MetLife MetDental Accreditation Information

The overwhelming majority of patients with periodontitis are treated in the offices of general practitioners and the most common services rendered are non-surgical in nature. This Guide addresses the subject of non-surgical therapy from the perspective of evidence-based dentistry to include a discussion of the etiology of periodontitis and the need for therapy as the basis for a rationale for treatment. The assessment of non-surgical treatment outcomes with a view to decisions regarding further treatment is a prominent feature of the Guide. The discussion of non-surgical approaches goes beyond mechanical debridement to include subgingival irrigation, systemic antibiotics and locally delivered antibiotics. Treatment planning decisions and the maintenance phase of therapy are also discussed. This edition includes updates from research published over the past three years, providing valuable guidance to the clinician providing periodontal care.

The dental record is the official document that houses all pertinent information about a patient receiving care in a dental practice. It archives historical and diagnostic information, as well as details diagnoses, treatment plans, consents to treatment, and the specifics of care provided. A properly constructed and maintained dental record allows concise and efficient communication between the dentist and the patient, as well as between the dentist and other health care professionals. A well-documented record may be the dentist’s best defense in a case of alleged malpractice and may serve as a key component of a forensic investigation. This Guide provides straightforward, concise guidance in constructing and maintaining a dental record that will meet contemporary standards of care, as well as federal patient privacy standards. Since general dentists often find it difficult to document occlusal status in an efficient manner, a helpful “Rapid Occlusal Assessment” template is provided as an appendix.

Dentists always faced the challenge of making good decisions regarding the incorporation of new technology into their practice. Questions of reliability, relative effectiveness, predictability, effect on outcomes of care, and cost all need to be answered based on objective, non-biased assessments. The sixth edition of this Guide provides the practitioner information about newer diagnostic instruments including cone beam and digital imaging, electronic apex locators, rotary instrumentation, disinfection and root canal filling in a concise format. The newest science is reviewed with regard to instrumentation and filling materials. The extensive references provide the reader with the basis for the author’s evaluation of the various technologies. This Guide can serve as a fundamental resource for the practitioner initiating or expanding the delivery of endodontic therapy within their practice.

Dentistry is moving toward a time when restorative materials exhibit properties beyond being inert or biocompatible. Choices are appearing that are designed to create positive effects within the oral environment. Materials have components that are antimicrobial, mineralizing, regenerating or some combination of those outcomes. These materials are often termed “bioactive”. The purpose of this evidence-based Quality Resource Guide (QRG) is to provide clarity for the dental provider around the concept of “bioactive” materials used for restorative dentistry by describing and discussing the types of available materials, their intended uses, and their modes of action. The QRG will identify the types of materials that have been referred to as “bioactive” and their modes of action. It will describe how certain “bioactive” materials claim to exert effects on bacteria or contribute to the mineralization of tooth structures. The QRG will serve as an essential resource for practitioners as they assess new restorative materials coming on the market with their suppliers and colleagues, striving to maximize the success of restorative outcomes and the oral health of their patients.

Clear Aligner Therapy (CAT) has become very popular approach to orthodontics in the United States. Consumers are often bombarded by information regarding why CAT may be appropriate for their or their children's dental condition and seek advice from their general dentist or the office staff. This Quality Resource Guide is designed to assist the general dentist's office t0 appropriately addressing those questions. CAT was first used as a treatment option for mild to moderate malocclusions but has recently gained widespread acceptance for broader applications due to advancements in its use of digital technology, appliance customization, 3D printing, and biomaterial science. The QRG discusses the history and development of CAT, explains the effectiveness of CAT for treating mild to moderate malocclusions, discusses advancements in digital technology, 3D printing, and biomaterial science, compares and contrasts the benefits and potential drawbacks of clear aligner treatment for patients and providers, and identifies the potential risks and complications associated with direct-to-consumer (DTC) aligner treatments. A diagram and associated narrative outline the workflow for successful orthodontic care with aligners. This QRG will serve as an essential resource for all dental office team members as they strive to provide maximal assistance for individuals exploring options for orthodontic therapy.

Opioid addiction is a major issue in many parts of the United States; many have labeled it a social crisis. Inappropriate prescribing by health care providers, including dentists, has been cited as one of the factors facilitating this problem. Analgesics play an important role in the management of dental pain, primarily as adjuncts to definitive interventions. Traditionally non-opioid/opioid combinations have been the drugs of choice for management dental pain. Increasingly strong scientific evidence for the superior pain relief provided by non-steroidal anti-inflammatory drugs has fundamentally changed the contemporary approach to the management of acute dental pain. This Quality Resource Guide (QRG) focuses on non-opioid oral analgesics for control of acute pain, with an emphasis on high-level scientific evidence. Principles of contemporary prescribing of analgesics in dental practice are covered, as well as a rationale for selection of specific drugs, the common adult dosage regimens, new NSAIDS options, the advantages of using a combination of drugs, and the use of liposomal bupivacaine for pre-emptive analgesia. Contraindications and warnings as well as adverse drug events associated with analgesics are discussed. This QRG will serve as an important resource for the dentist, and members of the office staff, when considering the use of analgesics for the patient with acute dental pain. It will also serve as a reference when explaining to a patient why the analgesics to be used may be different than they have experienced before.

The placement of dental implants to support prosthetic tooth replacements has increasing become a more important part of contemporary dental practice. Adequate alveolar bone is necessary to ensure appropriate osteointegration of the implant fixture and long-term success.  While “atraumatic” tooth extraction techniques greatly assist in maintaining adequate bone volume following healing of an extraction site, clinical conditions may necessitate the use of a bone graft to ensure adequate alveolar bone is present to receive an implant. The fourth edition of this Quality Resource Guide (QRG) provides an in-depth discussion of the healing that takes place following tooth extraction, the indications and evidence for the use of alveolar ridge preservation procedures, and expected clinical outcomes following their use. It also provides a clinical protocol, augmented by images, of a ridge preservation grafting procedure. This QRG is an important reference for the dental office that is assessing the role ridge preservation techniques may play in available therapy options. In addition, it provides background for the clinician to answer patients’ questions regarding the role of implants in their dental care.

