Current Policies

The American Dental Association supports the following policy:

1. Oral health is an integral component of systemic health.
2. Dentistry is an essential healthcare service because of its role in evaluating, diagnosing, preventing or treating oral diseases, which can affect systemic health.
3. The term "Essential Dental Care" be defined as any care that prevents and eliminates infection, preserves the structure and function of teeth as well as the orofacial hard and soft tissues, and that this term be used in lieu of the terms “Emergency Dental Care” and “Elective Dental Care” when communicating with legislators, regulators, policy makers and the media in defining care that should continue to be delivered during global pandemics or other disaster situations, if any limitations are proposed.
4. Government agencies such as the Department of Homeland Security and the Federal Emergency Management Agency have acknowledged dentistry as an essential service needed to maintain the health of Americans so they can sustain their health and livelihoods and live resiliently during the COVID-19 pandemic response. State agencies or officials be urged to recognize the oral health workforce when designating its essential workforce during public health emergencies, in order to assist them in protecting the health of their constituents.

American Dental Association
October 2020

Resolved, that the ADA supports the utilization of dentists who choose to participate to increase medical capacity during declared local, state or federal public health emergencies to include:

1. Administering critical vaccines
2. Performing FDA-authorized diagnostic tests to screen patients for infectious diseases
3. Taking patient medical histories and triaging medical patients
4. Performing other ancillary medical procedures and activities, as requested by medical personnel, to expand the nation’s surge capacity

and be it further

Resolved, that dentists should be granted immunity from personal liability and restrictions on the above listed services they provide for the duration of the emergency.

American Dental Association
October 2020

Resolved, that dentists with the requisite knowledge and skills can order and administer diagnostic medical tests to screen patients for chronic diseases and other medical conditions that could complicate dental care or put the patient and staff at risk, and be it further

Resolved, that point of care testing to screen is within a dentist's scope of practice, and be it further

Resolved, that point of care testing results be communicated with the patient and the patient be referred to their physician for appropriate diagnoses and treatment, and be it further

Resolved, that dentists comply with federal and state requirements, as appropriate, to administer the tests.

American Dental Association
October 2020

Resolved, that it is the position of the American Dental Association that dentists with the requisite knowledge and skills should be allowed to administer critical vaccines to prevent life or health-threatening conditions and protect the life and health of patients and staff at the point of care.

American Dental Association
October 2020

Resolved, that because dentists have the clinical skills and medical knowledge that are invaluable assets in a mass casualty event, dentists be given the opportunity with additional targeted training to become more effective responders to natural disasters and other catastrophic events, and be it further

Resolved, that the American Dental Association provide leadership in national, state and community disaster planning and response efforts by increasing participation in coalitions and programs that put “disaster preparedness into practice,” and be it further

Resolved, that the ADA promote multidisciplinary disaster education and training programs such as core, basic and advanced disaster life support courses, or other courses that train dentists and dental staff in the handling of declared emergencies, and be it further

Resolved, that the ADA advocate for national emergency preparedness solutions through research, public policy, and legislation.

American Dental Association
House of Delegates
October 2007 (Trans.2007:431)

Resolved, that the American Dental Association develop a response plan template that constituent and component dental societies can use to develop a response plan that can be integrated into the local mass disaster plan, and be it further

Resolved, that the ADA encourage the constituent and component dental societies to develop a plan for dentistry to respond to mass disasters that can be integrated into their local mass disaster plan using the ADA template as a model, and be it further

Resolved, that the ADA encourage constituent and component dental societies to establish a working relationship with the local public health and emergency management agencies.

American Dental Association
House of Delegates
October 2002 (Trans.2002:387)

Resolved, that the American Dental Association seek or support, and the constituent dental societies be urged to seek or support, federal and state legislation to grant dentists immunity from personal liability and restrictions on the services they provide when responding to a mass disaster following a declaration by an appropriate authority that an emergency situation exists that warrants such an action, for the duration of that emergency, and be it further

Resolved, the federal declaration should preempt state liability laws and dental practice acts.

