CORRECTIONAL MANAGED HEALTH CARE POLICY MANUAL Effective Date: 6/1/2017 Replaces: 4/24/2012 Formulated: 10/85 Reviewed: 10/16 NUMBER: E-36.1 Page 1 of 1 DENTAL TREATMENT LEVELS OF CARE PURPOSE: To assure all offenders have equitable access to dental preventive services and treatment procedures based upon the occurrence of disease, significant malfunction, or injury. POLICY: Offenders emergent/urgent, interceptive, and rehabilitative needs will be treated, as clinically indicated. PROCEDURE: I. There are three levels of dental treatment needs categorized as Emergency/Urgent (Level 1), Interceptive (Level 2), and Rehabilitative (Level 3). Appendix I to this policy contains a description and eligibility for each treatment level. II. Offenders who have not met oral self-care requirements (Dental Services Policy E- 36.6, Periodontal Disease Program) are provided offender education (Dental Services F-46.1, Dental Health Education and Prevention). III. IV. Level of dental need can only be assigned by the treating dentist and is based on offender needs. Appropriate documentation must be provided to support the assigned level of treatment need. The treating dentist may recommend treatment for dental needs not described in Appendix I. Exceptions can be requested for offenders judged to have a special dental need, regardless of length of incarceration, (Dental Services Policy E-36.5, Dental Utilization/Quality Review Committee). Reference: ACA Standard 4-4350 (Ref. 3-4355) Treatment Plan ACA Standard 4-4360 (Ref. 3-4347) Dental Care ACA Standard 4-4375 (Ref. 3-4358) Prostheses and Orthodontic Devices Page 1 of 7
APPENDIX I E-36.1 DENTAL TREATMENT LEVELS OF CARE 0 NO NEEDS No care needed (excludes periodontal maintenance) INDICATED 1 EMERGENT/ All offenders with an oral or maxillofacial (hard or soft tissue) URGENT condition which may be accompanied by substantial pain or an acute infection that affects their normal daily activities. Offenders with this designation will receive care at the time of the Sick Call Examination with follow-up definitive treatment as clinically indicated, but within 14 calendar days after a diagnosis is established. 2 INTERCEPTIVE All offenders requiring care for a subacute (hard or soft tissue) condition which is likely to become urgent without intervention. Offenders with a treatment plan for conditions with this designation will be seen for definitive care as clinically indicated, but at least once every 60 calendar days after a treatment plan is established. 3 REHABILITATIVE All offenders requiring care for chronic (hard or soft tissue) pathosis. Offenders requesting care are eligible for treatment of conditions with this designation after 12 months of incarceration and demonstration of maintenance of acceptable oral hygiene. Offenders with a treatment plan for conditions with this designation will be seen for definitive care at least once every 90 calendar days after a comprehensive treatment plan is established. Offenders periodontal maintenance appointments will be scheduled separately from routine care. Examples: Periodontics Type I or II requiring prophylaxis Periodontics Type III or IV Periodontal disease requiring non-surgical deep scaling and root planing procedures (Dental Services Policy E-36.6, Periodontal Disease Program). Restorative Incipient caries or fractured dentition requiring restoration with definitive restorative materials or transitional crowns. Page 2 of 7
Endodontic Asymptomatic anterior tooth requiring definitive root canal treatment if the tooth is restorable with available restorative materials and the offender s overall dentition is healthy. Oral Surgery Asymptomatic non-infected or non-restorable tooth requiring extraction; impacted tooth requiring removal or specialty referral; surgical procedures for the elimination of pathosis or restoration of essential physiologic relationships. Page 3 of 7
