• 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]

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.

Dental caries and periodontal disease

Counseling
Prevention

Dentistry
Pediatrics
Preventive Medicine

Allied Health Personnel
Dentists
Health Care Providers
Health Plans
Managed Care Organizations
Patients
Physicians
Public Health Departments

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

Infants, children, and adolescents

1. 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
2. Instruction of caregivers, parents, and patients in proper oral hygiene techniques

Incidence of dental caries and periodontal disease

Searches of Electronic Databases

A MEDLINE search was conducted using the terms "dental prophylaxis", "toothbrushing", "professional tooth cleaning", and "professional dental prophylaxis in children."

Not stated

Subjective Review

Not applicable

Review

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.

Expert Consensus

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:

1. The officers or trustees acting at any meeting of the Board of Trustees
2. A council, committee, or task force in its report to the Board of Trustees
3. Any member of the AAPD acting through the Reference Committee hearing of the General Assembly at the Annual Session
4. 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.

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Comparison with Guidelines from Other Groups
Peer Review

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.

A periodic professional prophylaxis should be performed to:

1. Instruct the caregiver and child or adolescent in proper oral hygiene techniques
2. Remove microbial plaque and calculus
3. Polish hard surfaces to minimize the accumulation and retention of plaque
4. Remove extrinsic stain
5. Facilitate the examination of hard and soft tissues
6. 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

None provided

All clinical guidelines are based on 2 sources of evidence: (1) the scientific literature; and (2) experts in the field.

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.

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.

An implementation strategy was not provided.

Staying Healthy

Effectiveness
Patient-centeredness

• 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]

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."

1986 (revised 2007 Jan)

American Academy of Pediatric Dentistry - Professional Association

American Academy of Pediatric Dentistry

Clinical Affairs Committee

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.

Council members and consultants were asked to disclose potential conflicts of interest. None was identified.

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.

None available

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.

This summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.