Antibiotics play an important role in the management of dental infections (primarily as adjuncts to surgical procedures) and for prevention of systemic infections arising from bacteremias associated with dental procedures in patients at risk for serious systemic infective complications. However, dental professionals must be vigilant in the use of these drugs, avoiding overuse that may lead to serious issues of antibiotic resistance. The fourth edition of this Quality Resource Guide (QRG) reviews the antibiotics commonly used in dental practice, presenting their characteristics and special considerations. It provides prescribing considerations, potential adverse affects, possible drug interactions, and a contemporary discussion of using prophylactic antibiotic therapy in dental practice. This QRG will serve as an important resource for the dentist, and members of the office staff, when considering the use of antibiotics as part of a therapy regimen. It will also serve as a reference when explaining to a patient why antibiotics appear to be used differently than they have experienced before.

Part 1 – Background, Incidence and Risk Factors 6th Edition

Bisphosphonates and other medications are used increasingly more often by physicians in the treatment of benign and malignant bone diseases.  A number of reports describing a unique type of osteonecrosis in the maxillas and mandibles of patients on bisphosphonate therapy have been published over the past few years.  The sixth edition of this Guide discusses the pathogenesis of bisphosphonate and other medication-related osteonecrosis of the jaw (MRONJ) and outlines the risk factors that may affect onset of the condition in a population presenting for dental care.  A companion Guide, “Bisphosphonate and Other Medication-Related Jaw Necrosis Part 2 – Clinical Management” will outline the strategies dentists should employ for patients with MRONJ.  It is suggested that Part 1 be thoroughly reviewed by the clinician before reading Part 2.

Part 2: Clinical Management (6th Edition)

A companion Guide, “Bisphosphonate and Other Medicated-Related Jaw Necrosis Part 1 – Background, Incidence and Risk Factors” discussed the pathogenesis of bisphosphonate and other medication-related osteonecrosis of the jaws (MRONJ) and the risk factors responsible for initiating the condition. It is suggested that Part 1 be thoroughly reviewed by the clinician before reading Part 2. This sixth edition Guide discusses the clinical presentation of MRONJ, presents a stage-specific management system for patients with MRONJ, and through a four-year longitudinal case report, presents the clinical intraoral sequela of MRONJ.

Dental caries is a complex disease affecting many adults. Although caries preventive efforts have historically focused on children, there are many issues that place some adults at greater risk for caries lesions. Identifying risk factors and creating a management protocol for each patient is key to a successful outcome. This quality Resource Guide (QRG), using an evidence-based approach, will discuss contemporary management of dental caries in adults, including: determining caries risk status; detecting caries lesions at an earlier stage and assessing their activity status; making a diagnosis of whether the disease is actually present; establishing a prognosis; applying intervention strategies focused on preventing, arresting and possibly reversing the caries process; and restricting restorative treatment to only when absolutely necessary. The QRG will outline the 4D approach (a Caries Management by Risk Assessment [CAMBRA] System) designed to personalize caries management with the goal of maintaining health and preserving tooth structure. The QRG is an important reference for the dental clinician assessing an adult with active dental caries. It also provides background information for the dental office team to answer a patient’s questions regarding the reasons why he/she may have increased caries activity, and the therapy options that are available.

LGBTQ+ is an umbrella term representing the lesbian, gay, bisexual, transgender, and queer community. Members of this community have historically faced discrimination, prejudice, and stigma, resulting in significant health disparities. These biases may further an unwelcome social environment or perception in healthcare settings, creating barriers to care. A culturally competent and inclusive oral health care provider can provide effective care to a diverse patient population by integrating an essential understanding of their culture, vocabulary, values, attitudes, and norms into the office environment. This Quality Resource Guide (QRG) discusses the challenges of the LGBTQ+ community accessing health care, the responsibilities of oral healthcare professionals to the LBTQ+ community, and ways to provide a welcoming environment and experience in the dental office for the LGBTQ+ community. An extensive listing of terms and culturally competent language to describe sexual attraction, romantic attraction, or gender identity (adapted from the Gay & Lesbian Alliance Against Defamation) is provided to assist the dental office team when communicating with LGBTQ+ patients. Access to a sample intake/registration form that provides relevant health information and supports a patient's identity is also included. This QRG will serve as an important resource for all office staff members and help ensure the office is providing a welcoming environment for the LBTQ+ community.

Since its introduction in 1999, Cone Beam Computerized Tomography (CBCT) has quickly become a popular method throughout the world for obtaining supplemental diagnostic images of the head and neck region.  The third edition of this Guide is designed to assist the dentist to understand the principles of CBCT imaging and recognize the areas of dentistry where CBCT technology may be used to enhance diagnosis and/or guide therapy. The Guide compares the attributes of CBCT with panoramic imaging and provides guidelines for appropriate use of CBCT in contemporary dental practice.

The updated and revised 7^th Edition of this Guide focuses on the concept that meeting a child’s needs and their parent’s expectations for appropriate care of carious lesions is based on early recognition of risk indications and timely implementation of corrective actions.  The benefits, and potential risks, of fluoride supplementation and topical application are discussed in detail. A table listing fluoride concentrations of various preparations is helpful to the prescribing dentist. A thorough discourse of the coordinated role of sealants, diet, and oral hygiene in the prevention and control of dental caries is also presented. The information in this guide should prove to be of value not only to the dentist but to the entire staff as they work to create an atmosphere in which the delivery of dental care is a positive experience for the child and gives parents the sense that the practice is anticipating and preventing problems.

