Current Policies

Resolved, that the American Dental Association supports the position that dentists should be granted immunity from personal liability for the services they provide when taking part in the medical response to a declared public health emergency, national disaster, or other mass casualty event, and be it further

Resolved, that a federal declaration of temporary liability protection should preempt state liability laws and dental practice acts.

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. 

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.

The American Dental Association supports the following policy:

1. Oral health is an integral component of systemic health.
2. Dentistry is essential healthcare 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 or 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. State agencies or officials should 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.

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.

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.

Resolved, that the Association strongly encourages dental facilities to adhere to dental best management practices for amalgam waste handling and disposal that include but are not limited to operation, maintenance, and record-keeping requirements, chairside traps, amalgam separators compliant with ISO 11143, ANSI/ADA Standard 108 or successors, and using a suitably licensed or permitted commercial waste disposal service to dispose of collected amalgam, in compliance with the EPA Clean Water Act, and supports other voluntary efforts by dentists to reduce amalgam discharges in dental facility wastewater, and be it further

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

Resolved, that the appropriate agencies of the Association continue to disseminate information to the state and local 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 dental facilities effectively reduce amalgam in dental facility 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 facilities 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.

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

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.

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.

Any regulation should exempt dental practices that place or remove no or only de minimis amounts of amalgams.

Any regulation should include an effective date or phase-in period of sufficient length to permit affected dentists a reasonable opportunity to comply.

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.

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.

Any regulation should not include a local numerical limit set by the local publicly owned treatment works (POTW).

Any regulation should not require wastewater monitoring at the dental office, although monitoring of the separators to assure proper operation may be required.

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.

Resolved, that the ADA recommends that clinicians review the risks and benefits of all restorative options with their patients, and that dental amalgam restorations continue to be used when appropriate for patient care, and be it further

Resolved, that the ADA supports the globally recognized need to reduce environmental mercury as set forth in the Minamata Convention on Mercury (September 2019) as a common good, and recognizes the responsibility of dentists to care for their patients’ well-being, in keeping with the ADA Principles of Ethics and Code of Professional Conduct, 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.

Resolved, that the American Dental Association acknowledges that oral health depends on proper diet and nutrition, and it is beneficial for consumers to avoid a steady diet of ultra-processed foods—defined as industrial creations reformulated with little if any whole foods, often additives and containing large amounts of added sugar and salt—especially those containing added sugars and low pH-level acids to help maintain optimal oral health, and be it further

Dentist’s Role in Nutrition and Oral Health

Resolved, that the ADA encourages the dental professional community to pursue continuing education credit opportunities that highlight nutritional science and motivational counseling, so that they may empower their patients to adopt a healthy dietary pattern of consuming a balanced diet with little to no ultra-processed foods containing added sugar, and be it further

Resolved, that the ADA encourages the dental professional community to pursue continuing education credit opportunities that highlight nutritional science and motivational counseling, so that they may empower their patients to adopt a healthy dietary pattern of consuming a balanced diet with little to no ultra-processed foods containing added sugar, and be it further

Resolved, that the ADA encourages the dental professional community to support their communities to:

• Promote widespread access to safe optimally fluoridated drinking water.
• Reduce the consumption of added sugar and sugar-sweetened beverages.
• Promote lifelong healthy behaviors, including appropriate oral hygiene measures, limiting consumption of ultra-processed foods containing added sugar, and seeing the dentist regularly.
• Reflect the link between oral health and overall health and well-being.
• Create environments where healthy foods are an attractive and affordable choice for all students.
• Oppose programs that promote or otherwise incentivize consumption of ultra-processed foods (e.g. pouring rights contracts, etc.)

and it be 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 the dental professional community 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 health care professionals, dieticians, social workers, community health workers, and other nutrition stakeholders to raise interprofessional awareness about the relationship between diet, nutrition, and oral health, and be it further

Resolved, that the ADA supports projects to educate the public to maintain a healthy diet and to reduce consumption of added sugar, and be it further

Resolved, that the ADA encourages constituent and component dental societies to work with state and local officials to ensure 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 collaboration with state and local officials to reduce consumption of ultra-processed foods, especially those containing added sugars, and promote nutritious and health diets in schools, 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

Resolved, that the ADA encourages collaboration between dental societies, local health departments, and community health centers to develop programs and initiatives that bring locally sourced nutritious foods to underserved communities, to food insecure individuals, and to local corner stores, and be it further

Resolved, that the ADA encourages collaboration with community stakeholders and state and local officials to develop alternative access points to healthy foods in underserved communities and FDA-designated food deserts, including the development of small footprint grocery stores, grocery coops, and community gardens,

and be it further

Government Affairs

Resolved, that the ADA should give priority to the following to advance 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, oral health associations with ultra-processed foods and 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 to increase consumer awareness about the role ultra-processed foods play in maintaining optimal oral health, including 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.
6. Supporting legislative actions, and state or federal programs that aim to address food insecurity, reduce or eliminate food deserts, and improve transportation infrastructure in underserved communities.

