From the Guidelines
Dental prophylaxis recommendations should prioritize oral hygiene and prevention of oral disease, with a focus on brushing teeth twice daily with fluoride toothpaste, flossing once daily, and visiting a dentist for professional cleanings every six months, as emphasized by the American Heart Association 1.
Key Recommendations
- Brush teeth twice daily with fluoride toothpaste containing at least 1000 ppm fluoride for adults, and a pea-sized amount for adults (children under 3 should use a rice-grain sized amount with lower fluoride concentration)
- Floss once daily to remove plaque and food particles from between teeth and under the gumline
- Visit a dentist for professional cleanings every six months to remove tartar and prevent gum disease
- Rinse with an antimicrobial mouthwash containing chlorhexidine (0.12%) or essential oils once daily, particularly for those prone to gum disease
- Limit sugary and acidic foods and beverages, and avoid tobacco products to reduce the risk of tooth decay and gum disease
Additional Considerations
- For high-risk individuals, dentists may recommend prescription-strength fluoride toothpaste (5000 ppm), fluoride varnish applications during dental visits, or dental sealants for children to provide extra protection against tooth decay
- The American Society of Clinical Oncology recommends that primary care clinicians counsel head and neck cancer survivors to seek regular professional dental care, minimize intake of sticky and/or sugar-containing food and drink, and use dental prophylaxis measures such as brushing with remineralizing toothpaste and fluoride use 1
- The American Heart Association also recommends that antibiotic prophylaxis be directed against viridans group streptococci for patients with certain conditions, such as infective endocarditis, who undergo dental procedures that involve manipulation of the gingival tissues or periapical region of a tooth 1
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Paroex ® (Chlorhexidine Gluconate Oral Rinse USP, 0.12%) therapy should be initiated directly following a dental prophylaxis. Patients using Paroex ® should be reevaluated and given a thorough prophylaxis at intervals no longer than six months. The recommendations for dental prophylaxis are to:
- Initiate therapy directly following a dental prophylaxis
- Reevaluate and give a thorough prophylaxis at intervals no longer than six months 2
From the Research
Dental Prophylaxis Recommendations
The recommendations for dental prophylaxis (dental disease prevention) include:
- Proper nutrition, with limited frequent intake of carbohydrates to prevent caries 3
- Regular and proper oral hygiene, including brushing teeth twice a day with fluoride toothpaste 4
- Use of fluoride products, such as fluoride varnishes or mouthrinses, to support remineralization and inhibit demineralization of the enamel 4, 5
- Regular check-ups with a dentist to monitor oral health and prevent dental diseases 3
Fluoride Prophylaxis
Fluoride compounds play an important role in dental caries prophylaxis, and their use can bring great benefits if used deliberately 4. The most effective method of caries prevention is brushing teeth twice a day with fluoride toothpaste, and special attention should be paid to the thorough removal of dental plaque during brushing 4. Other methods of topical fluoridation include fluoride varnishes or mouthrinses containing fluoride 4, 5.
Individualized Dental Prophylaxis
Dental prophylaxis should be adjusted to each patient individually, based on their level of risk for dental caries and other oral health factors 4, 5. High-risk patients may require more frequent applications of chlorhexidine or fluoride varnish, while low-risk patients may require less frequent use of fluoride-containing products 5.
Community-Based Dental Prophylaxis
Community-based dental prophylaxis, such as fluoridation of community water supplies, can reduce the incidence of dental caries by about 65% and significantly increase the number of children who are completely free of cavities 6. However, less than half of all Americans have access to fluoridated water, and school drinking water is seldom fluoridated despite evidence supporting its efficacy 6.
Endocarditis Prophylaxis
The necessity of antimicrobial prophylaxis before certain dental procedures for patients at increased risk for acquiring infective endocarditis (IE) is still a topic of debate 7. Current recommendations from various organizations, such as the American Heart Association and the European Society of Cardiology, restrict prophylaxis to patients with the highest risk for developing IE and/or the highest risk for an adverse outcome from IE 7. However, more research is needed to ultimately define the role of antibiotic prophylaxis in preventing IE.