A dentist is often faced with the decision whether to use antibiotics prior to dental procedures to prevent an infection in the patient at a distant site. The rationale for prophylactic antibiotic use is based in biologic plausibility as bacteria from the mouth have been implicated in severe infections in other parts of the body, specifically in cardiac valves and prosthetic joints. Since antibiotic use has both individual and societal side effects, especially when used repeatedly (as in antibiotic prophylaxis), multiple considerations face the dentist considering use of prophylactic antibiotics prior to dental therapy. This Quality Resource Guide, using an evidence-based approach, focuses on antibiotic prophylaxis in patients with cardiac valvular disease and with prosthetic joints. It discusses the rationale and implementation of guidelines derived by respected associations. Clear and easily referenced tables outline: Dental Procedures for Which Endocarditis Prophylaxis is Reasonable in High Risk Patients; Cardiac Conditions Associated with the Highest Risk of Adverse Outcome from Endocarditis for Which Antibiotic Prophylaxis before Dental Procedures is Reasonable; Antibiotic Regimens for a Dental Procedure; and Special Considerations for Selected Patients. The most recent guidance for use of prophylactic antibiotic therapy in patients with a prosthetic joint or other orthopedic implant is discussed, as well as the Appropriate Use Criteria (AUC) developed by the Academy of Oral and Maxillofacial Surgery. The QRG is an important reference for the dental clinician assessing a patient with cardiac or orthopedic considerations. It also provides background information for the dental office team to answer patients’ questions regarding prophylactic antibiotic therapy.

Local anesthetics form the backbone of pain control techniques in dentistry. Used properly, local anesthetics are the safest and most effective drugs for the prevention and management of peri- and post-operative pain. This Quality Resource Guide (QRG) provides an evidence-based review of the evolution and clinical characteristics of local anesthetic solutions available in North America and discusses their differences in metabolism. An in-depth discussion of local anesthetic systemic toxicity (LAST), its prevention, recognition and management provide guidance that should be periodically reviewed by all dental practitioners. Recent advances in local anesthetics, including articaine, the use of buffering solutions and the role of phentolamine in reversing local anesthesia are thoroughly assessed. The QRG will serve as an important update resource for practitioners administering local anesthetics and a useful periodic review.

Dr. Michael Buonocore introduced the profession to the concept of adhesive restorative dentistry over 50 years ago, and dentistry has never been the same.  Since that time numerous formulations have been offered and etch-and-rinse and self-etch adhesives have been introduced.  As with many products, strengths and shortcomings of various adhesives are only appreciated after their introduction and use in clinical practice.  The sixth edition of this Guide provides an updated review of the essential information related to adhesives as the basis for discussing their clinical applications.  The critical comparison of adhesives allows the practitioner to select the system most applicable to the clinical situation.  The subject of dental adhesives is still a work in progress and the practitioner is urged to follow the evidence-based literature as it becomes available.

Bleeding associated with dental therapy for the patient with an underlying hematologic impairment may lead to serious and potentially grave consequences. It is important for the general dentist to understand the basic physiology of blood coagulation, as well as the inherited and acquired conditions that may affect coagulation. The fourth edition of this Quality Resource Guide (QRG) is designed to assist the clinician to identify and manage patients in their practice that are “at risk” of bleeding abnormally following dental therapy. Following a comprehensive discussion of ways to identify a dental patient that may exhibit abnormal coagulation, the author carefully outlines management guidelines and adjunctive materials that may be used to prevent and control abnormal bleeding. This QRG will serve as an important resource for the dentist who encounters a patient with a history, or clinical findings that indicate a bleeding disorder.

Pregnancy poses a unique set of management considerations for the dental practitioner who has an obligation to provide safe and effective dental care that addresses the mother’s needs and ensures the well being of the developing child. A recent National Consensus document concluded that dental care can be safely delivered during all trimesters of pregnancy. Unfortunately, patients often avoid routine dental care during pregnancy and many healthcare providers continue to believe dental procedures are either unnecessary or unsafe during pregnancy. The pregnant patient should be educated on the importance of establishing and maintaining good oral health for the well being of both herself and her developing child. Withholding necessary dental care during pregnancy is neither recommended nor justified. This Quality Resource Guide (QRG) briefly summarizes the physiologic changes associated with pregnancy and reviews contemporary dental management considerations for the pregnant and nursing patient, including vital sign monitoring, patient positioning, treatment timing, radiography, drug administration and pregnancy associated oral pathology. The QRG will serve as an important resource for all dental offices as they strive to improve care for pregnant patients and allow these patients to make better health decisions.

About one million knee and hip joint replacements are performed annually in the United States and have been reported to become infected 2.1% and 2.3% of the time. The economic burden of prosthetic joint infection in the United States has been estimated to be annually over $1.5 billion, and the infections are associated with significant morbidity and even mortality. Oral bacteria entering the blood were initially thought to be a possible cause of PJI, leading to the concept of giving the patient prophylactic antibiotics before undergoing invasive, bacteremia-causing dental procedures. This evidence-based QRG reviews the history of recommendations for providing invasive dental procedures for patients with prosthetic joints, presents current literature findings regarding the efficacy of antibiotic pre-medication in preventing prosthetic joint infections, and analyzes the tenets of evidence-based dentistry and its impact on contemporary antibiotic prophylaxis decisions for patients with prosthetic joints. The QRG is a critical reference for the dental clinician assessing a patient with orthopedic implants. It also provides background information for the entire dental office team to answer patients’ questions regarding prophylactic antibiotic therapy.

Systemic sclerosis (SSc), or scleroderma, is an uncommon autoimmune disease characterized by vascular abnormalities and fibrosis of the skin and internal organs. The disease predominately affects women with an average age of onset of 45 years and is associated with significant morbidity and mortality. This Quality Resource Guide (QRG) reviews the role of autoimmunity as an etiology for various diseases, specifically discussing the symptoms, clinical manifestations, diagnostic criteria, medical management, prognosis, pharmacologic agents used in management of SSc. Narrative dialogue and concise tables describe: orofacial manifestations of SSc; concerns that the dentist must consider when recommending preventive regimes and must control when delivering therapy (hyposalivation, microstomia, side effects of management drugs used), and; methods to control oral diseases that could complicate systemic disease management. This QRG will serve as an important resource for the dentist, and members of the office staff, as they assist with management of this devastating disease.

You are most likely treating your dental waterlines, but are you testing your dental waterlines? Treating is not testing! To provide safe care for patients and to protect your team, you need to know how to reduce bacteria in your dental waterlines. View this webinar to learn the five-step process for maintaining excellent water quality.

