OnTarget Highlight: The Pediatric Prophy Appointment

Oral healthcare is essential at any age, but for children, maintaining a healthy mouth holds special importance. Dental caries is the most common chronic childhood infectious disease. As of 2015, approximately 573 million children worldwide had at least one untreated cavity. Due to a lack of access to resources like dental care and proper nutrition, the disease disproportionately affects children from lower-income households, and they are more than twice as likely to suffer from dental caries than those in higher-income families.

The potentially widespread and long-lasting impact of untreated childhood caries cannot be understated. In the short-term, pain, discomfort, and infection can diminish a child’s appetite, disrupt their sleep schedule, and reduce their ability to learn and socialize due to lack of concentration, low school attendance, and embarrassment. Long-term effects include continuing and worsening oral health problems, especially for children with early childhood caries (ECC) – primary tooth decay in infants or toddlers. Young children with untreated caries are more likely to experience carious lesions in permanent dentition, have insufficient physical development due to inadequate nutrition, and suffer from speech, socialization, and other quality-of-life problems that can last into adulthood. Childhood dental caries also places a significant burden on parents, as they face increased treatment costs and office visits, as well as many other challenges inherent in caring for a child with physical and psychological stressors.

Good news for children’s oral health

The good news is that caries is entirely preventable and, since the 1970s, rates of childhood tooth decay have largely declined. Likewise, there has been an increase in pediatric prophylaxis appointment attendance – in 2014, 64.6% of children under 18 reportedly visited their dentist every six months; in 2017, a similar study showed 84.6% of children having at least one dental visit in the past year. Alongside a low-sugar diet and quality at-home oral hygiene, the pediatric prophy appointment is a staple of childhood preventive dental care. Regular appointments not only help children eliminate and prevent caries, but also provide them with the tools and habits they need for a lifetime of good oral health.

While the specifics differ depending on the child’s age and individual oral health needs, the core components of the pediatric prophy appointment are similar to its adult counterpart. During the visit, oral and overall health are evaluated, caries risk is assessed, diagnostic procedures such as X-rays may be performed, and teeth are cleaned to remove plaque and calculus. To properly treat and prevent childhood tooth decay, however, a few extra steps are required – fluoride and dental sealant application.

Fluoride

Fluoride works to slow and reverse demineralization of teeth, thus providing an effective defense against dental caries. Beginning in the 1950s, communities have undergone efforts to fluoridate public water supplies while manufacturers have added fluoride to toothpaste. Together, these measures have reportedly reduced childhood and adolescent caries by 29% to 51%.

Professional topical fluoride application during the pediatric prophy appointment also is recommended because it can prevent approximately one-third of cavities in primary teeth. Due to the way fluoride interacts with tooth surfaces, the application of fluoride varnish, foam, or gel is especially effective for young children with moderate to high risk of primary tooth decay and demineralization. Experts from the Centers for Disease Control and Prevention (CDC) and the American Dental Association suggest biannual applications for moderate- and high-risk pediatric patients beginning no later than 1 year of age.

During the prophy appointment, dentists should assess the patient’s degree of fluoride exposure and recommend and/or provide parents with at-home products like fluoride toothpaste, rinses, and supplements, particularly if the child’s drinking water is not optimally fluoridated. Collectively, fluoride therapy has been shown to decrease childhood caries by up to 70% when compared to no therapy, making it an essential part of pediatric preventive care.

Dental sealants

Dental sealants are another powerful tool for combating childhood caries. Approximately 90% of tooth decay in permanent teeth occurs in the hard-to-clean molar occlusal surfaces, where bacteria and food particles gather. According to data gathered by the CDC, pit-and-fissure sealants on permanent molars can prevent > 80% of caries in this region up to two years after placement. Studies also show that sealants retain their preventive efficacy for as long as 9 years, protecting a child’s teeth through adolescence with no clinically significant adverse effects. Combined with fluoride treatments, which prevent decay in all teeth, sealant application effectively shields pediatric dentition from decay.

