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Policy on the Role of Dental Prophylaxis in Pediatric Dentistry

Latest Revision
2022

Purpose
The American Academy of Pediatric Dentistry recognizes the dental prophylaxis as an integral component
of periodic oral health assessment, education, and preventive care.

Methods
This policy was developed by the Clinical Affairs Committee, adopted in 19861, and last revised in 20172.
This revision included a new literature search of PubMed®/MEDLINE using the terms: dental prophylaxis,
tooth-brushing, professional tooth cleaning, fluoride uptake, and professional dental prophylaxis,
limited to children (birth to 18 years), the last 10 years, and English language, resulting in 1,390 articles.
The resultant list was filtered to utilize randomized control studies and systematic reviews only, resulting
in 109 papers for review. When necessary, hand searching for articles and Google Scholar searches
were utilized. Expert and/or consensus opinion by experienced researchers and clinicians also was
considered.

Background
The aim of oral prophylaxis is to remove supragingival plaque, stain, and calculus from patients’ teeth.3
This may be accomplished utilizing hand instruments, ultrasonic scalers, rubber rotary cup, toothbrush,
interdental cleaners (e.g., floss), and air polishing. Persistent gingival inflammation in young patients with
reasonable supragingival home plaque control often is related to calculus deposits previously not detected
or only partially removed.4 Attachment loss due to chronic subgingival calculus in young children has been
reported.5 Thus, a dental prophylaxis is an important component of initial and recall dental appointments.3
The instrumentation (e.g., toothbrush prophylaxis, hand-scaling) needed for each patient is determined on
an individual basis. In example, in the young or pre-cooperative patient, patients with special health care
needs, or patients with no calculus, a toothbrush prophylaxis may be utilized by the dental professional.

Limited evidence suggests that, although prophylaxis may lead to short-term reductions in plaque levels
and gingival bleeding, it may not lead to the prevention of gingivitis.6,7 Nevertheless, prophylaxis is an
important component of pediatric oral health care and, among other benefits detailed below, facilitates the
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conduct of a high-quality comprehensive oral examination. The coronal polish procedure typically entails
the application of a dental polishing paste to tooth surfaces with a rotary rubber cup or bristle brush to
remove plaque and stains from teeth. A toothbrush coronal polish (i.e., toothbrush and toothpaste) is a
procedure that is used to remove plaque from tooth surfaces and demonstrate brushing techniques to
caregivers for young children and for patients with special needs who cannot tolerate the use of a rotary
rubber cup.8 Air polishing uses a mix of pressurized air, abrasive powder, and water to remove
supragingival stains, plaque, and deposits from teeth.9 Dental scaling is a procedure in which hand or
ultrasonic instruments are used to remove calculus and stain. Full mouth debridement may be necessary
as a preliminary treatment for those whose medical, psychological, physical, or periodontal condition
result in calculus accumulation beyond the scope of routine prophylaxis.

These procedures facilitate the clinical examination and introduce dental procedures to the patient.
Additionally, the accompanying preventive visit demonstrates proper oral hygiene methods to the patient
and/or caregiver. Professional oral hygiene instruction and reinforcement can lead to behaviors that
reduce both plaque and gingivitis10, but in the absence of patient oral hygiene instruction, professional
supra-gingival and sub-marginal plaque and calculus removal has little value in gingivitis prevention.3,11

The frequent disruption or removal of bacterial dental plaque, known as biofilm, from various areas of
the oral cavity is crucial to oral disease prevention and is achieved through regular personal oral hygiene
and professional prophylaxis.12 Accurate detection of biofilm is critical to effective removal and special
dyes of iodine, gentian violet, erythrosine, basic fuchsin, fast green, food dyes, fluorescein, and two-tone
disclosing agents are available in the forms of tablets, solutions, wafers, lozenges, or mouthrinses.13
Biofilm staining allows for effective personalized oral health guidance from healthcare providers. Severe
dental caries is most strongly associated with biofilm in the upper posterior palatal, lower posterior
buccal, and lower posterior lingual spaces, as well as on the tongue.14 Disclosing agents for both
professional and personal use can supplement a personal oral hygiene protocol.

Flossing is an important part of the prophylaxis that removes interproximal and subgingival plaque,
aids in educating the patient, and facilitates the oral examination. Since interdental plaque biofilm is
not completely removed with brushing10,15, interdental cleaning is indicated when interdental spaces are
filled with gingiva or contacts are closed16,17. Different devices (e.g., dental floss, interdental brushes,
oral irrigations) are used to remove plaque interdentally.10,15 The benefits of various prophylaxis
options are shown in the Table below.
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Numerous reports have shown plaque and pellicle are not a barrier to fluoride uptake in enamel and,
consequently, patients who receive rubber cup dental prophylaxis or a tooth-brush prophylaxis before
fluoride treatment exhibit no difference in caries rates.6,7,18 Rubber cup prophylaxis is not required
prior to the topical application of fluorides.

A patient’s risks for caries and periodontal disease3,19, as determined by the patient’s dental provider, can
help establish the interval of the prophylaxis or periodontal maintenance. An individualized preventive
plan increases the probability of good oral health through proper oral hygiene methods and techniques as
demonstrated by oral health professionals. In addition, removing plaque, stain, calculus, and the factors
that influence their buildup increases the probability of good oral health. Patients who exhibit higher
risk for developing caries or periodontal disease can benefit from recall visits at more frequent
intervals.3,19-21

Policy statement
The American Academy of Pediatric Dentistry supports a professional prophylaxis during new patient
comprehensive and periodic examinations to:
 instruct the caregiver and child or adolescent in proper oral hygiene techniques.
 remove dental plaque, extrinsic stain, and calculus deposits from the teeth.
 facilitate the examination of hard and soft tissues.
 introduce dental procedures to the young child and apprehensive patient.

