III. Clinical

A. Anesthesia

Deep Sedation/General Anesthesia

Subject: III. Clinical - A. Anesthesia

Department: Clinical Affairs

Origination Date: December 4, 2013

Reviewed and/or Revised: 09/01/2017, 05/16/2022, 9/27/2023, 02/05/2024, 09/18/2024

Purpose: Safe use of deep sedation/ general anesthesia

Definitions:

Deep sedation – a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.

General anesthesia – a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug- induced depression of neuromuscular function. Cardiovascular function may be impaired.

Because sedation and general anesthesia are a continuum, it is not always possible to predict how an individual patient will respond. Hence, practitioners intending to produce a given level of sedation should be able to diagnose and manage the physiologic consequences (rescue) for patients whose level of sedation becomes deeper than initially intended.

Policy and/or Procedure: Deep Sedation or General Anesthesia

1. Patient Evaluation

Patients considered for deep sedation or general anesthesia must be suitably evaluated prior to the start of any sedative procedure. In healthy or medically stable individuals (ASA I, II) this must consist of at least a review of their current medical history and medication use and NPO status. However, patients with significant medical considerations (e.g., ASA III, IV) may require consultation with their primary care physician or consulting medical specialist.

2. Pre-operative Preparation

The patient, parent, guardian or care giver must be advised regarding the procedure associated with the delivery of any sedative or anesthetic agents and informed consent for the proposed sedation/anesthesia must be obtained.
Determination of adequate oxygen supply and equipment necessary to deliver oxygen under positive pressure must be completed.
Baseline vital signs must be obtained unless the patient’s behavior prohibits such determination.
A focused physical evaluation must be performed as deemed appropriate.
Preoperative dietary restrictions must be considered based on the sedative/anesthetic technique prescribed.
Pre-operative verbal and written instructions must be given to the patient, parent, escort, guardian or care giver.
An intravenous line, which is secured throughout the procedure, must be established except as provided in part IV. C.6. Pediatric and Special Needs Patients.

3. Personnel and Equipment Requirements

Personnel: A minimum of three (3) individuals must be present.

A dentist qualified in accordance with part III. C. of the ADA Guidelines for the Use of Sedation and General Anesthesia by Dentists (as adopted by the October 2007 ADA House of Delegates) to administer the deep sedation or general anesthesia.
Two additional individuals who have current certification of successfully completing a Basic Life Support (BLS) Course for the Healthcare Provider.
When the same individual administering the deep sedation or general anesthesia is performing the dental procedure, one of the additional appropriately trained team members must be designated for patient monitoring.

Equipment:

A positive-pressure oxygen delivery system suitable for the patient being treated must be immediately available.
When inhalation equipment is used, it must have a fail-safe system that is appropriately checked and calibrated. The equipment must also have either (1) a functioning device that prohibits the delivery of less than 30% oxygen or (2) an appropriately calibrated and functioning in-line oxygen analyzer with audible alarm.
An appropriate scavenging system must be available if gases other than oxygen or air are used.
The equipment necessary to establish intravenous access must be available.
Equipment and drugs necessary to provide advanced airway management, and advanced cardiac life support must be immediately available.
If volatile anesthetic agents are utilized, an inspired agent analysis monitor and capnograph must be used. A protocol for an MH emergency with appropriate medications must be immediately available.
Resuscitation medications and an appropriate defibrillator must be immediately available.

4. Monitoring and Documentation

Monitoring: A qualified dentist administering deep sedation or general anesthesia must remain in the operatory room to monitor the patient continuously until the patient meets the criteria for recovery. The dentist must not leave the facility until the patient meets the criteria for discharge and is discharged from the facility. Monitoring must include:

Oxygenation:
- Color of mucosa, skin or blood must be continually evaluated.
- Oxygenation saturation must be evaluated continuously by pulse oximetry.
Ventilation:
- Intubated patient: End-tidal CO2 must be continuously monitored and evaluated.
- Non-intubated patient: Breath sounds via auscultation and/or end-tidal CO2 must be continually monitored and evaluated.
- Respiration rate must be continually monitored and evaluated.
Circulation:
- The dentist must continuously evaluate heart rate and rhythm via ECG throughout the procedure, as well as pulse rate via pulse oximetry.
- The dentist must continually evaluate blood pressure.
Temperature:
- A device capable of measuring body temperature must be readily available during the administration of deep sedation or general anesthesia.
- The equipment to continuously monitor body temperature should be available and must be performed whenever triggering agents associated with malignant hyperthermia are administered.

Documentation:

Appropriate time-oriented anesthetic record must be maintained, including the names of all drugs administered, including local anesthetics, doses and monitored physiological parameters.
Pulse oximetry and end-tidal CO2 measurements (if taken), heart rate, respiratory rate and blood pressure must be recorded at appropriate intervals.

