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Orofacial Soft Tissue Lesions

(Adopted 1995, Revised 1997)

Preamble (Adopted 1994)

The key element in the design of this set of parameters for orofacial soft tissue lesion(s) 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 (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 orofacial soft tissue lesion(s) 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 orofacial soft tissue lesion(s).

The dentist should determine the need for, and/or type of, biopsy or cytological evaluation.

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 orofacial soft tissue lesion(s) may be multifactorial.

In developing a treatment plan, the dentist should consider that the underlying pathosis(es) of orofacial soft tissue lesion(s) may be inflammatory, degenerative, hyperplastic, dysplastic and/or neoplastic in nature.

The behavioral, psychological, anatomical, developmental and physiological limitations of the patient should be considered by the dentist in developing the treatment plan.

Restorative and reconstructive implications, pulpal/endodontic status, tooth position, and periodontal status and prognosis should be considered in developing a treatment plan.

The dentist may recommend that the patient return for further evaluation. The frequency and type of

evaluation(s) should be determined by the dentist, based on the patient's risk factors.

When the dentist considers it necessary, (an)other health care professional(s) should be consulted to acquire additional information.

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.

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.)

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 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.

After consideration of the individual circumstances, including microscopic evaluation, if any, the dentist should decide whether the orofacial soft tissue lesion(s) should be monitored or treated.

Following evaluation, treatment priority may 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 necessary coordinated treatment should be communicated and coordinated between the referring dentist and the health professional(s) accepting the referral.

The dentist may take this opportunity to emphasize the prevention and early detection of orofacial disease through patient education.

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 chemotherapy and/or radiotherapy are used in treating orofacial soft tissue lesion(s), the frequency and type of palliative and/or preventive dental treatment should be determined by the dentist.

The dentist should consider the characteristics and requirements of each patient in selecting material(s) and treatment(s).

The patient should be instructed regarding the nature of the orofacial soft tissue lesion(s). 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.

Chemotherapeutic agents may be used by the dentist to facilitate treatment.

The dentist may excise or ablate the orofacial soft tissue lesion(s) with or without associated structures.

Surgical reconstruction may be performed primarily or secondarily by the dentist.

Maxillofacial restoration(s) (prostheses), including implant-supported restoration(s) (prostheses), may be used for therapy and reconstructive purposes.

Pulpal/endodontic therapy and/or root resection may be performed by the dentist.

Local etiologic factors should be removed.

Periodontal surgical procedures may be performed by the dentist to facilitate treatment.

The dentist may alter tooth morphology and/or position by modifying occluding, articulating, adjacent or approximating teeth to facilitate treatment or reduce symptoms.

Placement of restoration(s) (prostheses), and modification or replacement of restoration(s) (prostheses) may be performed to facilitate treatment or reduce symptoms.

Teeth may be removed, as determined by the dentist. When appropriate, the patient should be informed of the necessity to replace any removed teeth.

Fixed, removable and implant-supported restoration(s) (prostheses) may be placed, repaired, modified or replaced, 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 status of orofacial soft tissue lesion(s).

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.