Guideline on the role of Dental Prophylaxis in Pediatric Dentistry

Resident: Adam J. Bottrill
Date: 23MAR11
Region: Providence
Article title: Guideline on the role of Dental Prophylaxis in Pediatric Dentistry
Author(s): Clinical Affairs Committee
Journal: Pediatric Dentistry Reference Manual
Page #s: 141-142
Vol:No Date: 2010
Major topic: Prophylaxis
Minor topic(s): None
Type of Article: Guidelines

Main Purpose: Provide a guideline for the indications for and benefits of a dental prophylaxis in conjunction with periodic infant oral health assessment.

Key points in the article discussion:

I. General:

A. Microbial plaque is the primary etiological factor in caries and periodontal disease. MOST of this plaque can be removed with home hygiene, but MOST patients do not have the necessary skillz to remain plaque-free for long periods of time.

B. Indications:
1. Removal of plaque, stain, and calculus.
2. Elimination of factors that influence the build-up and retention of plaque.
3. Demonstration of proper oral hygiene methods to the pt/caregiver.
4. Facilitation of a thorough clinical exam.
5. Introduction of dental procedures to the child.

C. Type and frequency varies based on individual risk-assessment:
1. MH.
2. Age and cooperation.
3. Compliance.
4. Past and current caries.
5. FH of caries.
6. Past and current perio health.
7. FH of perio health.
8. OH.
9. Plaque.
10. Calculus.
11. Staining.
12. Local factors that would influence the build-up and retention of plaque.

D. Prophy can be performed with TB, cup, floss, instruments.
1. With no stain or calculus, TB is ok.
2. Rubber cup prophy for extrinsic staining and smoothing edges after scaling.
3. Rubber cup using pumice may be used prior to Fl Tx.
4. abrasive toothpastes and pumice may remove pellicle which may increase chances of enamel loss through exposure to dietary acids.
5. Pumice may remove up to 0.6-4.0 microns of outer enamel (includes the Fl-rich layer).

II. Recommendations:

A. Periodic Prophy should be performed to:
1. Instruct.
2. Remove plaque and calculus.
3. Polish hard surfaces.
4. Remove staining.
5. Facilitate the exam.
6. Introduce dental procedures to young children and apprehensive patients.

B. Practitioner should choose the least aggressive technique that fulfills the goals of the procedure. Least abrasive paste with light pressure.

C. If pumice or course past is used, Fl application indicated.

D. Patients at higher risk should have prophy at more frequent interval than 6 months.
1. Allows for OH monitoring and frequent Tx.

E. Individualized Tx plans are necessary.

Assessment of Article: Short and sweet and common sense. I suppose the AAPD needs to have this guideline, but it seems silly. I'm glad they didn't waste more than 2 pages.