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CH-357CPT ONLY - COPYRIGHT 2009 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.
CHILDREN’S SERVICES HANDBOOK
APPENDIX G:THSTEPS DENTAL GUIDELINES
G.1 American Academy of Pediatric Dentistry Periodicity Guidelines (9 Pages) . . . . . . . . CH-358
G.2 American Dental Association Guidelines for Prescribing Dental Radiographs (3 Pages) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . CH-367
CH-358CPT ONLY - COPYRIGHT 2009 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.
TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2
G.1 American Academy of Pediatric Dentistry Periodicity Guidelines (9 Pages)
CH-359CPT ONLY - COPYRIGHT 2009 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.
CHILDREN’S SERVICES HANDBOOK
Copyright © American Association of Pediatric Dentistry. Reprinted by permission.
CH-360CPT ONLY - COPYRIGHT 2009 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.
TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2
CH-361CPT ONLY - COPYRIGHT 2009 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.
CHILDREN’S SERVICES HANDBOOK
CH-362CPT ONLY - COPYRIGHT 2009 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.
TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2
CH-363CPT ONLY - COPYRIGHT 2009 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.
CHILDREN’S SERVICES HANDBOOK
CH-364CPT ONLY - COPYRIGHT 2009 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.
TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2
CH-365CPT ONLY - COPYRIGHT 2009 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.
CHILDREN’S SERVICES HANDBOOK
Clinical oral examination 1
Assess oral growth and development 2
Caries-risk assessment 3
Radiographic assessment 5
Prophylaxis and topical uoride 3,4
Fluoride supplementation 5
Anticipatory guidance/counseling
Oral hygiene counseling
Dietary counseling
Injury prevention counseling
Counseling for nonnutritive habits
Counseling for speech/language development
Substance abuse counseling
Counseling for intraoral/perioral piercing
Assessment and treatment of developingmalocclusion
Assessment for pit and ssure sealants
Assessment and/or removal of third molars
Transition to adult dental care
11
4
6
7
8
9
10
1 First examination at the eruption of the 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 ndings, and susceptibility to oral disease.
5 Consider when systemic 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 re ned carbohydrates and frequency of snacking in caries development and childhood obesity.
9 Initially play objects, paci ers, car seats; when learning to walk; then with sports and routine playing, including the importance of mouthguards.
10 At rst, discuss the need for additional sucking: digits vs paci 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 ngernail biting, clenching, or bruxism.
11 For caries-susceptible primary molars, permanent molars, premolars, and anterior teeth with deep pits and ssures; placed as soon as possible after eruption.
CH-366CPT ONLY - COPYRIGHT 2009 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.
TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2
Clin
ical
ora
l exa
min
atio
n1
Ass
ess
oral
gro
wth
and
dev
elop
men
t2
Car
ies-
risk
asse
ssm
ent
3
Rad
iogr
aphi
c as
sess
men
t
Pro
phyl
axis
and
topi
cal
uor
ide
3,4
Flu
orid
e su
pple
men
tatio
n5
Ant
icip
ator
y gu
idan
ce/c
ouns
elin
g
Ora
l hyg
iene
cou
nsel
ing
Die
tary
cou
nsel
ing
Inju
ry p
reve
ntio
n co
unse
ling
Cou
nsel
ing
for
nonn
utrit
ive
habi
ts
Cou
nsel
ing
for
spee
ch/la
ngua
ge d
evel
opm
ent
Sub
stan
ce a
buse
cou
nsel
ing
Cou
nsel
ing
for
intr
aora
l/per
iora
l pie
rcin
g
Ass
essm
ent a
nd tr
eatm
ent o
f dev
elop
ing
mal
occl
usio
n
Ass
essm
ent f
or p
it an
d s
sure
sea
lant
s
Ass
essm
ent a
nd/o
r re
mov
al o
f thi
rd m
olar
s
Tra
nsiti
on to
adu
lt de
ntal
car
e
6 7 8 9 10 114
7 I
nitia
lly, r
espo
nsib
ility
of p
aren
t; as
chi
ld m
atur
es, j
oint
ly w
ith p
aren
t; th
en, w
hen
indi
cate
d, o
nly
child
.
