appendix g: thsteps dental guidelines - tmhp. · pdf file53$eptof(ealthand(uman3ervices...

CH-357CPT ONLY - COPYRIGHT 2009 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.

CHILDREN’S SERVICES HANDBOOK

APPENDIX G:THSTEPS DENTAL GUIDELINES

G.1 American Academy of Pediatric Dentistry Periodicity Guidelines (9 Pages) . . . . . . . . CH-358

G.2 American Dental Association Guidelines for Prescribing Dental Radiographs (3 Pages) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CH-367


TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2

G.1 American Academy of Pediatric Dentistry Periodicity Guidelines (9 Pages)



Clinical oral examination 1

Assess oral growth and development 2

Caries-risk assessment 3

Radiographic assessment 5

Prophylaxis and topical uoride 3,4

Fluoride supplementation 5

Anticipatory guidance/counseling

Oral hygiene counseling

Dietary counseling

Injury prevention counseling

Counseling for nonnutritive habits

Counseling for speech/language development

Substance abuse counseling

Counseling for intraoral/perioral piercing

Assessment and treatment of developingmalocclusion

Assessment for pit and ssure sealants

Assessment and/or removal of third molars

Transition to adult dental care

11

4

6

7

8

9

10

1 First examination at the eruption of the rst tooth and no later than 12 months. Repeat every 6 months or as indicated by child’s risk status/susceptibility to disease. Includes assessment of pathology and injuries.

2 By clinical examination.

3 Must be repeated regularly and frequently to maximize effectiveness.

4 Timing, selection, and frequency determined by child’s history, clinical ndings, and susceptibility to oral disease.

5 Consider when systemic uoride exposure is suboptimal. Up to at least 16 years.

6 Appropriate discussion and counseling should be an integral part of each visit for care.

7 Initially, responsibility of parent; as child matures, jointly with parent; then, when indicated, only child.

8 At every appointment; initially discuss appropriate feeding practices, then the role of re ned carbohydrates and frequency of snacking in caries development and childhood obesity.

9 Initially play objects, paci ers, car seats; when learning to walk; then with sports and routine playing, including the importance of mouthguards.

10 At rst, discuss the need for additional sucking: digits vs paci ers; then the need to wean from the habit before malocclusion or skeletal dysplasia occurs. For school-aged children and adolescent patients, counsel regarding any existing habits such as ngernail biting, clenching, or bruxism.

11 For caries-susceptible primary molars, permanent molars, premolars, and anterior teeth with deep pits and ssures; placed as soon as possible after eruption.



Clin

ical

ora

l exa

min

atio

n1

Ass

ess

oral

gro

wth

and

dev

elop

men

t2

Car

ies-

risk

asse

ssm

ent

3

Rad

iogr

aphi

c as

sess

men

t

Pro

phyl

axis

and

topi

cal

uor

ide

3,4

Flu

orid

e su

pple

men

tatio

n5

Ant

icip

ator

y gu

idan

ce/c

ouns

elin

g

Ora

l hyg

iene

cou

nsel

ing

Die

tary

cou

nsel

ing

Inju

ry p

reve

ntio

n co

unse

ling

Cou

nsel

ing

for

nonn

utrit

ive

habi

ts

Cou

nsel

ing

for

spee

ch/la

ngua

ge d

evel

opm

ent

Sub

stan

ce a

buse

cou

nsel

ing

Cou

nsel

ing

for

intr

aora

l/per

iora

l pie

rcin

g

Ass

essm

ent a

nd tr

eatm

ent o

f dev

elop

ing

mal

occl

usio

n

Ass

essm

ent f

or p

it an

d s

sure

sea

lant

s

Ass

essm

ent a

nd/o

r re

mov

al o

f thi

rd m

olar

s

Tra

nsiti

on to

adu

lt de

ntal

car

e

6 7 8 9 10 114

7 I

nitia

lly, r

espo

nsib

ility

of p

aren

t; as

chi

ld m

atur

es, j

oint

ly w

ith p

aren

t; th

en, w

hen

indi

cate

d, o

nly

child

.

8

At

ever

y ap

poin

tmen

t; in

itial

ly d

iscu

ss a

ppro

pria

te f

eedi

ng p

ract

ices

, th

en t

he r

ole

of r

e n

ed c

arbo

-

hy

drat

es a

nd fr

eque

ncy

of s

nack

ing

in c

arie

s de

velo

pmen

t and

chi

ldho

od o

besi

ty.

9 I

nitia

lly p

lay

obje

cts,

pac

i er

s, c

ar s

eats

; w

hen

lear

ning

to

wal

k; t

hen

with

spo

rts

and

rout

ine

play

ing,

in

clud

ing

the

impo

rtan

ce o

f mou

thgu

ards

.

10

At

rst

, di

scus

s th

e ne

ed f

or a

dditi

onal

suc

king

: di

gits

vs

paci

ers

; th

en t

he n

eed

to w

ean

from

the

hab

it

be

fore

mal

occl

usio

n or

ske

leta

l dy

spla

sia

occu

rs.

For

sch

ool-a

ged

child

ren

and

adol

esce

nt p

atie

nts,

c

ouns

el r

egar

ding

any

exi

stin

g ha

bits

suc

h as

ng

erna

il bi

ting,

cle

nchi

ng, o

r br

uxis

m.

11

For

car

ies-

susc

eptib

le p

rimar

y m

olar

s, p

erm

anen

t m

olar

s, p

rem

olar

s, a

nd a

nter

ior

teet

h w

ith d

eep

pits

a

nd

ssur

es; p

lace

d as

soo

n as

pos

sibl

e af

ter

erup

tion.

1

Firs

t ex

amin

atio

n at

the

eru

ptio

n of

the

rs

t to

oth

and

no la

ter

than

12

mon

ths.