The term ‘cracked tooth’ has been used to describe many types of fractures in teeth. One type of dental fracture is the Crown-originating fracture (COF). A COF typically originates in the tooth crown and is not related to previous root canal treatment. A COF is often extremely difficult to diagnose because symptoms vary widely and may mimic other pathologic conditions. This Quality Resource Guide (QRG) provides an evidence-based discussion of the COF, including characteristics, symptoms, diagnosis (using radiographic information, clinical/tactile findings, pulp testing, percussion and periodontal probing), treatment options and prognosis. A section also discusses appropriate methods of communicating with the patient through the sometimes very difficult processes of determining a diagnosis and selecting a treatment option. The QRG is an important reference for the clinician assessing a patient presenting with pain that is suspected of being from a tooth. It also provides background information for the dental office team to answer patients’ questions regarding a potential COF and the options they face regarding therapy.

Symptoms of a Vertical Root Fracture (VRF) are often lacking or mild in nature, complicating its diagnosis and management. In addition, the clinical presentation of a VRF can be confused with other dental conditions and lead to misdiagnosis. This QRG describes the clinical and radiographic aspects of a VRF and discusses management of these dental problems. It provides an evidence-based discussion of the VRF, including characteristics, symptoms, diagnosis, treatment options and prognosis. A section also discusses appropriate methods of communicating with the patient through the sometimes very difficult processes of determining a diagnosis and selecting a treatment option. Multiple well-documented clinical cases are presented to demonstrate the descriptions and findings discussed in the narrative. The QRG is an important reference for the clinician assessing a patient presenting “soreness” in a tooth,that is difficult to differentiate. It also provides background information for the dental office team to answer patients’ questions regarding a potential VRF and the options they face regarding therapy.

Are you thinking about including digital radiography in the design of a new office, converting your office to digital imaging or needing to assess your current digital system regarding a possible upgrade? This Guide has something for you. What kind of sensor best meets the needs of your practice? Should you have intraoral capability only, or intraoral plus panoramic? What about detector sensitivity?  What are these DICOM standards you have been hearing about? How are images displayed best, and what about storage and making hard copies? Do you go all digital, or do you need to maintain conventional radiographic capability?  These are just some of the questions the 7^th edition of this Guide addresses.  Most important, the information is an impartial, objective assessment of the current status of the subject.

Dental patients experiencing bruxism, even after having detailed discussions with their treating clinician, often bring up follow-up questions with other members of the dental team – hygienists, assistants or even the front office staff members. These questions may be focused on causes, symptoms and/or treatment options. This evidence-based Quality Resource Guide (QRG) is designed to assist all members of the dental office team to respond to patients’ questions regarding bruxism in a professional and consistent manner. Following a brief overview of bruxism, the QRG provides concise and well referenced discussions of the causes of bruxism, signs and symptoms of the condition and treatment options. Tables enhance the summary of these discussions and a Frequently Asked Questions section helps the dental team to prepare for questions that are commonly asked. This QRG will serve as an important resource for all the members of the dental office team as they strive to provide maximal assistance for the patient suffering from bruxism.

More than ever, practice success is linked to understanding and valuing differences between people – your patients and your colleagues. If you’ve thought about learning more about DEI, but haven’t had the time, this Quality Resource Guide is the primer that may be just what you need. It’s full of practical examples and recommended resources to learn more.

Agents capable of whitening teeth were initially discovered in the 1940s and were introduced into the mainstream market in the 1980s due to an increased interest in esthetics and a desire by individuals to have whiter teeth. The options for tooth whitening are numerous, with whiting products available as gels, strips, rinses, gums, dentifrice, and paint-on liquids. This Quality Resource Guide, directed to dentists, dental hygienists, dental therapists, and all office support personnel, provides an evidence-based review of methods and materials designed to whiten teeth. It describes the mechanisms for tooth whitening, discusses options and the effectiveness and safety of whitening modalities, and examines issues patients should understand when considering whitening treatment. Dental professionals are critical in effective, safe tooth whitening, and counseling patients about their options. This QRG will serve as an essential resource for all dental office team members as they strive to provide maximal assistance for individuals exploring options for whitening their teeth.

Many patients presenting for care in the dental office have significant systemic health issues, calling for the dental practitioner to work closely with the patient’s medical and other healthcare providers to optimize the possibility of successful outcomes. It may be necessary for the dentist to obtain information on a patient’s systemic conditions that impact on the delivery of dental care, as well as to alert the medical team to findings that may suggest undiagnosed or poorly managed systemic disease. Patients are best served when dental providers are a part of the patients’ inter-professional health care team, working together to promote not only oral but also systemic health. This evidence-based Quality Resource Guide (QRG) provides: formats and templates for consultations and referrals to physicians; communication and record-keeping guidance (including communicating consultation requests or referrals, keeping track of requests sent out and received back and documenting and reviewing information received) and; discussions of conditions warranting consultation or referral to a physician. The QRG provides all members of the dental staff with the information to better understand the general importance of consulting with and/or referring to physicians in specific circumstances. An extensive table provides an easily accessible resource when questions arise. This QRG will serve as an important resource for the dentist, and all members of the office staff, as they assess and provide therapy for patients with unique and/or complex medical issues.

National standards to provide security for a patient’s Protected Health Information (PHI) result from the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Since the law was passed, there have been many updates to define the standards for healthcare providers and others with access to people’s health information. This Quality Resource Guide (QRG) is designed to be an introduction to HIPAA for dental office staff members new to the environment of health care. It explains the relationship of HIPAA to dental practices, describes what health information is considered to be protected, presents the HIPAA policies and procedures required for a dental office, and illustrates violations that may occur along with actions that must be taken if a breach of information is discovered. The QRG includes a comprehensive Privacy Compliance Checklist to assist the office in determining whether they are compliant with HIPAA Privacy Rules. A FAQ section provides answers to HIPAA questions that often arise. The QRG will serve as an essential part of a new staff member’s orientation as well as a resource supporting periodic office updates regarding patient information security

Human Papilloma Virus (HPV) has emerged as a significant risk factor and is changing the epidemiology of oral cancer that occurs in the oropharynx. Since 1988, the prevalence of oral cancers associated with the traditional risk factors of smoking and drinking alcohol has decreased by 50% whereas the prevalence of those in the oropharynx associated with HPV infection has increased by 225%. It is estimated that over 50% of all oral cancers will be HPV-related by 2030. This Quality Resource Guide (QRG) discusses the epidemiology, prevention, and dental considerations for HPV-associated oral cancer. It describes the principles of a thorough exam necessary to discover HIV-associated pharyngeal cancer, and appropriate referral if warranted. The dental team’s role in the education of young men and women, and their parents, about HPV infection and preventive vaccines is also covered. Detailed tables will serve as a quick reference for the dentist when evaluating suspicious symptoms occurring in the oropharynx and for the dental team when discussing HPV vaccination with patients and parents. This QRG will serve as an important resource for the dentist, and members of the office staff, as they assist with management of this rapidly increasing oral health dilemma.