8
At
ever
y ap
poin
tmen
t; in
itial
ly d
iscu
ss a
ppro
pria
te f
eedi
ng p
ract
ices
, th
en t
he r
ole
of r
e n
ed c
arbo
-
hy
drat
es a
nd fr
eque
ncy
of s
nack
ing
in c
arie
s de
velo
pmen
t and
chi
ldho
od o
besi
ty.
9 I
nitia
lly p
lay
obje
cts,
pac
i er
s, c
ar s
eats
; w
hen
lear
ning
to
wal
k; t
hen
with
spo
rts
and
rout
ine
play
ing,
in
clud
ing
the
impo
rtan
ce o
f mou
thgu
ards
.
10
At
rst
, di
scus
s th
e ne
ed f
or a
dditi
onal
suc
king
: di
gits
vs
paci
ers
; th
en t
he n
eed
to w
ean
from
the
hab
it
be
fore
mal
occl
usio
n or
ske
leta
l dy
spla
sia
occu
rs.
For
sch
ool-a
ged
child
ren
and
adol
esce
nt p
atie
nts,
c
ouns
el r
egar
ding
any
exi
stin
g ha
bits
suc
h as
ng
erna
il bi
ting,
cle
nchi
ng, o
r br
uxis
m.
11
For
car
ies-
susc
eptib
le p
rimar
y m
olar
s, p
erm
anen
t m
olar
s, p
rem
olar
s, a
nd a
nter
ior
teet
h w
ith d
eep
pits
a
nd
ssur
es; p
lace
d as
soo
n as
pos
sibl
e af
ter
erup
tion.
1
Firs
t ex
amin
atio
n at
the
eru
ptio
n of
the
rs
t to
oth
and
no la
ter
than
12
mon
ths.
Rep
eat
ever
y 6
mon
ths
or a
s in
dica
ted
by c
hild
’s r
isk
stat
us/s
usce
ptib
ility
to
dise
ase.
Inc
lude
s
as
sess
men
t of p
atho
logy
and
inju
ries.
2 B
y cl
inic
al e
xam
inat
ion.
3 M
ust b
e re
peat
ed r
egul
arly
and
freq
uent
ly to
max
imiz
e ef
fect
iven
ess.
4 T
imin
g, s
elec
tion,
and
fre
quen
cy d
eter
min
ed b
y ch
ild’s
his
tory
, cl
inic
al
ndi
ngs,
and
sus
cept
ibili
ty to
ora
l dis
ease
.
5
Con
side
r w
hen
syst
emic
uo
ride
expo
sure
is s
ubop
timal
. Up
to a
t lea
st 1
6 ye
ars.
6
App
ropr
iate
dis
cuss
ion
and
coun
selin
g sh
ould
be
an in
tegr
al p
art o
f eac
h vi
sit f
or c
are.
CH-367CPT ONLY - COPYRIGHT 2009 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.
CHILDREN’S SERVICES HANDBOOK
G.2 American Dental Association Guidelines for Prescribing Dental Radiographs (3 Pages)
Copyright © American Dental Association. Reprinted by permission.
CH-368CPT ONLY - COPYRIGHT 2009 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.
TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 2
* From: American Dental Association, US Food & Drug Administration. The Selection of Patients For Dental Radiograph Examinations. Available on “www.ada.org”.
