Dental prophylaxis is the medical term for procedures that promote oral health. This can include anything from a dental check-up to getting sealants to protect the teeth from cavities.

Learn more about the different types of prophylaxis and decide if you could benefit from one of the procedures.

Dental services that are considered prophylactic include a variety of options.

Each service provides a different function for your teeth. Dental exams check the mouth for cavities, gum disease, oral cancer, and more. X-rays check for any signs of tooth decay. Cleanings by a dental hygienist or dentist are performed to remove plaque, calculus (also called tartar).

Scaling or root planing is a form of cleaning or scraping to remove tartar and other deposits from teeth. Flossing is said to remove food and dental plaque between teeth. Polishing involves cleaning with a pumice-type paste that removes stains and dental plaque accumulation.

Fluoride treatments or sealants, usually for kids, are a dental treatment to prevent tooth decay.

Children have unique needs when it comes to dental care. They are extremely vulnerable to decay and other dental problems. One review by the American Academy of Pediatrics states: "Poor oral health is one of the most common health conditions of childhood in the United States.” 

The American Academy of Pediatric Dentistry recommends that kids have their first dental examination and prophylactic treatment at 12 months of age.

Pediatric dentists specialize in helping children who experience fear and anxiety related to dental visits. The primary goal of early intervention of prophylaxis for young children is to get them accustomed to seeing the dentist early on.

This way, the dentist can administer preventative procedures when needed—such as sealants and fluoride treatments—to prevent tooth decay down the road.

There are many recommendations about dental prophylactic measures, including how often each procedure should be done. How effective are these recommendations? Do they really help prevent tooth decay and gum disease? What does the scientific research say?

The journal Evidence-Based Dentistry is committed to measuring the effectiveness of dental prophylactic practices.

Evidence-Based Dentistry (EBD) provides reviews or summarizes reviews from other organizations. The EBD puts together evidence about what is working and what is not when it comes to dental procedures.

One review examined data from the Children’s Health Insurance Program (CHIP), which looked at 36,000 kids to evaluate how preventative dental exams impacted dental care over time. What the study found was that in the long-term, preventative visits were linked with fewer dental appointments for fillings and other restorative care in the future.

Contrary to many dentists' recommendations, however, the study authors reported that it was not actually cost-effective for children to see the dentist twice each year. The study questioned what the primary reason is that kids don't see the dentist more often with dental issues. It could be that kids who visit the dentist regularly don't need to come in more often later on with dental issues.

On the other hand, it could mostly be due to the fact that children get sealants that protect them from experiencing dental issues that would require more dentist visits.

A standard procedure that accompanies most annual dental prophylactic appointments is dental X-rays. According to a leading authority on dentistry, The American Dental Association (ADA), not everyone needs to get yearly X-rays, especially those who have no apparent dental problems. 

The ADA reports that adults who brush properly and take good care of their teeth (and have no cavities or gum/oral conditions) only need X-rays every couple of years, and up to every three years.

Although the ADA clearly states that annual bitewings are not necessary for everyone, most dentists still perform them yearly. 

What about that yearly polishing and scraping? As it turns out, it is not always necessary. In fact, one review was performed to measure the impact of routine dental cleaning—including polishing and scaling. The examination of eight different studies resulted in inconclusive evidence as to whether scaling and polishing procedures provide more benefits or harm.

One such harmful event that can result from dental scaling is called periprosthetic joint infection resulting from bacteremia (bacteria in the blood). This occurs as a result of the agitation of the gums, causing bacteria to travel from the mouth into the bloodstream.

Many studies have shown the presence of bacteremia immediately following gum agitation from dental procedures such as dental prophylaxis. However, this doesn’t indicate that regular dental cleaning is not warranted. 

There is an entire scope of treatment to administer antibiotics before dental treatments for those who have recently had joint replacements, or who are otherwise at risk of consequences of bacteremia.

Treating dental patients with antibiotics before dental cleaning and/or restorative procedures is also considered a type of dental prophylaxis.