Determination of interval for periodic examinations takes into consideration a patient’s assessed risk
for caries and periodontal disease.3,19

References
1. American Academy of Pediatric Dentistry. The role of prophylaxis in pediatric dentistry. Colorado
Springs, Colo.: American Academy of Pediatric Dentistry; May, 1986.
2. American Academy of Pediatric Dentistry. Policy on role of dental prophylaxis in pediatric dentistry.
Pediatr Dent 2017;39(6):47-8.
3. American Academy of Pediatric Dentistry. Risk assessment and management of periodontal diseases
and pathologies in pediatric dental patients. The Reference Manual of Pediatric Dentistry. Chicago,
Ill.: American Academy of Pediatric Dentistry, PENDING.
4. Clerehugh V, Tugnait A. Diagnosis and management of periodontal diseases in children and
adolescents. Periodontol 2000 2001;26:146-68.
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5. Roberts-Harry EA, Clerehugh V. Subgingival calculus: Where are we now? A comparative review. J
Dent 2000;28(2):93-102.
6. Horowitz AM. Rubber cup dental prophylaxis is not needed prior to the topical application of
fluorides and rubber cup dental prophylaxis at recall is not effective in the prevention of gingivitis.
J Evid Base Dent Pract 2012;12:77-8.
7. Azarpazhooh A, Main PA. Efficacy of dental prophylaxis (rubber cup) for the prevention of caries and
gingivitis: A systematic review of literature. Br Dent J 2009;207(7):E14; discussion 328-9.
8. Ramos-Gomez F, Crystal YO, Ng MW, Tinanoff N, Featherstone JD. Caries risk assessment,
prevention, and management in pediatric dental care. Gen Dent 2010;58(6):505-17; quiz 518-9.
9. Graumann SJ, Sensat ML, Stoltenberg JL. Air polishing: A review of current literature. J Dent Hyg
2013;87(4):173-80.
10. Chapple IL, Van der Weijden F, Doerfer C, et al. Primary prevention of periodontitis: Managing
gingivitis. J Clin Periodontol 2015;42(Suppl 16):S71-6.
11. Tonetti MS, Eickholz P, Loos BG, et al. Principles in prevention of periodontal diseases: Consensus
report of group 1 of the 11th European Workshop on Periodontology on effective prevention of
periodontal and peri-implant diseases. J Clin Periodontol 2015;42(Suppl 16):S5-11.
12. Larsen T, Fiehn NE. Dental biofilm infections - An update. APMIS 2017;125(4):376-84.
13. Dipayan D, Kumar SGR, Narayanan MBA, Selvamary AL, Sujatha A. Disclosing solutions used in
dentistry. World J Pharmaceut Res 2017;6(6):1648-56.
14. Fasoulas A, Pavlidou E, Petridis D, Mantzorou M, Seroglou K, Giaginis C. Detection of dental plaque
with disclosing agents in the context of preventive oral hygiene training programs. Heliyon
2019;10;5(7):e02064.
15. Perry DA, Takei HH, Do JH. Plaque biofilm control for the periodontal patient. In: Newman MG, Takei
HH, Klokkevold PR, Carranza FA, eds. Newman and Carranza's Clinical Periodontology. 13th ed.
Philadelphia, Pa: Elsevier; 2019: 511-20.
16. Drummond BK, Brosnan MG, Leichter JW. Management of periodontal health in children: Pediatric
dentistry and periodontology interface. Periodontol 2000 2017;74(1):158-67.
17. Silva DR, Law CS, Duperon DF, Carranza FA. Gingival disease in childhood. In: Newman MG, Takei
HH, Klokkevold PR, Carranza FA, eds. Newman and Carranza's Clinical Periodontology. 13th ed.
Philadelphia, Pa: Elsevier; 2019: 277-86.
18. Weyant RJ, Tracy SL, Anselmo TT, et al. Topical fluoride for caries prevention: Executive summary
of the updated clinical recommendations and supporting systematic review. J Am Dent Assoc
2013;144(11):1279-91.
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19. American Academy of Pediatric Dentistry. Caries risk assessment and management for infants,
children, and adolescents. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American
Academy of Pediatric Dentistry. PENDING
20. Patel S, Bay RC, Glick M. A systematic review of dental recall intervals and incidence of dental caries.
J Am Dent Assoc 2010;141(5):527-39.
21. American Academy of Pediatric Dentistry. Periodicity of examination, preventive dental services,
anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents. The
Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry.
PENDING.

Table. BENEFITS OF PROPHYLAXIS OPTIONS

Plaque Stain Calculus Education of Facilitate
removal removal removal patient/ examination
caregiver
Toothbrush Yes No No Yes Yes
Rubber cup Yes Yes No Yes Yes
Hand instruments Yes Yes Yes Yes Yes
Ultrasonic scalers Yes Yes Yes Yes Yes
Air polishing Yes Yes Yes Yes Yes
Flossing/interdental Yes No No Yes Yes
cleaning