Policy Statements

 

TEMPOROMANDIBULAR DISORDERS (TMD)

The AADR recognizes that temporomandibular disorders (TMDs) encompass a group of musculoskeletal and neuromuscular conditions that involve the temporomandibular joints (TMJs), the masticatory muscles, and all associated tissues. The signs and symptoms associated with these disorders are diverse, and may include difficulties with chewing, speaking, and other orofacial functions. They also are frequently associated with acute or persistent pain, and the patients often suffer from other painful disorders (comorbidities). The chronic forms of TMD pain may lead to absence from or impairment of work or social interactions, resulting in an overall reduction in the quality of life.

Based on the evidence from clinical trials as well as experimental and epidemiologic studies:

  1. It is recommended that the differential diagnosis of TMDs or related orofacial pain conditions should be based primarily on information obtained from the patient's history, clinical examination, and when indicated TMJ radiology or other imaging procedures. The choice of adjunctive diagnostic procedures should be based upon published, peer-reviewed data showing diagnostic efficacy and safety. However, the consensus of recent scientific literature about currently available technological diagnostic devices for TMDs is that except for various imaging modalities, none of them shows the sensitivity and specificity required to separate normal subjects from TMD patients or to distinguish among TMD subgroups. Currently, standard medical diagnostic or laboratory tests that are used for evaluating similar orthopedic, rheumatological and neurological disorders may also be utilized when indicated with TMD patients. In addition, various standardized and validated psychometric tests may be used to assess the psychosocial dimensions of each patient’s TMD problem.
  2.  It is strongly recommended that, unless there are specific and justifiable indications to the contrary, treatment of TMD patients initially should be based on the use of conservative, reversible and evidence-based therapeutic modalities. Studies of the natural history of many TMDs suggest that they tend to improve or resolve over time. While no specific therapies have been proven to be uniformly effective, many of the conservative modalities have proven to be at least as effective in providing symptomatic relief as most forms of invasive treatment. Because those modalities do not produce irreversible changes, they present much less risk of producing harm. Professional treatment should be augmented with a home care program, in which patients are taught about their disorder and how to manage their symptoms

References
 1)   de Leeuw R, Klasser GD, Albuquerque RJ. Are female patients with orofacial pain medically compromised? J Am Dent Assoc 2005;136(4):459-68.
 2)   Diatchenko L, Nackley AG, Tchivileva IE, Shabalina SA, Maixner W. Genetic architecture of human pain perception. Trends Genet 2007;23(12):605-13.
 3)   Sessle BJ. Sensory and motor neurophysiology of the TMJ. In: Laskin DM, Greene CS, Hylander WL, eds. Temporomandibular Disorders: An Evidence-Based Approach to Diagnosis and Treatment. Chicago: Quintessence; 2006. p. 69-88.
 4)   Reissmann DR, John MT, Schierz O, Wassell RW. Functional and psychosocial impact related to specific temporomandibular disorder diagnoses. J Dent 2007 Aug;35(8):643-50.
 5)   Klasser GD, Okeson JP. The clinical usefulness of surface electromyography in the diagnosis and treatment of temporomandibular disorders. J Am Dent Assoc. 2006;137(6):763-71.
 6)   Suvinen TI, Kemppainen P. Review of clinical EMG studies related to muscle and occlusal factors in healthy and TMD subjects. J Oral Rehabil 2007;34(9):631-44.
 7)   Greene CS. The Role of Technology in TMD Diagnosis. In Laskin DM, Greene CS, Hylander WL (Eds).  TMDs – An Evidence-Based Approach to Diagnosis and Treatment.  Chicago, Quintessence Publishing Co, 2006, pp 193-202.
 8)   Greene CS, Laskin DM. Temporomandibular disorders: moving from a dentally based to a medically based model. J Dent Res 2000;79(10):1736-9.
 9)   Truelove E. Role of oral medicine in the teaching of temporomandibular disorders and orofacial pain. J Orofac Pain 2002;16(3):185-90.
 10)  Dworkin SF, Massoth DL. Temporomandibular disorders and chronic pain: disease or illness? J Prosthet Dent 1994;72(1):29-38.
 11)  Carlson CR. Psychological considerations for chronic orofacial pain. Oral Maxillofac Surg Clin North Am 2008;20(2):185-95.
 12)  Lindroth JE, Schmidt JE, Carlson CR. A comparison between masticatory muscle pain patients and intracapsular pain patients on behavioral and psychosocial domains. J Orofac Pain 2002;16(4):277-83.
 13)  AmericanAcademy of Orofacial Pain. Temporomandibular Disorders. In: de Leeuw R, ed. Orofacial Pain: Guidelines for Assessment, Diagnosis and Management. Chicago: Quintessence; 2008.
 14)  Stohler CS, ZarbGA. On the management of temporomandibular disorders: a plea for a low-tech, high-prudence therapeutic approach. J Orofac Pain 1999;13(4):255-61.
 15)  Fricton J. Myogenous temporomandibular disorders: diagnostic and management considerations. Dent Clin North Am 2007;51(1):61-83.
 16)  Okeson JP. Joint intracapsular disorders: diagnostic and nonsurgical management considerations. Dent Clin North Am 2007;51(1):85-103.
 17)  Carlson CR, Bertrand PM, Ehrlich AD, Maxwell AW, Burton RG. Physical self-regulation training for the management of temporomandibular disorders. J Orofac Pain 2001;15(1):47-55.
 18)  Dworkin SF, Huggins KH, Wilson L, Mancl L, Turner J, Massoth D, LeResche L, Truelove E. A randomized clinical trial using research diagnostic criteria for temporomandibular disorders-axis II to target clinic cases for a tailored self-care TMD treatment program. J Orofac Pain 2002;16(1):48-63.

