| Preamble
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
The key element in the design of this set of parameters
for orofacial trauma is the professional judgment of the attending
dentist, for a specific patient, at a specific time.
In a patient presenting with orofacial trauma, medical stabilization
takes precedence over dental treatment.
The patient’s chief complaint, concerns and expectations
should be considered by the dentist.
When possible, the dentist should instruct the patient on the
protocol for managing the orofacial trauma prior to evaluation.
The dentist should attempt to manage the patient’s pain,
anxiety and behavior during examination
and 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.)
Following oral evaluation (see limited, comprehensive, periodic,
detailed and extensive evaluation parameters) and consideration
of the patient’s needs, the dentist should provide the
patient with information about orofacial trauma prior to obtaining
consent for treatment.
The dental and medical histories should be considered by the dentist
to identify medications and predisposing conditions that may
affect the prognosis, progression and management of orofacial
trauma.
The dentist should utilize a process of differential diagnosis
when evaluating orofacial trauma.
The dentist should consider that the cause of orofacial trauma
may be multifactorial and may affect multiple sites with differing
degrees of severity.
The dentist should consider the possibility that the patient may
be the victim of physical abuse and/or neglect.
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.
Factors affecting the patient’s speech, function, and orofacial
aesthetics should be considered by the dentist in developing
a treatment plan.
The behavioral, psychological, anatomical, developmental and physiological
limitations of the patient should be considered by the dentist
in developing a treatment plan.
Restorative and dental 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
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 Antibiotic
Prophylaxis for Dental Patients With
Total Joint Replacements.)
After consideration of the individual circumstances the dentist
should decide whether the orofacial trauma should be monitored
or treated.
Following evaluation, treatment priority should be given to the
management of emergency conditions, pain and anxiety.
The dentist, when possible, should recommend treatment; present
treatment options, if any; and discuss the probable benefits,
limitations and risks associated with treatment and the probable
consequences of no treatment.
When possible, 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.
Relevant and appropriate information about the patient and any
necessary coordinated treatment should be communicated between
the referring dentist and the health professional(s) accepting
the referral.
The dentist should consider the individual needs of each patient
in selecting material(s) and treatment(s).
The dentist should be responsible for educating the patient about
maintaining good oral hygiene, appropriate for the patient’s
condition.
The dentist should consider, and inform the patient, that treatment
for orofacial traumas may include multiple phases of treatment.
The dentist may prescribe and/or administer pharmacological agents.
Foreign matter may be removed from the trauma area.
Lacerations may be repaired.
Alteration of tooth morphology and/or modification or placement
of restorations may be performed by the dentist to facilitate
treatment or reduce symptoms.
Resective and/or reconstructive surgical procedures may be performed
by the dentist.
Endodontic therapy may be performed by the dentist.
Transitional or provisional restorations may be used by the dentist
to facilitate treatment.
The dentist may utilize manipulation and/or stabilization techniques
to facilitate treatment.
Surgical management of this condition may include the removal,
repositioning, and/or reimplantation of teeth, and other intra-oral
and extra-oral surgical procedures. The patient should be informed
of appropriate treatments to maintain space and/or replace teeth.
as determined by the dentist.
The dentist should communicate, by prescription, necessary information
and authorization for fabrication of appliance(s) or prosthesis(es)
to the dental laboratory technician. Although the fabrication
may be delegated, the dentist is responsible for the accuracy
and delivery of the appliance(s) or prosthesis(es).
The dentist should emphasize the prevention of oral trauma through
patient education in preventive oral health practices, which
may include orofacial protective appliances.
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.
Documentation of treatment provided, counseling and recommended
preventive measures, as well as consultations with and referrals
to other health care professionals, should be included in the
patient’s dental record.
Return to Top |