Resolved, recognizing that safe, free drinking water is an essential component of student health and wellness, ADA supports the development of school drinking water policies, programs and procedures:

• designed to make safe, free drinking water readily available in multiple locations throughout the school day and at school-sponsored events and activities;
• that include water promotion strategies detailing the consumption of water as a healthy beverage, and
• that govern the purchase, placement, distribution and maintenance of systems designed to provide access to safe, free drinking water.

Resolved, that in order to ensure optimal fluoride intake, the American Dental Association supports actions by its members to educate their patients and communities 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, telephone number and website, and be it further

Resolved, that the American Dental Association urges its members and the public to refer to the International Bottled Water Association’s “List of Brands Containing Fluoride,” and be it further

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

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.

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. 

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.

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.

Medicaid is a taxpayer funded public health insurance program based on federal-state partnership. Medicaid covers low-income people including families and children, pregnant women, the elderly, and people with disabilities. Each state and territory determine eligibility criteria and program structure to support delivery of care to underserved populations.

General Program Considerations: While children covered by Medicaid programs have access to a mandatory Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, the ADA strongly supports a comprehensive adult dental benefit for the Medicaid-eligible population in an adequately funded program and encourages the federal and state governments to institute an adult dental benefit in Medicaid. The ADA believes that the federal Medicaid match for children and adult dental care should be enhanced to 90/10 or better (FMAP).

Medicaid Program Structure: The ADA believes that successful Medicaid programs are those that are supported by a strong state level multi-stakeholder Medicaid Dental Advisory Committee that can provide guidance and analysis of program success, support program integrity and participate in program improvement initiatives. Such a committee should also be supported by a full-time Chief Dental Medicaid Director.

In addition to a Medicaid Dental Advisory Committee, the ADA believes that state-level peer-review committees with dentists licensed in the state in collaboration with local dental public health professionals, can support Medicaid programs in assessing clinical issues related to administering the Medicaid benefit.

The ADA encourages state dental associations to remain a significant voice within their state Medicaid programs and in turn should encourage their Medicaid programs to share program decisions which impact access, quality of care and availability of specialty care. The ADA encourages all state dental associations to actively participate in the establishment or continuation of an existing Medicaid Dental Advisory Committee which includes representation from dental public health and dental education professionals, that is recognized by the state Medicaid agency as the professional body to provide recommendations on Medicaid dental issues.

The ADA strongly believes that every patient should have a dental home and a managed care plan should never be addressed as the “dental home” for a Medicaid enrolled beneficiary.

The ADA also supports the rights and freedom of patients to choose their own dentist, as well as their own Medicaid Managed Care Plan.

Provider Participation: The ADA encourages dentists to participate in the Medicaid program. The ADA encourages dentists to refer patients seeking care, to dentists enrolled in Medicaid in those instances wherein they are unable to accommodate them. The ADA supports a dentist’s autonomy to choose their level of participation in Medicaid programs.

Network adequacy for Medicaid programs is dependent on the adequate number and diversity of providers to address the disease burden and promote prevention. The ADA believes that Medicaid programs should establish policies that incentivizes any dentist willing to provide a dental home for children from birth to age 5. Dentists should be allowed to claim a tax credit for the first $10,000 of services (based on the most recent Code on Dental Procedures and Nomenclature (CDT) codes) and credited at a rate consistent with the dentists’ full fees for that region or state.

Opportunities for early-career dentists to engage with state Medicaid programs can be enhanced through loan repayment programs for dentists who are willing to treat a disproportionate number of Medicaid beneficiaries. Such loan repayment programs should be commensurable with the level of Medicaid participation. The ADA also supports additional funding such as enhanced reimbursement to dental schools that treat Medicaid beneficiaries.

Annually reviewed reimbursement, aligned with current Fair Health provider charges data, is necessary to assure adequate compensation such that the majority of dentists in a region would be encouraged/motivated to participate in the program.

Transparency & Reporting: The ADA believes that transparency and standardization of reporting data in all Medicaid programs relating to access to care, patient / provider satisfaction rates, and network adequacy is essential for the public, state dental associations, researchers and other stakeholders to effectively assess the success of the Medicaid program regardless of whether the program is administered directly by the state or through managed care contracts. Data should be publicly available on an annual basis. When the Medicaid benefit is administered through managed care contracts, information regarding medical/dental loss ratio should also be made publicly available.

