| 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 orofacial pain of non-dental origin 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 pain of non-dental origin
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
pain of non-dental origin.
The dentist should consider that orofacial pain of non-dental
origin may be influenced by craniofacial, musculoskeletal, stomatognathic,
neurological, vascular, and/or psychological factors that are
dynamic throughout life and that the etiology of orofacial pain
of non-dental origin may be multifactorial.
The dentist should consider a differential disease classification
of orofacial pain that may include neurogenic pain, neurovascular
pain, neuromuscular, and sympathetic and/or referred pain involving
the trigeminal and oropharyngeal systems, when developing a treatment
plan.
The dentist should consider that orofacial pain of non-dental
origin may be the result of medical conditions which contribute
to or mimic other disorders.
The dentist should consider the possibility that the patient may
be the victim of physical abuse and/or neglect.
The dentist should consider that orofacial pain of non-dental
origin may be self-limiting, and episodic and/or progressive,
and 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, and
the nature and severity of the patient’s orofacial pain.
When the dentist considers it necessary, (an)other health care
professional(s) should be consulted to acquire additional information.
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.
Craniofacial relationships, musculoskeletal relationships, and
the status of the temporomandibular joints, should be considered
by the dentist in developing a treatment plan.
Factors affecting the patient’s speech, function, and orofacial
aesthetics should be considered by the dentist in developing
a treatment plan.
The behavioral, psychological, anatomical, developmental and physiological
limitations of the patient should be considered by the dentist
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
on oral health.
The dentist should counsel the patient that orofacial pain situations
are often managed, rather than resolved, and that symptoms may
persist or recur intermittently.
The patient should be informed that the success of treatment is
often dependent upon patient compliance with prescribed treatment
and recommendations for behavioral modifications. Lack of compliance
should be recorded.
Medications should be prescribed, modified and/or administered
for dental patients whose known conditions
would affect or be affected by 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 and A-Z Topic: Antibiotic Prophylaxis.)
After consideration of the individual circumstances, the dentist
should decide whether the orofacial pain should be monitored
or treated.
Following evaluation, treatment priority should be given to the
management of pain, infection, traumatic injuries or other emergency
conditions.
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.
Initially the dentist should select the least invasive and most
reversible therapy that may ameliorate the patient’s pain
and/or functional impairment.
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 evaluate the effectiveness of initial therapy
prior to considering more invasive and/or irreversible therapy.
Before initiating invasive and/or irreversible therapy, the dentist
should attempt to determine and inform the patient of the likelihood
of its therapeutic success, and expected and/or potential side
effects.
Relevant and appropriate information about the patient and any
necessary coordinated treatment should be communicated between
the referring dentist and the health professional(s) accepting
the referral.
The dentist may emphasize the prevention and early detection of
oral diseases through patient education in preventive oral health
practices.
The dentist should be responsible for educating the patient about
maintaining good oral hygiene when orofacial pain and/or treatment
limits the patients ability to achieve an appropriate level of
oral hygiene.
The dentist should be responsible for educating the patient concerning
self-management and the elimination of behaviors that may contribute
to orofacial pain of non-dental origin.
The dentist should consider, and inform the patient, that treatment
for orofacial pain of non-dental origin may include multiple
phases of treatment.
The dentist should consider that orofacial pain
of non-dental origin requiring treatment may develop at any time
during an individual’s lifetime, regardless of the patient’s
previous treatment history.
The dentist may prescribe or administer physical medicine (therapy)
modalities.
The dentist should attempt to manage the patient’s 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 prescribe and/or administer pharmacological agents.
Anesthetic injections may be performed for diagnostic and/or therapeutic
purposes.
The dentist should periodically evaluate the patient’s medication
regimen to determine the effectiveness and appropriateness of
continued pharmacological therapy.
Following diagnosis of orofacial pain of non-dental origin, the
treatment of dental conditions may be performed.
Transitional or provisional restorations (prostheses) may be utilized
by the dentist to facilitate treatment.
The dentist should communicate, by prescription, 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 stint(s) or prosthesis(es).
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 the orofacial pain.
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 |
