CHILDREN S SERVICES HANDBOOK APPENDIX G: THSTEPS DENTAL GUIDELINES G.1 American Academy of Pediatric Dentistry Periodicity Guidelines (9 Pages)........ CH-382 G.2 American Dental Association Guidelines for Prescribing Dental Radiographs (3 Pages)..................................................................... CH-391 CH-381
TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2 G.1 American Academy of Pediatric Dentistry Periodicity Guidelines (9 Pages) Copyright American Association of Pediatric Dentistry. Reprinted by permission. CH-382
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TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2 CH-384
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CHILDREN S SERVICES HANDBOOK Clinical oral examination 1 Assess oral growth and development 2 Caries-risk assessment 3 4 Radiographic assessment 5 3,4 Prophylaxis and topical fluoride 5 Fluoride supplementation 6 Anticipatory guidance/counseling 7 Oral hygiene counseling 8 Dietary counseling 9 Injury prevention counseling 10 Counseling for nonnutritive habits Counseling for speech/language development Substance abuse counseling Counseling for intraoral/perioral piercing Assessment and treatment of developing malocclusion 11 Assessment for pit and flssure sealants Assessment and/or removal of third molars Transition to adult dental care 1 First examination at the eruption of the flrst 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 flndings, and susceptibility to oral disease. 5 Consider when systemic fluoride 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 reflned carbohydrates and frequency of snacking in caries development and childhood obesity. 9 Initially play objects, paciflers, car seats; when learning to walk; then with sports and routine playing, including the importance of mouthguards. 10 At flrst, discuss the need for additional sucking: digits vs paciflers; 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 flngernail biting, clenching, or bruxism. 11 For caries-susceptible primary molars, permanent molars, premolars, and anterior teeth with deep pits and flssures; placed as soon as possible after eruption. CH-389
CH-390 Clinical oral examination 1 Assess oral growth and development 2 Caries-risk assessment 3 Radiographic assessment 3,4 Prophylaxis and topical fl uoride 5 Fluoride supplementation 6 Anticipatory guidance/counseling Oral hygiene counseling 7 8 Dietary counseling 9 Injury prevention counseling 10 Counseling for nonnutritive habits Counseling for speech/language development Substance abuse counseling Counseling for intraoral/perioral piercing Assessment and treatment of developing malocclusion 11 Assessment for pit and flssure sealants Assessment and/or removal of third molars 4 TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2 Transition to adult dental care 1 First examination at the eruption of the fl 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 fl ndings, and susceptibility to oral disease. 5 Consider when systemic fl 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 reflned carbohydrates and frequency of snacking in caries development and childhood obesity. 9 Initially play objects, pacifl ers, car seats; when learning to walk; then with sports and routine playing, including the importance of mouthguards. 10 At fl rst, discuss the need for additional sucking: digits vs pacifl 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 fl ngernail biting, clenching, or bruxism. 11 For caries-susceptible primary molars, permanent molars, premolars, and anterior teeth with deep pits and fl ssures; placed as soon as possible after eruption.
CHILDREN S SERVICES HANDBOOK G.2 American Dental Association Guidelines for Prescribing Dental Radiographs (3 Pages) Copyright American Dental Association. Reprinted by permission. CH-391
TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2 PATIENT AGE AND DENTAL DEVELOPMENTAL STAGE TYPE OF ENCOUNTER Child with Primary Dentition (prior to eruption of first permanent tooth) Child with Transitional Dentition (after eruption of first permanent tooth) Adolescent with Permanent Dentition (prior to eruption of third molars) Adult, Dentate or Partially Edentulous Adult, Edentulous New patient* being evaluated for dental diseases and dental development Individualized radiographic exam consisting of selected periapical/occlusal views and/or posterior bitewings if proximal surfaces cannot be visualized or probed. Patients without evidence of disease and with open proximal contacts may not require a radiographic exam at this time. Individualized radiographic exam consisting of posterior bitewings with panoramic exam or posterior bitewings and selected periapical images. Individualized radiographic exam consisting of posterior bitewings with panoramic exam or posterior bitewings and selected periapical images. A full mouth intraoral radiographic exam is preferred when the patient has clinical evidence of generalized dental disease or a history of extensive dental treatment. Individualized radiographic exam, based on clinical signs and symptoms. Recall patient* with clinical caries or at increased risk for caries** Recall patient* with no clinical caries and not at increased risk for caries** Recall patient* with periodontal disease Patient for monitoring of growth and development Patient with other circumstances including, but not limited to, proposed or existing implants, pathology, restorative/endodontic needs, treated periodontal disease and caries remineralization Posterior bitewing exam at 6-12 month intervals if proximal surfaces cannot be examined visually or with a probe Posterior bitewing exam at 12-24 month intervals if proximal surfaces cannot be examined visually or with a probe Posterior bitewing exam at 18-36 month intervals Posterior bitewing exam at 6-18 month intervals Posterior bitewing exam at 24-36 month intervals Clinical judgment as to the need for and type of radiographic images for the evaluation of periodontal disease. Imaging may consist of, but is not limited to, selected bitewing and/or periapical images of areas where periodontal disease (other than nonspecific gingivitis) can be identified clinically. Clinical judgment as to need for and type of radiographic images for evaluation and/or monitoring of dentofacial growth and development Clinical judgment as to need for and type of radiographic images for evaluation and/or monitoring of dentofacial growth and development. Panoramic or periapical exam to assess developing third molars Usually not indicated Not applicable Not applicable Not applicable Clinical judgment as to need for and type of radiographic images for evaluation and/or monitoring in these circumstances. *Clinical situations for which radiographs may be indicated include but are not limited to: A. Positive Historical Findings 1. Previous periodontal or endodontic treatment 2. History of pain or trauma 3. Familial history of dental anomalies 4. Postoperative evaluation of healing 5. Remineralization monitoring 6. Presence of implants or evaluation for implant placement B. Positive Clinical Signs/Symptoms 1. Clinical evidence of periodontal disease 2. Large or deep restorations 3. Deep carious lesions 4. Malposed or clinically impacted teeth 5. Swelling 6. Evidence of dental/facial trauma 7. Mobility of teeth 8. Sinus tract ( fistula ) 9. Clinically suspected sinus pathology 10. Growth abnormalities 11. Oral involvement in known or suspected systemic disease 12. Positive neurologic findings in the head and neck 13. Evidence of foreign objects 14. Pain and/or dysfunction of the temporomandibular joint 15. Facial asymmetry 16. Abutment teeth for fixed or removable partial prosthesis 17. Unexplained bleeding 18. Unexplained sensitivity of teeth 19. Unusual eruption, spacing or migration of teeth 20. Unusual tooth morphology, calcification or color 21. Unexplained absence of teeth 22. 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 fiuoride exposure 7. Prolonged nursing (bottle or breast) 8. Frequent high sucrose content in diet 9. Poor family dental health 10. Developmental or acquired enamel defects 11. Developmental or acquired disability 12. Xerostomia 13. Genetic abnormality of teeth 14. Many multisurface restorations 15. Chemo/radiation therapy 16. Eating disorders 17. Drug/alcohol abuse 18. Irregular dental care * From: American Dental Association, US Food & Drug Administration. The Selection of Patients For Dental Radiograph Examinations. Available on www.ada.org. CH-392
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