5. Recovery and Discharge

Oxygen and suction equipment must be immediately available if a separate recovery area is utilized.
The dentist or clinical staff must continually monitor the patient’s blood pressure, heart rate, oxygenation and level of consciousness.
The dentist must determine and document that level of consciousness; oxygenation, ventilation and circulation are satisfactory for discharge.
Post-operative verbal and written instructions must be given to the patient, parent, escort, guardian or care giver.

6. Pediatric and Special Needs Patients

Because many dental patients undergoing deep sedation or general anesthesia are mentally and/or physically challenged, it is not always possible to have a comprehensive physical examination or appropriate laboratory tests prior to administering care. When these situations occur, the dentist responsible for administering the deep sedation or general anesthesia should document the reasons preventing the recommended preoperative management. In selected circumstances, induction of deep sedation or general anesthesia may be utilized without establishing an indwelling intravenous line. These selected circumstances may include very

Brief procedures or periods of time, which, for example, may occur in some pediatric or adult patients with special needs. The establishment of intravenous access may occur after deep sedation or general anesthesia has been induced because of poor patient cooperation.

7. Emergency Management

The qualified dentist is responsible for sedative/anesthetic management, adequacy of the facility and staff, diagnosis and treatment of emergencies related to the administration of deep sedation or general anesthesia and providing the equipment, drugs and protocols for patient rescue.

IV Moderate Sedation

Subject: III. Clinical - A. Anesthesia

Department: Clinical Affairs

Origination Date: December 4, 2013

Effective Date: December 4, 2013

Reviewed and/or Revised: 09/01/2017, 05/16/2022, 09/27/2023, 02/28/2024, 09/18/2024

Purpose: Safe use of Oral/ IV moderate sedation

Definitions:

Moderate Sedation – a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.2

Note: In accord with this particular definition, the drugs and/or techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely. Repeated dosing of an agent before the effects of previous dosing can be fully appreciated may result in a greater alteration of the state of consciousness than is the intent of the dentist. Further, a patient whose only response is reflex withdrawal from a painful stimulus is not considered to be in a state of moderate sedation.

The following definition applies to the administration of moderate or greater sedation:

titration – administration of incremental doses of a drug until a desired effect is reached. Knowledge of each drug’s time of onset, peak response and duration of action is essential to avoid over sedation. Although the concept of titration of a drug to effect is critical for patient safety, when the intent is moderate sedation one must know whether the previous dose has taken full effect before administering an additional drug increment.

Policy and/or Procedure: Moderate Sedation

1. Patient Evaluation

Patients considered for moderate sedation must be suitably evaluated prior to the start of any sedative procedure. In healthy or medically stable individuals (ASA I, II) this should consist of at least a review of their current medical history and medication use. However, patients with significant medical considerations (e.g., ASA III, IV) may require consultation with their primary care physician or consulting medical specialist.

2. Pre-operative Preparation

The patient, parent, guardian or care giver must be advised regarding the procedure associated with the delivery of any sedative agents and informed consent for the proposed sedation must be obtained.
Determination of adequate oxygen supply and equipment necessary to deliver oxygen under positive pressure must be completed.
Baseline vital signs must be obtained unless the patient’s behavior prohibits such determination.
A focused physical evaluation must be performed as deemed appropriate.
Preoperative dietary restrictions must be considered based on the sedative technique prescribed.
Pre-operative verbal or written instructions must be given to the patient, parent, escort, guardian or care giver.

3. Personnel and Equipment Requirements

Personnel:

At least one additional person trained in Basic Life Support for Healthcare Providers must be present in addition to the dentist.

Equipment:

A positive-pressure oxygen delivery system suitable for the patient being treated must be immediately available.
When inhalation equipment is used, it must have a fail-safe system that is appropriately checked and calibrated. The equipment must also have either (1) a functioning device that prohibits the delivery of less than 30% oxygen or (2) an appropriately calibrated and functioning in-line oxygen analyzer with audible alarm.
An appropriate scavenging system must be available if gases other than oxygen or air are used.
The equipment necessary to establish intravenous access must be available.

4. Monitoring and Documentation

Monitoring: A qualified dentist administering moderate sedation must remain in the operatory room to monitor the patient continuously until the patient meets the criteria for recovery. When active treatment concludes, and the patient recovers to a minimally sedated level a qualified auxiliary may be directed by the dentist to remain with the patient and continue to monitor them as explained in the guidelines until they are discharged from the facility. The dentist must not leave the facility until the patient meets the criteria for discharge and is discharged from the facility. Monitoring must include:

Consciousness:
- Level of consciousness (e.g., responsiveness to verbal command) must be continually assessed.
Oxygenation:
- Color of mucosa, skin or blood must be evaluated continually.
- Oxygen saturation must be evaluated by pulse oximetry continuously.
Ventilation:
- The dentist must observe chest excursions continually.
- The dentist must monitor ventilation. This can be accomplished by auscultation of breath sounds, monitoring end-tidal CO2 or by verbal communication with the patient.
Circulation:
- The dentist must continually evaluate blood pressure and heart rate (unless the patient is unable to tolerate, and this is noted in the time-oriented anesthesia record).
- Continuous ECG monitoring of patients with significant cardiovascular disease should be considered.