Pediatric prophy products

With routine professional prophylaxis, including topical fluoride and sealant application, your younger patients can expect years of excellent oral health. Though you may be familiar with these common treatment strategies, with so many preventive care products available, choosing the right ones can be overwhelming. Following is a selection of solutions to help you deliver exceptional results for pediatric patients of all ages.

Dental sealants

Patterson Pit & Fissure Sealant (Patterson Dental) inhibits dental caries by sealing occlusal surfaces to protect teeth from acidic conditions caused by oral bacteria and dietary carbohydrates. Patterson Pit & Fissure Sealant is light-cured, radiopaque, and fluoride-releasing, and contains bis-GMA and other resins. The product is available in low (7.7% filled) and regular (34.4% filled) viscosities and contains no bisphenol A (BPA) or gluten.

DELTON Light-Curing Pit and Fissure Sealant (Dentsply Sirona) is a nonsurgical solution applied to tooth surfaces to fill and seal pits and fissures. When used alongside fluoride therapy, DELTON Sealants provide an effective strategy for caries treatment and prevention. These sealants feature high wetting ability for maximum coverage and low viscosity, which allows the material to flow freely into pits and fissures for improved protection. DELTON Sealants are available in a variety of colors (opaque and clear), fill levels (38% and 55%), and delivery systems (syringe, direct delivery, and lift and place).

Fluoride varnish

Patterson 5% Sodium Fluoride White Varnish (Patterson Dental) is ideal for treating dentinal hypersensitivity, reducing postoperative sensitivity, and preventing dental caries. Featuring a smooth consistency, the varnish can be quickly and easily applied to enamel in a thin, even layer. Patterson varnish hardens within 10 seconds of contact with saliva or moisture, remains on the tooth for several hours, and completely dries to a natural tooth shade. The varnish contains xylitol, a naturally occurring, low-calorie sugar substitute that helps combat caries.

Prophy paste

Zooby Prophy Paste (Young Dental) is formulated with abrasive and adhesive properties to reduce spatter and enhance stain removal. The paste contains xylitol and 1.23% fluoride, comes in six gluten-free flavors, and is available in fine, medium, and coarse grits. Each box includes an autoclavable Zooby Animal prophy paste gripper with a wide base for ease of handling.

Prophy angles

Denticator Zooby Disposable Prophy Angles (Young Dental) feature soft web, latex-free cups that fit on all slow-speed handpieces. The angles come in five fun animal character designs (zebra, giraffe, tiger, flamingo, and penguin).

Patterson Disposable Prophy Angles (Patterson Dental) aid in the cleaning and polishing of teeth with dental prophy paste. Suitable for all slow-speed Doriot handpieces, Patterson disposable prophy angles (DPAs) feature durable and flexible latex-free cups to reduce paste spatter. To prevent cross-contamination, each angle is individually wrapped and fully disposable. Patterson DPAs are available in both long and short sizes and an assortment of handle colors (blue, pink, and green).

Selected references

Bishop SB. Early childhood caries planning. Peoria City/County Health Department. August 2010.

Centers for Disease Control and Prevention. Children’s oral health. May 14, 2019.

Çolak H, Dülgergil CT, Dalli M, et al. Early Childhood caries update: A review of causes, diagnoses, and treatments. J Nat Sci Biol Med. 2013;4(1):29-38.

Griffin SO, Wei L, Gooch BF, et al. Vital signs: Dental sealant use and untreated tooth decay among U.S. school-aged children. MMWR. 2016;65(41):1141-5.

Hakes H. Pediatric prophylaxis: Helpful hints for dental appointments with children. Today’s RDH. June 6, 2019.

National Institute of Dental and Craniofacial Research. Dental caries (tooth decay) in children age 2 to 11. July 2018.

Oral health: Oft overlooked. 2019;3(10):663. The Lancet Child Adolescent Health.

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This blog post originally appeared in OnTarget. Read the full issue and see current highlighted promotions: pattersondental.com/dental/ontarget