
Significantly larger areas of plaque substitute were removed when
the tips of the TFI-3, TFI-9, and P-12 inserts were orientated per-
pendicularly to the slide compared to the parallel orientation (P
<0.05). Of the 4 inserts used, the TFI-9 insert removed the most
material while the straight tip produced no apparent removal.
Removal by AMS required the presence of a water medium and
such forces were found to decrease with distance from the scaling
tip. No plaque substitute removal was seen at a distance of 7 mm
for the TFI-9 insert at 37.5 µm displacement with the tip orientation
parallel to the slide.
Conclusions: It is concluded that AMS occurs around ultrasonic
scalers and this depends on the displacement amplitude, tip orienta-
tion, and presence of a water medium. AMS may play a role in dis-
ruption of subgingival biofilms associated with periodontal disease.
J Periodontol 1999;70:626-631.
KEY WORDS
Acoustic microstreaming; periodontal diseases/therapy;
scaling/instrumentation; ultrasonics/instrumentation.
* School of Dentistry, University of Birmingham, Birmingham, UK.
626
Volume 70 • Number 6
T
he ultrasonic scaler removes plaque
by either the chipping action of the
tip or the biophysical action of the
ultrasound within the associated cooling
water. 1,2 The oscillatory action of the
ultrasonic scaling tip within water pro-
duces acoustic microstreaming. There is a
rapid rate of change of streaming velocity
with distance, from the oscillating tip.3-5
These velocity gradients occur over a
small distance and produce large hydro-
dynamic shear stresses even though the
velocities themselves are only in the order
of a few cm sec-1. These forces are large
enough to disrupt or damage most biolog-
ical cells and tissues.5,6 Dental plaque is a
biofilm made of organisms and surround-
ing extracellular matrix and will therefore
be susceptible to the physical effects of
ultrasound.7 The forces generated by the
streaming should be of sufficient magni-
tude to shear the plaque away from itself
and from the tooth surface. Such forces
will assist the mechanical and cavitational
role that occurs during plaque removal by
the ultrasonic scaler. High energy levels
generated by the ultrasonic scaler may
disrupt or disaggregate bacteria within the
dental plaque and periodontal bacteria
such as Gram-negative organisms have
been shown to be sensitive to ultra-
sound.7-9 The relative resistance of Gram-
positive bacteria, spores and viruses10,11
can be explained by differences in size,
rigidity, and strength of their cell walls.10 It
is postulated that the lack of such features
in Gram-negative species render them
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J Periodontol • June 1999 Khambay, Walmsley