Documentation:

Appropriate time-oriented anesthetic record must be maintained, including the names of all drugs administered, including local anesthetics, dosages and monitored physiological parameters.
Pulse oximetry, heart rate, respiratory rate and blood pressure must be recorded continually.

5. Recovery and Discharge

Oxygen and suction equipment must be immediately available if a separate recovery area is utilized.
The qualified dentist or appropriately trained clinical staff must continually monitor the patient’s blood pressure, heart rate, oxygenation and level of consciousness.
The qualified dentist must determine and document that level of consciousness; oxygenation, ventilation and circulation are satisfactory for discharge.
Post-operative verbal and written instructions must be given to the patient, parent, escort, guardian or care giver.
If a reversal agent is administered before discharge criteria have been met, the patient must be monitored until recovery is assured.

6. Emergency Management

If a patient enters a deeper level of sedation than the dentist is qualified to provide, the dentist must stop the dental procedure until the patient returns to the intended level of sedation.

The qualified dentist is responsible for the sedative management, adequacy of the facility and staff, diagnosis and treatment of emergencies related to the administration of moderate sedation and providing the equipment, drugs and protocol for patient rescue.

7. Management of Children

For children 12 years of age and under, the American Dental Association supports the use of the American Academy of Pediatrics/American Academy of Pediatric Dentists Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures.

Oral Anxiolysis, Minimal Sedation, and Nitrous Oxide

Subject: III. Clinical - A. Anesthesia

Department: Clinical Affairs

Origination Date: 12/04/2013

Reviewed and/or Revised: 09/01/2017, 05/16/2022, 09/27/2023, 02/28/2024, 09/18/2024, 08/01/2025

Purpose: To ensure safe use of Oral anxiolysis/minimal sedation, and Nitrous Oxide

Definitions:

Minimal Sedation – a minimally depressed level of consciousness, produced by a pharmacological method, that retains the patient’s ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected.

Note: In accordance with this particular definition, the drug(s) and/or techniques used should carry a margin of safety wide enough never to render unintended loss of consciousness. Further, patients whose only response is reflex withdrawal from repeated painful stimuli would not be considered to be in a state of minimal sedation.

When the intent is minimal sedation for adults, the appropriate initial dosing of a single enteral drug is no more than the maximum recommended dose (MRD) of a drug that can be prescribed for unmonitored home use.

The use of preoperative sedatives for children (aged 12 and under) except in extraordinary situations must be avoided due to the risk of unobserved respiratory obstruction during transport by untrained individuals.

Children (aged 12 and under) can become moderately sedated despite the intended level of minimal sedation; should this occur, the guidelines for moderate sedation apply.

Nitrous oxide/oxygen may be used in combination with a single enteral drug in minimal sedation.

Nitrous oxide/oxygen when used in combination with sedative agent(s) may produce minimal, moderate, deep sedation or general anesthesia.

1 Portions excerpted from Continuum of Depth of Sedation: Definition of General Anesthesia and Levels of Sedation/Analgesia , 2004, of the American Society of Anesthesiologists (ASA). A copy of the full text can be obtained from ASA, 520 N. Northwest Highway, Park Ridge, IL 60068-2573.

The following definitions apply to administration of minimal sedation:

maximum recommended (MRD) – maximum FDA-recommended dose of a drug, as printed in FDA-approved labeling for unmonitored home use.

incremental dosing – administration of multiple doses of a drug until a desired effect is reached, but not to exceed the maximum recommended dose (MRD).

supplemental dosing - during minimal sedation, supplemental dosing is a single additional dose of the initial dose of the initial drug that may be necessary for prolonged procedures. The supplemental dose should not exceed one-half of the initial dose and should not be administered until the dentist has determined the clinical half-life of the initial dosing has passed. The total aggregate dose must not exceed 1.5x the MRD on the day of treatment.

Anxiolysis.

A permit is not required for a dentist to administer anxiolysis.
A dentist who intends to administer anxiolysis shall indicate the intent to administer anxiolysis in the patient's records.
A dentist who administers anxiolysis may not administer a dose that is inappropriate for a patient's:
(1) Age; (2) Weight; (3) Medical condition; (4) Infirmities; or (5) Other propensities.
Medications used to produce anxiolysis may not exceed current limits set by the manufacturer for unmonitored use by the individual.
A dentist who administers anxiolysis shall maintain a margin of safety and a level of consciousness that does not approach moderate sedation and other deeper states of sedation and general anesthesia.

Policy and/or Procedure:

1. Nitrous oxide use must be approved by attending/covering faculty who must also be present in close proximity during use.