APPENDIX II DENTAL SERVICES PARAMETERS FOR CARE A range of acceptable treatment modalities exists within which dental health care professionals are expected to provide dental care. Parameters are strategies designed to assist dentists in making clinical decisions. They are designed to help dental professionals ensure quality, timeliness, effectiveness of care, and contain costs. Parameters describe clinical matters that should be considered in the diagnosis, documentation and treatment of oral conditions. Dental staff may deviate from the parameters in offender cases depending on clinical circumstances. They are not intended to restrict the dentist s exercise of professional judgement. Access to Care: Treatment Levels 1. Level of dental need can only be assigned by the treating dentist. 2. Each offender with a diagnosed level 1 treatment need shall have treatment initiated. 3. Each offender with a diagnosed level 2 treatment need, who has requested care, shall have treatment initiated or scheduled. 4. Each offender with a diagnosed level 3 treatment need, who has requested care and met eligibility requirements, shall have treatment initiated or scheduled. 5. Each offender, who in the opinion of the attending dentist, has a special need that is not emergent or urgent, and is not otherwise addressed in the CMHC Policy, should be referred to the Dental Utilization Quality Review Committee for review and preauthorization prior to initiating care. Dental Examination and Care 1. The nature of each sick call request and response to the offender are documented in the offender s health record. 2. Each request for care is reviewed by a dentist, dental hygienist or licensed medical worker. 3. Each specific complaint (e.g., trauma, pain, swelling, bleeding, infection) is appropriately managed at the sick call visit. 4. Each request for rehabilitative care (e.g., filling, exam, cleaning) results in the creation of a reminder for a comprehensive treatment plan if eligibility requirements have been met. Page 4 of 7
5. Appointments for comprehensive treatment plans will be scheduled as the facility is compliant with the policy timeframes for emergent/urgent, interceptive, and rehabilitative care. 6. Offenders should receive oral hygiene counseling and a baseline plaque index at the comprehensive treatment plan visit. 7. The dental and medical history should be current, reviewed and initialed by the treating health care provider on the Dental Health Record (HSD-4). 8. The SOAP format should be used to document each new complaint. Subjective: Offender s complaint or reason offender was scheduled Objective: Observations by the clinician Assessment: Diagnosis of each observed abnormality Plan: Individual treatment plan, which addresses the specific complaint or if a request for routine care addresses each observed abnormality. 9. Appropriate radiographs of diagnostic quality should be present or ordered. 10. Treatment plans should be appropriate, consistent with the clinical and radiographic evidence and numerically listed by level of need. 11. Treatment plans should be charted in black ink on the Dental Health Record (HSD-4) in the Diseases and Abnormalities section and listed in the Treatment Plan section. 12. Care provided should be appropriately documented in the offender s chart on the Dental Health Record (HSD-4), Restoration and Treatment Section. 13. Planned care should be fully explained to each offender and include information on the disease process, potential complications, the expected results, and the offender s responsibilities in treatment. 14. The potential consequences to the offender s health should be explained if no treatment is provided. Page 5 of 7
DENTAL SERVICES PARAMETERS FOR CARE DENTAL SEALANTS Dental sealants have been recognized by the American Dental Association, the World Health Organization, Centers for Disease Control, and the Surgeon General s Report on Oral Health in America as being a safe and effective procedure to prevent dental caries. Sealants have been available for many years and originally were provided to children and adolescents, but should also be beneficial to the adult population with a moderate to high risk for caries. Offender s caries risk must be assessed to determine if the application of sealants is indicated. While sealants are recommended for all moderate to high risk offenders, even low risk offenders with a predisposition for development of occlusal caries due to tooth anatomy can benefit from this preventive procedure. Page 6 of 7
DENTAL SERVICES PARAMETERS FOR CARE DENTAL SEALANTS EXAMINATION CARIES RISK FACTORS 1. previous caries experience 2. anatomy of tooth 3. oral hygiene 4. diet/sugar intake 5. access to daily topical fluoride No caries Incipient caries Pit & fissures enamel only Caries involving Dentin Low Caries Risk NO SEALANT Moderate to high caries risk SEALANT RECOMMENDED SEALANT RECOMMENDED RESTORATION INDICATED Page 7 of 7