General dentists are increasingly performing both stages (placement and restoration) of dental implant therapy. The fifth edition of this Guide discusses factors to consider during treatment planning, surgery and post-operative care of implants. The Guide also presents a thorough discussion of the contraindications for dental implant therapy, as well as the complications that can occur during and after treatment. A series of diagrams and photos allows the clinician to visualize various aspects of implant placement.

A medical history does not identify all “infectious patients” in the dental office. Therefore, Standard Precautions must be used when providing care to all patients. Part One of this two part Guide discusses the history of: 1) infectious diseases and the healthcare worker; 2) the development of guidelines by the Center for Disease Control to protect both the patient and the healthcare worker; and 3) the OSHA regulations that impact the dental office. It discusses Standard Precautions for use during dental care, as well as vaccine recommendations and management of dental waterlines. A companion Guide, “Infection Control and OSHA Update Part Two” outlines specific infection control procedures for the dental office. It is suggested that Part One be thoroughly reviewed by the clinician before reading Part Two.

A companion Guide, “Infection Control and OSHA Update Part One 5^th Edition” discusses the history of infection control in the dental office. It is suggested that Part One be thoroughly reviewed by the clinician before reading Part Two. This fifth edition discusses specific infection control procedures for the dental office, including aseptic procedures and personal protective barriers. Charts and photos provide practical guidance for the clinician as they prepare their office, their staff and themselves to deliver dental care.

The U.S.Center for Disease Control Guidelines state that each dental office should assign at least one person as an infection control coordinator (ICC). The ICC should understand the modes of cross-contamination in dentistry, current infection prevention policies, products/equipment available to maintain staff and patient safety, and agencies' policies/guidelines that impact infection prevention and safety in dental practice. While the ICC is responsible for coordinating the infection prevention program, the entire dental team must be committed and accountable to comply with the office’s written infection control program. This Quality Resource Guide (QRG) discusses regulatory and advisory agencies that impact infection prevention in dentistry, the role and responsibilities of the infection control coordinator, the precautions needed to prevent disease transmission in the dental setting and provides current updates for infection prevention policies and protocols. This QRG will serve as an essential resource for the dental office ICC and all office team members during new staff members’ orientation, as well as periodic office updates regarding infection control.

The key to a health care professional’s success when managing TMD is determining an accurate and complete diagnosis. Critical causative and maintaining factors must be identified and addressed in a case-specific plan of care. The cornerstone of any management protocol is patient education. Since the most common reason for the compromise of this orthopedic system is overload or excessive mechanical stress, the patient must participate in the management by conscious avoidance of activities which may aggravate the condition. Typically, treatment will include physical, pharmacologic, and behavior management strategies. Altering the consistency of foods, limiting opening, using moist heat and/or ice, as well as avoidance of clenching/grinding the teeth is extremely beneficial. Generally, mild pain relievers such as acetaminophen, non-steroidal anti-inflammatory medications, or aspirin provide appropriate relief. Muscle relaxants and sleep aid medications may also enhance treatment outcomes in select cases. This Quality Resource Guide (QRG), using an evidence-based approach, reviews the primary types of intraoral appliances available to provide therapy for the patient with TMD, outlines the pros and cons of each approach and discusses the issues that must be assessed when implementing a course of therapy. It is expected that following study of this QRG, the reader will: understand the rationale for the utilization of various intraoral appliances; recognize the multifaceted nature of TMD management with multi-disciplinary approaches; appreciate the criteria for achieving an optimum treatment outcome with occlusal orthosis therapy; and minimize complications that arise for the clinician when they use intraoral appliances. This QRG will serve as an important resource for the dentist, and all members of the office staff, as they assess and provide therapy for individuals demonstrating TMD.

Think about how much dentists depend on the bitewing radiograph for diagnosis, and how much information this simple film, if properly exposed, can reveal. Without careful attention to detail, full potential of this imaging technique will not be achieved. Every practice has had the experience of having an assistant leave the office just as they were consistently producing high quality radiographs. This Guide is designed to assist with that problem. It can be useful to the individual seeking to improve their radiographic skills, but perhaps more importantly, it serve as the starting point for the new employee who will assume responsibility for radiographic studies. The guide is concise, practical and has been well received by practices across the country.

Access to dental care can be tremendous challenge for patients with special health care needs (SHCN).  The Quality Resource Guide (QRG) discusses the oral health care needs of patients with SHCN and provides guidance to allow the dental team to deliver effective and efficient care to a patient with SHCN in a general dental practice. The QRG briefly discusses the etiology and presentation of neurodevelopmental disorders, then outlines guidelines and approaches for the dental healthcare team to consider when assessing the oral status of a patient with SHCN and providing appropriate care. Effective pre-appointment processes, scheduling strategies, helpful desensitization approaches, and steps to assist with developing a coordinated team approach for providing safe and effective care are outlined. Specific recommendations are made to lower the caries and periodontal risk for patients with SHCN. This QRG will serve as an important resource for the dentist, and all members of the office staff, as they assess and provide therapy for patients with SHCN.

* Note: The terminology of “Special Needs” is considered in many communities as pejorative as it inadvertently suggests an “ableist” view. Ableism is the discrimination of and social prejudice against people with disabilities based on the belief that typical abilities are superior. Special Healthcare Needs is a better accepted term.

