(Adopted 1995, Revised 1997)
The key element in the design of this set of parameters for dental attrition 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 of the patient (see limited, comprehensive, periodic, detailed and extensive evaluation parameters) and consideration of the patient's needs, the dentist should provide the patient with information about dental attrition 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 dental attrition.
In developing a treatment plan, the dentist should consider that dental attrition can be generalized or site-specific, progressive and predisposing to other conditions.
When the dentist considers it necessary, (an)other health care professional(s) should be consulted to acquire additional information.
Factors affecting the patient's speech, function, and orofacial aesthetics should be considered by the dentist in developing a treatment plan.
In developing a treatment plan, the dentist should consider that the etiology of dental attrition can be multifactorial, characterized by craniofacial, musculoskeletal, stomatognathic and/or dental interrelationships that are dynamic throughout life.
The behavioral, psychological, anatomical, developmental and physiological limitations of the patient should be considered by the dentist in developing the treatment plan.
Restorative implications, pulpal/endodontic status, tooth position, and periodontal status and prognosis should be considered in developing a treatment plan.
The dentist may counsel the patient concerning the potential effects of the patient's health condition, medication use, and behaviors and/or habits on his or her oral health.
Medications should be prescribed, modified and/or administered for dental patients whose known conditions would affect or be affected by dental treatment provided without the medication or its modification. The dentist should consult with the prescribing health care professional(s) before modifying medications being taken by the patient for known conditions. (See: ADA Statement on Antibiotic Prophylaxis, Prevention of Bacterial Endocarditis: A Statement for the Dental Profession (PDF), and A-Z Topic: Antibiotic Prophylaxis.)
After consideration of the individual circumstances, the dentist should decide whether the dental attrition should be monitored or treated.
The dentist should recommend treatment; present treatment options, if any; and discuss the probable benefits, prognosis, limitations and risks associated with treatment, and the probable consequences of no treatment.
Any treatment performed should be with the concurrence of the patient and the dentist. If the patient insists upon treatment not considered by the dentist to be beneficial for the patient, the dentist may decline to provide treatment. If the patient insists upon treatment considered by the dentist to be harmful to the patient, the dentist should decline to provide treatment.
Following evaluation, treatment priority should be given to the management of pain, infection, traumatic injuries or other emergency conditions.
The dentist should refer the patient to (an)other health professional(s) when the dentist determines that it is in the best interest of the patient.
Relevant and appropriate information about the patient and any coordinated treatment should be communicated and coordinated between the referring dentist and the health professional(s) accepting the referral.
The dentist should consider the characteristics and requirements of each patient in selecting material(s) and treatment(s).
The dentist should consider the compatibility of the selected treatment with the surrounding oral tissues and should provide an environment accessible for maintenance.
Counseling and/or therapy for parafunctional behaviors which can contribute to attrition may be performed.
Following occlusal evaluation, occlusal guards, splinting and/or adjustments may be used to facilitate treatment.
The dentist should attempt to manage the patient's pain, anxiety and behavior during treatment to facilitate safety, efficiency and patient cooperation. (See: ADA Policy Statement: The Use of Sedation and General Anesthesia by Dentists and Guidelines for the Use of Sedation and General Anesthesia by Dentists.)
Placement of restorations, or modification or replacement of restorations may be performed to facilitate treatment or reduce symptoms resulting from lost tooth structure.
Transitional or provisional restorations may be utilized by the dentist to facilitate treatment.
The dentist may alter tooth morphology and/or position, and/or modify occluding, articulating, adjacent or approximating teeth, or the tooth in question, to facilitate treatment or reduce symptoms.
Pulpal tissue should be protected by the dentist when indicated.
Endodontic therapy may be performed by the dentist.
Fixed, removable and/or implant-supported restorations (prostheses) may be repaired, modified or replaced, as determined by the dentist.
The dentist should communicate by prescription the necessary information for fabrication of the prosthesis(es) to the dental laboratory technician. Although the fabrication may be delegated, the dentist is responsible for the accuracy of the prosthesis(es).
Periodontal procedures, including surgery, may be performed by the dentist to facilitate treatment.
Chemotherapeutic agents may be used.
Teeth may be removed, as determined by the dentist. When appropriate, the patient should be informed of the necessity to replace any removed teeth.
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 dental attrition.
The patient should be informed that the success of the treatment is often dependent upon patient compliance with the prescribed treatment and recommendations for behavioral modifications. Lack of compliance should be recorded.
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.