Rep

eat

ever

y 6

mon

ths

or a

s in

dica

ted

by c

hild

’s r

isk

stat

us/s

usce

ptib

ility

to

dise

ase.

Inc

lude

s

as

sess

men

t of p

atho

logy

and

inju

ries.

2 B

y cl

inic

al e

xam

inat

ion.

3 M

ust b

e re

peat

ed r

egul

arly

and

freq

uent

ly to

max

imiz

e ef

fect

iven

ess.

4 T

imin

g, s

elec

tion,

and

fre

quen

cy d

eter

min

ed b

y ch

ild’s

his

tory

, cl

inic

al

ndi

ngs,

and

sus

cept

ibili

ty to

ora

l dis

ease

.

5

Con

side

r w

hen

syst

emic

uo

ride

expo

sure

is s

ubop

timal

. Up

to a

t lea

st 1

6 ye

ars.

6

App

ropr

iate

dis

cuss

ion

and

coun

selin

g sh

ould

be

an in

tegr

al p

art o

f eac

h vi

sit f

or c

are.



G.2 American Dental Association Guidelines for Prescribing Dental Radiographs (3 Pages)

Copyright © American Dental Association. Reprinted by permission.



* From: American Dental Association, US Food & Drug Administration. The Selection of Patients For Dental Radiograph Examinations. Available on “www.ada.org”.

*Clinical situations for which radiographs may be indicated include but are not limited to:

A. Positive Historical Findings1. Previous periodontal or endodontic treatment2. History of pain or trauma3. Familial history of dental anomalies4. Postoperative evaluation of healing5. Remineralization monitoring6. Presence of implants or evaluation for implant placement

B. Positive Clinical Signs/Symptoms1. Clinical evidence of periodontal disease2. Large or deep restorations3. Deep carious lesions4. Malposed or clinically impacted teeth5. Swelling6. Evidence of dental/facial trauma7. Mobility of teeth8. Sinus tract (“ stula”)

9. Clinically suspected sinus pathology10. Growth abnormalities11. Oral involvement in known or suspected systemic disease12. Positive neurologic ndings in the head and neck13. Evidence of foreign objects14. Pain and/or dysfunction of the temporomandibular joint15. Facial asymmetry16. Abutment teeth for xed or removable partial prosthesis17. Unexplained bleeding18. Unexplained sensitivity of teeth19. Unusual eruption, spacing or migration of teeth20. Unusual tooth morphology, calci cation or color21. Unexplained absence of teeth22. Clinical erosion

**Factors increasing risk for caries may include but are not limited to: 1. High level of caries experience or demineralization 2. History of recurrent caries 3. High titers of cariogenic bacteria 4. Existing restoration(s) of poor quality 5. Poor oral hygiene 6. Inadequate uoride exposure 7. Prolonged nursing (bottle or breast) 8. Frequent high sucrose content in diet 9. Poor family dental health10. Developmental or acquired enamel defects11. Developmental or acquired disability12. Xerostomia13. Genetic abnormality of teeth14. Many multisurface restorations15. Chemo/radiation therapy16. Eating disorders17. Drug/alcohol abuse18. Irregular dental care

PATIENT AGE AND DENTAL DEVELOPMENTAL STAGE

TYPE OF ENCOUNTER

Child with PrimaryDentition (prior to eruption of rst permanent tooth)

Child withTransitional Dentition(after eruption of rstpermanent tooth)

Adolescent withPermanent Dentition(prior to eruption ofthird molars)

Adult, Dentate orPartially Edentulous

Adult, Edentulous

New patient* being evaluated for dental diseases and dental development

Individualizedradiographic examconsisting of selectedperiapical/occlusalviews and/or posteriorbitewings if proximalsurfaces cannot bevisualized or probed.Patients withoutevidence of disease andwith open proximalcontacts may notrequire a radiographicexam at this time.

Individualizedradiographic examconsisting of posteriorbitewings withpanoramic exam orposterior bitewings andselected periapicalimages.

Individualized radiographic exam consisting ofposterior bitewings with panoramic exam orposterior bitewings and selected periapical images. A full mouth intraoral radiographic exam ispreferred when the patient has clinical evidence of generalized dental disease or a history of extensive dental treatment.

Individualizedradiographic exam,based on clinical signsand symptoms.

Recall patient* with clinical caries or at increased risk for caries**

Posterior bitewing exam at 6-12 month intervals if proximal surfaces cannot be examined visually or with a probe

Posterior bitewingexam at 6-18 monthintervals

Not applicable

Recall patient* with no clinical caries and not at increased risk for caries**

Posterior bitewing exam at 12-24 month intervalsif proximal surfaces cannot be examined visuallyor with a probe



Not applicable

Recall patient* with periodontal disease

Clinical judgment as to the need for and type of radiographic images for the evaluation of periodontaldisease. Imaging may consist of, but is not limited to, selected bitewing and/or periapical images ofareas where periodontal disease (other than nonspeci c gingivitis) can be identi ed clinically.

Not applicable

Patient for monitoring of growth and development

Clinical judgment as to need for and type ofradiographic images for evaluation and/ormonitoring of dentofacial growth and development

Clinical judgment as toneed for and type ofradiographic images forevaluation and/ormonitoring ofdentofacial growth anddevelopment.Panoramic or periapicalexam to assessdeveloping third molars

Usually not indicated

Patient with other circumstances including, but not limited to, proposed or existing implants, pathology, restorative/endodontic needs, treated periodontal disease and caries remineralization

Clinical judgment as to need for and type of radiographic images for evaluation and/or monitoring in these circumstances.

appendix g: thsteps dental guidelines - tmhp. · pdf file53$eptof(ealthand(uman3ervices...

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