Administrative Practices: To better ensure patient safety and access to care, the ADA believes that Medicaid programs should:

• Based on provider experience, use a single credentialing system across all managed care plans within Medicaid (state specific) to decrease administrative burdens, such that providers who are willing to participate can join the program in a timely manner thus ensuring an adequate network.
• Establish uniform processes to transfer prior authorizations between managed care plans.
• Support coverage for caries risk assessment, case management, transportation, language services, appointment compliance, desensitization visits for patients with disabilities and coordination of other medical appointments.
• Support coverage for preventive services related to tobacco cessation, nutritional counseling, home care practices, and any other services that improve overall health outcomes.
• Conduct any necessary audits through 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.
• Ensure that each managed care entity establishes a designated Provider Advocate position to conduct educational sessions for participating providers and provide ongoing technical and navigational support.
• Address case management for Special Needs patients through enhanced payment schedules.

The ADA encourages state dental associations, whenever possible, to actively participate in any request for information, request for proposals, or contract development processes using resources developed by the Association to ensure appropriate administration of Medicaid managed care.

Resolved, that the American Dental Association recommends that U.S. Centers for Medicare & Medicaid Services (CMS) publish a state by state assessment of managed care organizations with the percentage of allocated Medicaid funding that is being spent on dental services, and be it further

Resolved, that the American Dental Association recommends that CMS require each state Medicaid agency to monitor the dental loss ratio among their contractors. 

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.

Resolved, that the American Dental Association encourages state dental associations to work with their respective state Medicaid agency to adopt such guidelines for Medicaid Dental Reviews and/or in States that use a managed care model to incorporate such guidelines into their request for proposal (RFP) to third-party payers interested in managing the dental benefit:

Guidelines for Medicaid Dental Reviews

The Auditor/Reviewer shall demonstrate adherence, not only to individual State Board regulations and requirements, but also an understanding, acceptance and adherence to Medicaid State guidelines and specific specialty guidelines as applicable. In addition, the Auditor/Reviewer shall demonstrate experience in treatment planning specific patient demographic groups and/or unique care delivery sites that influence treatment planning being reviewed.

It is recommended that entities, which conduct Medicaid Dental reviews and audits, utilize auditors and reviewers who:

1. Have a current active license to practice dentistry in the State where audited treatment has been rendered and be available to present their findings.
2. Are of the same specialty (or equivalent education) as the dentist being audited.
3. Document and reference the guidelines of an appropriate dental or specialty organization as the basis for their findings, including the definition of Medical Necessity being used within the review.
4. Have a history of treating Medicaid recipients in the state in which the audited dentist practices.
5. Have experience treating patients in a similar care delivery setting as the dentist being audited, such as a hospital, surgery center or school-based setting, especially if a significant portion of the audit targets such venues.

In addition, these entities shall be expected to conduct the review and audit in an efficient and expeditious manner, including:

1. Stating a reasonable period of time in which an audit can proceed before dismissal can be sought.
2. Defining the reasonable use of extrapolation in the initial audit request.

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. 

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 requirement
• 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.

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, and be it further

Resolved, that the ADA lead efforts to protect the eligibility status of program participants when unforeseen circumstances, such as the removal of a health professional shortage area designation, undermine the participating dentist’s good faith efforts to meet their service obligations.

Resolved, that it is the position of the American Dental Association (ADA) that dentists should not be excluded from government relief of public and commercial student loan debt without obligation or condition, and be it further

Resolved, that the following principles guide the ADA efforts to shape specific student loan forgiveness proposals:

1. Education debt associated with graduate and professional programs should be eligible.
2. Any means testing should account for regional differences in cost of living and purchasing power.
3. The consideration for eligibility and amount of forgiveness should account for the cost, length and rigor of dental education programs.

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 their 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 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.

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 Boards recommendations for safe opioid prescribing.
3. Dentists should register with and utilize prescription drug monitoring program (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.

Continuing Education

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

Dosage and Duration

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.

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.

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 and successful treatment protocols among dentists, dental and dental hygiene students, and dental team members.

and be it further

Resolved, the ADA encourages the states to create and maintain well-being programs that address substance use disorders as well as other mental and physical challenges that dentists might experience throughout their career.

and be it further

Resolved, the ADA encourages the states to maintain a list of volunteer dentists experienced with health and well-being challenges to provide support and make it available to dentists faced with like challenges.

Dentists are encouraged to inquire about pregnant or postpartum patients’ history of alcohol and other drug use, including nicotine.

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.

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.

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.

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, 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 dentists should obtain an adequate health history and when necessary, inform the patient about the Quitline to receive additional resources for tobacco cessation, 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.