| Preamble
Adopted 1994
The American Dental Association developed these
dental practice parameters for voluntary use by practicing dentists.
The parameters are intended, foremost, as an aid to clinical
decision making and thus, they describe clinical considerations
in the diagnosis and treatment of oral health conditions. Evaluation
in the context of these parameters includes diagnosis.
Additionally, parameters will assist the dental profession by
providing the basis on which the profession’s commitment
to high-quality care can be demonstrated and can continue to
be improved.
The dental practice parameters are condition-based, presenting
an array of possible diagnostic and treatment considerations
for oral health conditions. Condition-based parameters, rather
than procedure-based parameters, were determined to be the most
useful because this approach recognizes the need for integrated
treatments of oral conditions rather than emphasizing isolated
treatment procedures. The parameters are also oriented toward
the process of care and describe elements of diagnosis and treatment.
While the parameters describe the common elements of diagnosis
and treatment, it is acknowledged that unique clinical circumstances,
and individual patient preferences, must be factored into clinical
decisions. This requires the dentist’s careful professional
judgment. Balancing individual patient needs with scientific
soundness is a necessary step in providing care.
It is understood that treatment provided by the dentist may deviate
from the parameters, in individual cases, depending on the clinical
circumstances presented by the patient. This should be documented
and explained to the patient.
The elements of care that are described in the parameters were
derived from a consensus of professional opinion. This consensus
included expert opinion on the topic and the clinical experience
of practicing dentists. In addition, the research literature,
and parameters and guidelines of other dental organizations were
reviewed.
The American Dental Association recognizes that other interested
parties, such as payers, courts, legislators and regulators may
also opt to use these parameters. The Association encourages
users to become familiar with these parameters as the profession’s
statement on the scope of clinical oral health care.
However, these parameters are not designed to address considerations
outside of the clinical arena and, therefore, may not be directly
applicable to all health policy issues.
Furthermore, these parameters are intended to describe the range
of acceptable treatment modalities. They are intended as educational
resources, not legal requirements. As such, the parameters are
not intended to establish standards of dental care, which are
rigid and inflexible, and represent what must be done; nor are
they guidelines which are less rigid, but represent what should
be done; nor are they intended to undermine or restrict the dentist’s
exercise of professional judgment. In this context, considerable
thought was given to the use of the verbs "may," "should" and "must." The
verb "may" clearly allows the practitioner to decide
whether to act.
The verb "should" indicates a degree of preference and
differs in meaning from "must" or "shall" (which
require the practitioner to act).
Throughout the parameter document, "dentist" refers
to the patient’s attending dentist. Additionally, elements
of the parameters concerned with patient consent refer to the
patient’s parent, guardian or other responsible party,
when the patient is a minor or is incompetent.
The Association intends to continually develop, revise and maintain
parameters, in order to include all dental conditions and to
accommodate advances in dental technology and science.
Return to Top Parameters
Adopted 1994, Revised 1997
The key element in the design of this set of parameters
for comprehensive evaluation is the professional judgment of
the attending dentist, for a specific patient, at a specific
time.
The patient’s chief complaint, concerns and expectations
should be considered by the dentist.
The dentist should perform a comprehensive oral evaluation when
indicated by his or her professional judgment.
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 the oral
health condition. (See: JADA article: New national guidelines on hypertension  .)
The patient should be provided with appropriate information by
the dentist about the diagnostic procedure(s) to be performed
prior to giving consent to a comprehensive evaluation.
Medications should be prescribed, modified and/or administered
for dental patients whose known conditions
would affect or be affected by diagnostic procedures provided
without the medication
or its modification. The dentist should
consult with the prescribing health care professional(s) before
modifying medications being
taken by the patient for known conditions.
(See: ADA
Statement on Antibiotic Prophylaxis, Prevention
of Bacterial Endocarditis: A Statement
for the Dental Profession (PDF), and Antibiotic
Prophylaxis for Dental Patients With
Total Joint Replacements.)
Any evaluation performed should be with the concurrence of the
patient and the dentist. If the patient refuses diagnostic procedures,
the dentist may decline to evaluate the patient. If the patient
insists upon diagnostic procedures not considered by the dentist
to be necessary for evaluation, the dentist may decline to provide
those procedures.
In the process of diagnosis and treatment planning, the attending
dentist should review the accuracy of the data collected as part
of patient evaluation.
The behavioral, psychological, anatomical, developmental and physiological
limitations of the patient should be considered by the dentist
in performing the comprehensive evaluation and in developing
the treatment plan.
The dentist should attempt to manage the patient’s pain,
anxiety and behavior during evaluation
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.)
An extra-oral examination of the head and neck should be performed
by the dentist to determine the presence of disease, structural
anomalies, functional anomalies and signs of physical abuse.
An intraoral examination should be performed by the dentist to
determine existing conditions. These may include the presence
of disease, structural anomalies, functional anomalies and signs
of physical abuse. All restorations, including fixed and removable
prostheses, should be examined. (See:
Periodontal
Screening and Recording® (PSR®):
An Early Detection System Q & A
)
Radiographs or images of diagnostic quality should be obtained.
The number and type of radiographs or images required to provide
the information needed for diagnostic purposes will vary according
to the needs of the individual patient and should be determined
by the attending dentist. (See: Professional Topic "Radiography/X-Rays," The Selection of Patients for Dental Radiographic Examinations | PDF file/60k.)
Additional diagnostic tests relevant to the evaluation of the
patient may be performed and used by the dentist in diagnosis
and treatment planning.
When the dentist considers it necessary, (an)other health care
professional(s) should be consulted to acquire additional information.
The dentist should refer the patient to (an)other health professional(s)
when the dentist determines that it is in the best interest of
the patient.
Relevant and appropriate information about the patient and any
necessary coordinated treatment should be communicated and coordinated
between the referring dentist and the health professional(s)
accepting the referral.
The patient should be informed of the findings and observations
of the comprehensive evaluation.
The dentist should emphasize the prevention and early detection
of oral diseases through patient education in preventive oral
health practices, which may include oral hygiene instructions.
The dentist may recommend that the patient return for further
evaluation. The frequency and type of evaluation(s) should be
determined by the dentist, based on the patient’s risk
factors.
The health history, and the findings and observations of the comprehensive
evaluation and general health assessment, including counseling
and recommended preventive measures, as well as consultations
with, and referrals to other health professionals, should be
included in the patient’s dental record.
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