Standards of Patient Care

General Care Standards

 Admissions

  • All prospective patients shall be offered an admissions consultation within four weeks of contact by the patient when the admissions clinic is in operation.
  • During the admissions consultation appointment all patients shall be offered an information session and a brief oral examination.
  • Patients shall be admitted to the predoctoral clinics for treatment on the basis of matching the patient’s needs with the scope of the predoctoral educational program to assure the delivery of care within an appropriate range of expertise of the students and the supervising faculty.
  • No patients shall be denied admission to the predoctoral clinics on the basis of race, color, creed, religion, national origin, sex, sexual orientation, age, marital status, disability, or status as a disabled veteran or Vietnam era veteran.
  • Patients who are denied admission shall be informed at the time of the decision and the reason for that decision shall be documented in the patient record.
  • Patients seeking limited services which are within the scope of the predoctoral clinical programs shall be admitted for care as long as the patients consent to limited treatment, the limitation of care is clearly documented, and such limitations are not detrimental to their health and well-being.

Timeliness of Care

  • All comprehensive care patients shall be assigned to a student within eight weeks of admission when school is in session. (Exceptions:  Selected prosthodontic patients, patients with specialized needs (e.g. veneers, implant) who may be assigned to honors students at limited times of the academic year.
  • Accepted patients with emergent needs will be treated or referred as appropriate to stabilize their oral health status.
  • All patients shall have the opportunity to receive their comprehensive clinical examination (basic assessment) within four weeks of their admissions consultation when school is in session.
  • Treatment plans shall be developed and then submitted to the Office of Clinical Services within eight weeks of assignment of a patient to a student.
  • Adult patients shall have the opportunity to be seen at least once per quarter when school is in session.  Pediatric patients shall have the opportunity to be seen at least once per month when school is in session.
  • Adult patients with active oral disease shall have the opportunity to be seen at least once per month when school is in session.

Informed Consent

  • All comprehensive care patients (or parents, guardians or responsible adults when treating a pediatric patient) shall be completely informed of their oral health needs prior to the onset of treatment.  This informed consent shall include problem identification, treatment alternatives, cost estimates, time commitment required, and any significant risk or consequence associated with either the treatment or non-treatment of their conditions.
  • All patients shall acknowledge their understanding of their oral condition, the proposed treatment, and the existence of treatment alternatives and cost estimates by signing an appropriate consent statement.
  • All patients shall sign an appropriate consent prior to commencement of active treatment.

Patient Records

  • A patient record shall be established and maintained which documents all diagnostic and therapeutic actions as well as significant communication related to patient care.  The record shall include the health history, treatment consultation reports, dental charts, progress notes, correspondence related to care, laboratory reports, prescription data for medications, prescription data for dental laboratory services, and radiographs.
  • Medical alert labels shall be attached to the outside of the patient record when the care provider’s attention to previous health history findings are of significance to the process of care.
  • Patient records shall remain confidential and be managed in accordance with Washington state law, chapter 70.02 RCW.  The complete law can be found at the Washington State Department of Health website:  www.doh.wa.gov.

Comprehensive and Limited Care

  • All patients seeking comprehensive care shall be presented with a problem-oriented treatment plan proposal following all appropriate consultations and faculty approval and signature.
  • All adult patients seeking comprehensive care shall receive a letter that contains an explanation of all elements of the treatment plan.
  • Treatment plans shall be modified as necessary as treatment progresses to reflect the changing needs of the patient in terms of clinical conditions, response to therapy, financial considerations, and patient availability.
  • At a minimum, treatment plans shall be updated annually.
  • Limited care services shall be made available to patients who seek selected services such as, but not limited to, oral surgery, endodontics, and diagnostic services, as long as the service being sought is within the scope of the predoctoral program and will improve the oral health status of the patient.
  • All comprehensive care patients shall be notified by mail of delay of care, or of severance of the professional relationship between the school and the patient.