To administer minimal sedation the dentist must have successfully completed:
1. Training to the level of competency in minimal sedation consistent with that prescribed in the ADA Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students, or a comprehensive training program in moderate sedation that satisfies the requirements described in the Moderate Sedation section of the ADA Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students at the time training was commenced,
  or
2. An advanced education program accredited by the ADA Commission on Dental Accreditation that affords comprehensive and appropriate training necessary to administer and manage minimal sedation commensurate with these guidelines;
  and
3. Current certification in Basic Life Support for Healthcare Providers.
Administration of minimal sedation by another qualified dentist or independently practicing qualified anesthesia healthcare provider requires the operating dentist and his/her clinical staff to maintain current certification in Basic Life Support for Healthcare Providers.

2. Patient Evaluation

Patients considered for minimal sedation must be suitably evaluated prior to the start of any sedative procedure. In healthy or medically stable individuals (ASA I, II) this may consist of a review of their current medical history and medication use. However, patients with significant medical considerations (ASA III, IV) may require consultation with their primary care physician or consulting medical specialist.

3. Pre-Operative Preparation

The patient, parent, guardian or care giver must be advised regarding the procedure associated with the delivery of any sedative agents and informed consent for the proposed sedation must be obtained.
Determination of adequate oxygen supply and equipment necessary to deliver oxygen under positive pressure must be completed.
Baseline vital signs must be obtained unless the patient’s behavior prohibits such determination.
A focused physical evaluation must be performed as deemed appropriate.
Preoperative dietary restrictions must be considered based on the sedative technique prescribed.
Pre-operative verbal and written instructions must be given to the patient, parent, escort, guardian or care giver.

4. Personnel and Equipment Requirements

Personnel:

At least one additional person trained in Basic Life Support for Healthcare Providers must be present in addition to the dentist.

Equipment:

A positive-pressure oxygen delivery system suitable for the patient being treated must be immediately available.
When inhalation equipment is used, it must have a fail-safe system that is appropriately checked and calibrated. The equipment must also have either (1) a functioning device that prohibits the delivery of less than 30% oxygen or (2) an appropriately calibrated and functioning in-line oxygen analyzer with audible alarm.
An appropriate scavenging system must be available if gases other than oxygen or air are used.

5. Monitoring and Documentation

Monitoring: A dentist, or at the dentist’s direction, an appropriately trained individual, must remain in the operatory during active dental treatment to monitor the patient continuously until the patient meets the criteria for discharge to the recovery area. The appropriately trained individual must be familiar with monitoring techniques and equipment. Monitoring must include:

Oxygenation:
- Color of mucosa, skin or blood must be evaluated continually.
- Oxygen saturation by pulse oximetry may be clinically useful and should be considered.
Ventilation:
- The dentist and/or appropriately trained individual must observe chest excursions continually.
- The dentist and/or appropriately trained individual must verify respirations continually.
Circulation:
- Blood pressure and heart rate should be evaluated pre-operatively, post-operatively and intra-operatively as necessary (unless the patient is unable to tolerate such monitoring).

Documentation: An appropriate sedative record must be maintained, including the names of all drugs administered, including local anesthetics, dosages, and monitored physiological parameters.

6. Recovery and Discharge

Oxygen and suction equipment must be immediately available if a separate recovery area is utilized.
The qualified dentist or appropriately trained clinical staff must monitor the patient during recovery until the patient is ready for discharge by the dentist.
The qualified dentist must determine and document that level of consciousness, oxygenation, ventilation and circulation are satisfactory prior to discharge.
Post-operative verbal and written instructions must be given to the patient, parent, escort, guardian or care giver.

7. Emergency Management

If a patient enters a deeper level of sedation than the dentist is qualified to provide, the dentist must stop the dental procedure until the patient returns to the intended level of sedation.

The qualified dentist is responsible for the sedative management, adequacy of the facility and staff, diagnosis and treatment of emergencies related to the administration of minimal sedation and providing the equipment and protocols for patient rescue.

8. Management of Children

B. Central Material Services

Central Materials Services (CMS) Sterile Processing Training Procedure

Subject: III. Clinical - B. Central Material Services, New Employee Orientation and Training & Refresher Training Procedures

Reviewed and/or Revised: 09/01/2017, 02/01/2024, 08/01/2025

Department: Central Materials Services (CMS)

Procedure Statement: Each new employee hired into the Central Materials Services Sterilization Department will have a minimum of five (5) weeks of orientation provided by the department Coordinators, training supervisor, lead supervisor, and shift supervisor.

Purpose of Procedure: To assure every new and existing employee is provided the information and training (annually, continuously) needed to support the individual to succeed and stay current as it relates to their job.