(adopted 1996, revised 2010)

 

SEALANTS

Pit and fissure sealants are polymeric materials that are applied to the occlusal surfaces of teeth, which do not benefit from the caries-preventive effects of fluoride as much as do the smooth surfaces. A large percentage of occlusal surfaces can remains caries-free for up to ten years or more after a single application of sealant. Furthermore, studies show that incipient caries lesions that remain sealed do not progress. Based on current evidence, the American Association for Dental Research (AADR) strongly recommends, greater use of sealants by practitioners in private and public health practice.  The AADR also endorses the practice that sealants could be used in conjunction with other caries-preventive measures, such as fluoride application.

Supportive references:
JD Bader, DA Shugars, and AJ Bonito (2001). Systematic reviews of selected dental caries diagnostic and management methods.  J Dent Educ. 65(10): 960-968
Benedict I. Truman, Barbara F. Gooch, Iddrisu Sulemana, Helen C. Gift, Alice M. Horowitz, Caswell A. Evans Jr, Susan O. Griffin, Vilma G. Carande-Kulis. The Task Force on Community Preventive Services (2002). Reviews of Evidence on Interventions to Prevent Dental Caries, Oral and Pharyngeal Cancers, and Sports-Related Craniofacial Injuries. Am J Prev Med;23(1S)
Ahovuo-Saloranta A, Hiiri A, Nordblad A, Worthington H, Mäkelä M (2004). Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD001830. DOI: 10.1002/14651858.CD001830.pub2.
Hiiri A, Ahovuo-Saloranta A, Nordblad A, Mäkelä M (2006). Pit and fissure sealants versus fluoride varnishes for preventing dental decay in children and adolescents. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD003067. DOI: 10.1002/14651858.CD003067.pub2
Griffin SO, Oong E, Kohn W, Vidakovic B, Gooch BF, Bader J, et al (2008). The Effectiveness of Sealants in Managing Carious Lesions. Journal of Dental Research 2008 (accepted).
ADA, and CDC Sealant Guidelines-To be published JADA 2008
Oong E, Griffin S, Kohn W, Gooch B, Caufield P. The effect of dental sealants on bacteria levels in caries lesions: a review of the evidence. JADA 2008 (accepted 12/31/2007)

(adopted 1991; revised 2009)

 

TOPICAL FLUORIDES

Fluoride’s predominant effect in caries prevention and management is post-eruptive and topical. However, as it relates to this statement, topical fluorides are those that are applied to erupted teeth, with the understanding that water fluoridation’s and dietary fluoride’s main effect is also topical. The American Association for Dental Research (AADR) strongly recommends twice daily use of fluoride-containing dentifrices that meet the acceptance criteria of the American Dental Association as an effective means of reducing caries.  Furthermore, based on current evidence, the AADR also strongly recommends that fluoride-containing dentifrices should be used in small amounts in pre-school-aged children in order to reduce the risk of dental fluorosis through unintentional ingestion. It is important to note that professionally applied gels and varnishes also reduce caries incidence. Studies show that application at six-monthly intervals is appropriate for patients at moderate caries risk, but application frequency may be decreased or increased according to risk status and degree of exposure to other sources of fluoride. Higher-risk patients should receive applications at three to six-month intervals. In addition, the AADR recommends the use of daily or weekly fluoride mouth rinses and gels for this group.   The AADR makes the following additional caveats:  A) Because of their high fluoride concentration, these forms of topical fluoride (i.e., mouthrinses and prescription gels) are not recommended for pre-school-aged children. B) Unintentional ingestion of fluoride-based solutions or gels should be minimized.