Emergency Services

  • Emergency services shall be provided for patients who are not patients of record on a space available basis during normal business hours regardless of the patient’s ability to pay for services at that appointment.
  • Pediatric patients who are not patients of record of the school shall not be seen for emergency care.
  • Patients of record of the school who need emergency care during normal business hours shall be seen by their assigned student in the appropriate clinic regardless of their scheduled activity for that day.
  • Pediatric patients of record of the school who need emergency care during normal business hours shall be assigned to a student for care or care shall be provided directly by a faculty member.
  • Patients of record of the school who need emergency care after normal business hours shall be seen in the dental clinic at the University of Washington Medical Center.
  • Pediatric patients of record of the school who need emergency care after normal business hours shall be referred to Children’s Hospital and Medical Center.
  • Patients who are not patients of record of the school who need emergency care after normal business hours shall be referred to the dental clinic at the University Medical Center and are subject to normal charges for emergency services.

Patient Safety

  • Patients shall be treated in a sanitary workstation by care providers who use contemporary infection control and biohazards management strategies.
  • Patient care shall be performed by or under the supervision of School of Dentistry faculty members licensed in the State of Washington.
  • Patients shall receive diagnostic and treatment services in such a manner that is consistent with the patient’s medical history and any medical consultations.  This shall include the consideration of appropriate premedications, timing of the procedure, post-operative medications, choice of anesthesia and pain control, and the selection of the services to be rendered.
  • Patients shall have health histories updated in such a manner that is consistent with the history of the individual patient.  At minimum the history shall be updated every six months during active care.

Medical Emergency

  • In case of cardiac arrest or other life-threatening emergencies, the EMS system shall be activated by calling Medic I at 9-911.
  • In cases of serious, but not immediately life-threatening situations requiring follow-up medical care, the Emergency Department at UWMC shall be contacted at 8-4000.
  • Faculty, clinical staff and students shall be currently certified in basic life support procedures.
  • Appropriate and current medical equipment and devices, drug kits and first aid kits shall be available in each clinic.

General Diagnostic Standards

Examination Standards

  • All admitted comprehensive care patients shall be referred to the Diagnostic Clinic for a comprehensive clinical examination.
  • All patients referred to the Diagnostic Clinic shall receive a complete head, neck and oral examination including periodontal and dental screening to detect the presence of odontogenic and other orofacial pathology.  The assessment shall include a thorough medical, dental and social history and assessment of risk factors for oral and regional disease.
  • All patients shall receive additional appropriate diagnostic tests when there are indications that such testing is reasonable and justified by symptoms or findings accumulated during the comprehensive examination.  These diagnostic tests may include, but are not limited to, special clinical examination procedures such as joint function, neurological assessment and laboratory tests.
  • Necessary intraoral and extraoral radiographic and other imaging modalities shall be ordered when clinical findings clearly indicate their need, and the results written into the patient record.
  • Patients shall receive a written list of their problems, proposed or tentative treatments and need for medical or dental consultation before their diagnostic visit is completed.  This tentative problem list shall serve as the guide for subsequent consultation and formulation of a plan of care.
  • Any patient with history or clinical findings that suggest the need for medical, psychological or other professional consultations shall be provided with the written consultation order at the end of the diagnostic appointment and shall be provided with clear information about why the consultation is needed.

Radiographic Standards

  • The decision to order and take radiographs shall be made strictly based on clinical symptoms and findings that demonstrate that imaging of the structure is necessary to make a definitive diagnosis or to make a decision on treatment or follow-up.
  • The standards of the State of Washington regarding radiation safety shall be followed in making decisions on whether to expose a patient to ionizing radiation.  Those same standards shall be used as the major decision criteria in practicing radiation safety during the exposure of patients to imaging modalities.
  • All radiographs shall be labeled with the name of the patient and the exposure date and findings recorded in the patient record.
  • All radiographic exposures shall be recorded in the Radiographic Log section of the patient record including the number and type of exposure, and the date of exposure.
  • The use of intraoral dental radiographs shall be limited to the amount of exposure necessary to arrive at a diagnosis and the ordering and taking of films without clear clinical justification shall be avoided.
  • The developing facilities and handling of radiographic images shall meet standards that prevent needless damage to films and loss of films.
  • Radiographs shall be taken by non-dentists only when authorization is obtained from a licensed faculty member.

