The instrumentation gap in pediatric preventive care

Pediatric dental practices play a central role in shaping lifelong oral health habits in children, but many offices remain underequipped when it comes to dental hygiene instruments. It is not uncommon for pediatric practices to maintain only one or two types of hand scalers—often limited to a sickle scaler—while also avoiding the use of ultrasonic scalers. I have personally witnessed this many times in my career. This limited armamentarium does not reflect the clinical needs of the diverse pediatric population.

Children are not simply “small adults,” but neither are they uniformly low-risk patients. In fact, many pediatric patients present with oral hygiene challenges that rival or exceed those seen in general practice. Inadequate instrumentation limits the hygienist’s ability to provide thorough, evidence-based care and ultimately compromises patient outcomes.

Clinical needs of pediatric patients

The belief that children only require supragingival scaling with a basic sickle scaler is severely outdated. Pediatric patients frequently present with plaque and calculus on posterior teeth and subgingival surfaces, early periodontal concerns, and anatomically challenging areas that demand a range of instruments. Molars with deep pits and fissures, tight interproximal contacts, and developing gingiva require curettes and area-specific instruments designed for posterior and subgingival adaptation.

Effective removal of biofilm and calculus in these areas cannot be reliably achieved with a single instrument type without increasing the risk of incomplete debridement, operator fatigue, and patient discomfort. The goal of prophylaxis, whether with hand or powered instruments, is to remove plaque, stain, and calculus thoroughly and safely as part of regular preventive care. Both hand and ultrasonic devices are recognized as appropriate instruments in professional dental prophylaxis. Ultrasonic devices may cause less soft-tissue trauma, reduce treatment time, and be less operator-sensitive than hand instrumentation alone.¹

Ultrasonic scaling: A valuable, yet underutilized tool

Despite these recognized benefits, ultrasonic scalers are often absent in pediatric settings. Many practitioners cite outdated concerns about comfort, safety, or necessity in younger patients. However, the evidence does not support a blanket exclusion of ultrasonic instrumentation, especially for patients with heavy plaque and calculus accumulation.

Powered scalers are widely used by clinicians for effective debridement. Surveys of periodontal practices demonstrate that the vast majority of dental professionals combine hand and mechanical instruments—primarily ultrasonic scalers—to manage subgingival deposits, reflecting clinical preference for a hybrid approach in comprehensive care.²

Furthermore, pediatric patients often face additional obstacles that increase the need for efficient, adaptable instrumentation. Children frequently struggle with consistent oral hygiene due to developmental factors, limited manual dexterity, and varying levels of caregiver support. These challenges are compounded in patients with orthodontic appliances, such as brackets, bands, and wires, which create ideal niches for plaque retention and bacterial biofilm proliferation. In such cases, relying exclusively on limited hand instruments is not sufficient for effective biofilm disruption and calculus removal.

Ultrasonic scalers facilitate access in difficult areas, disrupt biofilm more efficiently than hand instruments alone, and support more complete prophylaxis with less clinician fatigue. When used appropriately and with behavior-focused techniques, these devices are safe and well-tolerated in pediatric patients.

Supporting prevention and education

Pediatric dentistry emphasizes prevention, yet prevention cannot occur without effective instrumentation. Thorough debridement is foundational to caries prevention, gingival health, and strengthening patient education. Equipping hygienists with a full complement of instruments supports high-quality preventive care and reinforces positive outcomes.

Additionally, well-equipped hygienists are better positioned to educate patients and caregivers. Demonstrating improved gingival health, reduced inflammation, and cleaner orthodontic hardware reinforces the importance of home care and professional maintenance.

Raising the standard of pediatric care

Pediatric dental practices pride themselves on being child-centered and prevention-focused. To truly uphold these values, practices must ensure that hygiene departments are equipped to meet the needs of today’s pediatric patients. This includes a full assortment of hand instruments designed for posterior and subgingival scaling, as well as access to ultrasonic scaling devices when clinically indicated.

Children deserve the same standard of dental hygiene care as adults—tailored to their needs, not limited by outdated assumptions. Investing in comprehensive hygiene instrumentation is not an upgrade; it is a professional responsibility that supports optimal oral health outcomes and aligns with professional standards of care.

References

1. Policy on the role of dental prophylaxis in pediatric dentistry. American Academy of Pediatric Dentistry. Revised 2024. https://www.aapd.org/research/oral-health-policies--recommendations/role-of-dental-prophylaxis-in-pediatric-dentistry/
2. Krishna R, De Stefano JA. Ultrasonic vs. hand instrumentation in periodontal therapy: clinical outcomes. Periodontol 2000. 2016;71(1):113-127. doi:10.1111/prd.12119