*Clinical situations for which radiographs may be indicated include but are not limited to:
A. Positive Historical Findings1. Previous periodontal or endodontic treatment2. History of pain or trauma3. Familial history of dental anomalies4. Postoperative evaluation of healing5. Remineralization monitoring6. Presence of implants or evaluation for implant placement
B. Positive Clinical Signs/Symptoms1. Clinical evidence of periodontal disease2. Large or deep restorations3. Deep carious lesions4. Malposed or clinically impacted teeth5. Swelling6. Evidence of dental/facial trauma7. Mobility of teeth8. Sinus tract (“ stula”)
9. Clinically suspected sinus pathology10. Growth abnormalities11. Oral involvement in known or suspected systemic disease12. Positive neurologic ndings in the head and neck13. Evidence of foreign objects14. Pain and/or dysfunction of the temporomandibular joint15. Facial asymmetry16. Abutment teeth for xed or removable partial prosthesis17. Unexplained bleeding18. Unexplained sensitivity of teeth19. Unusual eruption, spacing or migration of teeth20. Unusual tooth morphology, calci cation or color21. Unexplained absence of teeth22. 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 uoride exposure 7. Prolonged nursing (bottle or breast) 8. Frequent high sucrose content in diet 9. Poor family dental health10. Developmental or acquired enamel defects11. Developmental or acquired disability12. Xerostomia13. Genetic abnormality of teeth14. Many multisurface restorations15. Chemo/radiation therapy16. Eating disorders17. Drug/alcohol abuse18. Irregular dental care
PATIENT AGE AND DENTAL DEVELOPMENTAL STAGE
TYPE OF ENCOUNTER
Child with PrimaryDentition (prior to eruption of rst permanent tooth)
Child withTransitional Dentition(after eruption of rstpermanent tooth)
Adolescent withPermanent Dentition(prior to eruption ofthird molars)
Adult, Dentate orPartially Edentulous
Adult, Edentulous
New patient* being evaluated for dental diseases and dental development
Individualizedradiographic examconsisting of selectedperiapical/occlusalviews and/or posteriorbitewings if proximalsurfaces cannot bevisualized or probed.Patients withoutevidence of disease andwith open proximalcontacts may notrequire a radiographicexam at this time.
Individualizedradiographic examconsisting of posteriorbitewings withpanoramic exam orposterior bitewings andselected periapicalimages.
Individualized radiographic exam consisting ofposterior bitewings with panoramic exam orposterior bitewings and selected periapical images. A full mouth intraoral radiographic exam ispreferred when the patient has clinical evidence of generalized dental disease or a history of extensive dental treatment.
Individualizedradiographic exam,based on clinical signsand symptoms.
Recall patient* with clinical caries or at increased risk for caries**
Posterior bitewing exam at 6-12 month intervals if proximal surfaces cannot be examined visually or with a probe
Posterior bitewingexam at 6-18 monthintervals
Not applicable
Recall patient* with no clinical caries and not at increased risk for caries**
Posterior bitewing exam at 12-24 month intervalsif proximal surfaces cannot be examined visuallyor with a probe
Posterior bitewingexam at 18-36 monthintervals
Posterior bitewingexam at 24-36 monthintervals
Not applicable
Recall patient* with periodontal disease
Clinical judgment as to the need for and type of radiographic images for the evaluation of periodontaldisease. Imaging may consist of, but is not limited to, selected bitewing and/or periapical images ofareas where periodontal disease (other than nonspeci c gingivitis) can be identi ed clinically.
Not applicable
Patient for monitoring of growth and development
Clinical judgment as to need for and type ofradiographic images for evaluation and/ormonitoring of dentofacial growth and development
Clinical judgment as toneed for and type ofradiographic images forevaluation and/ormonitoring ofdentofacial growth anddevelopment.Panoramic or periapicalexam to assessdeveloping third molars
Usually not indicated
Patient with other circumstances including, but not limited to, proposed or existing implants, pathology, restorative/endodontic needs, treated periodontal disease and caries remineralization
Clinical judgment as to need for and type of radiographic images for evaluation and/or monitoring in these circumstances.
CH-369CPT ONLY - COPYRIGHT 2009 AMERICAN MEDICAL ASSOCIATION. ALL RIGHTS RESERVED.
CHILDREN’S SERVICES HANDBOOK
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