Treatment Standards

Periodontics

  • All patients seeking admission to the school for general care shall receive a periodontal screening examination using the Periodontal Screening and Recording (PSR) system.
  • Comprehensive care patients with PSR scores of three or more in any one sextant shall be referred to the Department of Periodontics for management of their periodontal needs.  
  • All comprehensive care patients being managed by the Department of Periodontics shall have the entire natural dentition evaluated for periodontal integrity upon entry into the periodontics program.  Findings shall be recorded on a periodontal chart and stored in the patient record.
  • All comprehensive care patients being managed by the Department of Periodontics shall have the entire natural dentition evaluated for periodontal integrity as treatment progresses. New findings shall be recorded on a periodontal chart and compared with the initial clinical findings in the patient record to determine the efficacy of the care strategy.
  • All comprehensive care patients being managed by the Department of Periodontics shall not receive other than primary restorative, prosthetic, or orthodontic care until the patient’s periodontal condition has been stabilized unless extenuating circumstances require a different treatment strategy.
  • Periodontal surgery shall not be carried out for patients needing such services until they demonstrate the ability to maintain an acceptable level of oral hygiene required for post-surgical long-term care.

Prosthodontics

  • Removable prosthodontic procedures shall be integrated with treatment services supervised by other departments in a master treatment plan.  They will be provided in a logical sequence of care which is not influenced by the graduation requirements of students.
  • All removable prosthodontic restorations shall meet the standard of care of the profession before being accepted by the supervising faculty as a completed service.  Wherever possible, all removable prostheses should exhibit the following features:
    • maximum extension consistent with anatomy;
    • a vertical dimension of occlusion which provides adequate interocclusal distance;
    • occlusion in harmony with centric relation of the jaws and with bilateral balance in eccentric jaw positions;
    • bases which are comfortable, stable and retentive to the degree permitted by the supporting anatomy;
    • removable partial denture frameworks which seat passively on the teeth and have adequate retention; and
    • prostheses which are esthetically pleasing to the patient.
  • All treatment plans of patients assigned for prosthodontic treatment shall be reviewed and approved by the Prosthodontic advisor.  This includes the design of removable partial dentures, the selection of the type of immediate denture, and the sequence of treatment.
  • Oral tissues should exhibit good health before a definitive removable prosthodontic restoration is initiated.  This includes, but is not limited to, control of caries and periodontal disease, treatment of inflammatory papillary hyperplasia, and removal of interfering soft tissues, teeth and tori.  Interim appliances may be used during treatment of these conditions, but are intended to be used for a period not to exceed one year.
  • Procedures used in the construction of all removable prostheses are described in the appropriate Prosthodontic syllabi and orientation manuals and shall be followed by students in treatment of patients.
  • Nutrition counseling related to oral health shall be provided for patients reporting inadequate diets or clinical symptoms that may be related to nutritional deficiencies.
  • All referrals for services to be performed by a Prosthodontic Laboratory shall be done in accordance with Washington state law.
  • Appropriate follow-up care shall be provided in a timely manner under Prosthodontic supervision until an acceptable result consistent with the standard of care of the profession is achieved in the opinion of the Prosthodontic advisor.  In general, at least six weeks of care are required post-insertion in order to ascertain patient comfort.  All follow-up care is to be provided by the treating student until his/her graduation, except when away from the School on an extended block assignment.

Restorative Dentistry

  • Restorative procedures shall be provided in a fashion which integrates with the overall treatment plan and sequence of care in a master plan of care.  Restorative procedures shall be coordinated with the treatment provided by other disciplines and departments.
  • The provision of restorative procedures is dependent upon the patients’ needs and circumstances and neither the choice of procedures nor the sequence of care shall be influenced by graduation requirements of students.

