| Preamble
Adopted 1994
The American
Dental Association developed these dental practice parameters
for voluntary use by practicing dentists. The parameters are
intended, foremost, as an aid to clinical decision making and
thus, they describe clinical considerations in the diagnosis
and treatment of oral health conditions. Evaluation in the context
of these parameters includes diagnosis.
Additionally, parameters will assist the dental profession by
providing the basis on which the profession’s commitment
to high-quality care can be demonstrated and can continue to
be improved.
The dental practice parameters are condition-based, presenting
an array of possible diagnostic and treatment considerations
for oral health conditions. Condition-based parameters, rather
than procedure-based parameters, were determined to be the most
useful because this approach recognizes the need for integrated
treatments of oral conditions rather than emphasizing isolated
treatment procedures. The parameters are also oriented toward
the process of care and describe elements of diagnosis and treatment.
While the parameters describe the common elements of diagnosis
and treatment, it is acknowledged that unique clinical circumstances,
and individual patient preferences, must be factored into clinical
decisions. This requires the dentist’s careful professional
judgment. Balancing individual patient needs with scientific
soundness is a necessary step in providing care.
It is understood that treatment provided by the dentist may deviate
from the parameters, in individual cases, depending on the clinical
circumstances presented by the patient. This should be documented
and explained to the patient.
The elements of care that are described in the parameters were
derived from a consensus of professional opinion. This consensus
included expert opinion on the topic and the clinical experience
of practicing dentists. In addition, the research literature,
and parameters and guidelines of other dental organizations were
reviewed.
The American Dental Association recognizes that other interested
parties, such as payers, courts, legislators and regulators may
also opt to use these parameters. The Association encourages
users to become familiar with these parameters as the profession’s
statement on the scope of clinical oral health care.
However, these parameters are not designed to address considerations
outside of the clinical arena and, therefore, may not be directly
applicable to all health policy issues.
Furthermore, these parameters are intended to describe the range
of acceptable treatment modalities. They are intended as educational
resources, not legal requirements. As such, the parameters are
not intended to establish standards of dental care, which are
rigid and inflexible, and represent what must be done; nor are
they guidelines which are less rigid, but represent what should
be done; nor are they intended to undermine or restrict the dentist’s
exercise of professional judgment. In this context, considerable
thought was given to the use of the verbs "may," "should" and "must." The
verb "may" clearly allows the practitioner to decide
whether to act.
The verb "should" indicates a degree of preference and
differs in meaning from "must" or "shall" (which
require the practitioner to act).
Throughout the parameter document, "dentist" refers
to the patient’s attending dentist. Additionally, elements
of the parameters concerned with patient consent refer to the
patient’s parent, guardian or other responsible party,
when the patient is a minor or is incompetent.
The Association intends to continually develop, revise and maintain
parameters, in order to include all dental conditions and to
accommodate advances in dental technology and science.
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Parameters
Adopted 1994, Revised 1997
The key element in the design of this set of parameters
for patients without clinical signs or symptoms of oral disease
is the professional judgment of the attending dentist, for a
specific patient, at a specific time.
This parameter recognizes that the patient without clinical signs
and symptoms may require counseling and preventive measures to
assist in maintaining oral health.
The patient’s chief complaint, concerns and expectations
should be considered by the dentist.
The patient’s aesthetic concerns and needs may be considered
by the dentist.
The dental and medical histories should be considered by the dentist
in identifying medications and predisposing conditions that may
affect the prognosis, progression, and management of patients
without clinical signs or symptoms of oral disease.
Following oral evaluation of the patient (see limited, comprehensive,
periodic, detailed and extensive evaluation parameters) and consideration
of the patient’s needs, the dentist should provide the
patient with information about the status of his or her oral
health prior to obtaining consent for treatment.
Medications should be prescribed, modified and/or administered
for dental patients whose known conditions
would affect or be affected by dental treatment provided without
the medication
or its modification. The dentist should
consult with the prescribing health care professional(s) before
modifying medications being
taken by the patient for known conditions.
(See: ADA
Statement on Antibiotic Prophylaxis, Prevention
of Bacterial Endocarditis: A Statement
for the Dental Profession (PDF), and Antibiotic
Prophylaxis for Dental Patients With
Total Joint Replacements.)
The dentist may counsel the patient concerning the potential effects
of the patient’s health condition, medication use and behaviors
on his or her oral health.
The dentist should recommend treatment; present treatment options,
if any; and discuss the probable benefits, limitations and risks
associated with treatment, and the probable consequences of no
treatment.
Any treatment performed should be with the concurrence of the
patient and the dentist. If the patient insists upon treatment
not considered by the dentist to be beneficial for the patient,
the dentist may decline to provide treatment. If the patient
insists upon treatment considered by the dentist to be harmful
to the patient, the dentist should decline to provide treatment.
When the dentist considers it necessary, (an)other health care
professional(s) should be consulted to acquire additional information.
The behavioral, psychological, anatomical, developmental and physiological
limitations of the patient should be considered by the dentist
in developing the treatment plan.
The dentist should attempt to manage the patient’s pain,
anxiety and behavior to facilitate safety,
efficiency and patient cooperation. (See: ADA Policy Statement: The Use of Sedation and General Anesthesia by Dentists and Guidelines for the Use of Sedation and General Anesthesia by Dentists.)
The dentist should emphasize the prevention and early detection
of oral diseases through patient education in preventive oral
health practices, which may include oral hygiene instructions.
The dentist should refer the patient to (an)other health professional(s)
when the dentist determines that it is in the best interests
of the patient.
Relevant and appropriate information about the patient and any
necessary coordinated treatment should be communicated and coordinated
between the referring dentist and the health professional(s)
accepting the referral.
The dentist is responsible for providing the patient with appropriate
information about the maintenance of oral health, and the common
risks and limitations associated with preventive measures. The
patient should also be informed about the benefits of these measures
and the potential consequences of no preventive treatment.
Nutrition counseling may be provided to assist in maintaining
oral health.
Counseling may be provided regarding tobacco use or other behaviors
that may compromise oral health.
Counseling may be provided regarding those general health conditions
that may compromise oral health.
Dental sealants may be applied as a preventive measure. (See:
Bisphenol A and Dental Sealants, Composite Dental Fillings.)
Counseling may be provided concerning the relationship of the
fluoride levels in drinking water to dental caries and fluorosis.
(See: ADA
Statement on Water Fluoridation Efficacy and Safety and Fluoridation
Facts)
Dietary fluoride supplements may be prescribed by the dentist.
(See: Facts About Fluoride/Dietary Fluoride Supplements)
Topical fluoride may be applied or prescribed as a preventive
measure. (See: Facts About Fluoride/Topical Fluorides)
Nicotine cessation medications may be prescribed by the dentist.
(See: Summary
of Policy and Recommendations Regarding Tobacco)
Prophylaxis may be performed as determined by the dentist.
Oral protective appliances may be fabricated to reduce the risk
of injuries.
The dentist should determine the frequency and type of preventive
measures based on the patient’s risk factors.
Documentation of treatment provided, counseling and recommended
preventive measures, as well as consultations with and referrals
to other health care professionals, should be included in the
patient’s dental record.
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