ORAL HEALTH POLICIES: ROLE OF DENTAL PROPHYLAXIS

Policy on the Role of Dental Prophylaxis in

Pediatric Dentistry
Latest Revision How to Cite: American Academy of Pediatric Dentistry. Policy on
2024 the role of dental prophylaxis in pediatric dentistry. The Reference
Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of
Pediatric Dentistry; 2024:95-7.

Purpose pediatric oral health care and, among other benefits detailed
The American Academy of Pediatric Dentistry recognizes the in the Table, facilitates the conduct of a high-quality compre-
dental prophylaxis as an integral component of periodic oral hensive oral examination and home oral hygiene techniques.
health assessment, education, and preventive care. The coronal polish procedure typically entails the application
of a dental polishing paste to tooth surfaces with a rotary rub-
Methods ber cup or bristle brush to remove plaque and extrinsic stains
This policy was developed by the Clinical Affairs Committee, from teeth. A toothbrush coronal polish (i.e., toothbrush
adopted in 19861, and last revised in 20222. This revision by and toothpaste) is a procedure that is used to remove plaque
the Council on Clinical Affairs included a new literature from tooth surfaces and demonstrate brushing techniques to
®
search of PubMed /MEDLINE using the terms: dental pro-
phylaxis, toothbrushing, professional tooth cleaning, fluoride
patients/caregivers for young children and for patients with
special needs who cannot tolerate the use of a rotary rubber
uptake, and professional dental prophylaxis, limited to children cup. 9 Air polishing uses a mix of pressurized air, abrasive
(birth to 18 years), the last 10 years, and English language, powder, and water to remove supragingival extrinsic stains,
resulting in 1,039 articles. The resultant list was filtered to plaque, and deposits from teeth.10 Dental scaling is a procedure
utilize randomized control studies and systematic reviews, in which hand or ultrasonic instruments are used to remove
relevant review studies, and book chapters resulting in 113 calculus and extrinsic stains. Ultrasonic devices may cause less
papers for review. When necessary, hand searching for articles soft tissue trauma, require a shorter treatment time, and are less
and Google Scholar searches were utilized. Expert and/or con- technique and operator sensitive than hand instrumentation.11
sensus opinion by experienced researchers and clinicians also Full mouth debridement may be necessary as a preliminary
was considered. treatment for those whose medical, psychological, physical, or
periodontal condition results in calculus accumulation beyond
Background the scope of routine prophylaxis.
The aim of oral prophylaxis is to remove supragingival plaque, These procedures facilitate the clinical examination and
extrinsic stain, and calculus from patients’ teeth.3 This may be introduce dental procedures to the patient. Additionally, the
accomplished utilizing toothbrush, dental floss, rotary rubber accompanying preventive visit allows the practitioner to
cup, hand instruments, ultrasonic scalers, and air polishers. Per- educate the patient/caregiver about the need to remove plaque
sistent gingival inflammation in young patients with reasonable biofilm and demonstrate proper oral hygiene methods. Pro-
supragingival home plaque control often is related to calculus fessional oral hygiene instruction and reinforcement can lead
deposits previously not detected or only partially removed.4 to behaviors that reduce both plaque and gingivitis,12 but in
Attachment loss due to chronic subgingival calculus in young the absence of patient oral hygiene instruction, professional
children has been reported. 5 Thus, supra- and subgingival supragingival and submarginal plaque and calculus removal
instrumentation is an important component of initial and has little value in gingivitis prevention.13 A comprehensive oral
recall dental appointments.6 The instrumentation technique health education program with oral prophylaxis is effective
(e.g., toothbrush prophylaxis, hand-scaling) needed for each in reducing plaque and improving oral health knowledge,
patient is determined on an individual basis. For example, in desirable oral health behaviors, and attitudes 14 .

the young or pre-cooperative patient, patients with special The frequent disruption or removal of plaque biofilm from
health care needs, or patients with no calculus or extrinsic various areas of the oral cavity is crucial to oral disease pre-
stain, a toothbrush prophylaxis may be utilized by the dental vention and is achieved through regular personal oral hygiene
professional. and professional prophylaxis.15 Accurate detection of biofilm
Limited evidence suggests that, although prophylaxis may is critical to effective removal, and special dyes of iodine,
lead to short-term reductions in plaque levels and gingival gentian violet, erythrosine, basic fuchsin, fast green, food dyes,
bleeding, it may not lead to the prevention of gingivitis. 7,8 fluorescein, and two-tone disclosing agents are available in the
Nevertheless, prophylaxis is a fundamental component of forms of tablets, solutions, wafers, lozenges, or mouthrinses.16