Procedure

General

The basic orientation period is five (5) weeks. The time is based on everyone's level to meet CMS department’s expectations.
The overall training period is 15 weeks. The twelve (12) weeks after the initial orientation will be devoted to on-the-job training. The new employee will be tasked with normal duties under close supervision.
During the first week, the new employee will be tasked to work directly with the training Supervisor or lead/shift supervisor.
Reminder that training is on a continuous basis, it never ends.

Orientation Schedule - Day 1 - Meet with CMS Director/ Coordinators

Introduction to department personnel
Explanation of department policies and procedures
The new employee will be required to successfully pass UMSOD annual training requirements.
Review of UMSOD CORE Values
Complete tour of department
Observe operation of department

Contingent upon Hepatitis B vaccination and a series of shots.

The hepatitis B vaccine is the best way to prevent infection. It is a series of 3 or 4 shots usually given over a 6-to-12-month period. It is given by an injection into the arm muscle of adolescents and adults and the thigh muscle of infants and young children. Estimates of long-term protection for those getting the full vaccination (3 or 4 doses) suggest that protection from hepatitis B could last for up to 20 or 30 years and possibly for life (Walgreens). You can also request a Titer test, which is a blood test that checks your immune status to Hepatitis B vaccinations or diseases you may have received in the past.

Week 1-3

The new employee will be introduced to various cassettes and will work alongside the training supervisor, lead, shift supervisor, or designated trainer.

Week 4-6 (Depending on Hepatitis Titer B results, new employees could be training in Decontamination in Weeks 2-6)

Decontamination Room

Meaning/Purpose of Decontamination
Equipment Operation A. Washer/Disinfectors B: Ultrasonic Washer C. Cleaning /Transporting Carts
Cleaning and maintaining work surfaces A. Sinks B. Counters C. Equipment
Manual cleaning procedure A. Proper Attire B. Sorting Procedures C. Approved cleaning chemicals D. Use of brushes where appropriate E. Drying Procedures
Care of specific equipment
Use of RFID Bluetooth tracking system

Prep and Pack (Clean Side)

Maintenance of work surfaces and equipment
Operation of equipment (Steam Sterilizers)
Changing of charts on sterilizers
Computerized sterilization recordkeeping system
Use of load sticker system
Bowie Dick test
Preparation and use of biological indicators
Proper loading/unloading procedures for all sterilizers and aerator
Proper handling and distribution of sterilized items (cooling time)
Completion and dust covering of trays
Preparation and handling of all cassettes
Use of Receiving and Dispensing Control Sheet
Use of RFID Bluetooth tracking system

You may print the following forms as needed:

Click on the following link to access the List of CMS Internal Trainings (Continuous and New-Hire) (PDF)

Annual Training Requirements

Customer Service
Regulations and Standards
Infection Control and Prevention
Problem Solving
Emergency Response
HIPAA
Bloodborne Pathogens
Title IV
Sexual Harassment
Safety and Risk Management

Central Sterilization Process

Subject: III. Clinical - B. Central Material Services

Department: Central Materials Services (CMS)

Reviewed and/or Revised: 09/01/2017, 02/01/2024, 08/01/2025

Purpose: To ensure accountability for school-owned instruments, handpieces and equipment

Policy and/or Procedure:

Central Sterilization Step Process

I - Start-Up

Turn on and warm up all Getinge Autoclave Sterilization machines (systems #1, #2, #3).
Test Sterilization Machines (with Bowie Dick Test pack enclosed). The test cycle process takes about 30 minutes.
Collect Confirmations Receipt Sheets generated on the exterior of the machine(s) to assure that sterilization machines are working properly.
Remove Bowie Dick test Pack. Locate the result card from the Bowie Dick Test Pack to assure acceptable operational sterilization. A Black and white color pattern on the card indicates proper sterilization. Black and off-white or yellow coloration indicates a failure. The operator/supervisor fills out the reverse side of the Bowie Dick Card (Attachment #1A for Bowie Dick Result Card Sample PDF).
Staple the Confirmation Receipt Sheet and Bowie Dick Card together.
After each machine has been tested, the documentation is placed into a Steam Load Release pouch (located inside CS area) for the month and rotated into a filer room box for safekeeping (at the conclusion of the month). The documentation envelopes are held for a specific period as prescribed by law. (ANSI/AAMI ST79:2010 & A1:2010 &A2:2011 & A3:2012).
After each machine has been tested:
1. A satisfactory test result is indicated by a test sheet that shows uniform dark brown/black color development. A uniform color change result indicates rapid steam penetration, adequate air removal, and lack of significant air leaks.
2. Fail – An unsatisfactory test result is indicated by a test sheet that shows non-uniform color development with a lighter-colored area in the indicator ink pattern, usually near the center of the test sheet. A non-uniform color change result is caused by residual air in the sterilizer chamber and indicates incomplete air removal from the chamber or failure of the sterilizer to hold a vacuum during the test cycle.
3. If a non-uniform color change is noted for the first test, retest the sterilizer. If the second test also shows a non-uniform color change, it should be reported immediately to the supervisor and that sterilizer should not be used until it is examined for possible malfunction
Racks are constructed to slide into the machines and contain the pieces for each run to be “cooked” (sterilized).
The first load for each machine must also include a 3M Attest Super Rapid Readout Biological Indicator 1492V. The packet is a self-contained biological indicator specially made for rapid and reliable qualification testing and routine monitoring of 270°F (132°C) and 275°F (135°C) dynamic air- removal (pre-vacuum) stem sterilization processes when in conjunction with the 3M Attest. After the sterilization, the vile is checked for color to assure proper operations and sterilization; pink indicates a proper status – orange coloration indicates a sterilization failure. The Bio Sign Card is then filled out appropriately. (Attachment #1B for 3M Record Keeping Sheet).
1. Note: All cycles are logged and saved to a removable USB flash drive. The flash drive may be used to periodically transfer the cycle reports to CMS Directors for external hard drive for safe record keeping. Each cycle report logged complete with a unique load number (Time in, Time Out, Temperature, load number of sterilizers)
Simultaneous with each successive load (after the test load) is a continuous receipt of paper roll collection located on the exterior of each sterilization machine. After the test receipts are collected, the entire day paper trail for each machine is kept continuous, until the end of the evening operation. At that time, the receipt rolls for each machine are placed with the test cards and test receipts and placed in a weekly envelope (located inside the CS area Big yellow manila envelope). At the end of each month, the envelopes are rotated into a file room box for safekeeping. The documentation envelopes are held for a specific period as prescribed by law. (ANSI/AAMI ST79:2010 & A1:2010 & A2:2011 & A3:2012).
Labels containing date, load, and sterilizer number are printed and attached to all items being sterilized.