American Dental Association
House of Delegates
October 2002 (Trans.2002:398)

Resolved, that the following principles guide the American Dental Association's support for the national pretreatment standard for dental office wastewater:

1. Any regulation should require covered dental offices to comply with best management practices patterned on the ADA's best management practices (BMPs), including the installation of International Organization for Standardization (ISO) compliant amalgam separators or separators equally effective;
2. Any regulation should defer to existing state or local law or regulation requiring separators so that the regulation would not require replacement of existing separators compliant with existing applicable law;
3. Any regulation should exempt dental practices that place or remove no or only de minimis amounts of amalgams;
4. Any regulation should include an effective date or phase-in period of sufficient length to permit affected dentists a reasonable opportunity to comply;
5. Any regulation should provide for a reasonable opportunity for covered dentists to repair or replace defective separators without being deemed in violation of the regulation;
6. Any regulation should minimize the administrative burden on covered dental offices by (e.g.) primarily relying upon self certification (subject to verification or random inspection) and not requiring dental-office-specific permits;
7. Any regulation should not include a local numerical limit set by the local publicly owned treatment works (POTW);
8. Any regulation should not require wastewater monitoring at the dental office, although monitoring of the separators to assure proper operation may be required;
9. Any regulation should provide that compliance with it shall satisfy the requirements of the Clean Water Act unless a more stringent local requirement is needed.

American Dental Association
September 2019

Resolved, that the ADA recommends that dentists eliminate the use of bulk dental mercury and bulk amalgam alloy and that they use only precapsulated amalgam alloy in their dental practices.

American Dental Association
October 2017 (1994:676; 2017:80)

Resolved, that based on current documented scientific research, the conclusions of conferences and symposiums on the biocompatibility of metallic restorative material, and upon joint reports of the Council on Dental Materials, Instruments and Equipment and the Council on Dental Therapeutics of the Association, the continued use of dental amalgam as a restorative material does not pose a health hazard to the nonallergic patient, and be it further

Resolved, that to advocate to a patient or the public the removal of clinically serviceable dental amalgam restorations solely to substitute a material that does not contain mercury is unwarranted and violates the ADA Principles of Ethics and Code of Professional Conduct, and be it further

Resolved, that in those instances where state dental boards initiate proceedings on this question that the ADA cooperate in such proceedings by making available scientific personnel as expert witnesses.

American Dental Association
October 2017 (1994:676; 2017:80)

Resolved, that although the safety and efficacy of dental restorative materials has been extensively researched, the Association, consistent with its Research Agenda, will continue to actively promote such research to ensure that the profession and the public have the most current, scientifically valid information on which to make choices about dental treatment requiring restorative materials, and be it further

Resolved, that the Association use its existing communications vehicles to educate opinion leaders and policy makers about the scientific methods used to assess the safety and efficacy of dental restorative materials, and be it further

Resolved, that the Association continue to promptly inform the public and the profession of any new scientific information that contributes significantly to the current understanding of dental restorative materials.

American Dental Association
October 2017 (2003:387; 2017:80)

Resolved, that the ADA defines "dental best management practices" to mean a series of amalgam waste handling and disposal practices that include but are not limited to initiating bulk mercury collection programs, using chair side traps, amalgam separators complaint with ISO 11143 and vacuum collection, inspecting and cleaning traps, and recycling or using a commercial waste disposal service to dispose of the amalgam collected, and be it further

Resolved, that the ADA take, and constituent and component dental societies be urged to take, immediate steps to increase universal awareness and use of best management practices by dentists to reduce amalgam waste, and be it further

Resolved, that the ADA acknowledges the need for flexibility for each constituent and component society to make appropriate policy choices on behalf of their members based on local conditions.

American Dental Association
September 2007 (2002:422; 2007:441)

Resolved, that the Association strongly encourages dentists to adhere to best management practices and supports other voluntary efforts by dentists to reduce amalgam discharges in dental office wastewater, and be it further

Resolved, that the Association encourages constituent and component societies to enter into collaborative arrangements with regional, state or local wastewater authorities to address their concerns about amalgam in dental office wastewater, and be it further

Resolved, that the appropriate agencies of the Association continue to disseminate information to the constituent and component societies to help them address concerns of regional, state or local wastewater authorities about amalgam in dental office wastewater, and be it further

Resolved, that the appropriate agencies of the Association continue to investigate products and services that will help dentists effectively reduce amalgam in dental office wastewater and keep the profession advised, and be it further

Resolved, that the Association include in its advocacy messages the importance of basing environmental regulations or guidance affecting dental offices on sound science, and be it further

Resolved, that the Association continue to identify and urge the Environmental Protection Agency to fund studies that accurately and appropriately identify whether amalgam wastewater discharge affects the environment.

