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To identify staff lines of authority and responsibility, describe the physical components of the dental program, and general principles of oral health care delivery.

Description and Organization

The [Facility] Dental Program is directly responsible to the health director. The Dental Program is the responsibility of the [individual].


[Staff, eg. Dentist, dental assistant, hygienists, receptionist, others] staff the dental clinic. Referrals to private specialists are provided through contract health service funds or other funds identified by the [Facility] Health Department.

Scope of Work

The dental program is designed to provide basic preventive and restorative dental services to the entire family through education, disease prevention services, diagnosis and treatment of oral health problems.

Each adult is responsible for his/her dental health. Parents/legal guardians are responsible for the dental health of their legal wards.

Medically Necessary Care

This facility adheres to the American Academy of Pediatric Dentistry’s (AAPD) guidelines for medically necessary care (MNC). According to the AAPD’s 2011 guidelines:

MNC is defined as:

“Medically necessary care (MNC) is the reasonable and essen­tial diagnostic, preventive, and treatment services (including supplies, appliances, and devices) and follow-up care as determined by qualified health care providers in treating any condition, disease, injury, or congenital or developmental mal-formation. MNC includes all supportive health care services that, in the judgment of the attending dentist, are necessary for the provision of optimal quality therapeutic and preventive oral care. These services include, but are not limited to, seda-tion, general anesthesia, and utilization of surgical facilities. MNC must take into account the patient’s age, developmental status, and psychosocial well-being, in addition to the setting appropriate to meet the needs of the patient and family.” (AAPD, 2011. Available online at

Providing Medically Necessary Care:

“Dental care is medically necessary to prevent and eliminate orofacial disease, infection, and pain, to restore the form and function of the dentition, and to correct facial disfiguration or dysfunction. MNC is based upon current preventive and therapeutic practice guidelines formulated by professional organizations with recognized clinical expertise. Expected benefits of MNC outweigh potential risks of treatment or no treatment. Early detection and management of oral conditions can im­prove a child’s oral health, general health and well-being, school readiness, and self-esteem. Early recognition, prevention, and intervention could result in savings of health care dollars for individuals, community health care programs, and third party payors. Because a child’s risk for developing dental disease can change over time, continual professional reevaluation and preventive maintenance are essential for good oral health. Value of services is an important consideration, and all stakeholders should recognize that cost-effective care is not necessarily the least expensive treatment.

The AAPD encourages:

1. oral health care to be included in the design and provision of individual and community-based health care pro-grams to achieve comprehensive health care.

2. establishment of a dental home for all children by 12 months of age in order to institute an individualized pre-ventive oral health program based upon each patient’s unique caries risk assessment.

3. health care providers who diagnose oral disease to either provide therapy or refer the patient to a primary care dentist or dental/medical specialist as dictated by the nature and complexity of the condition. Immediate intervention is necessary to prevent further dental destruction, as well as more widespread health problems.

4. evaluation and care provided for an infant, child, or adolescent by a cleft lip/palate, orofacial, or craniofacial de-formities team as the optimal way to coordinate and deliver such complex services.

5. the dentist providing oral health care for a patient to determine the medical indication and justification for treatment. The dental care provider must assess the patient’s developmental level and comprehension skills, as well as the extent of the disease process, to determine the need for advanced behavior guidance techniques such as sedation or general anesthesia.” (AAPD, 2011. Available online at:

These principles of Medically Necessary Care will be applied to all dental services for patients of all ages.

Patient Rights

Describe process of informing patients of their rights.


Upon registration patients are informed of their rights and responsibilities. Each patient or parent/guardian acknowledges understanding of these policies by signing a form which is kept in their patient registration chart.
Protected Information
The confidentiality of patient records will be maintained according to the Privacy Act of 1974 and Health Insurance Privacy and Accountability Act (HIPAA). Any release of patient information not covered under “Routine Uses” provision of the Privacy Act and/or HIPAA must be authorized by the patient, the patient's legal guardian or by court order. Patients are informed of their HIPAA rights at registration.

Grievances concerning the dental program can be brought by patients directly to the [appropriate individual]. The grievance will be fully investigated and the patient informed of the findings in a timely manner.

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