When general practitioners began to characterize themselves as practicing Family Dentistry, one objective was to convey to the public that children, adults and the elderly all would receive comprehensive care. The key to effectively meeting a child’s needs and the expectations of their parents is based in early recognition whether it is a behavioral problem or an elevated risk for caries or a pending developmental problem. The 7^th edition of this Guide covers these subjects and much more.  Included are tips on what to avoid when treating children, the use of local anesthesia, guidance in regard to fluoride supplementation and the pros and cons of sealants. Of special interest to the practitioner is a section on pulp therapy for primary teeth. The information in this Guide should prove to be of value not only to the dentist but to the entire staff as they work to create an atmosphere in which the delivery of dental care is a positive experience for the child and gives parents the sense that the practice is preventing and anticipating problems. Key areas of the text are summarized in a series of tables for easy reference.

If a compromised outcome of care is suspected to have been caused by the negligence of the providing dentist and/or his or her staff, a malpractice suit may arise. Negligence in the dental office is generally preventable. The third edition of this Guide reviews nine areas where malpractice claims most often arise against a dental practitioner. Discussions of each area include the common reasons for compromised outcomes of care and straightforward, concise guidance to prevent them. The importance of appropriate informed consent, “time-outs” before initiating therapy and accurate records are outlined. Review of this Guide by all office personnel will assist in providing due care during dental therapy.

Therapy to manage a patient with cancer is multidisciplinary and many times requires careful management of oral sequelae. Oral management of the patient with cancer can be divided into 3 stages: 1) oral assessment and therapy prior to initiation of cancer therapy, 2) oral supportive care during cancer therapy, and 3) oral care following completion of cancer therapy. This Quality Resource Guide (QRG) reviews the commonly encountered adverse effects associated with cancer therapy and the three stages of oral care and support for patients with cancer. The author carefully outlines management guidelines and adjunctive considerations that may be used by the oral health care provider to manage the oral cavity before, during and after cancer therapy. A variety of quick-reference tables will assist the dental clinician to review clinical protocols and agents that may be helpful for his/her patients. This QRG will serve as an important resource for the dentist who encounters a patient with cancer and will allow them to function as an important member of the therapy team.

Dentin hypersensitivity is a quality-of-life issue, impacting a significant number of individuals. Left untreated, it creates suffering for the patient and risk for further deterioration of tooth structure. This Quality Resource Guide (QRG) presents the theories of causation, and the clinical contributing factors, for dentin hypersensitivity, as well as its classic symptoms. The QRG then, using an evidence-based approach, discusses contemporary management of the condition, including prevention and treatment with at-home and in-office approaches. The QRG is an important reference for the dental clinician assessing a patient with dentin hypersensitivity. It also provides background information for the dental office team to answer a patient’s questions regarding the reasons why he/she may have dentin hypersensitivity, and the therapy options that are available.

One factor in deciding whether to undertake a procedure is an awareness of the potential complications and the ability to manage them should they occur.  This advice is applicable to all aspects of clinical dental practice, especially endodontic therapy. This Guide discusses the causes and prevention of complications and then outlines the management of complications should they occur.  The fourth edition of this Guide expands the discussions of obtaining adequate anesthesia in the tooth with symptomatic pulpitis and appropriate use of antibiotics during endodontic therapy.  The Guide’s tables provide a quick reference to treatment options.  Attached to this Guide are the American Association of Endodontists’ Case Difficulty Assessment Form and Guidelines and a form for obtaining informed consent for non-surgical endodontic therapy.

Xerostomia is the subjective, self-reported complaint of a “dry mouth.” Xerostomia and hyposalivation are typically interrelated, with salivary flow reduced by 50%. However, hyposalivation may be absent despite the complaint of xerostomia, and patients may complain of dryness irrespective of the amount of saliva in the mouth. Xerostomia affects about 10% of 30-year-olds and up to 20% of older adults and is commonly associated with medical conditions, medication use, stressful conditions, and hyposalivation. This Quality Resource Guide (QRG) reviews the functions of saliva in maintaining oral health, the prevalence and causes of xerostomia, the symptoms of xerostomia and signs of hyposalivation, the management of symptoms of xerostomia and hyposalivation, and methods to prevent and treat the complications of hyposalivation. Narrative dialogue and concise tables describe the prevalence & etiology of xerostomia, prescription drugs that may reduce saliva, diseases associated with xerostomia, methods used to recognize the manifestations of xerostomia and hyposalivation, and products and preventive strategies for xerostomic patients. This QRG will serve as an essential resource for the dentist and office staff members, as they assist patients who voice concerns about a dry mouth and manage the direct effect of xerostomia on dental caries.

Non-Carious Cervical Lesions (NCCLs) are a loss of tooth structure near the gingival margin typically extending from the cementoenamel junction (CEJ) onto the root surface. NCCL development generally progresses slowly and typically results in dental sclerosis. Using an evidence-based approach, this Quality Resource Guide (QRG) reviews the risk factors of NCCLs, analyzes their diagnostic characteristics, outlines management approaches, and discusses factors to consider when initiating a management plan for patients with NCCLs. The QRG discusses NCCLs’ multifactorial etiology and diagnostic characteristics. A review of therapy approaches examines the recommendation of a preventive protocol or restorative management. This QRG will serve as a valuable resource for the dental provider as they assist patients with NCCLs in choosing a therapy approach designed to maximize the health of their dentition and comfort.

A patient with a severely worn dentition can be one of the most challenging clinical conditions a general dentist faces. The author updated this guide for a fourth edition to assist the clinician with all aspects of managing a patient with a worn dentition. Following a comprehensive discussion of possible etiologic factors, the Guide systematically walks through the steps necessary to adequately evaluate and create plans for therapy options. Photos of a case supplement discussion of the sequencing of treatment. Finally, maintenance care is outlined to assist the patient and the clinician to protect the investment.

When it comes to the subject of management of medical emergencies, the person most frequently associated with the topic is Dr. Stanley Malamed.  The sixth edition of this guide reflects the updated AHA Guidelines for CPR, along with the basic essentials.  Beginning with an explicit description of how to prepare a dental office including the assignment of responsibilities to various members of the dental team, Dr. Malamed proceeds to describe the minimally essential drugs and equipment that should be readily available to manage those situations we hope will never occur.  The Guide concludes with a description of the steps to be taken should the need arise.  An algorithm in diagram form showing these steps is included in such a way as to facilitate duplication for posting.  A table that summarizes the preparation of the dental team can also be produced and aid in identifying the individuals in the office who will assume specific responsibilities.  This Guide is intended for everyone working in the dental office and can serve as the basis for discussion of roles during periodic training.