American Dental Association
October 2003 (2003:387)

In General

Resolved, that oral health depends on proper nutrition and healthy eating habits, and necessarily includes avoiding a steady diet of foods containing natural and added sugars, processed starches and low pH-level acids, and be it further

Resolved, that the ADA acknowledges it is beneficial for consumers to avoid a steady diet of foods containing natural and added sugars, processed starches and low pH-level acids as way to help maintain optimal oral health, and be it further

Resolved, that the ADA supports the findings and recommendations in the Council on Access, Prevention and Interprofessional Relations Supplemental Report 3 to the 2012 House of Delegates: Formulation a Strategic Approach for Addressing the Complex Emerging Issues Related to Oral Health and Nutrition in the United States (2012:4114) (PDF)*, and be it further

Dentist's Role in Nutrition and Oral Health

Resolved, that the ADA encourages dentists to routinely counsel their patients about the oral health benefits of maintaining a well-balanced diet and limiting the number of between-meal snacks, and be it further

Resolved, that the ADA encourages dentists to stay abreast of the latest science-based nutrition recommendations and nutrition-related screening, counseling and referral techniques, and be it further

Resolved, that the ADA encourages dentists to serve on local school wellness planning boards to establish and maintain local school wellness policies that:

• Appropriately balance the nutritional benefits of consuming certain foodstuffs and the risk of tooth decay.
• Promote lifelong mouth healthy behaviors, such brushing twice a day, flossing once a day, limiting consumption of sugary snacks and beverages and seeing the dentist regularly.
• Reflect the inextricable link between oral health and overall health and well-being.

and be it further

Access and Prevention

Resolved, that the ADA supports its members by providing access to current information and educational materials, and cultivating learning opportunities (e.g., continuing education modules, etc.), for dentists to learn more about the relationship between diet, nutrition and oral health—including latest science-based nutrition recommendations and nutrition-related screening and counseling techniques, and be it further

Resolved, that the ADA encourages collaborations with dieticians and other nutrition experts to raise interprofessional awareness about the relationship between diet, nutrition and oral health, and be it further

Resolved, that the ADA supports projects, as appropriate and feasible, to educate the public about the oral health benefits of maintaining a healthy diet and to encourage consumers to adopt healthier diets and establish better eating habits, and be it further

Resolved, that the ADA supports public information campaigns to reduce the amount of added sugars consumed in American diets, and be it further

Resolved, that the ADA encourages constituent and component dental societies to work with state and local officials to ensure locally-administered nutrition and food assistance programs have an oral health component (e.g., WIC, SNAP, NSLP, etc.), and be it further

Resolved, that the ADA encourages constituent and component dental societies to work with state and local school officials to prohibit schools from entering into contractual arrangements, including school pouring rights contracts, that incentivize schools to sell and aggressively advertise foods and beverages with high added sugar content on school grounds (e.g., providing free samples, posting signage, branding school equipment, sponsoring events, etc.), and be it further

Resolved, that the ADA supports the World Health Organization’s 2015 Guideline on Sugar Intake for Adults and Children, and be it further

Government Affairs

Resolved, that the ADA should give priority to the following when advancing public policies on diet, nutrition and oral health:

1. Ensuring government-supported nutrition education and food assistance programs (e.g., WIC, SNAP, NSLP, etc.) have an oral health component, such as and general guidelines that promote good oral health.
2. Encouraging federal research agencies to develop the body of high-quality scientific literature examining, among other things, the extent to which dental caries rates fluctuate with changes in total added sugar consumption and over what period(s).
3. Maintaining the separate line-item declaration of added sugars content on Nutrition Facts labels and listing the declared added sugars content in relatable terms (e.g., teaspoons, grams, etc.).
4. Supporting legislative and regulatory actions, as appropriate and feasible, to increase consumer awareness about the role dietary sugar consumption may play in maintaining optimal oral health and the potential benefits of limiting added sugar consumption in relation to general and oral health.
5. Requiring third-party payers to cover nutrition counseling in dental offices as an essential plan benefit.

