2 IN TIR - The American Academy of Pediatric Dentistry

1 REFERENCE MANUAL V 38 / NO 6 16 / 17. Overview Definitions and scope of Pediatric Dentistry diverse audience to provide the highest possible level of care Pediatric Dentistry is an age-defined specialty that provides to children. This audience includes, but is not limited to: both primary and comprehensive preventive and therapeutic Pediatric dentists. oral health care for infants and children through adolescence, General dental practitioners and other dental specialists. including those with special health care Physicians and other health care providers. To become a Pediatric dental specialist, a dentist must sat- Government agencies and health care policy makers. isfactorily complete a minimum of 24 months in an advanced Individuals interested in the oral health of children. education program accredited by the Commission on Dental The AAPD Reference Manual is divided into five sections: Accreditation of the American Dental Association (ADA).

2 Such (1) definitions, (2) oral health policies, (3) clinical practice programs must be designed to provide special knowledge and guidelines, (4) endorsements, and (5) resources. Oral health poli- skills beyond the DDS or DMD 1 The curriculum cies are statements relating to AAPD positions on various public of an advanced program provides the dentist with neces- health issues. Clinical guidelines are practice recommendations sary didactic background and clinical experiences to provide designed to assist the dental provider in making decisions con- comprehensive primary oral health care and the services of a cerning direct patient care. Adherence to the guidelines increases specialist. Pediatric dentists provide care, conduct research, the probability of a favorable practice outcome and decreases and teach in a variety of clinical and institutional settings, in- the likelihood of an unfavorable practice outcome.

3 Practice cluding private practice and public health. They work in recommendations that have been developed by the AAPD ap- coordination with other health care providers and members pear in the Clinical Practice Guidelines section. Endorsements of social disciplines for the benefit of children. includes clinical guidelines relevant to the practice of Pediatric The primary focus of most dental specialties is a particular Dentistry that have been developed by another organization with area of dental, oral, or maxillofacial expertise. Pediatric dentist- recognized expertise and adopted by the AAPD. Resources con- ry encompasses a variety of disciplines, techniques, procedures, tains supplemental information to be used as a quick reference and skills that share a common basis with other specialties, when more detailed information is not readily accessible, as but are modified and adapted to the unique requirements of well as clinical forms offered to facilitate excellence in practice.

4 Infants, children, adolescents, and those with special health Proper utilization of this Reference Manual necessitates care needs. By being an age-specific specialty, Pediatric dentist- recognizing the distinction between standards and guidelines. ry encompasses disciplines such as behavior guidance, care of Although there are certain instances within the guidelines the medically and developmentally compromised and disabled where a specific action is mandatory, the AAPD Reference patient, supervision of orofacial growth and development, Manual is not intended nor should it be construed to be caries prevention, sedation, pharmacological management, and either a standard of care or a scope of practice document. The hospital Dentistry , as well as other traditional fields of den- AAPD Reference Manual contains practice guidelines which tistry.

5 These skills are applied to the needs of children through- are intended to be recommendations for care that could be out their ever-changing stages of development and to treating modified to fit individual patient needs based on the patient, conditions and diseases unique to growing individuals. the practitioner, the health care setting, and other factors. The American Academy of Pediatric Dentistry (AAPD), founded in 1947, is the membership organization representing Definitions the specialty of Pediatric Dentistry . The membership provides For the purpose of this document, the following definitions care to millions of our nation's infants, children, adolescents, shall apply. They are based on definitions established by the and persons with special health care needs. They are the primary ADA, the Institute of Medicine, and the Joint Commission contributors to professional education programs and publi- on Accreditation of Health Care Organizations.

6 Cations on Pediatric oral health. Standards: Any definite rule, principle, or measure established The AAPD, in accordance with its vision and mission, by authority. advocates optimal oral health and health care for all children Standards are intended to be applied rigidly and carry the and persons with special health care needs. Its advocacy activi- expectation that they are applied in all cases and any deviation ties take place within the broader health care community from them would be difficult to justify. A standard of care in- and with the public at local, regional, and national levels. The dicates that measurable criteria are present and these criteria Reference Manual is one of the components of the AAPD's shall be used to arrive at a given level of outcome. Standards say advocacy activities. what must be done.

7 The courts define legal standards of care. Guidelines: Systematically developed recommendations de- Intent of the AAPD Reference Manual signed to assist the practitioner, patient, and caregiver in The AAPD Reference Manual is intended to encourage a making decisions relating to specific clinical situations. 2 INTRODUCTION. American Academy OF Pediatric Dentistry . Guidelines are intended to be more flexible than stand- Regardless of the source, proposals are considered care- ards. Guidelines should be followed in most cases, but they fully, and those deemed sufficiently meritorious by a majority recognize that treatment can and should be tailored to fit vote of the BOT are referred to the CCA for development or individual needs, depending on the patient, practitioner, setting, review/revision. and other factors.

8 Deviations from guidelines could be fairly Once a charge (directive from the BOT) for development common and could be justified by differences in individual or review/revision of an oral health policy or clinical guideline circumstances. Guidelines are designed to produce optimal is sent to the CCA, it is assigned to one or more members of outcomes, not minimal standards of practice. the CCA for completion. CCA members are instructed to fol- Guidelines originate in an organization with recognized low the specified format for a policy or guideline. Oral health professional expertise and stature. Although they may be un- policies and clinical guidelines utilize two sources of evidence: solicited, they usually are developed following a stated request the scientific literature and experts in the field. CCA, in col- or perceived need for clinical advice or instruction.

9 Guidelines laboration with the Council on Scientific Affairs, performs are kept current by regular review and modification by the a comprehensive literature review for each document. When developing body. scientific data do not appear conclusive, experts may be Must or shall: Indicates an imperative need and/or duty; consulted. an essential or indispensable item; mandatory. The CCA meets on an interim basis to discuss proposed Should: Indicates the recommended need and/or duty; oral health policies and clinical guidelines. Each new or highly desirable. reviewed/revised policy and guideline is discussed, amended if May or could: Indicates freedom or liberty to follow a necessary, and confirmed by the entire council. suggested alternative. Once developed by the CCA, the proposed policy or Parent: Unless otherwise indicated, the term parent as used guideline is submitted for the consideration of the BOT.

10 In these oral health policies and clinical guidelines has a broad While the Board may request revision, in which case it is meaning encompassing a natural/biological father or mother returned to the council for modification, once accepted by ma- of a child with full parental legal rights, a custodial parent jority vote of the Board, it is referred for Reference Committee who in the case of divorce has been awarded legal custody of hearing at the upcoming Annual Session. The Reference Com- a child, a person appointed by a court to be the legal guardian mittee hearing is an open forum for the membership to provide of a minor child, or a foster parent (a noncustodial parent comment or suggestion for alteration of the document. CCA. caring for a child without parental support or protection who carefully considers all remarks presented at the Reference was placed by local welfare services or a court order).