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Guideline Summary
Guideline Title
Guideline on periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents.
Bibliographic Source(s)
American Academy of Pediatric Dentistry (AAPD). Clinical guideline on periodicity of examination, preventive dental services, anticipatory guidance/counseling and oral treatment for infants, children, and adolescents. Chicago (IL): American Academy of Pediatric Dentistry (AAPD); 2009. 8 p. [91 references]
Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: American Academy of Pediatric Dentistry. Guideline on periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents. Chicago (IL): American Academy of Pediatric Dentistry; 2007. 11 p. [81 references]

Scope

Disease/Condition(s)

Oral and dental conditions and diseases, such as:

  • Dental caries
  • Periodontal disease
  • Malocclusion
  • Injury
Guideline Category
Counseling
Evaluation
Prevention
Risk Assessment
Clinical Specialty
Dentistry
Pediatrics
Preventive Medicine
Intended Users
Dentists
Guideline Objective(s)

To help practitioners make clinical decisions concerning preventive oral health interventions, including anticipatory guidance and preventive counseling, for infants, children, and adolescents

Target Population

Infants, children, and adolescents who have no contributory medical conditions and are developing normally

Interventions and Practices Considered
  1. Clinical oral examination
  2. Assessment of oral growth and development
  3. Caries risk assessment
  4. Prophylaxis and topical fluoride treatment
  5. Fluoride supplementation
  6. Anticipatory guidance/counseling on oral hygiene, diet, nonnutritive oral habits, injury prevention, speech/language development, intraoral/oral piercing, and substance abuse
  7. Radiographic assessment
  8. Treatment of dental disease/injury
  9. Treatment of developing malocclusion
  10. Sealants
  11. Assessment of and/or removal of third molars
  12. Referral for regular and periodic dental care
Major Outcomes Considered
  • Oral health
  • Disease prevention rate

Methodology

Methods Used to Collect/Select the Evidence
Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence

This guideline is a compilation of related policies and guidelines published by the American Academy of Pediatric Dentistry (AAPD), in addition to pediatric oral health literature and national reports and recommendations. The related policies and guidelines provide additional references for individual recommendations.

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence
Expert Consensus (Committee)
Rating Scheme for the Strength of the Evidence

Not applicable

Methods Used to Analyze the Evidence
Review
Description of the Methods Used to Analyze the Evidence

Not stated

Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations

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 clinical guidelines. Each new or reviewed/revised guideline is reviewed, discussed, and confirmed by the entire council.

Rating Scheme for the Strength of the Recommendations

Not applicable

Cost Analysis

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

Method of Guideline Validation
Peer Review
Description of Method of Guideline Validation

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.

Recommendations

Major Recommendations

An accurate, comprehensive, and up-to-date medical history is necessary for correct diagnosis and effective treatment planning.

Recommendations for Pediatric Oral Health Assessment, Preventive Services, and Anticipatory Guidance/Counseling

Since each child is unique, these recommendations are designed for the care of children who have no contributing medical conditions and are developing normally. These recommendations will need to be modified for children with special health care needs or if disease or trauma manifests variations from normal. The American Academy of Pediatric Dentistry (AAPD) emphasizes the importance of very early professional intervention and the continuity of care based on the individualized needs of the child. Refer to the text of the original guideline document for supporting information and references.