American Dental Association
Adopted 2016 (2016:330)

______________________
* The findings and recommendations in the Council on Access, Prevention and Interprofessional Relations Supplemental Report 3 to the 2012 House of Delegates: Formulation a Strategic Approach for Addressing the Complex Emerging Issues Related to Oral Health and Nutrition in the United States (2012:4114) (PDF) are:

FINDINGS

RECOMMENDATIONS

Resolved, that in the interest of public health, the American Dental Association recommends the fluoridation of community water systems in accordance with the standards established by the appropriate authority, and be it further

Resolved, that the American Dental Association supports ongoing research on the safety and effectiveness of community water fluoridation.

American Dental Association
November 2015 (1950:224; 2015:274)

1. The Association endorses community water fluoridation as a safe, beneficial and cost-effective and socially equitable public health measure for preventing dental caries in children and adults.
2. The Association supports the fluoridation of community water systems as recommended by the U.S. Public Health Service.
3. The Association urges individual dentists and dental societies to exercise leadership in all phases of activity which lead to the initiation and continuation of community water fluoridation, including making scientific knowledge and resources available to the community and collaborating with state and local agencies.
4. The Association encourages governmental, philanthropic and other entities to make funding available to communities seeking to initiate and/or maintain community water fluoridation.
5. The Association supports the following actions to maintain the quality of national community water fluoridation and its infrastructure:

• performance of periodic assessments of community water fluoridation infrastructure needs by appropriate state agencies;
• allocation of needed resources to or by appropriate state agencies to upgrade and maintain the fluoridation infrastructure; and
• observance of the standards established by the appropriate state agencies related to engineering and administrative recommendations for water fluoridation in accordance with guidance issued by the Centers for Disease Control and Prevention.

American Dental Association
November 2015 (1997:673; 2015:273)

Resolved, the American Dental Association recognizes that community-based topical fluoride programs are safe and efficacious in reducing dental caries.

American Dental Association
October 2014 (2014:507)

Resolved, that in order to ensure optimal fluoride intake, the American Dental Association supports actions by its members to educate their patients regarding the level of fluoride in bottled water and the possible removal of fluoride by some home water treatment systems, and be it further

Resolved, that the American Dental Association urges its members to inquire about their patients’ primary and secondary water source as part of the health history, and be it further

Resolved, that the American Dental Association supports the labeling of bottled water with the fluoride concentration of the product and company contact information including address and telephone number, and be it further

Resolved, that the American Dental Association supports the inclusion of information on the system’s effect on water fluoride levels with each home water treatment system.

American Dental Association
November 2013 (2002:390; 2013:342)

Resolved, that the American Dental Association urge state dental societies to continue efforts to educate professionals and consumers about the role of fluoride in community oral health, and be it further

Resolved, that the Association urge state dental societies to encourage state and local dental public health and drinking water authorities to identify the state’s groundwater sectors with natural fluoride levels that exceed 2.0 parts per million, and be it further

Resolved, that the Association encourage state and local dental societies to communicate with local health and drinking water authorities regarding standards for fluoride levels, and be it further

Resolved, that the Association urge dentists to become familiar with the water fluoride concentrations in their area of practice that exceed 2.0 parts per million and provide appropriate counseling to parents and caregivers of young children to reduce the risk of dental fluorosis in permanent teeth, and be it further

Resolved, that the Association encourage dentists to educate pediatric health care workers about groundwater sectors and water systems with fluoride levels that exceed 2.0 parts per million so that parents and caregivers of young children receive appropriate counseling to reduce the risk of dental fluorosis in permanent teeth.

American Dental Association
October 1999 (1999:921)

Resolved, that the federal Medicaid match for dental care should be enhanced to 90/10 or better.

American Dental Association
October 2020

Resolved, that dentists should be allowed to claim a tax credit for the first $10,000 of services provided under the Medicaid program, and be it further

Resolved, that the tax credit should be based upon the most recent Code on Dental Procedures and Nomenclature (CDT) codes and credited at a rate consistent with the most recent ADA Survey of Dental Fees for that region or state. 

American Dental Association
October 2020

Resolved, that that the American Dental Association supports the Children’s Health Insurance Program (CHIP), and be it further

Resolved, that funds dedicated to the program should be used to provide medical and dental care to children with family income less than or equal to 200 percent of the federal poverty level before any expansion to children in families above that level, and be it further

Resolved, that decisions to cover children beyond 200 percent of the federal poverty level continue to be made on a state-by-state basis.

