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.
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.
Prevention of Orthopaedic Implant Infection
Three recommendations have been created to guide clinical practice in the prevention of orthopaedic implant infections in patients undergoing dental procedures: 1) proposes that the practitioner consider changing the long-standing practice of routinely prescribing prophylactic antibiotic for patients with orthopaedic implants who undergo dental procedures; 2) addresses the use of oral topical antimicrobials in the prevention of periprosthetic joint infections; and 3) addresses the maintenance of good oral hygiene.
The panel concluded that dietary fluoride supplements should be prescribed only for childeren 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.
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