*Note: In the event a sterilization machine does not pass any initial or subsequent sterilization test, Steris personnel will be contacted and expected to perform a service call before machine is deemed operational inspect analyze and repair the cause of any malfunction. The CMS Director should also be notified and continuously updated on the status.

The 3-M Attest –Super Rapid Readout Biological Indicator (1492V) provides a final fluorescent result in (1 Hour)

Sonic wash (TOSI) test daily

Decontamination Washers: Test daily (SONOCHECK)

Friday: Descaler test (Steris Liquid Descaler) performed on Steris Sonic Washers (#1, #2) and Steris AMSCO 400 Washers (#1, #2, #3). Record all changes and adjustments to the washer according to the results found from the TOSI® test relative to the chart scale. Utilizing the supplied log sheet (Located in CS department. Refer to CS Supervisor)

II. Processing

A. Cassette Processing

Hand Pieces and associated materials are processed in a circuit type of flow in the following circuit or pattern:

The dirty cassettes are logged into the RFID system as being received by decontamination. Place on racks and loaded for cleaning into the Steris AMSCO 400 Washer Machines - a process taking minutes to complete.
From the washer, the pieces are distributed to Central Sterilization Aides (technicians) who inspect, clean and polish each instrument and cassette with a lint free cloth. Each cassette with an RFID Bluetooth tracking magnet (internal tracking system) is entered into the LM Dental Tracking software tracking system.
Each Cassette is wrapped with the appropriately sized blue sterilization wrapping paper and taped with striped autoclave tape. (Autoclave tape has white striping when it has not passed through steam heat sterilization. The striping of the tape becomes black after successful sterilization). Cassettes are steam sterilized and then placed in the appropriate location within the Central Sterilization or to its destination for which it is bound (Prep Dispensary).

*Note: Generally, there are two to four Sterilization Aide personnel working on the cleaning and wiping down of cassettes and handpieces. One person is dedicated to special projects if the demand warrants it. Other personnel will make the rounds of clinical areas to retrieve hand pieces from Prep Dispensary locations at designated times and as needed. (Additional staff may be added as required.)

Special Projects: To ensure all instruments and materials are available we require sixty (60) days in advance notification via email. Quantity, specific hand pieces, type of cassettes, date, time location, materials needed, and duration of the project.

B. Hand Pieces and Motorized Tool Processing

Prep Dispensaries have materials picked up from their locations (by Central Sterile personnel) several times per day/evening. The high-speed hand pieces and micro-motorized hand tools which are brought to the Central Sterile location are cleaned by the following process:

Each motor piece is wiped with alcohol, sprayed internally through the end with Bien Air SprayNet Cleaner, and then Sprayed again with Bien Air Lubricant in the same manner. The cassettes are tagged with an RFID Bluetooth tracking magnet and washed. The High-Speed hand pieces are placed into hand piece plastic cassettes, and then the high-speed pieces are sterilized by the Steris
Autoclaves. The cassettes once cleaned are stacked by color and type on a rack by the Steris Washers for distribution back to the Prep Dispensaries as needed. Finally, the High-Speed pieces are picked up or returned to the prep dispensaries.
Daily pick-ups are random based upon daily clinical activity.
Prep dispensary personnel may bring materials to be sterilized to the Central Sterilization location as needed at various times of the day and evening. Each Crosstex bag brought to the CMS department must have the date of packaging, initials of person packaging item, location of prep and all packaging must contain a Stem Chemical Indicator Strip. They are delivered in Clinical Enhancement bags and Crosstex pouches. The personnel delivering the items sign the material in and list the quantity in a binder located at the entrance to the Central Sterilization Department. Hand pieces in hand pieces plastic cassettes and Clinical Enhancement Bags are placed in specific trays (metal bins) with each prep’s identification. These metal bins are placed upon racks and loaded into the Steris Autoclave machines for an intensive heat sterilization process. The pouches and bags have color indicators which change colors (from pink to tan) once they are sterilized, for easy identification of each container’s condition.
Once removed from the sterilization racks, the tools are placed on a rack at the entrance to Central Sterilization Department and labeled for the appropriate Prep location. Prep personnel pick up the items and sign out the materials they are receiving. Similarly, Central Sterilization may prepare items upon request which are placed in Crosstex Sterilization Pouches and Clinical Enhancement Bags to be delivered for special projects or activities on floors via the Prep Dispensaries. All bags and pouches are manually signed in and out of Central Sterilization. And all cassettes and hand pieces are scanned into the appropriate location using the RFID Bluetooth tracking system. Tools are returned to the same prep Dispensary from which they were picked up.
Enhancement Sheets are advance requests sent to Central Sterile from the Prep locations indicating hand piece requirements for the following day(s) or upcoming event. These sheets are usually sent in the afternoon. Schedules provided by faculty prior to or even after the beginning of an academic semester may indicate special handpiece and tool requirements well in advance. Central Sterilization monitors such schedules to prepare special classes for programs and other utilization by faculty.
All RFID Bluetooth tagged cassettes being sterilized will be scanned as per: ANSI/AAMI ST79:2010 & A1:2010 &A2:2011 & A3:2012).

C. Low Heat Sterilization Tool Processing

Because some tools cannot take the intensive high heat process, Steris Autoclaves offer a low heat setting which is the pre-vac delicate cycle in the Central Sterilization Department. Once placed in the machines, the heat process is activated and once sterilization is complete, the items are removed, placed in pouches, and delivered to locations as required.

D. Prep Dispensary Materials Identification and Processing

There are 13 different Hand Piece Cassette configurations and sizes. Hand pieces and cassettes are color coded by floor. The color-coding for kits includes:

4th Floor PEP: Green
4th Floor SPC: Black
3rd Floor POR: Blue
3rd Floor 3AB: White
2nd Floor AGD: Orange
2nd Floor 2AB: Yellow
1st Floor FDS: Purple
1st Floor DSS: Pink

Hand tools and motorized items once sterilized must be returned to the same Prep Dispensary from which it was taken. This enables better tool control of inventory for tracking purposes.

E. Separation Trays - Processing

Some items, trays for instance, require special separation, and cleaning. The Central Sterile Department Aides assist the central Sterile Department and assemble swabs and other associated materials not of a hand piece nature for uses in clinics and Preps. Much of the separation tray material is assembled by the evening shift and left for the morning aides.

F. Decontamination

Dispensaries and clinics forward (or have picked up) used burs blocks and other associated materials to the Central Sterile Department. These items are too small for Steris washer or sterilization machine processes. The burs are collected, placed by hand into the block (they are magnetized and stay in place), placed on appropriate trays, and (1) placed into one of two Steris Ultra Sonic machines for proper washing, sterilization, and drying, and (2) placed in Crosstex Pouch for delivery to the clinical prep dispensaries.

Expendable Clinic Supplies and Materials Purchased in the School Store

Subject: III. Clinical - B. Central Material Services

Department: Central Materials Services (CMS)

Origination Date: January 1, 2010: Updated July 2016

Effective Date: January 1990

Reviewed and/or Revised: 09/01/2017, 02/02/2024, 08/01/2025

Purpose: Ordering clinical Supplies and Materials

Policy and/or Procedure:

Orders for clinical supplies can be placed by either of the two following processes.

Preprinted paper order forms for the most used items can be completed and submitted to the school store to place an order.

OR

Orders for supplies via the computerized ordering system (Microquix) will connect the end user directly to the school store to place an order for supplies and materials.

There is a 48-hour turnaround time for delivery of orders. For example, orders received on Monday will be delivered on Wednesday.

Manage the return of Instrument, Handpiece and Equipment Inventory

Subject: III. Clinical - B. Central Material Services

Department: Central Materials Services (CMS)

Origination Date: January 1, 2010: Updated July 2016

Effective Date: January 1990

Reviewed and/or Revised: 09/01/2017, 02/01/2024, 08/01/2025

Purpose: To ensure accountability for school-owned instruments, handpieces and equipment

Policy and/or Procedure:

All providers will participate and comply with the CMS handpiece sterilization process.