susceptible to the shearing forces of ultrasonic

acoustic phenomena,7,8 and thereby contribute to
the post-ultrasonic instrumental changes in the
microbial composition of dental plaque.12-14 In a
deep periodontal pocket not all the bacteria will be
exposed to the same magnitude of shear forces,
thus possibly producing a further clinical variability.
There have been few studies that have measured the
amount of acoustic microstreaming that occurs dur-
ing plaque removal by the ultrasonic scaler. Previous
work with a model system composed of particulate
matter removed from a slide showed that activity in
the associated cooling water cleaned the slide close
to the probe.2 This removal was demonstrated on
the plaque covered surface of the tooth but no direct
measurement of the amount removed was made.15
Similar areas of erosion or “cleaning” were observed
on root surfaces subjected in vitro to a scaling tip Figure 1.
The scaling tips used in the study (from left to right) TFI-3,TFI-9,TFI-1, and P-12.
with water flow.16 The development of a suitable
model system would assist in determining the rela- Photomicrographs were taken of the observed motion
tive contributions of both the mechanical and the of the particles.
streaming forces around the ultrasonic scaler. This pre-
vious work has demonstrated the presence of acoustic Development of Model System
streaming; 15,16 however, it is not known how such The model system consisted of soft cheese‡ applied
forces are affected by different scaling tip designs and to a microscope slide which was used as a suitable
the magnitude of their oscillation. plaque substitute. An even thickness of the plaque
The aims of this investigation were as follows: 1) to substitute of 0.2 mm was obtained by placing the
develop an in vitro model to detect and measure the slide on a perspex block designed with 2 stops on
hydrodynamic shear stresses produced by acoustic either side of the slide. Excess material was removed
microstreaming; and 2) to determine the factors which by drawing a further slide across the top surface. The
effect the amount of acoustic microstreaming that slide was positioned on one pan of a weighing scale
occurs around the ultrasonic scaler. and weights were placed on the opposite pan. A sin-
gle nylon bristle was removed from a toothbrush and
MATERIALS AND METHODS allowed to contact the surface of the slide 1 minute
Instrumentation after the cheese was first taken out of a refrigerator at
Four designs of ultrasonic scaler tip were selected 4°C. The force required to remove the plaque substi-
(Fig. 1): 1) straight (TFI-1); 2) broad base with taper tute in a single pass was recorded by the gradual
(TFI-3); 3) broad shaped (TFI-9); and 4) sickle addition of weights to the opposite pan. This was
shaped (P-12). All scaling tips were powered by an repeated 10 times.
ultrasonic generator† working at a frequency of 25
Effect of Tip Operation on Medium Removal
kHz.
A coated microscope slide (cheese thickness 0.2
Detection of Acoustic Microstreaming mm) was submerged in a water filled petri dish. The
A glass petri dish was filled with distilled water and scaling tip was positioned at a distance of 1 mm by
zinc stearate powder was directly sieved onto the the use of a calibrated guide. The scaling tip was
water. The tip of an ultrasonic scaler (P-12) was sub- powered for 30 seconds at 2 displacement ampli-
merged 2 mm beneath the surface with the tip paral- tudes corresponding to mid-range power settings.
lel to the surface of the water. All cooling water was The longitudinal oscillations of the tip are along the
directed away from the tip but allowed to cool the long axis of the instrument17 and the scaling tip was
main part of the working insert. The scaling tip was orientated either parallel or perpendicular to the
viewed under a stereomicroscope to produce an coated slide. Therefore, the oscillations were directed
image of the zinc stearate and the water surface. The perpendicular into and away from the slide and par-
scaling tip displacement amplitudes ranged from 10.5 allel where the oscillations moved across the coated
(low power) to 47.5 µm (high power). The displace-
ment amplitude of the scaling tip was measured using † Dentsply, York Division, Long Island, NY.
a stereomicroscope and calibrated graticule. 17 ‡ Kites Cheese Spread, Portsmouth, UK.

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Acoustic Microstreaming Around Ultrasonic Scalers Volume 70 • Number 6

slide was removed and replaced with a new

medium covered slide and the tip reactivated to
ensure the medium was starting to be removed.
This distance was recorded and taken as the fur-
thest extent of the streaming forces. This was
repeated 5 times with the tip orientated either par-
allel or perpendicular and driven at the 2 displace-
ment amplitudes for all 4 designs.
Effect of Water on Medium Removal
A coated slide was placed in the petri dish with no
water added. The TFI-9 scaling tip was driven at a
displacement amplitude of 37.5 µm and orientated
with the scaling tip oscillations parallel to the slide.
The tip was lowered on to the coated slide to contact
the plaque substitute medium under a load of 0.3 N
and activated for 30 seconds. The slide was
removed and the medium was allowed to bench dry
for future measurements. The experiment was
repeated 5 times. The arrangement was repeated
but with water added to the petri dish.
Determination of the Area of Medium Removed
The dried medium covered slides were assessed to
calculate the area of medium which had been
removed during the experiments. This was under-
taken using a computerized imaging system consist-
ing of a personal computer,§ a frame grabber with
768 x 512, 8 bit grey scale square pixels,|| and an
image analysis program.¶ The areas of removal
were captured with a grey scale scanner# at a reso-
lution of 1 pixel = 42.55 mm corresponding to the
area of 1 pixel = 1810.50 mm2. A preliminary scan
of the slides compared the digitized image to the
actual outline on the slide and the contrast and
Figure 2. brightness were adjusted until they displayed the
Diagram showing the experimental apparatus for the detection of acoustic
microstreaming. A (top).The probe tip is set at a parallel orientation with the long
area of interest accurately. Finally the images were
axis of the probe tip parallel to the long axis of the slide; i.e., broken lines are thresholded to binary at an initially determined value
parallel to each other. B (bottom).The probe tip is set at a perpendicular orientation image so that foreground corresponded to the
with the long axis of the probe tip perpendicular to the long axis of the slide, i.e., removed areas and background to the unremoved
broken lines intersect at right angles. cheese. All the slides were scanned using the same
settings for contrast, brightness, and thresholding
slide (Fig. 2). The slide was removed from the water levels. The area of removal was calculated by counting
and allowed to bench dry for future measurements. the number of pixels that belonged to the foreground in
The experiment was repeated for all 4 scaling tip the image.
designs using both orientations. All of the scaling tips
were adjusted so that there was a difference of 7.5 Statistics Analysis
µm between the 2 mid-range power settings. A 2-sample t-test was the statistical analysis of choice
and a confidence level of 95% (P <0.05) was considered
Effect of Tip Distance From Medium to be statistically significant.
and Its Removal
A prepared slide was placed in the water filled petri RESULTS
dish. The scaling tip was lowered into the water The use of zinc stearate particles on the water surface
directly above the medium and activated at different showed that acoustic microstreaming did occur around
displacement amplitudes. Measurements were made
of when the medium began to be removed from the § Pentium 60MHz, Viglin Computers, Alperton, Middlesex, UK.
|| Vision plus-AT OFG, Imaging Technology Inc., Bedford, NY.
slide during lowering of the tip. The instrument was ¶ Optimas Corporation, version 4.0, Bothell, WA.
then deactivated and maintained in this position. The # Hewlett-Packard Scanjet Plus, Tokyo, Japan.

