Prophylaxis pastes: using one grit for everything is the commonest error

Prophylaxis paste is treated as an undifferentiated consumable, and in most practices there is a single type for every situation. It is a simplification that costs enamel.

Pastes differ by abrasive grit, expressed in micrometres or labelled coarse, medium, fine and extra-fine, often with colour codes.

The correct logic is the same as for burs: one starts with the grit needed to remove the deposit and works down to fine for polishing. Using coarse alone leaves a rough surface.

That residual roughness is the problem that goes unnoticed. A rough surface is recolonised more rapidly, and a poorly polished patient accumulates plaque faster than before the appointment.

The final polish is not a cosmetic step: it determines how long the result of the appointment will last. Skipping it to save two minutes undoes part of the work done.

Coarse pastes should be reserved for significant pigmented deposits, and used only where needed. Passing them over every surface out of habit removes enamel that will not return.

On exposed necks and root surfaces coarse grit is contraindicated. Cementum and dentine are far softer than enamel, and the abrasion is disproportionate.

Fluoride pastes are the standard choice, but there are situations where fluoride should be avoided. Before a sealant or an adhesive procedure, fluoride residue can interfere with etching.

For these indications fluoride-free and oil-free pastes exist, and it is a detail that bears on sealant adhesion more than is generally considered.

Air polishing with low-abrasivity powders has partly replaced paste in some indications, particularly on root surfaces and around implants, where mechanical abrasion carries more risk.

It does not, however, replace the final polish, which remains the step that closes the appointment whatever technique was used for removal.

The cup should be used at low speed with light pressure. High speed and pressure generate heat, and heat on an exposed root surface produces sensitivity the patient attributes to the appointment.

In summary: grit chosen according to deposit and surface, a sequence always ending in fine, fluoride-free pastes before adhesive procedures, and a cup run at low speed with light pressure.