American Dental Association
October 2020

Resolved, that the American Dental Association encourages all state dental associations to work with their respective state Medicaid agency to ensure that Medicaid dental audits be conducted by dentists who have similar educational backgrounds and credentials as the dentists being audited, as well as being licensed within the state in which the audit is being conducted.

American Dental Association
October 2017 

Resolved, that the American Dental Association encourages all state dental associations to work with their state Medicaid agency in hiring a Chief Medicaid Dental Officer, who is a member of organized dentistry, and be it further

Resolved, that the American Dental Association encourages all state dental associations to actively participate in the establishment or continuation of an existing Medicaid dental advisory committee that is recognized by the state Medicaid agency as the professional body to provide recommendations on Medicaid dental issues.

American Dental Association
November 2015 

Resolved, that the ADA advocate for adequate funding and to ensure adequate safeguards are in place to provide comprehensive oral health care to underserved children and adults in any legislation that would convert the federal share of Medicaid to a block grant to the states, and be it further

Resolved, that the ADA opposes any such block grant proposal in the event adequate funding and safeguards cannot be assured to provide comprehensive oral health care to underserved children and adults.

American Dental Association
October 2014 

Resolved, that the ADA make lobbying for adequate funds to provide oral health care to Medicaid and other indigent care populations a high priority and that the constituent and component societies be urged to do the same, and be it further

Resolved, that the ADA and its constituent and component societies carry out an intensive educational program, subject to current budgetary limits, to enlighten the public and government agencies of the value of oral health care and the consequences of untreated oral health disease to the overall health of our citizens and to health care payment systems, and be it further

Resolved, that the appropriate ADA agency study how to improve health outcomes through greater accountability and responsibility of dental patients to the care, educational and preventive opportunities provided to them.

American Dental Association
October 2014 

Resolved, that the Association seek to retain federal statutes or regulations regarding the definition of "dental services" under Medicaid so they continue to require dental care services be delivered by a dentist or under the appropriate supervision of a dentist, and be it further

Resolved, that Association constituent societies encourage their members to enroll in Medicaid.

American Dental Association
October 2014 

Resolved, that funding for the provision of dental preventive services by non-dental providers should not come from dental assistance program budgets.

American Dental Association
October 2014 

Resolved, that the ADA support and encourage states to adopt adequately funded fee-for-service models for Medicaid programs to increase dentist participation and increase access to care for Medicaid participants.

American Dental Association
October 2014 

Resolved, that the ADA adopt policy supporting the inclusion of adult dental services in the federal Medicaid program, and be it further

Resolved, that the ADA take every opportunity to educate policy makers that, consistent with ADA's position on health system reform (Trans.1993:664; Trans.1994:656) oral health is an integral part of overall health, and be it further

Resolved, adult coverage under Medicaid should not be left to the discretion of individual states but rather, should be provided consistent with all other basic health care services.

American Dental Association
October 2012 

Resolved, that the American Dental Association supports the development of policy at the federal, state, and local levels that supports the fair, equitable, choice-driven provision of dental care to promote improved health and well-being in elderly patients.

American Dental Association
October 2020

Resolved, that the American Dental Association recognizes that oral health care for adults age 65 and older depends on acceptable and sustainable financing of that care, and be it further

Resolved, that for the purpose of presenting potential legislation that includes dental benefits for adults age 65 and over in a tax payer-funded public program such as Medicaid, CHIP, privately administered Medicare or other federal or state programs, then the ADA shall support a program that:

• Covers individuals under 300% FPL
• Covers the range of services necessary to achieve and maintain oral health
• Is primarily funded by the federal government and not fully dependent upon state budgets
• Is adequately funded to support an annually reviewed reimbursement rate such that at least 50% of dentists within each geographic area receive their full fee to support access to care
• Includes minimal and reasonable administrative requirements
• Allows freedom of choice for patients to seek care from any dentist while continuing to receive the full program benefit

and be it further

Resolved, that the appropriate agency urge passage of legislation to enable dental offices to offer in-office membership plans to support direct care for all seniors.