Age 6-12 months 12-24 months 2-6 years 6-12 years >12 years
Clinical oral examination1 X X X X X
Assess oral growth and development2 X X X X X
Caries-risk assessment3 X X X X X
Radiographic assessment4 X X X X X
Prophylaxis & topical fluoride3,4 X X X X X
Fluoride supplementation5 X X X X X
Anticipatory guidance/counseling6 X X X X X
Oral hygiene counseling7 Parent Parent Patient/Parent Patient/Parent Patient
Dietary counseling8 X X X X X
Injury prevention counseling9 X X X X X
Counseling for nonnutritive habits10 X X X X X
Counseling for speech/language development X X X    
Substance abuse counseling       X X
Counseling for intraoral/perioral piercing       X X
Assessment and treatment of developing malocclusion     X X X
Assessment for pit and fissure sealants11     X X X
Assessment and/or removal of third molars         X
Transition to adult dental care         X
  1. First examination at the eruption of the first tooth and no later than 12 months. Repeat every 6 months or as indicated by child's risk status/susceptibility to disease. Includes assessment of pathology and injuries.
  2. By clinical examination.
  3. Must be repeated regularly and frequently to maximize effectiveness.
  4. Timing, selection, and frequency determined by child's history, clinical findings, and susceptibility to oral disease.
  5. Consider when systemic fluoride exposure is suboptimal. Up to at least 16 years.
  6. Appropriate discussion and counseling should be an integral part of each visit for care.
  7. Initially, responsibility of parent; as child matures, jointly with parent; then, when indicated, only child.
  8. At every appointment; initially discuss appropriate feeding practices, then the role of refined carbohydrates and frequency of snacking in caries development and childhood obesity.
  9. Initially play objects, pacifiers, car seats; then when learning to walk, sports and routine playing, including the importance of mouthguards.
  10. At first discuss the need for additional sucking: digits vs. pacifiers; then the need to wean from the habit before malocclusion or skeletal dysplasia occurs. For school-aged children and adolescent patients, counsel regarding any existing habits such as fingernail biting, clenching, or bruxism.
  11. For caries-susceptible primary molars, permanent molars, premolars, and anterior teeth with deep pits and fissures; placed as soon as possible after eruption.
Clinical Algorithm(s)

None provided

Evidence Supporting the Recommendations

Type of Evidence Supporting the Recommendations

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

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits
  • Improvement in a child's oral health, general health and well-being, and school readiness
  • Early diagnosis of developing malocclusions
  • Prevention of disease by identification and minimization of causative factors
  • Prevention, inhibition, and reversal of caries
  • Cost-effectiveness of early diagnosis and treatment
Potential Harms

Appropriate precautionary measures should be taken to prevent swallowing of any professionally-applied topical fluoride.

Qualifying Statements

Qualifying Statements
  • The American Academy of Pediatric Dentistry emphasizes the importance of very early professional intervention and the continuity of care based on the individualized needs of the child.
  • Recommendations may be modified to meet the unique requirements of patients with special needs.

Implementation of the Guideline

Description of Implementation Strategy

An implementation strategy was not provided.

Implementation Tools
Chart Documentation/Checklists/Forms
Resources
For information about availability, see the Availability of Companion Documents and Patient Resources fields below.

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need
Getting Better
Staying Healthy
IOM Domain
Effectiveness
Patient-centeredness
Timeliness

Identifying Information and Availability

Bibliographic Source(s)
American Academy of Pediatric Dentistry (AAPD). Clinical guideline on periodicity of examination, preventive dental services, anticipatory guidance/counseling and oral treatment for infants, children, and adolescents. Chicago (IL): American Academy of Pediatric Dentistry (AAPD); 2009. 8 p. [91 references]
Adaptation

This guideline is in part adapted from related policies and guidelines published by the American Academy of Pediatric Dentistry (AAPD).

Date Released
1991 (revised 2009)
Guideline Developer(s)
American Academy of Pediatric Dentistry - Professional Association
Source(s) of Funding

American Academy of Pediatric Dentistry

Guideline Committee

Clinical Affairs Committee

Composition of Group That Authored the Guideline

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.

Financial Disclosures/Conflicts of Interest

Council members and consultants derive no financial compensation from the American Academy of Pediatric Dentistry (AAPD) for their participation and are asked to disclose potential conflicts of interest. No conflicts were identified.

Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: American Academy of Pediatric Dentistry. Guideline on periodicity of examination, preventive dental services, anticipatory guidance/counseling, and oral treatment for infants, children, and adolescents. Chicago (IL): American Academy of Pediatric Dentistry; 2007. 11 p. [81 references]

Guideline Availability

Electronic copies: Available from the American Academy of Pediatric Dentistry Web site External Web Site Policy.

Print copies: Available from the American Academy of Pediatric Dentistry, 211 East Chicago Avenue, Suite 700, Chicago, Illinois 60611.

Availability of Companion Documents

Information about the American Academy of Pediatric Dentistry (AAPD) mission and guideline development process is available on the AAPD Web site External Web Site Policy.  External Web Site Policy 

The following implementation tools are available for download from the AAPD Web site:

Patient Resources

None available

NGC Status

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 was updated by ECRI Institute on February 23, 2010. The updated information was verified by the guideline developer on March 22, 2010.

Copyright Statement

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

Disclaimer

NGC Disclaimer

The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.

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