| 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 1994, Revised 1997
The key element in the design of this set of parameters
of dental caries 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 dental caries.
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
caries prior to obtaining consent for
further 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 A-Z Topic: Antibiotic Prophylaxis.)
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.
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.)
When the dentist considers it necessary, (an)other health care
professional(s) should be consulted to acquire additional information.
Additional diagnostic tests relevant to the dental caries of the
patient may be performed and used by the dentist in diagnosis
and treatment planning.
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.
After consideration of the individual circumstances, the dentist
should decide whether the tooth with a carious lesion(s) should
be monitored, treated or removed.
Factors affecting the patient’s speech,
function, and orofacial aesthetics
should be considered by the dentist in developing
a treatment plan.
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 consider the characteristics and requirements
of each patient in selecting material(s) and treatment(s).
The tooth preparation should be appropriate for the extent of
the lesion and/or the choice of the restorative material. (See:
FDA
Approvals of Laser Systems for Hard Tissue Applications)
All clinically apparent caries should be removed before the restoration
is placed, except in some instances where indirect pulp-capping
or pulpotomy techniques are used.
Pulpal tissue should be protected by the dentist when indicated.
The restorative material selected should restore form and function,
and withstand the forces of occlusion. (See: ADA
Statement on Dental Amalgam)
The dentist may modify occluding, articulating,
adjacent or approximating teeth to
enhance the final restoration’s
form and function as well as its
ability to withstand the forces of occlusion.
Tissues and/or restorations adjacent to the restorative site may
be altered by the dentist to facilitate treatment or sustain
the tooth being restored.
Orthodontic repositioning may be performed by the dentist to facilitate
treatment.
Transitional or provisional restorations may be utilized by the
dentist to facilitate treatment or reduce pulpal symptoms.
Dental sealants may be applied as a preventive measure. (See:
Bisphenol A and Dental Materials)
Chemotherapeutic agents may be used for caries prevention and
the treatment of incipient caries.
Modification of the root surface followed by application of chemotherapeutic
agents may be used to treat caries.
Depth and narrowness of pits and fissures may be modified by the
dentist for caries prevention.
Dietary fluoride supplements may be prescribed by the dentist.
(See: Facts About Fluorides/Dietary Fluoride Supplements)
Topical fluoride may be applied or prescribed as a preventive
measure. (See: Facts About Fluoride/Topical Fluorides)
Endodontic therapy and/or root resection may be performed by the
dentist in the treatment of caries.
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
condition of the oral cavity.
The dentist should determine the frequency
and type of preventive treatment
based on the patient’s
risk factors or presence of oral
disease. (See: ADA
Statement on Sugar-free Foods and Medication)
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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