Prevention of Disease

  • All treatment plans shall include preventive services appropriate to the patient.  This includes both professional services and patient actions.
  • An essential component for dentulous persons is the reduction and removal of pathogenic plaque.
    • The patient shall be instructed in and encouraged to comply with appropriate oral hygiene practices.
    • A professional prophylaxis shall be accomplished at regular intervals appropriate for the individual. Efforts shall be made to remove all plaque, extrinsic stain and calculus. Enamel and cementum surfaces shall be polished and smooth.
  • Caries prevention may include the following as appropriate for the patient:
    • Diagnostic tests for patients with high caries rates.
    • Provision of and/or prescription for topical fluoride.
    • Use of occlusal sealants.
    • Dietary evaluation and instruction.
    • Prescription for chlorhexidine to control cariogenic bacteria.
    • Recommendation for use of xylitol chewing gum.
    • Use of fluoride containing varnish.
    • Consultation with the patient’s physician when drug induced xerostomia is present.
  • Caries control treatment (restorations) may be performed for patients who demonstrate high caries activity.  Materials of choice are reinforced zinc oxide/eugenol for posterior teeth and glass ionomer for anterior teeth.  If this course of treatment is selected, all deep lesions should be treated with these materials as quickly as possible.  In such cases the selection and placement of extensive crown and bridge procedures should be delayed until all caries activity has been eliminated.
  • Other areas of prevention:
    • All tobacco use should be discouraged.
    • Good dietary and nutritional habits shall be encouraged.
    • Removal of mechanical and chemical irritants and highly cariogenic substances from the oral environment shall be encouraged (e.g., habitual use of lozenges, ill-fitting dentures).

Operative Dentistry

  • In general, treatments of choice for minimal to moderate loss of tooth structure not undermining cusps on posterior teeth include silver amalgam, compacted gold, or cast gold restorations.  Exceptions include:
    • Conservative class 1 or class 2 restorations where direct composite, indirect heat-cured composite or porcelain restorations may be appropriate if esthetics is a primary concern and occlusal function on the restoration is minimal.
    • Involved teeth that are to be prosthetic abutments.
    • Glass ionomer restorations for cases with cervical lesions and/or elevated caries activity.
    • Selected cases where small class 1 and 5 lesions are restored with direct gold restorations.
  • In general, treatments of choice for minimal to moderate loss of tooth structure on anterior teeth not involving or undermining the incisal edge is composite resin.  Anterior lesions of moderate depth in patients that exhibit high caries activity may be restored with glass ionomer cement.  Cervical caries or erosion/abrasion lesions in anterior teeth may be restored with glass ionomer cement or compacted gold.
  • Where incisal edges of anterior teeth are involved, the following treatment is indicated:
    • Use composites for cases involving incisal edges where minimizing the removal of sound tooth structure is desired.
    • The use of labial veneers, where appropriate, to conserve tooth structure.  Prognosis, as in all cases, should be explained to the patient.
    • A general sequence of choices for the use of anterior restorations is as follows:  1) composite, glass ionomer; 2) labial veneer (resin or porcelain); and 3) complete crown (porcelain fused to metal or porcelain jacket).
  • Where there is gross loss of tooth structure, such that there is insufficient tooth structure to support an indicated cast restoration, the tooth should be first strengthened with an amalgam foundation or cast post/core.  Retention/ resistance features may include pins, slots, wells, posts or intrapulpal chamber retention if endodontically treated.
  • Complete crowns or partial coverage cast restorations are indicated when there is insufficient tooth structure left to support inlays, amalgams, composites, or glass ionomer restorations.  When crowns are indicated on molars, and esthetics is not a concern, the material of choice is cast high noble metal.  When esthetics is a concern, porcelain fused to metal should be used.  An onlay should be considered when sufficient tooth structure is present but cusps need protection.
  • Rubber dam shall be used whenever possible.
  • Use of high speed burs and diamonds shall be accompanied by air/water spray.
  • Pulp capping materials, such as calcium hydroxide, shall be used after deep caries removal where an exposure is suspected.  Small, clean pulp exposures shall be capped using sterile instruments and materials.  A protective base should be placed over the calcium hydroxide to protect the capped site before proceeding with a restoration.
  • Zinc phosphate or glass ionomer cement are the bases of choice for thermal insulation.  Reinforced zinc oxide/eugenol base may be used for thermal insulation if it was placed as a temporary restoration where all caries was removed and does not require removal for preparation of the definitive restoration.
  • When extensive decay removal results in removal of all active caries (infected dentin) but removal of all inactive decay (affected dentin) will result in exposure of vital pulp, an “indirect” pulp cap may be accomplished by inserting a reinforced zinc oxide/eugenol temporary (IRM). After three months without clinical symptoms, the temporary material can be removed and a suitable permanent restoration placed.
  • All restorations shall reproduce sound tooth contours, have flush margins, and restore interproximal and non-traumatic occlusal contact where feasible and desirable.
  • “Esthetic” restorations shall match tooth shade and translucency as closely as possible.

