MetLife MetDental Accreditation Information

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.

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.

A large percentage of people seeking dental care have anxiety and/or fear about receiving treatment. This Quality Resource Guide (QRG) discusses: the differences between anxiety, fear and dental phobia and their expression in the dental environment; tools available to identify dental anxiety; techniques used to manage a patient’s dental anxiety and fear; management options for the patient with dental phobia; and the role of the patient in the management of their dental anxiety and fear. The origins of dental anxiety, fears and phobias; ways to measure dental anxiety; and approaches that can help lead to successful management of anxious and fearful patients are covered in depth. A series of tables explain the process of dental anxiety, a questionnaire to measure dental anxiety and practical advice for patients to reduce their anxiety. 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 anxious, fearful or phobic patients.

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.

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.

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.

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.

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

Factors associated with dementia may influence oral health, and multiple components of memory, decision-making, and judgment affect the ability of an individual with dementia to perform adequate oral hygiene and participate effectively with the dental office team during dental care. Using an evidence-based approach, this Quality Resource Guide (QRG) discusses the relationship between oral and systemic health facets essential to consider when providing care for a patient with dementia, describes appropriate oral health therapy for a person with dementia, reviews the general dentist's role and anesthesia use for individuals with dementia, and discusses the future of oral health care for individuals 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.

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.