| 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 gingival inflammation with loss of connective tissue attachment
(periodontitis) is the professional judgment of the attending
dentist, for a specific patient, at a specific time.
The patient’s chief complaint, concerns and expectations
should be considered by the dentist.
The dental and medical histories should be considered by the dentist
to identify medications and predisposing conditions that may
affect the prognosis, progression, and management of periodontitis.
Following 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 periodontitis prior to obtaining
consent for treatment. (See:
Periodontal
Screening and Recording® (PSR®):
An Early Detection System Q & A
)
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 professional(s)
should be consulted to acquire additional information.
When recommending treatment, the dentist should recognize that
periodontal disease that can be episodic or linear, and generalized
or site specific.
Following evaluation, treatment priority should be given to the
management of pain, infection, traumatic injuries or other emergency
conditions.
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 during treatment
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 refer the patient to (an)other health professional(s)
when the dentist determines that it is in the best interest 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 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 patient should be informed that the success of the treatment
is often dependent upon patient compliance with home care instructions
and recommendations for behavioral modifications. Lack of compliance
should be recorded.
Additional diagnostic tests relevant to the periodontitis of the
patient may be performed and used by the dentist in diagnosis
and treatment planning.
The presence of carious lesions should be considered in developing
a treatment plan.
The relationship of the mucogingival junction to the loss of attachment
should be noted and considered in developing a treatment plan.
Clinically apparent plaque, calculus and other local etiologic
factors should be removed.
Root planing should be performed.
Chemotherapeutic agents may be used by the dentist to facilitate
treatment.
Alteration of tooth morphology and/or position, placement of restorations,
modification or replacement of restorations, and treatment of
carious lesions may be performed by the dentist to facilitate
treatment.
The replacement of missing teeth and/or those indicated for extraction
may be performed by the dentist to facilitate treatment.
Occlusal analysis and adjustments may be performed by the dentist
to facilitate treatment.
Occlusal guards and/or splinting may be used by the dentist to
stabilize mobile teeth.
Resective, regenerative, recontouring and/or augmentation procedures
may be performed by the dentist.
Root resection may be performed by the dentist.
Endodontic therapy may be performed by the dentist.
Teeth may be removed as determined by the dentist.
The dentist should inform the patient that he or she should participate
in a prescribed program of continuing care to allow the dentist
to evaluate the effectiveness of the treatment provided and the
condition of the periodontium.
The dentist should determine the frequency and type of preventive
treatment, based on the patient’s risk factors or presence
of oral disease.
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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