Fixed Prosthodontics

  • Prior to initiating fixed prosthodontic treatment for any tooth (teeth), a thorough evaluation of the current periodontal and endodontic status must be documented in writing.  This includes evaluation of appropriate radiographs, probing depths, mobility, assessment of attached tissue levels, pulp vitality and assessment of plaque control.
  • In the absence of specific contraindications (such as compromised general health status, compromised periodontal support or financial constraints), the replacement of choice, when one or two adjacent posterior teeth are missing and there is a tooth available as an acceptable abutment both anteriorly and posteriorly, is a fixed partial denture. This applies even when the missing teeth are in all four quadrants. However, it does not apply when a removable partial denture is necessary to replace teeth in the opposite side of the same arch. An implant-supported fixed partial denture can also be considered for the replacement of both anterior and posterior missing teeth.
  • When up to all four of the incisors are missing in an arch and acceptable abutments are present, a fixed partial denture is the restoration of choice. This applies even if a removable distal extension partial denture is necessary to replace posterior teeth.
  • The retainers of choice for fixed partial dentures are usually 3/4 crown, full crown, porcelain or resin veneered crown, or resin-bonded retainers, though alternative retainers may be indicated in some cases.
  • If conditions are favorable, cantilever fixed partial dentures are acceptable for the replacement of lateral incisors with the cuspid as the abutment.  In special circumstances, a posterior replacement by a cantilever is acceptable, however double abutments are usually indicated. Buccolingual occlusal width should be reduced in such cases.
  • Resin-bonded fixed partial dentures are acceptable for the replacement of teeth where there is no, or minimal, carious involvement or restoration of the abutments. Presence of existing restorations may temper the use of this type of retainer. Long span fixed partial dentures or periodontally compromised abutments are contraindications for resin-bonded fixed partial dentures. The retainer should fully cover any existing restoration(s).
  • When posts or post and copings are necessary they should be separate from the crown or fixed partial denture abutment casting. It is essential that there be an adequate root to crown ratio for the post.
  • Margins, contour and contact points shall be as for restorative dentistry. Contours of pontics should facilitate mechanical cleansing.
  • Not all missing teeth should be replaced. As a rule, second or third molars, particularly when nonfunctional, should not be replaced.  When there is no problem with mastication or esthetics, replacements are indicated primarily to preserve the remaining dentition. Therefore, the decision not to replace should be backed up with records and measurements of the teeth adjacent to and opposing the edentulous areas.  Tooth position should be included in this analysis. This would enable the dentist to note whether deterioration and movement has taken place over time.  In the event this occurs, the decision not to replace should be reversed. The patient shall be informed of the recommendation, its rationale and the prognosis.
  • If malposed teeth are the primary reason for the rejection of a fixed partial denture, consideration should be given to orthodontic therapy.
  • The materials of choice for fixed prosthodontic restorations are high noble or noble metal castings with or without esthetic porcelain or resin veneers.
  • Patients shall receive thorough instructions in special oral hygiene procedures related to fixed partial dentures.