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ORAL HEALTH POLICIES: ROLE OF DENTAL PROPHYLAXIS

Policy statement
Table. BENEFITS OF PROPHYLAXIS OPTIONS
The American Academy of Pediatric Dentistry supports a
Plaque Extrinsic- Calculus Facilitate Facilitate professional prophylaxis during new patient comprehensive
removal stain removal education examination
removal on home
or evaluation and periodic examinations to:
care • instruct the caregiver and child or adolescent in
techniques proper oral hygiene techniques.
Toothbrush Yes No No Yes Yes • remove dental plaque, extrinsic stains, and cal-
culus deposits from the teeth.
Interdental
cleaners • facilitate the examination of hard and soft tissues.
(e.g., floss, Yes No No Yes Yes • introduce dental procedures to the young child
interdental and apprehensive patient.
brush)
Rotary rubber Yes Yes No No Yes
cup or bristle Determination of interval for periodic examinations takes
brush into consideration a patient’s assessed risk for caries 22 and
Hand Yes Yes Yes No Yes periodontal disease6.
instruments
Ultrasonic Yes Yes Yes No Yes References
scalers 1. American Academy of Pediatric Dentistry. The role of
Air polishing Yes Yes Yes No Yes prophylaxis in pediatric dentistry. Colorado Springs,
Colo.: American Academy of Pediatric Dentistry;
May, 1986.
Biofilm staining allows for effective personalized oral health 2. American Academy of Pediatric Dentistry. Policy on role
guidance from healthcare providers. Severe dental caries is of dental prophylaxis in pediatric dentistry. The Reference
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professional and personal use can supplement a personal oral Clin Periodontol 1996;23(3 Pt 2):263-7.
hygiene protocol. 4. Clerehugh V, Tugnait A. Diagnosis and management of
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interproximal and subgingival plaque, aids in educating the dontol 2000 2001;26:146-68.
patient/caregiver, and facilitates the oral examination. Since 5. Roberts-Harry EA, Clerehugh V. Subgingival calculus:
interdental plaque biofilm is not completely removed with Where are we now? A comparative review. J Dent 2000;
brushing,12,18 interdental cleaning is indicated when interdental 28(2):93-102.
spaces are filled with gingiva or contacts are closed.19,20 Differ- 6. American Academy of Pediatric Dentistry. Periodontal
ent devices (e.g., dental floss, interdental brushes, oral irrigations) conditions in pediatric dental patients. The Reference
are used to remove plaque interdentally.12,18 The benefits of Manual of Pediatric Dentistry. Chicago, Ill.: American
various prophylaxis options are shown in the Table. Academy of Pediatric Dentistry; 2024:505-22.
Numerous reports have shown plaque and pellicle are not 7. Azarpazhooh A, Main PA. Efficacy of dental prophylaxis
a barrier to fluoride uptake in enamel and, consequently, pa- (rubber cup) for the prevention of caries and gingivitis:
tients who receive rotary rubber cup dental prophylaxis or a A systematic review of literature. Br Dent J 2009;207(7):
toothbrush prophylaxis before fluoride treatment exhibit no E14; discussion 328-9.
difference in caries rates.7,8,21 Prophylaxis is not required prior 8. Horowitz AM. Rubber cup dental prophylaxis is not
to the topical application of fluoride. needed prior to the topical application of fluorides and
A patient’s risks for caries 22 and periodontal disease 6, as rubber cup dental prophylaxis at recall is not effective in
determined by the patient’s dental provider, can help establish the prevention of gingivitis. J Evid Base Dent Pract 2012;
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An individualized preventive plan increases the probability 9. Ramos-Gomez F, Crystal YO, Ng MW, Tinanoff N,
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benefit from recall visits at more frequent intervals.6,22-24

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 ORAL HEALTH POLICIES: ROLE OF DENTAL PROPHYLAXIS

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