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J Periodontol • June 1999 Khambay, Walmsley

Figure 3.
Video captured digitized image of a P-12 insert showing the moving zinc stearate particle vortices A (left) at 10.5 µm displacement amplitude
and B (right) at 47.5 µm displacement amplitude.

the tip, these were seen as distinct vortices around the Water is required for removal to occur. The removal
tip. At low powers there was an ordered arrangement to was greatest when the slide was immersed in water
these vortices (Fig. 3A). While with increasing power (Fig. 4). Allowing the tip to contact a nonimmersed
these vortices became more erratic in nature and coated slide resulted in a smaller amount of removal.
decreased in number (Fig. 3B).
DISCUSSION
The force required to remove the cheese medium
from the slide in a single pass of the nylon toothbrush The detection of acoustic microstreaming may be
filament was 1.8 grams ± 0.16 grams (1 S.D.; n = 10). demonstrated by the movement of zinc stearate parti-
The effect of tip displacement produced different cles floating on the water surface into which the scaler
amounts of removal of the plaque substitute (Table
Table 1.
1). The TFI-3, TFI-9, and P-12 inserts all removed
more medium from the slide at the higher tip dis- Mean Area Removed From Slide for Different
placement. When the tip displacement was Inserts, Tips With a Parallel or Perpendicular
increased by 7.5 µm, the area of medium did not
Orientation
increase equally for each probe when orientated
perpendicularly to the medium. The TFI-1 insert did Insert Tip Displacement Area removed 1 S.D.
not remove any medium regardless of tip displace- orientation amplitude (µm) (mm2) (n = 5)
ment and there was no evidence of surface distur-
bance. Where removal occurred, increasing tip dis- TFI-3 Parallel 30.0 1.4 0.0
placement by 7.5 µm did not produce similar linear Perpendicular 30.0 0.0 -
increases in removal of the medium. Furthermore, Parallel 37.5 32.2 11.8
where the tip displacement was 37.5 µm, the 3 tips Perpendicular 37.5 0.0 -
differed in the amount of medium removed with the
TFI-9 insert removing the most medium and the P- TFI-9 Parallel 30.0 34.1 0.7
12 tip the least. Perpendicular 30.0 13.2 0.7
There was a marked reduction of medium Parallel 37.5 56.7 14.9
removal with the TFI-9, TFI-3, and P-12 inserts Perpendicular 37.5 31.0 0.8
when the orientation changes from parallel to per-
pendicular (Table 1). All the settings of the probes TFI-1 Parallel 22.5 0.0 -
are the same. The TFI-1 insert still resulted in no Perpendicular 22.5 0.0 -
medium being removed. Parallel 30.0 0.0 -
The effectiveness of the streaming was depen- Perpendicular 30.0 0.0 -
dent on distance. The TFI-9 insert operated at a tip
P-12 Parallel 37.5 0.0 -
displacement of 37.5 µm will produce medium
Perpendicular 37.5 0.3 0.4
removal up to 6.6 mm away from the slide.
However at a tip displacement of 30 µm this was Parallel 45.0 0.9 0.3
reduced to 4.2 mm. Perpendicular 45.0 0.2 0.4

