4.4 Scaling and Prophylaxis

Some children with special health care needs develop excessive calculus caused by mouthbreathing, inadequate salivary flow, metabolic disorders, kidney failure, tube feedings, oral motor dysfunction, or inadequate oral hygiene. Scaling with hand or power instruments may be needed. Meticulous suctioning is required to prevent aspiration of water or fragments of calculus.

If oral debris is heavy, a very light rubber cup prophylaxis may be useful to remove gross layers of debris or stain. However, use of rubber prophy cups is not recommended for general plaque removal in young children, because the cups remove the outer fluoride-rich layer of enamel in primary teeth that is important for preventing dental caries and remineralization. Toothbrushing is as effective for plaque removal and is generally more acceptable to children.