Tankless water heaters heat water by passing it through a heat exchanger -- thin copper or stainless steel tubes with gas burners or electric elements around them. Mineral scale (calcium carbonate) builds up inside those tubes over time, especially in hard water areas. Scale insulates the tubes from the heat source, reducing efficiency, lowering flow rate, and eventually triggering error codes that shut the unit down. Annual descaling with food-grade white vinegar dissolves the scale and restores full performance. Skip it and the heat exchanger fails early -- a $500-$1,000 repair.