Endodontics

  • The standards of care are based on the premise that endodontic treatment procedures should be of such quality that predictable and favorable results will routinely occur.
  • The patient’s medical history must be appropriately interpreted.
  • Findings derived from clinical examination procedures must be appropriately interpreted.
  • Access into the pulp chamber and canal space must be adequate to perform intracanal procedures but excessive tooth structure should not be removed.
  • Canal instrumentation (cleaning and shaping) should be maintained within the original contour of the root canal space.
  • The prepared root canal space should be obturated within 1.0 mm of the apical foramen or the radiographic apex.
  • The solid core filling material should be contained within tooth structure.
  • The prepared root canal space should appear to be completely obturated on post-treatment radiographs.
  • Treatment procedures should be carried out in an aseptic manner.
  • X-ray exposure should be limited to those radiographs required to effectively complete treatment.
  • The comfort and safety of the patient must be provided for during the course of all treatment procedures.
  • Treatment is considered on-going until the patient is completely comfortable.

Oral Medicine

 Emergency Dental Care

  • All patients seeking emergency evaluation and treatment in the emergency clinic shall be provided with the opportunity to be examined and treated during normal hours of operation.
  • Patients with serious infections, traumatic injury and severe pain shall be evaluated within 24 hours or referred to community clinics that provide such care.
  • The care provided in the emergency clinic shall be at the standard of general practice and necessary palliative treatments delivered including pulp removal, extractions, temporary restorations and treatment of soft tissue diseases and infections.
  • Patients with acute pain and/or infection shall be provided with analgesic, antibiotic and other appropriate prescriptions.
  • Infections and traumatic injuries beyond the scope of competence of those staffing the emergency clinic shall be immediately referred to the Oral & Maxillofacial Surgery service.
  • Emergency patients shall receive written notification of their diagnosis and prognosis at the end of their emergency clinic visit.

Disabled Patient Care

  • Patients with physical, emotional, medical and developmental disabilities shall be given full access to the service for diagnostic and emergency management.
  • Patients with disabilities that are beyond the management skill level of the faculty and students shall be referred to the hospital dental service at the University of Washington Medical Center.
  • The quality and timeliness of care for disabled patients shall meet the standard of the School of Dentistry except where the nature of the disability makes compliance impossible (e.g., uncooperative retarded patient, severe seizures and palsy states).
  • Disabled patients shall have the same radiology, diagnostic assessment, recall and prevention protocols as routine patients.

Oral Medicine Care

  • Patients of the Diagnostic Clinic found to have mucosal lesions, salivary dysfunctions, neurosensory disorders, chronic facial pain, and Temporomandibular disorders shall be referred to the Oral Medicine and Facial Pain clinic or assessed through immediate consultation with the Oral Medicine Service attending specialist.
  • Patients with soft tissue oral disease and chronic facial pain managed in the Oral Medicine Clinic shall be assessed by a member of the Oral Medicine clinical specialty faculty in conjunction with assigned students.  The faculty member will act as the continuing source of care for the patient.
  • Lesions that represent potential risk of carcinoma or other destructive pathological processes shall be biopsied, studied through laboratory tests, or otherwise carefully followed to assure that the patient’s risk of serious disease is not increased through inattention to follow-up.
  • Patients seen in the Oral Medicine clinic shall receive appropriate pharmacological treatments, physical treatments and/or behavioral therapies in a timely manner.
  • Private practitioners that refer patients to the Oral Medicine Clinic shall receive written notice that the patient has been scheduled.
  • The diagnosis and treatment of TMD and chronic facial pain shall follow accepted authoritative guidelines for diagnosis and management such as the President’s report from the ADA.
  • Unsubstantiated treatments for TMD shall be restricted and the use of palliative therapies that alter jaw or tooth position resulting in surgery or orthodontic therapy will not be provided.
  • The diagnosis and treatment of salivary dysfunctions shall include not only direct assessment and treatment of the gland defect but also primary prevention of potential dental disease which often results from xerostomia.
  • Behavioral, stress reduction, cognitive therapy and physical treatments directed toward pain reduction shall be employed for those patients that demonstrate the need for such interventions through verbal report or from scores and diagnoses made using behavioral measures.
  • Standardized examination techniques shall be used in the assessment of all patients with chronic pain or TMD with a major focus being the use of assessment techniques that have been demonstrated to be reliable.
  • Diagnostic protocols for chronic facial pain shall include the use of medications as therapeutic trials to establish definitive diagnoses when specific laboratory or clinical tests do not exist.

