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DENTAL PRACTICE PARAMETERS APPROVED BY THE AMERICAN DENTAL ASSOCIATION (ADA)
PUBLISHED ON LINE (http://www.ada.org/1945.aspx)
The dental practice parameters describe the clinical considerations in the diagnosis and
treatment of 30 oral health conditions and 4 types of evaluations. Each year the parameters
are reviewed by a committee of dentists and are updated, as necessary. They are intended to
be used voluntarily by dentists to aid in their clinical decision making.
In the health care fields, many different terms are applied to documents that are aimed at
providing clinical guidance to practitioners, such as parameters guidelines, standards,
clinical recommendations, clinical options, and so forth. Although these terms are
commonly used interchangeably, the developers of the guidance documents often choose a
particular label they think connotes the intended use and force of the recommendations
presented in the documents. Thus, the ADA defined parameters as distinct from guidelines
and standards and defined the terms as follows (Trans.1993: 47):
Parameters describe the range of appropriate treatment for a given condition. In
comparison to standards or guidelines, parameters broaden the range of professional
judgment for the practitioner. They strengthen the ability of the provider to evaluate
options and arrive at appropriate treatment.
Guidelines are intended to be more flexible than standards. Guidelines should be
followed in most cases, but they recognize that treatment can and should be tailored
to fit individual needs, depending on the patient, setting and other factors.
Deviations from guidelines would be fairly common and could be justified by
differences in individual circumstances.
Standards are intended to be applied rigidly and carry the expectation that they be
applied in all cases and any deviation from them would be difficult to justify. A
standard of care indicates that measurable criteria are present and these criteria
shall be used in order to arrive at a given level of outcome. Standards say what must
Another distinction among standards, guidelines and parameters, postulated in the 1990s, was
the degree to which each was based on scientific evidence versus professional consensus.
Today as evidence-based practice has come to the fore, guidelines, parameters, standards,
recommendations, etc. are equally likely to be developed on the basis of scientific evidence.
This is clearly apparent in perusing the National Guidelines Clearinghouse,
www.guidelines.gov, which is a database of guidelines, parameters, standards,
recommendations, protocols, etc. that are evidence-based, albeit to varying degrees. The
dental practice parameters were developed through a professional consensus process.
The American Dental Association continues to maintain the dental practice parameters; but,
in addition, it is developing evidence-based information and recommendations. The dentist
may thus refer to both sources of information.
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
professions commitment to high-quality care can be demonstrated and can continue to be
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 dentists careful professional judgment.
Balancing individual patient needs with scientific soundness is a necessary step in providing
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 professions 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 dentists
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 patients attending dentist.
Additionally, elements of the parameters concerned with patient consent refer to the
patients parent, guardian or other responsible party, when the patient is a minor or is
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.
THE COMPLETE LIST OF PARAMETERS IS AVAILABLE IN http://www.ada.org/1945.aspx
The key element in the design of this set of parameters for dental abrasion is the
professional judgment of the attending dentist, for a specific patient, at a specific
The patients chief complaint, concerns and expectations should be considered by the
Following oral evaluation (see limited, comprehensive, periodic, detailed and
extensive evaluation parameters) and consideration of the patients needs, the
dentist should provide the patient with information about dental abrasion 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 abrasion.
In developing a treatment plan, the dentist should consider that dental abrasion may
be the result of one or many factors and can be in combination with other dental
conditions, such as dental erosion and microfractures of tooth structure associated
with occlusal forces.
In developing a treatment plan, the dentist should consider that dental abrasion 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 patients oral function and/or 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 the
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 patients
health condition, medication use, and behaviors and/or habits on his or her oral
health. (See: Statement on Intraoral/Perioral Piercing.)
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