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.
Dietary Fluoride Supplement Recommendations remain unchanged in light of the New Recommendations for Community Water Fluoridation in the United States.
On April 27th the Department of Health and Human Services released the U.S. Public Health Service (USPHS) recommendation for fluoride levels in the drinking water for the prevention of dental caries (community water fluoridation). The new recommendation is 0.7 parts per million (mg F/L) and does not vary by ambient temperature.
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In 2010, the American Dental Association Council on Scientific Affairs (CSA) released a systematic review and clinical recommendation for the use of dietary fluoride supplements (Rozier RG, et al., Journal of the American Dental Association, 2010; 142(12):1481-9, available here. These recommendations considered the risks and benefits of fluoride intake. Dietary supplements are prescribed by the dentist or physician based on an individual risk assessment, which includes caries status, child age, and overall fluoride exposure (which should consider the fluoride levels of fluoride in drinking water).
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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.
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The panel assessed the efficacy of various topical fluoride caries-preventive agents, including mouthrinses, varnishes, gels, foams and pastes.
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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.
View Fluoride Toothpaste for Young Children Guideline Now
The American Dental Association (ADA) Council on Scientific Affairs met with stakeholders to discuss differing public messaging on the use of fluoride toothpaste for young children. The participants agreed that a unified recommendation on the use of fluoride toothpaste for young children would be preferable and less confusing to the public.
View Non-Fluoride Caries Preventive Agents Guideline Now
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.
View Reconstituting Infant Formula Guideline Now
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.
View Pit-and-Fissure Sealants Guideline Now
The panel concluded that sealants are effective in caries prevention and that sealants can prevent the progression of early noncavitated carious lesions.
View Screening for Oral Cancer Guideline Now
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.
View Infective Endocarditis Guideline Now
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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