The availability of a current medical history is essential before undertaking dental treatment and helps insure the safe and effective management of the patient.  The increasing complexity of health care itself, patients living longer with chronic diseases, and the expanding numbers of available medications, contribute to the importance of having an up-to-date medical history and the challenge of obtaining one.  The seventh edition of this Guide takes a comprehensive approach to the topic and provides guidance in obtaining appropriate medical consultation. It also discusses prescription drugs and natural products that relate to oral health and/or complicate patient management.  Language barriers confronted during the obtainment of information are addressed with the introduction of a multi-language health history questionnaire.  Appended to the Guide are forms that the practitioner can duplicate for use in their office.  Regardless of who in the dental practice is responsible for obtaining the initial history or making sure health information is current, this Guide should facilitate completing this important aspect of patient care.

Cannabis is now (2023) approved for medical use in forty-one states, and for recreational purposes in twenty-three of those states. In the future, other states are certain to adopt similar laws. Considering that cannabis used for medicinal purposes is ingested or smoked, and that it is often smoked when used for recreational purposes, the effect of cannabis on the oral cavity is a concern for oral health care providers who will be seeing an increasing number of users. This Quality Resource Guide (QRG), using an evidence-based approach: reviews the diseases and disorders for which medical marijuana has been used; discusses the potential effects of cannabis use on oral health (oral mucosa, dental caries and the periodontal diseases); analyzes its role as a risk factor for oral cancer; examines the limitations and shortcomings of studies that have examined the relationship of cannabis use to oral disease; and explores the issues surrounding the obtainment of accurate patient histories regarding cannabis/marijuana use. This QRG will serve as an important resource for the dentist, and all members of the office staff, as they assess and provide oral health therapy in today’s world.

Adolescence is the time between childhood and adulthood. It includes significant changes in growth, and critical developmental experiences include physical and sexual maturation, social and economic independence, development of identity, acquisition of skills needed to carry out adult relationships and roles, and the capacity for abstract reasoning. The adolescent patient has different oral health needs than a younger, prepubertal child or many adults. Using an evidence-based approach, this Quality Resource Guide (QRG) reviews the distinctive oral health care needs and oral health risk factors specific to adolescents. It outlines oral health care recommendations for the adolescent patient and discussesvdental treatment planning considerations. This QRG will serve as an essential resource for the dentist and all office staff members, as they assess and provide therapy for adolescents within the practice.

Posterior composites, because of the continuing improvement in materials and patient popularity, continue to gain popularity as an alternative to traditional restorative materials.  The author has updated the information and references in this dynamic area of restorative dentistry.  Two important areas (Longevity and Causes of Failure) are included to aid the clinician in decision-making and communication with the patient. In addition, important new material has also been added to the section on curing lights, including discussion of the newer LED light sources.  The 7^th edition of this Guide continues to be a valuable contemporary reference for the dentist providing posterior composite restorations in their practice.

Long-term restorative success requires attentiveness to the restorative-periodontal interface. Using an evidence-based approach, this Quality Resource Guide (QRG) reviews the considerations for pre-prosthetic periodontal therapies to enhance oral health and restorative outcomes. It outlines the components and dimensions of the supracrestal tissue attachment and its importance to restorative outcomes, defines periodontal phenotype and discusses its role in maintaining periodontal and peri-implant health, gives examples of soft and hard tissue resection for pre-prosthetic site preparation in partially or fully edentulous patients, and discusses prosthetic space requirements for implant restorations in the completely edentulous patient. The QRG also discusses crown lengthening procedures and restorative site preparation for conventional removable prostheses at edentulous sites. The QRG will serve as an essential update resource for practitioners striving to maximize the success of restorative outcomes utilizing a multidisciplinary approach.

It is estimated that over 57.9 million people in the United States are aged 65 and over. As people live longer, they are retaining their natural teeth longer and have an increased need for dental care later in life. Many factors, including declines in motor skills, cognitive changes, multiple systemic diseases and medications, altered living situations and the need for caregivers, finances, and diminished health literacy, make it challenging for many older adults to maintain oral health. This Quality Resource Guide (QRG), using an evidence-based approach: reviews the factors that may impact the ability of an elderly patient to maintain oral health; discusses oral diseases that are more prevalent in the elderly, and; outlines preventive oral care measures to assist in maintaining oral health. It also outlines methods to assess and manage declines in motor and sensory skills, cognitive changes, and the complexities that arise when a patient has multiple systemic diseases or is taking multiple medications. This QRG will serve as an important resource for the dentist, and all members of the office staff, as they assess and provide therapy for a growing number of elderly patients within the practice.

Despite the increasing popularity of digital imaging systems, many diagnostic images taken in the dental practice are conventional radiographic exposures developed by manual and/or automatic processes. When one takes the time and effort to properly position and expose a diagnostic film, it’s frustrating to have it rendered as little or no diagnostic value by faulty processing, a totally preventable problem. Beginning with the design of the darkroom, the prevention of light leaks and the use of safelights, this Quality Resource Guide describes requirements of both manual and automatic processing. The narrative discussions, and an easily referenced table, outline the steps that lead to high quality films. In addition, various quality control tests for x-ray equipment are included in a table that could be easily used as a check list.

Risk assessment for periodontal disease must be part of every comprehensive dental evaluation and should include an accurate, current and comprehensive periodontal evaluation. In 2017, the World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions developed a new protocol to classify periodontal diseases. The severity of periodontitis is no longer described as slight, moderate, or severe, but is now categorized by its “stage.” This Quality Resource Guide (QRG) provides an overview of these stages and discusses the criteria assessed, and the effectiveness of the treatment plan based on the identified risks. The QRG will assist the dentist and his/her clinical team, in decision-making and answering patient questions regarding their periodontal status.

