Braces and Prophy Angles: Which are Best?

Tween and teen patients can be the highlight of my day. But that changes when they smile and reveal plaque-caked orthodontic wires and brackets. The inflamed gingiva from the host response to the pathogenic bacteria really wrecks a good smile. 

How do you polish and make teeth with brackets shine without injuring the gingival tissue? 

Back in the good old days (as in, early 2020), I would carefully use my trusty air polisher with erythritol to start clearing the field. Then I finished up with my ultrasonic scaler on low power to remove the residual powder around the orthodontics, and subgingivally if the tissue tolerated it. 

Things have changed, and so have our protocols. I still would not use an ultrasonic scaler around ortho appliances unless I have a clear field to prevent cavitating areas that have soft enamel from the caries process. 

We have all adapted to the requirements for a safe dental hygiene appointment, especially when it comes to polishing. Plaque still needs to be removed to create a healthier oral environment – but what’s the safest way?

First up, I would select the Vera Splatter Guard prophy angle to polish off the plaque. The Vera line of prophy angles are smaller than traditional prophy angles for easier access to the molar buccals and the mandibular linguals. These angles also have a soft prophy cup that will easily flare out and cover more tooth surface when I polish.

More importantly, the Vera Splatter Guard prophy cup has deep grooves on the outside and the, as well as a small shield under the cup to drastically reduce the splatter as the cup spins. Speaking of cup spin, these prophy angle cups are made with a screw attachment rather than a snap-on attachment, giving it a smooth rotating motion that doesn’t seize up when I’m working with it.

Poorly made prophy angles have gears that don’t mesh well and vibrate heavily during use, which makes polishing a tough experience on your hand and your patients. Plus, I get embarrassed when the prophy angle seizes up and I have to waste time replacing the angle.

Pointed polishers can also do the trick. Look for a pointed polisher flexible enough to work around brackets and under the wires of orthodontic appliances so you can polish without damaging tissues. Polishers with outer ridges also give an edge in stain removal.

Another option is a prophy angle brush. Instead of a prophy cup, the angle is equipped with a flat brush with firm bristles that fit nicely under bracket wires. While this brush is great for preparing tooth surfaces prior to sealants, it also supports orthodontic applications.

After polishing, I still use the ultrasonic scaler on low power to irrigate out the polishing paste. My patients leave with a gorgeous smile!