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Acoustic Microstreaming Around Ultrasonic Scalers
is placed. Although this provides evidence of the
streaming patterns, it does not provide a measurement
of any forces generated. It is these forces which are of
clinical significance when using the ultrasonic scaler.
It has been possible to develop an in vitro model that
begins to place a value on these forces and also assess
the many variables that appear to effect the size of the
force. The chosen medium of soft cream cheese has a
tenacity to the glass slide that is comparable to plaque
and requires 2 to 4 grams for its removal from teeth.18
Hence the soft cream cheese medium closely resem-
bles the in vivo situation and was chosen as a plaque
substitute. Further research is being undertaken to
develop an artificial plaque system to determine if there
are any differences in the effects of streaming.
The ultrasonic scaler removes the cheese from the
slide due to streaming forces. However this removal
pattern was dependent on the different operating vari-
ables of the instrument which were: displacement
amplitude of the tip, design, and orientation. As the dis-
placement amplitude of the inserts increased, there was
a correlated increase in the area of medium removed.
The exception was the TFI-1 insert, which removed no
medium. The displacement amplitude of the tip is pro-
portional to the power output of the scaler,6,17 and with
increasing power output, the magnitude of the shear
forces will be increased and therefore in a larger area of
medium removal. The TFI-1 insert produced acoustic
microstreaming that was not of significant strength to
remove cheese. When operated at the same displace-
ment amplitude, the TFI-3 and TFI-9 tips did remove
material. Therefore, the geometric design appears to be
a major influence on the production of streaming forces.
Of the 4 inserts tested, the TFI-9 insert removed the
most medium, followed by the TFI-3 insert and then the
P-12 insert. The TFI-9 insert is a rigid design with a
groove along its front face and may behave as a “pad-
dle,” disturbing a larger area of water with greater force,
therefore increasing the shear forces. The opposite
holds true for the TFI-1 insert which has a slimmer
design and is unable to disturb the water to the same
extent producing little or no streaming forces.
The removal of the plaque substitute may also occur
by cavitation.2 Small air bubbles in the cheese may act
as nuclei for cavitation and undergo transient cavitation
with subsequent disruption of the cheese from within its
structure. The streaming forces then clear the medium
away and this same process may be occurring within
plaque in the mouth. Both cavitation and acoustic
microstreaming are related physical consequences of
ultrasound and are synergistic in their actions in
medium removal and their effects merit further investi-
gation.
Acoustic microstreaming is a phenomenon that
exists in a fluid environment such as water and is char-
630
Volume 70 • Number 6
180
160
Area of medium removed (sq mm)
140
120
100
80
60
40
20
0
Non-immersed Immersed
Figure 4.
The area of medium removed from the glass slide with the TFI-9 insert at
37.5 µm displacement amplitude.The tip was touching the slide and
operated either immersed in or without an associated water medium
(error bars, n = 5, 1 SD).
acterized by the production of large shear forces. When
the TFI-9 insert was placed on the non-immersed
medium, only the area in contact with the face of the
insert was removed (9.2 mm2). When the procedure
was repeated, with both the medium and tip submerged
in water, a much larger area of medium was removed
(138.3 mm2). The difference of 129.1 mm2, can be
attributed to the effects of acoustic microstreaming. It
was also shown that the magnitude of the shear forces
decreases with increasing distance from the probe tip. A
decrease in the displacement amplitude from 37.5 µm
to 30 µm leads to reduction in the effective distance of
the shear forces from 7.6 mm to 4.4 mm. The acoustic
microstreaming is not only dependent upon displace-
ment amplitude but also the shear forces decrease with
increasing distance from the ultrasound source.
Clinically the shear stresses will be highest in the imme-
diate vicinity of the tip and will be most active especially
if the scaler is working within a periodontal pocket.
CONCLUSION
In this in vitro study acoustic microstreaming can be
indirectly detected by its effect on the disruption and
clearance of particulate matter in the presence of a
water medium. Acoustic microstreaming increased
with increasing displacement amplitude, although it
was dependent upon tip geometry, tip orientation, and
distance from the oscillating tip.
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J Periodontol • June 1999 Khambay, Walmsley

ACKNOWLEDGMENTS 15. Walmsley AD, Laird WRE, Williams AR. Dental plaque
The authors would like to thank Dr. G. Landini for his removal by cavitational activity during ultrasonic scaling.
J Clin Periodontol 1988;15:539-543.
help with the image analysis and the Photographic 16. Walmsley AD, Walsh TF, Laird WRE, et al. Effects of
Department of the School of Dentistry, University of cavitational activity on the root surface of the teeth
Birmingham. during ultrasonic scaling. J Clin Periodontol 1990;17:
306-312.
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