American Dental Association
October 2020

Resolved, that the American Dental Association supports the federal graduate and professional degree student loan programs authorized under the Higher Education Act of 1965, with an emphasis on:

1. Protecting access to federal Direct Unsubsidized Stafford Loans (Direct Loans) and Grad PLUS loans for graduate and professional degree students.
2. Reinstating eligibility for graduate and professional degree students to take advantage of federal Direct Subsidized Stafford Loans.
3. Removing annual and cumulative borrowing limits on federal student loans.
4. Lowering the interest rates and fees on federal student loans.
5. Capping total amount of interest that can accrue on federal student loans.
6. Halting the accrual of federal student loan interest while a dentist is completing a medical/dental internship or residency.
7. Extending the period of federal student loan deferment until after a new dentist has completed his or her medical/dental internship or residency.
8. Permitting federal graduate student loans to be refinanced more than once.
9. Simplifying and adding more transparency to the federal graduate student loan application process.
10. Encouraging institutions of higher education and lenders to offer training to help students make informed decisions about how to finance their graduate education.
11. Encouraging collaborative approaches to handling borrowers who fail (or are at risk of failing) to fully repay their federal student loan(s) in the required time period.

and be it further

Resolved, that the ADA's position on allowing private lenders to have a role in the federal student loan program shall depend on whether the loan terms and conditions and borrower protections are guaranteed to be as favorable or better than the existing system of federal student loans, and be it further

Resolved, that the ADA supports strengthening federal regulations for the protection of all student loan borrowers.

Resolved, that the American Dental Association supports using state and federal funds to provide payments toward a dental professional’s outstanding federal student loans in exchange for practicing in underserved areas, entering and remaining in public service and academic teaching and research positions, and filling other gaps in areas of national need, and be it further

Resolved, that the ADA supports removing barriers that prohibit those with private graduate student loans from taking advantage of state and federal student loan repayment programs.

Resolved, that the American Dental Association supports the tax deductibility of interest on health profession student loans, and be it further

Resolved, that the ADA supports a tax exemption for scholarship assistance and stipends awarded to health professions students under federal programs.

Resolved, that the ADA work to expand the availability of National Health Service Corps (NHSC) scholarships and loan repayments for dentists and dental students who agree to work in a NHSC-approved site.

American Dental Association
October 2016 (1988:488; 2016:347)

Resolved, that the ADA supports mandatory continuing education (CE) in prescribing opioids and other controlled substances, with an emphasis on preventing drug overdoses, chemical dependency, and diversion. Any such mandatory CE requirements should:

1. Provide for continuing education credit that will be acceptable for both DEA registration and state dental board requirements,
2. Provide for coursework tailored to the specific needs of dentists and dental practice,
3. Include a phase-in period to allow affected dentists a reasonable period of time to reach compliance,

and be it further

Resolved, that the ADA supports statutory limits on opioid dosage and duration of no more than seven days for the treatment of acute pain, consistent with Centers for Disease Control and Prevention (CDC) evidence-based guidelines, and be it further

Resolved, that the ADA supports improving the quality, integrity, and interoperability of state prescription drug monitoring programs.

American Dental Association
October 2018

(2018:XXX)

Resolved, that the ADA believes that any ADA or constituent-sponsored or endorsed medical and disability insurance coverage should include coverage for the treatment of chemical dependency (including alcoholism). constituent and component societies of the Association be urged to review current sponsored or endorsed medical and disability insurance coverage for chemical dependency (including alcoholism).

American Dental Association
October 2017

(1986:519; 2012:442; 2017:40)

Resolved, that the following ADA Statement on Alcohol and Other Substance Use by Pregnant and Postpartum Patients be adopted.

Statement on Alcohol and Other Substance Use by Pregnant and Postpartum Patients

1. Dentists are encouraged to inquire about pregnant or postpartum patients' history of alcohol and other drug use, including nicotine.
2. As healthcare professionals, dentists are encouraged to advise these patients to avoid the use of these substances and to urge them to disclose any such use to their primary care providers.
3. Dentists who become aware of postpartum patients' resumption of tobacco or illegal drug use, or excessive alcohol intake, are encouraged to recommend that the patient stop these behaviors. The dentist is encouraged to be prepared to inform the woman of treatment resources, if indicated.

American Dental Association
October 2017

(2005:330; 2017:40)

Resolved, that the following ADA Statement on Alcoholism and Other Substance Use Disorders be adopted.