During the review by AAP News and Journals Gateway, which examined data from the Children’s Health Insurance Program, it was discovered that the use of sealants—and not the preventative dental exam itself—may have been the primary reason for the long-term protective effects against tooth decay.

However, it has been shown that dental sealants can be applied—usually by a dental hygienist—without an accompanying examination by a dentist. This is actually more cost-effective as well. Fluoride treatments, also known as fluoride varnishing, have been supported by many clinical research studies. 

In fact, past study conclusions favoring fluoride have been so compelling that the U.S. Preventative Services Task Force (USPSTF) recommends fluoride supplementation—also known as dietary fluoride supplementation—in geographic areas of the country where the water is not fluoridated. 

The use of fluoride varnish (administered as part of dental prophylaxis) is recommended by the U.S. Preventative Services Task Force as well. The USPSTF found adequate evidence that fluoride varnish to the primary teeth (baby teeth) provides moderate benefit in preventing tooth decay.

One part of the professional dental prophylaxis procedure is dental flossing (which is usually performed by the dental hygienist after scaling and before polishing). 

Patients are strongly encouraged to floss regularly at home as well. What does the research say? Does flossing lend itself to lowering the incidence of tooth decay or gum disease? According to a Cochrane Database of Systemic Reviews, flossing was found to lower the incidence of a condition called gingivitis (inflammation of the gums) when combined with brushing. 

The review compared flossing and tooth brushing to brushing alone. However, contrary to what many dentists teach their patients, flossing had no impact on plaque removal, nor did it lower the incidence of tooth decay in this study.

One aspect of dental prophylaxis is to teach patients how to perform preventative measures at home, such as correct techniques for regular flossing and brushing.

The most impactful preventative action that dentists teach their patients is that regular brushing is advantageous to oral health, lending itself to lowering the incidence of dental cavities. According to one Cochrane review, it's important that fluoride toothpaste is used.

Rotating power toothbrushes were found to do a better job at removing plaque and reducing gingivitis than traditional toothbrushes. 

When it comes to how often a person should brush the teeth for optimal results, there haven't been a lot of studies conducted that provide reliable information. The studies that have been done, however, generally support brushing twice per day.

It's important to recognize that dental prophylaxis research contradicts some of the current standards of dental care. Various studies and reviews do support the idea of brushing two times each day with fluoride toothpaste for good oral health. For kids, the evidence strongly supports the use of fluoride varnish or sealants. Whether other recommended dental prophylaxis procedures are 100 percent necessary for oral health, however, requires further research.

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ADA Center for Evidence-Based Dentistry. Clinical practice guidelines.

Sen B, Blackburn J, Morrisey MA, et al. Effectiveness of preventive dental visits in reducing nonpreventive dental visits and expenditures. Pediatrics. 2013;131(6):1107-13. doi:10.1542/peds.2012-2586

Bader J. Insufficient evidence to understand effect of routine scaling and polishing. Evidence-Based Dentistry. 2005;6(1):5-6. doi:10.1038/sj.ebd.6400317.

Olson LB, Turner DJ, Cox GM, Hostler CJ. Prosthetic joint infection following dental cleaning despite antibiotic prophylaxis. Case Rep Infect Dis. 2019;2019:8109280. doi:10.1155/2019/8109280

American Dental Association. Antibiotic prophylaxis prior to dental procedures.

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American Dental Association. Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure. U.S. Department of Health and Human Services.

Bader, J. Insufficient Evidence to Understand Effect of Routine Scaling and Polishing. Nature.com. 

Christal, A. Dental Prophylaxis. The Edmonds Orthopedic Center.

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Gelber, S. Surprisingly Little Evidence for the Accepted Wisdom About Teeth. The New York Times.

Sen, B., Blackburn, J., Morrisey, M.A., Kilgore, M.L... Menachemi, N. Effectiveness of Preventive Dental Visits in Reducing Nonpreventive Dental Visits and Expenditures. AAP News and Journals Gateway.

The U.S. Preventative Services Task Force Staff. Final Recommendation Statement Dental Caries in Children from Birth Through Age 5 Years: Screening.

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