Guideline:
Clinical guideline on the role of dental prophylaxis in pediatric dentistry
Bibliographic Source(s)
- American Academy of Pediatric Dentistry. Guideline on the role of dental prophylaxis in pediatric dentistry. Chicago (IL): American Academy of Pediatric Dentistry; 2007. 4 p. [18 references]
Guideline Status
This is the current release of the guideline.
It updates a previously published version: American Academy of Pediatric Dentistry. Clinical guideline on the role of dental prophylaxis in pediatric dentistry. Chicago (IL): American Academy of Pediatric Dentistry; 2003. 3 p.
Guideline Category
Counseling
Prevention
Intended Users
Allied Health Personnel
Dentists
Health Care Providers
Health Plans
Managed Care Organizations
Patients
Physicians
Public Health Departments
Guideline Objective(s)
To educate caregivers and other interested third parties on the indications for and benefits of a dental prophylaxis in conjunction with a periodic oral health assessment
Target Population
Infants children and adolescents
Interventions and Practices Considered
- Dental prophylaxis using any one of the following methods based on risk factors for caries or periodontal disease:
- Toothbrush
- Power brush
- Rubber cup
- Hand instruments
- Instruction of caregivers parents and patients in proper oral hygiene techniques
Major Outcomes Considered
Incidence of dental caries and periodontal disease
Methods Used to Collect/Select Evidence
Searches of Electronic Databases
Description of Methods used to Collect/Select the Evidence
A MEDLINE search was conducted using the terms "dental prophylaxis" "toothbrushing" "professional tooth cleaning" and "professional dental prophylaxis in children."
Number of Source Documents
Not stated
Methods Used to Assess the Quality and Strength of the Evidence
Subjective Review
Rating Scheme for the Strength of the Evidence
Not applicable
Methods Used to Analyze the Evidence
Review
Description of the Methods Used to Analyze the Evidence
This guideline is based on a review of current preventive restorative and periodontal literature as well as the American Academy of Pediatric Dentistry's (AAPD's) Policy Statement on the Use of a Caries-risk Assessment Tool (CAT) for Infants Children and Adolescents and the American Academy of Periodontics' (AAP) Periodontal Diseases in Children and Adolescents.
Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations
Clinical guidelines of the American Academy of Pediatric Dentistry (AAPD) are developed under the direction of the Board of Trustees utilizing the resources and expertise of its membership operating through the Council on Clinical Affairs (CCA).
Proposals to develop or modify guidelines may originate from 4 sources:
- The officers or trustees acting at any meeting of the Board of Trustees
- A council committee or task force in its report to the Board of Trustees
- Any member of the AAPD acting through the Reference Committee hearing of the General Assembly at the Annual Session
- Officers trustees council and committee chairs or other participants at the AAPD's Annual Strategic Planning Session
Regardless of the source proposals are considered carefully and those deemed sufficiently meritorious by a majority vote of the Board of Trustees are referred to the CCA for development or review/revision.
Once a charge (directive from the Board of Trustees) for development or review/revision of a clinical guideline is sent to the CCA it is assigned to 1 or more members of the CCA for completion. CCA members are instructed to follow the specified format for a guideline. All clinical guidelines are based on 2 sources of evidence: (1) the scientific literature; and (2) experts in the field. CCA in collaboration with the Council on Scientific Affairs performs a comprehensive review of current scientific literature for each document. In cases where scientific data does not appear conclusive experts may be consulted.
The CCA meets on an interim basis (midwinter) to discuss proposed oral health policies and clinical guidelines. Each new or reviewed/revised guideline is reviewed discussed and confirmed by the entire council.