Supportive References:
Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States. CDC MMWR August 2001 August 17, 2001 / 50(RR14);1-42
Professionally applied topical fluoride. Evidence-based clinical recommendations. American Dental Association Council on Scientific Affairs (2006). J Am Dent Assoc, Vol 137, No 8, 1151-1159
Shellis RP, Duckworth RM: Studies on the cariostatic mechanisms of fluoride, Int Dent J 1994; 44(Suppl 1): 263-273
ten Cate JM: Current concepts on the theories of the mechanism of action of fluoride, Acta Odont Scand 1999; 57: 325-329
Featherstone JD: Prevention and reversal of dental caries: role of low level fluoride, Community Dent Oral Epidemiol 1999; 27: 31-40
Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride gels for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD002280. DOI: 10.1002/14651858.CD002280
Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD002279. DOI: 10.1002/14651858.CD002279
Marinho VCC, Higgins JPT, Logan S, Sheiham A. Topical fluoride (toothpastes, dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD002278. DOI: 10.1002/14651858.CD002278
Marinho VCC, Higgins JPT, Logan S, Sheiham A. Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2003, Issue 3, Art. No.: CD002284. DOI: 10.1002/14651858.CD002284
Marinho VCC, Higgins JPT, Logan S, Sheiham A. Topical fluoride (toothpastes, mouthrinses, gels or varnishes) for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD002782. DOI: 10.1002/14651858.CD002782
Marinho VCC, Higgins JPT, Sheiham A, Logan S. One topical fluoride (toothpastes, or mouthrinses, or gels, or varnishes) versus another for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD002780. DOI: 10.1002/14651858.CD002780.pub2
Marinho VCC, Higgins JPT, Sheiham A, Logan S. Combinations of topical fluoride (toothpastes, mouthrinses, gels, varnishes) versus single topical fluoride for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD002781. DOI: 10.1002/14651858.CD002781.pub2
Hiiri A, Ahovuo-Saloranta A, Nordblad A, Mäkelä M. Pit and fissure sealants versus fluoride varnishes for preventing dental decay in children and adolescents. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD003067. DOI: 10.1002/14651858.CD003067.pub2

(adopted 1996; revised 2009)

 

USE OF STEM CELLS IN DENTAL RESEARCH

The American Association for Dental Research (AADR) supports the use of stem cells in dental, oral, and craniofacial research. Basic research and the development of future applications of stem cell research require the ongoing commitment to scientific integrity and social responsibility. AADR supports a periodic review of issues that may arise from innovation in the use of stem cells in research and promotes an open, national dialogue on the scientific, ethical and policy issues raised by such advances.

(adopted 2007)

 

DENTAL AMALGAM RESTORATIONS

Dental amalgam has a well-documented history of safety and efficacy in dentistry. Its advantages include ease of handling, durability, and relatively low cost. Dental amalgam has numerous indications for use, especially for restorations in stress-bearing areas. Its main disadvantages are poor aesthetics and the necessity for sound tooth structures to be removed in order for retention to be obtained. Its use in restorative procedures is still indicated. Scientific evidence indicates that currently used restorative materials, including dental amalgam, cause no or very few significant side-effects. Extremely small amounts of mercury may escape from an amalgam restoration during normal use, but this minute mercury exposure does not cause verifiable adverse effects on the general health of patients or dental health personnel. Local allergic or other inflammatory reactions are rare side-effects of dental amalgam. The AADR endorses the use of best management practices for the use of amalgam restorations in dental offices.

(adopted 1996, revised 2004)

 

USE OF ANIMALS IN RESEARCH

The AADR recognizes the major contributions made to human and animal health through the responsible use of animals in biomedical research. Therefore, the AADR strongly supports the ethical use of animals by scientists worldwide. The AADR also endorses systematic research in validating alternatives to animal models.

(adopted, 1991; modified, 1999)

 

ORAL DISEASE RELATED TO TOBACCO USE

Tobacco use is the principal risk factor for oral cancer. It also increases the risk for periodontal disease and decreases the ability of oral tissues to heal. Other oral effects include halitosis (bad breath), decreased ability to taste, and increased staining of the teeth. Smokeless tobacco (spit tobacco) is not a safe alternative to smoking tobacco. Tobacco used in either form is harmful to health and should be discouraged. The AADR urges dental professionals to discourage initiation of tobacco use in any form among their patients and the public, and to facilitate and reinforce cessation among users.

(adopted 1996)

 

DIETARY FLUORIDE SUPPLEMENTS

The American Association for Dental Research (AADR), realizing that dental caries (tooth decay) ranks among the most prevalent chronic diseases world-wide; and
Recognizing that the consequences of tooth decay include pain, infection, tooth loss, the subsequent need for costly restorative treatment, and absence from work and school; and
Recognizing that, while fluoridation of water supplies is the most effective and least expensive measure to prevent tooth decay, large numbers of people do not currently have access to the benefits of community fluoridation; and
Taking into account that over 20 years of research have clearly demonstrated the safety and efficacy of dietary fluoride supplements; now, therefore,

  1. Strongly recommends use of dietary fluoride supplements in areas where optimal fluoridation of water supplies is not available, and
  2. Fully endorses the dosage schedule of dietary fluoride supplements recommended by the American Dental Association and the American Academy of Pediatrics.

References
Accepted Dental Therapeutics, American Dental Association, 38th ed., 1979, 385 pp.
Committee on Nutrition, American Academy of Pediatrics, Fluoride Supplementation: Revised Dosage Schedule, Pediatrics, Vol. 63, No. 1, January, 1979
Report of ORCA on Caries-preventive Fluoride Tablet Programs, Caries Res, Vol. 12, Supplement 1, 1978, 112 pp.
IADR, Policy Statement, J Dent Res, Nov. 1979, and AADR Policy Statement accepted July 10, 1980

(adopted 1982)

 

HEALTH CARE REFORM

 

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