Clinical Practice Guidelines
Clinical practice guidelines include recommendation statements intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options. These are the strongest resources to aid dental professionals in clinical decision making and help incorporate evidence gained through scientific investigation into patient care.
The process for developing clinical practice guidelines is described in the ADA Clinical Guidelines Handbook.
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Management of Patients with Prosthetic Joints
In 2014, the ADA Council on Scientific Affairs assembled an expert panel to update and clarify the clinical recommendations found in the 2012 evidence-based guideline Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures.
As was found in 2012, the 2014 updated systematic review found no association between dental procedures and prosthetic joint infections. Based on this review, the 2014 Panel concluded that prophylactic antibiotics given prior to dental procedures are not recommended for patients with prosthetic joint implants.
The ADA encourages dental professionals to review the full 2014 guideline and take this recommendation into account, consult with the patient’s orthopedic surgeon as needed and consider the patient’s specific needs and preferences when planning treatment.
The panel assessed the efficacy of various topical fluoride caries-preventive agents, including mouthrinses, varnishes, gels, foams and pastes. The guidelines are an update of the 2006 ADA recommendations.
The panel concluded that dietary fluoride supplements should be prescribed only for children who are at risk of developing caries and whose primary source of drinking water is deficient in fluoride.
Non-Fluoride Caries Preventive Agents
The panel addressed several questions regarding the efficacy of non-fluoride agents in reducing the incidence of caries and arresting or reversing the progression of caries. They concluded that certain agents may provide some benefit as adjunctive therapies in at-risk populations.
Reconstituting Infant Formula
The panel recommended that dentists can suggest the use of powdered or liquid concentrate infant formulas reconstituted with optimally fluoridated drinking water while being aware of the potential risks of enamel fluorosis due to exposure to fluoride from multiple sources.
Screening for Oral Cancer
The panel suggested that clinicians remain alert for signs of potentially malignant lesions or early-stage cancers while performing routine visual and tactile examinations in all patients, but particularly in those who use tobacco or consume alcohol heavily.
The panel concluded that sealants are effective in caries prevention and that sealants can prevent the progression of early noncavitated carious lesions.
Infective Endocarditis (IE)
The guidelines update the 1997 recommendations by the American Heart Association for the prevention of IE. The committee concluded that IE prophylaxis for dental procedures should be recommended only for patients with underlying cardiac conditions associated with the highest risk of adverse outcomes from IE.