(Adopted 1994, Revised 1997)
Preamble (Adopted 1994)
The key element in the design of this set of parameters for edentulous arch(es) 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 in identifying medications and predisposing conditions that may affect the prognosis, progression, and management of patients with edentulism.
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 edentulism 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 A-Z Topic: Antibiotic Prophylaxis.)
When the dentist considers it necessary, (an)other health care professional(s) should be consulted to acquire additional information.
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 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 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 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.
The patient should be informed that the success of treatment is often dependent upon his or her adaptability to, and acceptance and tolerance of the prosthesis.
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.
The dentist should emphasize the prevention and early detection of oral diseases through patient education in preventive oral health practices, which may include oral health instructions.
After consideration of the individual circumstances, the dentist should determine if the missing teeth should be replaced.
Additional diagnostic procedures relevant to the patient's edentulous arch(es) may be performed and used by the dentist in developing a treatment plan.
The presence, prognosis, stability, position and treatment implications of any teeth, implants or prostheses in the opposing arch should be considered by the dentist in developing and implementing a treatment plan.
The dentist should consider the characteristics and requirements of each patient in selecting material(s) and treatment(s).
Factors affecting the patient's speech, function, and orofacial aesthetics should be considered by the dentist in developing a treatment plan.
Tissue-and/or implant-supported prosthetic options should be considered by the dentist in developing a treatment plan.
Fixed prosthesis(es), removable prosthesis(es) or a combination of these prosthetic options should be considered by the dentist in developing a treatment plan.
Soft and hard tissue characteristics and morphology, ridge relationships, occlusion and occlusal forces, aesthetics, and parafunctional habits should be considered by the dentist in the design of the prosthesis(es). Craniofacial, musculoskeletal relationships, including the clinically apparent status of the temporomandibular joints, should be considered by the dentist in developing a treatment plan.
The dentist should consider the compatibility of the selected treatment with the surrounding oral tissues and should provide an environment accessible for maintenance.
Pre-prosthetic surgical procedures to alter hard and soft tissue morphology may be performed by the dentist to facilitate treatment.
Oral and maxillofacial surgical procedures may be performed by the dentist to facilitate treatment.
Tissue conditioners may be used by the dentist to facilitate treatment.
Transitional or provisional prostheses may be utilized by the dentist to facilitate treatment.
The dentist should communicate to the dental laboratory technician necessary information and authorization for fabrication of the prosthesis(es). Although the fabrication may be delegated, the dentist is responsible for the accuracy of the prosthesis(es).
Removable prostheses may be repaired, modified, relined, rebased or replaced, as determined by the dentist.
Fixed, implant-supported prostheses may be repaired, modified or replaced, as determined by the dentist.
The patient should be instructed by the dentist in the use and care of the prosthesis(es). The patient should be informed that the success of treatment is often dependent upon his or her compliance with the instructions. Lack of compliance should be recorded.
The patient should be informed by the dentist that the prosthesis(es) may need future replacement, rebasing and/or relining.
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 prosthesis(es) 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.
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.