54 Parameters <strong>of</strong> Care Tupac et al5. Preexisting systemic conditions6. Patient noncompliance with prescribed treatment7. Chronic pain behavior8. Psychosocial considerations9. Esthetic considerations10. Periodontal considerations11. Parafunctional habits12. Previous treatment13. Swallowing habits14. Tongue positionD. Standards <strong>of</strong> care1. Comprehensive clinical prosthodontic assessment [D0150, D0160, D0470, D0999 CDT-2005]2. Acute TMD Disorder [D0140, D7820, D7830, D7880, D7899, D7630, D9610 CDT 2005]3. Evaluation <strong>of</strong> previous treatment [D0170 CDT 2005]4. Appropriate diagnostic imaging [D0321, D0322, D0330, D0340, D0350 CDT 2005]5. Appropriate consultations/referrals6. Monitoring <strong>of</strong> adjunctive therapy [D0170 CDT 2005]7. Occlusal therapy, which may include: [(D2710-D2799, D7780, D8210, D8220, D9920, D9930,D9940, D9950-D9952, D9999 CDT 2005]a. Orthotic devicesb. Occlusal equilibrationc. Provisional restorationsd. Final restorations8. Maintenance [D0170 CDT 2005]9. Patient education10. Informed consent11. Pharmacological therapy [D9610, D9630 CDT 2005]12. Physical therapy [97014, 97032, 97001, 97002, 97110, 97014, 97504, 97010, 97039, 97112, 97520CPT 2005]13. Post-treatment follow-up careE. Specialty performance assessment criteria1. Favorable outcomes:a. Reduction/management <strong>of</strong> painb. Improved functionc. Improved intra-arch and interarch stability and supportd. Improved TM joint and or<strong>of</strong>acial muscle supporte. Acceptable patient compliance2. Known risks and complicationsa. Persistent or increased painb. Decreased stomatognathic functionc. Unanticipated motor or sensory nerve abnormalityd. Prolonged period <strong>of</strong> disabilitye. Psychological sequelaef. Recurrence <strong>of</strong> symptomsg. Postural limitationsh. Need for continued orthotic therapyi. Unfulfilled patient expectationsSelected References (Temporomandibular Disorders Parameter)This list <strong>of</strong> selected references is intended only to acknowledge some <strong>of</strong> the sources <strong>of</strong> information drawnupon in the preparation <strong>of</strong> this document. Citation <strong>of</strong> the reference material is not meant to imply2010 CDEL Re-recognition <strong>of</strong> the Specialty Report 94 <strong>of</strong> 279
December 2005, Supplement, Volume 14, Number 4 55endorsement <strong>of</strong> any statement contained in the reference material, or that the list is an exhaustivecompilation <strong>of</strong> information on the topic. Readers should consult other sources to obtain a completebibliography.Attanasio R, Cinotti WR, Grieder A: Craniomandibular disorders: exam and data collection. Clin Prev Dent 1988;10:26-30Baragona PM, Cohen HV: Long-term orthopedic appliance therapy. Dent Clin North Am 1991;35:109-121Bell WE: Or<strong>of</strong>acial Pains – Classification, Diagnosis, Management, (ed 4). Chicago, Year Book Medical Publishers, 1989Bell WE: Temporomandibular Disorders: Classification, Diagnosis, Management, (ed 3). Chicago, Year Book Medical Publishers,1990Clark GT, Seligman DA, Solberg WK, et al: Guidelines for the examination and diagnosis <strong>of</strong> temporomandibular disorders. JCraniomandib Disord 1980;3:7-14Dawson PE: Evaluation, Diagnosis and Treatment <strong>of</strong> Occlusal Problems, (ed 2). St. Louis, Mosby-Year Book, 1989Dobbs D: The medical/legal aspects <strong>of</strong> TMD. Cranio 1994;12:65-70Hilsen KL, Attanasio R, DeSteno C, et al: TMD prosthodontics: Treatment and management goals. J Prosthod 1995;4:58-64Kaplan AS, Assael LA: Temporomandibular Disorders: Diagnosis and Treatment. St. Louis, Saunders, 1994Kinderknecht KE, Hilsen KL: Informed consent for the prosthodontic patient with temporomandibular disorders. J Prosthod1995;4:205-209McNeill C: Temporomandibular Disorders: Guideline for Classification, Assessment and Management. The <strong>American</strong> Academy<strong>of</strong> Or<strong>of</strong>acial Pain. Chicago, Quintessence, 1990McNeill C: Temporomandibular disorders: Guidelines for diagnosis and management. CDA J 1991;19:1526Mohl ND, Zarb GA, Carlsson GE, et al: A Textbook <strong>of</strong> Occlusion. Chicago, Quintessence, 1988Nassif NJ, Hilsen KL: Screening for temporomandibular disorders: history and clinical examination. <strong>American</strong> Dental Association.J Prosthod 1992;1:42-46Okeson JP: Management <strong>of</strong> Temporomandibular Disorders and Occlusion. St. Louis, Mosby-Year Book, 1993Parker MW: A dynamic model <strong>of</strong> etiology in temporomandibular disorders. J Am Dent Assoc 1990;120:283-290Pullinger AG, Monteiro AA: Functional impairment in TMJ patient and nonpatient groups according to a disability index andsymptom pr<strong>of</strong>ile. Cranio 1988;6:156-164Pullinger AG, Selgiman DA, Solberg WK: Temporomandibular disorders. Part I: Functional status, dentomorphologic features,and sex differences in a nonpatient population. J Prosthet Dent 1988;59:228-235Pullinger AG, Selgiman DA, Solberg WK: Temporomandibular disorders. Part II: Occlusal factors associated with temporomandibularjoint tenderness and dysfunction. J Prosthet Dent 1988;59:363-367Talley RL, Murphy GJ, Smith SD, et al: Standards for the history, examination, diagnosis, and treatment <strong>of</strong> temporomandibulardisorders (TMD): a position paper. Cranio 1990;8:60-77Preface10) Upper Airway Sleep Disorders (UASDs) ParameterThe treatment <strong>of</strong> UASDs (severe snoring – Upper Airway Resistance Syndrome [UARS], and ObstructiveSleep Apnea [OSA]) falls into three main categories: oral devices, constant positive airway pressure(CPAP), and surgery. The prosthodontist is qualified to design and fabricate various types <strong>of</strong> oraldevices and use them in the treatment and management <strong>of</strong> these disorders. These devices mechanicallyreposition the anatomy to maintain airway potency by holding the tongue or mandible in a forwardposition or stabilize the s<strong>of</strong>t palate. Because these disorders can be serious health risks, they mustbe diagnosed, documented, and evaluated by qualified physicians and their progress monitored. Thisteamwork approach is mandatory. These disorders affect 50–100 million people and secondarily affecttheir bed partners.General Criteria and StandardsInformed Consent: All prosthodontic procedures should be preceded by the patient’s consent. Informedconsent is obtained after the patient has been informed <strong>of</strong> the indications for the procedure(s), goals<strong>of</strong> treatment, the known benefits and risks <strong>of</strong> the procedure(s), the factor(s) that may affect the knownrisks and complications, the treatment options, the need for active maintenance by the patient, the needfor future replacements and revisions, and the favorable outcome.Documentation: Parameters <strong>of</strong> care for prosthodontic procedures include documentation <strong>of</strong> objectivefindings, diagnosis, and patient management intervention.2010 CDEL Re-recognition <strong>of</strong> the Specialty Report 95 <strong>of</strong> 279
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A. General InformationThe American
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Changes in Scope of PracticeThe Ame
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ReferencesThe American College of P
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ENVISIONED FUTURE~ 10-30 YEAR HORIZ
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Prosthodontists will provide prosth
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GOALS AND OBJECTIVES~ 3-5 YEAR PLAN
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E4. Create effective linkages to fu
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28 Cllas$caizon of Complete Edentul
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30 Clmsjfication ofCom&e Edentulirm
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Figure 14. Class Ipatient. (A) Pano
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CPE Course History From 2000-2010Da
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Accreditation Standards forAdvanced
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Mission Statement of theCommission
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PrefaceMaintaining and improving th
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Educationally Qualified: An individ
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