Rating Scheme for the Strength of the Recommendations
Not applicable
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
Comparison with Guidelines from Other Groups
Peer Review
Description of Method of Guideline Validation
Once developed by the Council on Clinical Affairs (CCA) the proposed guideline is submitted for the consideration of the Board of Trustees. While the board may request revision in which case it is returned to the council for modification once accepted by majority vote of the board it is referred for Reference Committee hearing at the upcoming Annual Session. At the Reference Committee hearing the membership may provide comment or suggestion for alteration of the document before presentation to the General Assembly. The final document then is presented for ratification by a majority vote of the membership present and voting at the General Assembly. If accepted by the General Assembly either as proposed or as amended by that body the document then becomes the official American Academy of Pediatric Dentistry (AAPD) clinical guideline for publication in the AAPD's Reference Manual and on the AAPD's Web site.
Major Recommendations
A periodic professional prophylaxis should be performed to:
- Instruct the caregiver and child or adolescent in proper oral hygiene techniques
- Remove microbial plaque and calculus
- Polish hard surfaces to minimize the accumulation and retention of plaque
- Remove extrinsic stain
- Facilitate the examination of hard and soft tissues
- Introduce dental procedures to the young child and apprehensive patient
In addition to establishing the need for a prophylaxis the clinician should determine the most appropriate type of prophylaxis for each patient. The practitioner should select the least aggressive technique that fulfills the goals of the procedure. To minimize loss of the fluoride-rich layer of enamel during polishing the least abrasive paste should be used with light pressure. If a rubber cup/pumice prophylaxis is performed a topical fluoride application is recommended (Adair 2006).
A patient's risk for caries/periodontal disease as determined by the patient's dental provider should help determine the interval of the prophylaxis. Patients who exhibit higher risk for developing caries and/or periodontal disease should have recall visits at intervals more frequent than every 6 months. This allows increased professional fluoride therapy application microbial monitoring antimicrobial therapy reapplication and re-evaluating behavioral changes for effectiveness (United States Preventative Services Task Force 1996). An individualized preventive plan increases the probability of good oral health by demonstrating proper oral hygiene methods and techniques and removing plaque stain calculus (Clerehugh & Tugnait 2001) and the factors that influence their build-up (Roulet & Roulet-Mehrens 1982; Hosoya & Johnston 1989; Quirynen & Bollen 1995).
Table: Benefits of Prophylaxis Options
| Plaque Removal | Stain | Calculus | Polish/Smooth | Education of Patient/Parent | Facilitate Exam | |
|---|---|---|---|---|---|---|
| Toothbrush | Yes | No | No | No | Yes | Yes |
| Power brush | Yes | Yes | No | No | Yes | Yes |
| Rubber cup | Yes | Yes | No | Yes | Yes | Yes |
| Hand instruments | Yes | Yes | Yes | No | Yes | Yes |
Clinical Algorithm(s)
None provided
References Supporting the Recommendations
- Adair SM. Evidence-based use of fluoride in contemporary pediatric dental practice. Pediatr Dent 2006 Mar-Apr;28(2):133-42; discussion 192-8. [51 references] PubMed
- Clerehugh V Tugnait A. Periodontal diseases in children and adolescents: 2. Management. Dent Update 2001 Jul-Aug;28(6):274-81. [16 references] PubMed
- Hosoya Y Johnston JW. Evaluation of various cleaning and polishing methods on primary enamel. J Pedod 1989 Spring;13(3):253-69. PubMed
- Quirynen M Bollen CM. The influence of surface roughness and surface-free energy on supra- and subgingival plaque formation in man. A review of the literature. J Clin Periodontol 1995 Jan;22(1):1-14. [162 references] PubMed
- Roulet JF Roulet-Mehrens TK. The surface roughness of restorative materials and dental tissues after polishing with prophylaxis and polishing pastes. J Periodontol 1982 Apr;53(4):257-66. PubMed
- U.S. Preventive Services Task Force. Guide to clinical preventive services. 2nd ed. Baltimore (MD): Williams & Wilkins; 1996.
Type of Evidence supporting the Recommendations
All clinical guidelines are based on 2 sources of evidence: (1) the scientific literature; and (2) experts in the field.
Potential Benefits
An individualized preventive plan increases the probability of good oral health by demonstrating proper oral hygiene methods and techniques and removing plaque stain calculus and the factors that influence their build-up.