Oral & Maxillofacial Surgery

  • Patients shall have the benefit of an independent diagnostic opinion and an examination prior to the scheduling of any surgical treatment.
  • Patients shall have adequate imaging studies prior to the rendering of a diagnosis and surgical intervention.
  • Immediately prior to surgery the student shall record the patient’s vital signs and coordinate care consistent with the findings in the medical history.
  • All surgical care shall be performed only after attention has been given to the appropriate control of peri-operative and operative anxiety.
  • Patients shall be given postoperative care instructions appropriate for the surgical procedure performed.
  • Post-operatively the patient shall be given a telephone number for out-of-hours consultation in case of postoperative problems.  The department shall provide 24-hour-a-day, 365 days per year emergency coverage for patients of record.
  • All procedures shall be performed within the parameters of care as published by the American Association of Oral and Maxillofacial Surgeons.
  • Prior to a patient being discharged, the faculty member shall see the patient and countersign the chart entry.
  • When appropriate a postoperative follow-up outpatient appointment will be provided to the patient.
  • All human tissue removed during surgical intervention shall be managed in accordance with the School of Dentistry Human Tissue Management Policy.
  • Use of conscious sedation shall be carried out in accordance with the School of Dentistry Conscious Sedation Policy.

Orthodontics

  • All comprehensive care patients shall be screened for debilitating malocclusions, either functional or esthetic.  Orthodontic faculty will be available for consultation.
  • The Department of Orthodontics will provide limited orthodontic therapy in the predoctoral clinic.  Comprehensive orthodontic treatment shall be provided in the graduate or intramural practice clinics.
  • Treatment provided in the orthodontic clinic shall be coordinated with the other involved disciplines.

Pediatric Dentistry

  • The diagnostic process shall include assessments of the whole child.  Physical, emotional and behavioral findings are to be evaluated.  Consultation and referral to appropriate services are to be implemented.  Consultation and referral may include a variety of health professionals and in suspected cases of child maltreatment, Child Protective Services and/or law enforcement are to be contacted.
  • Treatment plans shall be designed to preserve and restore the primary and permanent dentition in order to foster normal growth and development of the orofacial anatomy and physiology.
  • Treatment plans shall be designed to preserve and restore the primary and permanent dentition in order to promote desirable esthetics in the developing child.
  • Disease prevention shall be an integral part of the patient’s plan of care and shall be consistent with accepted prevention strategies.
  • Space management therapy shall be delivered in accordance with the standards of the profession.
  • Accepted behavioral management strategies shall be used as needed during the performance of diagnostic and treatment procedures.
  • Consultations shall be sought from other specialty clinics within the School on an as-needed basis.
  • Patients shall be referred for care that cannot be provided by the Department of Pediatric Dentistry.

Completion and Maintenance Standards

Periodontics

  • Patients with active periodontal disease shall be seen as individually prescribed for oral health maintenance visits and appropriate therapy.  At a minimum, active periodontal patients shall be seen for periodontal maintenance every six months until they are released to the general care patient population.

Removable Prosthodontics

  • Patient who have received removable prostheses, and whose treatment is complete, are inactivated upon the treating student’s graduation, except for those receiving partial dentures opposed by a complete denture, or those with an overdenture.  These patients shall be maintained on a yearly recall program.
  • Prosthetic adjustment services shall be made available on an as-needed basis.

Restorative Dentistry

  • At a minimum, all restorative patients shall be seen for preventive maintenance every year until they are inactivated as a patient in the school.

Endodontics

  • Patients should be reexamined at appropriate time intervals to evaluate the success or failure of treatment.

Oral & Maxillofacial Surgery

  • Patients shall be returned to the referring clinician promptly after adequate healing has occurred following surgical treatment.
  • Long-term follow-up care may be undertaken by a supervising faculty in selected cases.

Orthodontics

  • Patients with active orthodontic appliances shall be seen regularly (two to six week intervals).  Patients whose active orthodontic treatment has been completed shall be supervised closely for two years and periodically thereafter.

Pediatric Dentistry

  • Patients shall be scheduled for routine recall examinations every six months. In some cases patient requirements dictate a variable period of monitoring and follow-up care.