| 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.
Return to Top Parameters
Adopted 1995, Revised 1997
The key element in the design of this set of parameters for dental
attrition 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.
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 dental
attrition prior to obtaining consent
for treatment.
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 dental attrition.
In developing a treatment plan, the dentist should consider that
dental attrition can be generalized or site-specific, progressive
and predisposing to other conditions.
When the dentist considers it necessary, (an)other health care
professional(s) should be consulted to acquire additional information.
Factors affecting the patient’s speech,
function and orofacial aesthetics
should be considered by the dentist in developing
a treatment plan.
In developing a treatment plan, the dentist should consider that
the etiology of dental attrition can be multifactorial, characterized
by craniofacial, musculoskeletal, stomatognathic and/or dental
interrelationships that are dynamic throughout life.
The behavioral, psychological, anatomical, developmental and physiological
limitations of the patient should be considered by the dentist
in developing the treatment plan.
Restorative implications, pulpal/endodontic status, tooth position,
and periodontal status and prognosis should be considered in
developing a treatment plan.
The dentist may counsel the patient concerning
the potential effects of the patient’s health condition,
medication use, and behaviors and/or
habits on his or her oral health.
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 A-Z Topic: Antibiotic Prophylaxis.)
After consideration of the individual circumstances, the dentist
should decide whether the dental attrition should be monitored
or treated.
The dentist should recommend treatment; present treatment options,
if any; and discuss the probable benefits, prognosis, 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.
Following evaluation, treatment priority should be given to the
management of pain, infection, traumatic injuries or other emergency
conditions.
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
coordinated treatment should be communicated and coordinated
between the referring dentist and the health professional(s)
accepting the referral.
The dentist should consider the characteristics and requirements
of each patient in selecting material(s) and treatment(s).
The dentist should consider the compatibility of the selected
treatment with the surrounding oral tissues and should provide
an environment accessible for maintenance.
Counseling and/or therapy for parafunctional behaviors which can
contribute to attrition may be performed.
Following occlusal evaluation, occlusal guards, splinting and/or
adjustments may be used to facilitate treatment.
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.)
Placement of restorations, or modification or replacement of restorations
may be performed to facilitate treatment or reduce symptoms resulting
from lost tooth structure.
Transitional or provisional restorations may be utilized by the
dentist to facilitate treatment.
The dentist may alter tooth morphology and/or position, and/or
modify occluding, articulating, adjacent or approximating teeth,
or the tooth in question, to facilitate treatment or reduce symptoms.
Pulpal tissue should be protected by the dentist when indicated.
Endodontic therapy may be performed by the dentist.
Fixed, removable and/or implant-supported restorations (prostheses)
may be repaired, modified or replaced, as determined by the dentist.
The dentist should communicate by prescription the necessary information
for fabrication of the prosthesis(es) to the dental laboratory
technician. Although the fabrication may be delegated, the dentist
is responsible for the accuracy of the prosthesis(es).
Periodontal procedures, including surgery, may be performed by
the dentist to facilitate treatment.
Chemotherapeutic agents may be used.
Teeth may be removed, as determined by the dentist. When appropriate,
the patient should be informed of the necessity to replace any
removed teeth.
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
status of dental attrition.
The patient should be informed that the success of the treatment
is often dependent upon patient compliance with the prescribed
treatment and recommendations for behavioral modifications. Lack
of compliance should be recorded.
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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