Potential Harms
The use of abrasive toothpastes and whitening products as well as abrasion during a prophylaxis can remove the acquired pellicle. This can have an adverse effect on exposed tooth surfaces by increasing the chances of enamel loss through exposure to dietary acids. Furthermore even though the pellicle begins forming immediately after it is removed it may take up to 7 days possibly longer to mature fully and offer maximal protection against dietary acid challenges.
Description of Implementation Strategy
An implementation strategy was not provided.
Implementation Tools
Chart Documentation/Checklists/Forms
Resources
For information about availability see the "Availability of Companion Documents" and "Patient Resources" fields below.
IOM Care Need
Staying Healthy
IOM Domain
Effectiveness
Patient-centeredness
Bibliographic Source(s)
- American Academy of Pediatric Dentistry. Guideline on the role of dental prophylaxis in pediatric dentistry. Chicago (IL): American Academy of Pediatric Dentistry; 2007. 4 p. [18 references]
Adaptation
The guideline is based in part on the American Academy of Pediatric Dentistry's (AAPD's) Policy Statement on the Use of a Caries-risk Assessment Tool (CAT) for Infants Children and Adolescents and the American Academy of Periodontics' (AAP) "Periodontal Diseases in Children and Adolescents."
Source(s) of Funding
American Academy of Pediatric Dentistry
Guideline Committee
Clinical Affairs Committee
Composition of Group that Authored the Guideline
The Council on Clinical Affairs and Council on Scientific Affairs are comprised of pediatric dentists representing the six geographical districts of the American Academy of Pediatric Dentistry (AAPD) along with additional consultants confirmed by the Board of Trustees.
Financial Disclosures/Conflicts of Interest
Council members and consultants were asked to disclose potential conflicts of interest. None was identified.
Guideline Status
This is the current release of the guideline.
It updates a previously published version: American Academy of Pediatric Dentistry. Clinical guideline on the role of dental prophylaxis in pediatric dentistry. Chicago (IL): American Academy of Pediatric Dentistry; 2003. 3 p.
Guideline Availability
Electronic copies: Available from the American Academy of Pediatric Dentistry Web site.
Print copies: Available from the American Academy of Pediatric Dentistry 211 East Chicago Avenue Suite 700 Chicago Illinois 60611.
Availability of Companion Documents
Information about the American Academy of Pediatric Dentistry (AAPD) mission and guideline development process is available on the AAPD Web site.
The following implementation tools are available for download from the AAPD Web site:
- Dental growth and development chart
- American Academy of Pediatric Dentistry Caries-Risk Assessment Tool (CAT)
Patient Resources
None available
NGC STATUS
This NGC summary was completed by ECRI on March 7 2005. The information was verified by the guideline developer on April 18 2005. This summary was updated by ECRI Institute on April 3 2008. The updated information was verified by the guideline developer on April 30 2008.
COPYRIGHT STATEMENT
This summary is based on the original guideline which is subject to the guideline developer's copyright restrictions.
NGC Disclaimer
The National Guideline Clearinghouse™ (NGC) does not develop produce approve or endorse the guidelines represented on this site.
All guidelines summarized by NGC and hosted on our site are produced under the auspices of medical specialty societies relevant professional associations public or private organizations other government agencies health care organizations or plans and similar entities.
Guidelines represented on the NGC Web site are submitted by guideline developers and are screened solely to determine that they meet the NGC Inclusion Criteria which may be found at http://www.guideline.gov/about/inclusion.aspx .
NGC AHRQ and its contractor ECRI Institute make no warranties concerning the content or clinical efficacy or effectiveness of the clinical practice guidelines and related materials represented on this site. Moreover the views and opinions of developers or authors of guidelines represented on this site do not necessarily state or reflect those of NGC AHRQ or its contractor ECRI Institute and inclusion or hosting of guidelines in NGC may not be used for advertising or commercial endorsement purposes.
Readers with questions regarding guideline content are directed to contact the guideline developer.
Tools
No Quick Reference tools have been developed.