Statement on Alcoholism and Other Substance Use Disorders

1. The ADA recognizes that alcoholism and other substance use disorders are primary, chronic, and often progressive diseases that ultimately affect every aspect of health, including oral health.
2. The ADA recognizes the need for research on the oral health implications of chronic alcohol, tobacco and/or other drug use.
3. The ADA recognizes the need for research on substance use disorders among dentists, dental and dental hygiene students, and dental team members.

American Dental Association
October 2017

(2005:328; 2017:40)

1. When considering prescribing opioids, dentists should conduct a medical and dental history to determine current medications, potential drug interactions and history of substance abuse.
2. Dentists should follow and continually review Centers for Disease Control and state licensing board recommendations for safe opioid prescribing.
3. Dentists should register with and utilize prescription drug monitoring programs (PDMP) to promote the appropriate use of controlled substances for legitimate medical purposes, while deterring the misuse, abuse and diversion of these substances.
4. Dentists should have a discussion with patients regarding their responsibilities for preventing misuse, abuse, storage and disposal of prescription opioids.
5. Dentists should consider treatment options that utilize best practices to prevent exacerbation of or relapse of opioid misuse.
6. Dentists should consider nonsteroidal anti-inflammatory analgesics as the first-line therapy for acute pain management.
7. Dentists should recognize multimodal pain strategies for management for acute postoperative pain as a means for sparing the need for opioid analgesics.
8. Dentists should consider coordination with other treating doctors, including pain specialists when prescribing opioids for management of chronic orofacial pain.
9. Dentists who are practicing in good faith and who use professional judgment regarding the prescription of opioids for the treatment of pain should not be held responsible for the willful and deceptive behavior of patients who successfully obtain opioids for non-dental purposes.
10. Dental students, residents and practicing dentists are encouraged to seek continuing education in addictive disease and pain management as related to opioid prescribing.

American Dental Association
October 2016

(2005:328; 2012:139; 2016:286)

Resolved, that the following Guidelines Related to Alcohol, Nicotine, and/or Drug Use by Child or Adolescent Patients be adopted.

Guidelines Related to Alcohol, Nicotine, and/or Drug Use by Child or Adolescent Patients

1. Dentists are urged to be knowledgeable about the oral manifestations of nicotine and drug use in adolescents.
2. Dentists are encouraged to know their state laws related to confidentiality of health services for adolescents and to understand the circumstances that would allow, prevent or obligate the dentist to communicate information regarding substance use to a parent.
3. Dentists are encouraged to take the opportunity to reinforce good health habits by complimenting young patients who refrain from using tobacco, drinking alcohol or using illegal drugs.
4. A dentist who becomes aware of a young patient's tobacco use is encouraged to take the opportunity to ask about it, provide tobacco cessation counseling and to offer information on treatment resources.
5. Dentists may want to consider having age- appropriate anti-tobacco literature available in their offices for their young patients.
6. Dentists who become aware of a young patient's alcohol or illegal drug use (either directly or through a report to a team member), are encouraged to express concern about this behavior and encourage the patient to discontinue the drug or alcohol use.
7. A dentist who becomes aware that a parent is supplying illegal substances to a young patient, may be subject to mandatory reporting under child abuse regulations.

American Dental Association
November 2013

(2005:330; 2013:64)

Resolved, that the following ADA Statement on Provision of Dental Treatment of Patients with Substance Use Disorders be adopted.

Statement on Provision of Dental Treatment for Patients with Substance Use Disorders

1. Dentists are urged to be aware of each patient's substance use history, and to take this into consideration when planning treatment and prescribing medications.
2. Dentists are encouraged to be knowledgeable about substance use disorders—both active and in remission—in order to safely prescribe controlled substances and other medications to patients with these disorders.
3. Dentists should draw upon their professional judgment in advising patients who are heavy drinkers to cut back, or the users of illegal drugs to stop.
4. Dentists may want to be familiar with their community's treatment resources for patients with substance use disorders and be able to make referrals when indicated.
5. Dentists are encouraged to seek consultation with the patient's physician, when the patient has a history of alcoholism or other substance use disorder.
6. Dentists are urged to be current in their knowledge of pharmacology, including content related to drugs of abuse; recognition of contraindications to the delivery of epinephrine-containing local anesthetics; safe prescribing practices for patients with substance use disorders—both active and in remission—and management of patient emergencies that may result from unforeseen drug interactions.
7. Dentists are obliged to protect patient confidentiality of substances abuse treatment information, in accordance with applicable state and federal law.

