| 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 1996, Revised 1997
The key element in the design of this set of parameters
for radicular and/or periradicular 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.
The dental and medical histories should be considered by the dentist
to identify medications and predisposing conditions that may
affect the management of radicular and/or periradicular lesion(s).
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 radicular and/or periradicular
lesion(s) prior to obtaining consent for treatment.
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.
When recommending treatment, the dentist should recognize that
radicular and/or periradicular lesion(s) can occur in singular
or multiple sites, and the rates of progression may vary and
can be predisposing to other conditions.
The behavioral, psychological, anatomical, developmental and physiological
limitations of the patient should be considered by the dentist
in developing the treatment plan.
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 Antibiotic
Prophylaxis for Dental Patients With
Total Joint Replacements.)
The dentist should utilize a process of differential diagnosis
when evaluating radicular and/or periradicular lesion(s) and
developing a treatment plan.
Additional diagnostic tests relevant to the radicular and/or other
periradicular lesion(s) of the patient may be performed and used
by the dentist in diagnosis and treatment planning.
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.
In developing a treatment plan the dentist should consider that
the underlying etiology may be multifactorial.
Factors affecting the patient’s speech, function, and orofacial
aesthetics 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
and behavioral habits should be considered by the dentist.
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 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.
After consideration of the individual circumstances, the dentist
should decide whether the radicular and/or periradicular lesion(s)
should be monitored or treated.
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 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.
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 determine the frequency and type of preventive
treatment based on the patient’s risk factors or presence
of oral disease(s).
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 should consider the compatibility of the selected
treatment with the surrounding oral tissues and should provide
an environment accessible for maintenance.
Alteration of tooth morphology and/or position, placement of restorations,
modification or replacement restorations, and treatment of carious
lesions may be performed by the dentist to facilitate treatment
or reduce symptoms.
The dentist may prescribe and/or administer pharmacological agents.
Local etiologic factors should be removed.
Counseling and/or therapy for parafunctional behaviors and/or
habits which can contribute to radicular and/or periradicular
lesion(s) may be performed.
Surgical management of this condition, which may include the removal
of teeth, and other intra-oral and extra-oral surgical approaches
may be utilized. The patient should be informed of appropriate
treatments to maintain space and/or replace teeth.
Periodontal procedures may be performed by the dentist to facilitate
treatment.
Treatment designed to reduce pulpal symptoms and/or protect the
pulpal tissue of the tooth in question may be utilized by the
dentist.
Pulpal/endodontic therapy and/or root resection may be performed
by the dentist. Endodontic therapy may be performed in multiple
stages.
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.
Fixed, removable and/or implant-supported restorations (prostheses)
and/or appliances may be repaired, modified or replaced as determined
by the dentist.
Transitional or provisional restorations (prostheses) may be utilized
by the dentist to facilitate treatment.
The dentist should communicate necessary information and authorization
for the fabrication of the appliance(s) or prosthesis(es) to
the dental laboratory technician. Although the fabrication may
be delegated, the dentist is responsible for the accuracy and
delivery of the appliance(s) or prosthesis(es).
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.
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 radicular and/or periradicular 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.
Return to Top |