Over the past twenty years, the use of dental implants has increased, and dental care providers are encountering the need for more dental implant maintenance procedures. The dental hygienist and dental assistant are essential in providing dental implant maintenance. Using an evidence-based approach, this Quality Resource Guide (QRG) describes the basic structure and anatomy of dental implants, discusses implant diseases and the role of maintenance in preventing these diseases, identifies three strategies for helping patients with implant home care, and outlines in-office maintenance care for patients with implants. This QRG will serve as an essential resource for new office staff members with limited experience with patients having dental implants. It will also serve as a valuable resource for the entire dental team as they strive to enhance the follow-up care for patients receiving dental implants.

The stage at which oral cancer is diagnosed is the most important prognostic factor in predicting patient survival and the dental practitioner is often in the best position to first identify these cancers. Yet, only 30% of patients currently diagnosed with oral cavity and pharynx cancer have early-stage disease. This Quality Resource Guide (QRG) discusses the causes of delayed diagnosis for oral cavity and pharynx cancer, describes the current standard for identifying premalignant and malignant lesions, reviews the essential principles for cytology-based, light-based, vital stain-based and molecular-based diagnostic adjuncts and applies objective criteria to assess the clinical utility and value of newly marketed adjunctive diagnostic aids for oral cancer. A convenient table contains the characteristics and lists the manufacturers of all generally available diagnostic adjuncts. A careful analysis concludes that all available adjunctive techniques are associated with a high burden of false positive results and that routine use is not recommended. The QRG is an important reference for the dental clinician as he/she establishes or modifies protocol for assessment of suspicious oral lesions.

Pain is the most common reason patients seek medical or dental care in the United States, with approximately 22% of the U.S. population experiencing orofacial pain on more than one occasion in a 6-month period.  Temporomandibular disorder (TMD) is currently viewed as a group of musculoskeletal and neuromuscular conditions that involve the TMJs, the masticatory muscles, and all associated tissues. TMD has been identified as one of the most commonly occurring non-odontogenic pain complaints. Population-based studies indicate the prevalence of TMD-related pain is 12% in the U.S. population. It is mandatory that dental practitioners develop the necessary scientific and clinical expertise on which he/she may base diagnostic and management approaches for patients with TMD. This Quality Resource Guide (QRG) reviews the signs and symptoms of TMD, discusses the etiologic factors that influence TMD and outlines management guidelines for the dental practitioner. This QRG will serve as an important resource for the dentist, and members of the office staff, when faced with patients experiencing orofacial pain. It will also serve as a reference when helping patients to understand TMD and its therapy.

An Introduction to Dementia for the Oral Healthcare Team

Dementia describes various neurological conditions that result in deficiencies in an individual's mental cognitive tasks, such as memory and reasoning, with symptoms that worsen over time. Different forms result in degenerative changes in specific brain expanses, causing brain pathways to malfunction. Using an evidence-based approach, this Quality Resource Guide (QRG) reviews the different types of dementia, discusses dementia awareness by the oral health care provider as a member of a professional collaborative team, describes the behavioral aspects of dementia, and outlines the critical aspects of providing dental care for a person with dementia. The QRG will serve as an essential update resource for the dental office team striving to maximize the success of care for their patients with dementia.

Providing Oral Healthcare for Patients with Dementia

Dementia describes various neurological conditions that result in deficiencies in an individual's mental cognitive tasks, such as memory and reasoning, with symptoms that worsen over time. Different forms result in degenerative changes in specific brain expanses, causing brain pathways to malfunction. Using an evidence-based approach, this Quality Resource Guide (QRG) reviews the different types of dementia, discusses dementia awareness by the oral health care provider as a member of a professional collaborative team, describes the behavioral aspects of dementia, and outlines the critical aspects of providing dental care for a person with dementia. The QRG will serve as an essential update resource for the dental office team striving to maximize the success of care for their patients with dementia.

Though scientific investigations link smoking with numerous chronic diseases including oral cancer and periodontal diseases, approximately 28.3 million individuals continue to smoke in the United States. Smoking creates a physical dependence upon nicotine coupled with psychological and behavioral dependences. This Quality Resource Guide (QRG) presents straightforward guidelines for the dental professional to determine the stage of a patient’s nicotine dependence. Based upon that assessment, the clinician is guided in ways they may assist the patient to create an appropriate withdrawal strategy, using the available behavioral and pharmacotherapeutic approaches. The sixth edition of this popular QRG provides several references, including Cochran Database of Systemic Reviews.

Pathologic root resorption of permanent teeth, sometimes leading to premature tooth loss is a very frustrating clinical situation for the practicing dentist. This guide presents an overview of the various types of tooth root resorption, describes suspected resorptive mechanisms, and discusses diagnosis, management and associated prognoses of teeth with root resorption. Detailed sets of radiographs, several with post-therapy follow-up, demonstrate the clinical resorptive conditions.  An easy to understand table differentiates the clinical, radiographic and recommended treatment differences between “Internal Resorption” and “External Resorption”. The fourth edition of this guide discusses the use of cone beam computed tomography as a definitive diagnostic tool in difficult cases.

Value considerations are taking on growing importance in efforts to reform and improve the U.S. health care system, including oral health care. As a result, there is increasing interest in understanding the concept of value as it relates to dental care and its application to clinical practice and third-party benefits. This Quality Resource Guide (QRG) provides a foundation and overview of current major initiatives being pursued to advance increased value in health care, including oral health care. The dynamic and profound changes that are occurring throughout the U.S. health care system are discussed, “value” as it pertains to healthcare is defined, current understanding of consumer’s perspectives of value in their healthcare is considered and current efforts to increase value in healthcare are discussed in detail. The potential implications of current directions to dental practice and health care payment plans are explored. The QRG will serve as an important resource for members of the dental team as they consider the foundation of value decisions in health care and their potential impact on care delivery for their patients in the future.

Biologic and social determinants impact differences in health expression in males and females. This evidence-based Quality Resource Guide (QRG) focuses on women’s unique oral health and general health issues that require consideration when assessing oral health and providing oral health care to women across the adult life-span. The QRG discusses: oral health and systemic health issues important to the dental care of women; evidence-based dental practice protocols for women across the life span; best practices for dental care of women; and the impact of systemic disease on the oral health of women. Concise narrative discussions and well-organized tables present guidelines and approaches for evaluating and managing the oral health of women at all stages of life. This QRG will serve as an important resource for the dentist, and all members of the office staff, as they assess and provide therapy for women within the practice.