American Dental Association
October 2005

(2005:329)

Resolved, that the following statement on e-cigarettes and vaping be adopted ADA policy:

That the American Dental Association (1) strongly supports regulatory, legislative, and/or legal action at the federal and/or state levels to ban the sale and distribution of all e-cigarette and vaping products, with the exception of those approved by the FDA for tobacco cessation purposes and made available by prescription only; and (2) advocate for research funding to study the safety and effectiveness of e-cigarettes and vaping products for tobacco cessation purposes and their effects on the oral cavity.

American Dental Association
October 2020

Dentist's Role in Preventing Tobacco Use

Resolved, that dentists should be fully aware of the oral and maxillofacial health risks that are causally associated with tobacco use, including higher rates of tooth decay, receding gums, periodontal disease, mucosal lesions, bone damage, tooth loss, jaw bone loss and more, and be it further

Resolved, that dentists should routinely screen patients for tobacco and non-tobacco nicotine use and provide clinical preventive services, such as in-office cessation counseling, to prevent first-time tobacco use and encourage current users to quit, and be it further

Resolved, that the dentists and health organizations should provide educational materials to help prevent first-time use and encourage current users to quit, and be it further

Resolved, that these educational materials should be developed or provided by credible and trustworthy sources with no ties to the tobacco industry or its affiliates, and be it further

Cessation Counseling and Nicotine Replacement Therapies

Resolved, that aside from the intended use of approved tobacco cessation products and nicotine replacement therapies, the American Dental Association discourages the use of all nicotine products made with or derived from tobacco, and be it further

Resolved, that dentists should be fully informed about nicotine cessation interventions and routinely apply those techniques to help patients stop using tobacco, and be it further

Resolved, that third-party payers should cover professionally administered cessation products and services (e.g., cessation counseling, prescription medications, etc.) as an essential plan benefit, and be it further

Modified Risk Tobacco Products

Resolved, that the American Dental Association does not consider the concept of "modified risk"—which is allowing some tobacco and other nicotine products (e.g., snus, electronic nicotine delivery systems) to be marketed as having a reduced or modified health risk compared to others (e.g., cigarettes)—to be a viable public health strategy to reduce the death and disease associated with tobacco use, and be it further

Resolved, that modified risk tobacco product (MRTP) applications should include extensive data examining the comparative impact on oral and maxillofacial health, both to the individual and the population as a whole, and the data should be made publicly available, and be it further

Regulation of Tobacco Products, Vaping Devices, and Other Nicotine Delivery Systems

Resolved, that the American Dental Association recognizes nicotine as an addictive chemical and supports its regulation as a controlled substance, and be it further

Resolved, that the ADA supports state and federal authority to investigate and strictly regulate nicotine and nicotine-containing products, including those made or derived from tobacco, and be it further

Resolved, that these nicotine-containing products include, but are not limited to:

• Cigarettes.
• Cigars (both premium and non-premium).
• Pipe tobacco.
• Hookah (also called waterpipe tobacco).
• Roll-your-own tobacco.
• Smokeless tobacco (e.g., chewing tobacco, moist snuff, snus, etc.).
• Dissolvables (e.g., nicotine lozenges, strips, sticks, etc.).
• Nicotine gels (absorbed through the skin).
• Electronic nicotine delivery systems (e.g., e-cigarettes, e-hooka, e-cigars, vape pens, advanced refillable personal vaporizers, e-pipes, etc.).

and be it further

Resolved, that the ADA supports strict regulation of these and other nicotine-containing products by (but without being limited to):

• Prohibiting product sales in all venues, including through vending machines and the internet.
• Levying significant taxes on these products.
• Setting age restrictions to purchase and receive these products.
• Requiring oral health warning statements, graphic images and ingredient disclosures on product packaging.
• Restricting the addition of added flavors (including menthol) and other ingredients and ingredient levels (including nicotine).
• Regulating second hand exposure to environmental smoke and vapor.
• Banning all forms of advertising and marketing (including bans on free sampling, product giveaways, promotional items, event sponsorships, etc.).
• Imposing licensure requirements for product wholesalers and retailers.
• Prohibiting the use of these products on and around public and private property, including government buildings and school campuses.

American Dental Association
October 2020