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Use of Dental Laboratories


Dental laboratories are used to fabricate dental appliances that cannot be fabricated in the Facility Dental Clinic. These appliances require a laboratory prescription and all cases must adhere to infection control policy and procedure, HIPAA requirements, and contract health guidelines. Because the dental laboratory is involved with the care of the patient, no HIPAA Business Associate Agreement is required. It is the responsibility of the dental laboratory to maintain confidentiality while the case in the laboratory and during shipment to the dental facility.

Dental Laboratory Fees

Laboratory cases are cleared prior to scheduling by the [appropriate individual] in charge of Contract Health. This will determine the correct resources prior to initiating treatment.

The patient or parent/guardian is responsible for all dental laboratory costs. Lab fees vary. An estimate will be given to the patient or parent/guardian at the examination appointment or at the time the need for the service is determined. This is an estimate only; patients will be responsible for unforeseen laboratory charges.
The estimated fee must be paid in advance by certified check or money order made out to the dental lab performing the service. Fees must be paid on or before the day of the dental appointment. If you arrive for your dental appointment and the lab fee has not been paid, the patient’s appointment will be rescheduled to allow more time to pay the fee.
Lab fees are ONLY refundable before the case is sent to the lab. If the patient does not keep the appointment for the delivery of the device the lab fee will not be refunded. If the device must be remade, the patient is responsible for paying the additional laboratory fee.

Sample Handout to Patients

Dental Laboratory Fees


Your treatment includes work that must be completed at a dental laboratory. Because [Health Center Name] must pay the dental laboratory for this service, lab fees are not a covered benefit. If you would like to have this treatment completed, you must pay the laboratory fee. This only applies to services done at an external dental laboratory. Payment of dental laboratory fees will be made according to the following procedures.


  1. The patient or parent/guardian is responsible for all dental laboratory costs. Lab fees vary. An estimate will be given to you at the examination appointment or at the time the need for the service is determined. This is an estimate only; patients will be responsible for unforeseen laboratory charges.




  1. The estimated fee must be paid in advance by certified check or money order made out to the dental lab listed below. Fees must be paid on or before the day of the dental appointment. If you arrive for your dental appointment and the lab fee has not been paid, we will be happy to reschedule your appointment to allow you more time to pay the fee.




  1. Lab fees are ONLY refundable before the case is sent to the lab. If you do not keep your appointment for the delivery of the device your lab fee will not be refunded. If you need to have the device remade you will have to pay another lab fee.


_______________ _________________ __________

Patient Chart Number Date

__________________________________________ __________________________

Procedure(s) Lab Fee Estimate


______________________________________________________

Dental Laboratory

I have read and understand the above policy. I agree to pay the estimated lab fees before any dental treatment requiring laboratory work is done.

_________________________________ _______________________

Patient or Parent/Guardian Signature Date
_________________________________ _______________________

Dentist Signature Date



B.12 PROTECTIVE STABILIZATION
PURPOSE
To establish procedures for the safe protective stabilization of patients during dental treatment.
PROCEDURE

This facility adheres to the American Academy of Pediatrics Dentistry’s’ (AAPD) guidelines for protective stabilization. The policy will apply to all patients, regardless of age. According to the AAPD’s 2006 Guideline for Behavior Guidance for the Pediatric Dental Patient:



The following is a statement by the American Academy of Pediatric Dentistry. Revise as needed for your facility.
“The use of any protective stabilization in the treatment of infants, children, adolescents, or persons with special health care needs is a topic that concerns health care providers, care givers, and the public. The broad definition of protective stabilization is restriction of patient’s freedom of movement, with or without the patient’s permission, to decrease risk of injury while allowing safe completion of treatment. The restriction may involve another human(s), a patient stabilization device, or a combination thereof. The use of protective stabilization has the potential to produce serious consequences, such as physical or psychological harm, loss of dignity, violation of a patient’s rights, and even death. Because of the associated risks and possible consequences of use, the dentist is encouraged to evaluate thoroughly its use on each patient and possible alternatives.

Partial or complete stabilization of the patient sometimes is necessary to protect the patient, practitioner, staff, or the parent from injury while providing dental care. Protective stabilization can be performed by the dentist, staff, or parent without the aid of restrictive device. The dentist should always use the least restrictive, but safe and effective, protective stabilization. The use of a mouthprop in a compliant patient is not considered protective stabilization.

The need to diagnose, treat, and protect the safety of patient, practitioner, staff, and parent should be considered for the use of protective stabilization. The decision to use protective stabilization should take into consideration:


  1. alternative behavior guidance modalities;

  2. dental needs of the patient;

  3. the effect on the quality of dental care;

  4. the patient’s emotional development;

  5. and the patient’s physical considerations.

Protective stabilization, with or without a restrictive device, performed by the dental team requires informed consent from a parent. Informed consent must be obtained and documented in the patient’s record prior to the use of protective stabilization. Due to the possible aversive nature of the technique, informed consent should also be obtained prior to a parent’s performing protective stabilization during dental procedures. Furthermore, when appropriate, an explanation to the patient regarding the need for restraint, with an opportunity for the patient to respond, should occur.

In the event of unanticipated reaction to dental treatment, it is incumbent upon the practitioner to protect the patient and staff from harm. Following immediate intervention to assure safety, if techniques must be altered to continue delivery of care, the dentist must have informed consent for the alternative methods. The patient’s record must include:



  1. informed consent for stabilization;

  2. indication for stabilization;

  3. type of stabilization;

  4. the duration of application of stabilization;

  5. frequency of stabilization evaluation and safety adjustments;

  6. behavior/evaluation rating during stabilization.

Objectives: The objectives of patient stabilization are to:



  1. reduce or eliminate untoward movement;

  2. protect patient, staff, dentist, or parent from injury;

  3. facilitate delivery of quality dental treatment.

Indications: Patient stabilization is indicated when:



  1. patients require immediate diagnosis and/or limited treatment and cannot cooperate due to lack of maturity;

  2. patients requires immediate diagnosis and/or limited treatment and cannot cooperate due to mental or physical disability;

  3. the safety of the patient, staff, dentist, or parent would be at risk without the use of protective stabilization;

  4. sedated patients require limited stabilization to help reduce untoward movement.

Contraindications: Patient stabilization is contraindicated for:



  1. cooperative nonsedated patients;

  2. patients who cannot be immobilized safely due to associated medical or physical conditions;

  3. patients who have experienced previous physical or psychological trauma from protective stabilization (unless no other alternatives are available);

  4. nonsedated patients with nonemergent treatment requiring lengthy appointments.

Precautions: The following precautions should be taken prior to patient stabilization:



  1. tightness and duration of the stabilization must be monitored and reassessed at regular intervals;

  2. stabilization around extremities or the chest must not actively restrict circulation or respiration;

  3. stabilization should be terminated as soon as possible in a patient who is experiencing severe stress or hysterics to prevent possible physical or psychological trauma. “


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