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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

    be done.

    http://www.ada.org/1945.aspx

  • 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

    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 dentists 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

    javascript:;

  • 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

    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.

    THE COMPLETE LIST OF PARAMETERS IS AVAILABLE IN http://www.ada.org/1945.aspx

    DENTAL ABRASION:

    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

    time.

    The patients chief complaint, concerns and expectations should be considered by the

    dentist.

    http://www.ada.org/1945.aspx

  • 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

    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 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

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