| 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 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.
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