All instruments, handpieces and equipment will be processed, sterilized and managed by CMS.

Instruments, handpieces, equipment and other materials will be distributed and tracked back to individual providers.

Loss or damage of instruments, handpieces and equipment may result in repair or replacement charges to providers.

Note: CMS is not authorized to sterilize any personal instruments or materials without written approval from the Associate Dean of Clinical Affairs.

School–owned instruments cannot be removed from the Dental School building without a complete and authorized “University of Maryland Equipment Removal Authorization” form is signed by the Assistant Dean of Clinical Affairs or his/her designee.

Reporting Damaged or Soiled Instruments

Subject: III. Clinical - B. Central Material Services

Department: Central Materials Services (CMS)

Origination Date: January 1, 2010, Updated July 2016

Effective Date: January 1990

Reviewed and/or Revised: 09/01/2017, 02/01/2024, 08/01/2025

Purpose: To alert CMS management and personnel of soiled or damaged instruments

Policy and/or Procedure:

Upon opening a cassette, if an instrument or handpiece is found to be soiled, broken or damaged, apply red tape (which can be found in the preps and each of the GP cluster cabinets) and immediately return it to the Prep Dispensary.

If an instrument is broken during patient care, place red tape around the damaged or unusable instrument. Return it to the prep dispensary and a replacement will be issued immediately. Upon returning the damaged or unusable instrument, be sure to fill out the Instrument Management Quality Assurance Form (PDF).

Return of Soiled Instruments, Handpieces and Equipment

Subject: III. Clinical - B. Central Material Services

Department: Central Materials Services (CMS)

Origination Date: January 1, 2010: Updated July 2016

Effective Date: January 1990

Reviewed and/or Revised: 09/01/2017, 02/01/2024, 08/01/2025

Purpose: To ensure accountability for school-owned instruments, handpieces and equipment

Policy and/or Procedure:

Immediately upon the completion of patient care but prior to removing PPE, following established infection control guidelines, all providers will return soiled/used instruments, handpieces and equipment to the “dirty side” of the Prep Dispensary assigned to their clinic.

Prior to returning instrument cassettes the provider will:

Remove sharps and deposit them into the Sharps container
Reassemble instrument cassettes
Place handpieces in appropriate handpiece cassette and/or gather all reusable items/materials for presentation to Prep personnel so that items can correctly be returned via the assigned RFID Bluetooth tracking system. .
Take items to the “dirty side” window of the Prep- Dispensary and verify with Prep Dispense Aide that all items have been returned and the provider account is cleared via the RFID Bluetooth tracking system and/or manual sign in and out sheets for reusable items/materials.
CMS Prep Dispense Aide will assemble used materials for transport to central sterilization and examine instruments for damage. Loss or damaged instruments, handpieces and equipment may result in a charge to providers.

C. Credentialing and Licensure

CDS Licensure Procedure

Subject: III. Clinical - C. Credentialing and Licensure

Effective Date: September 2016

Reviewed and/or Revised: 09/01/2017, 02/27/2024, 08/13/2025

Policy/Procedure: CDS Licensure Procedure

All Clinical Faculty who prescribe controlled drugs, need to have their own personal Maryland CDS License. A copy of the CDS License needs to be on file with the Director of Medical Credentialing and Quality Assurance.

If the Faculty provider does not have a CDS License and needs to obtain a CDS License, the faculty will need to complete and submit an online application for a Maryland Controlled and Dangerous Substance (CDS) License. The link to apply online is: https://egov.maryland.gov/mdh/cds

The faculty provider will need to apply for their CDS license prior to completing a Federal DEA Application form. Instructions for completing the Maryland Controlled and Dangerous Substance (CDS) license:

Section 1 A: select DDS or DMD

Section 1 B: check New

Section 1 C: Fee Exempt Information:

NOTE: All Fee Exempt License requests are sent to the Director of Medical Credentialing and Quality Assurance in the Office of Clinical Affairs to obtain pre-approval prior to renewing your CDS license.

Agency:	University of Maryland School of Dentistry
Division:	Office of the Dean
Address:	650 W. Baltimore Street, Suite 6402, Baltimore, MD 21201
Telephone:	410-706-7461
Certifier Name:	Dr. David George
Title of Certifier:	Chief of Staff
Email	DGeorge@umaryland.edu

Section 2: Complete A through F.

Section 3:

Note your Maryland Dental License number
Federal DEA Number – put “pending” if you do not yet have a DEA License
Social Security or Tax ID#. – Input your social security number since this license is for you, the provider.

Answer D, E, F and G.

Sign and date your application

You will apply for your CDS License BEFORE applying for your DEA License. You may check the status of your CDS application by checking the link below:

CDS Registration Verification

Enter your name to see if you have been issued a CDS License number. Once you have your CDS License number, you may apply for your Federal DEA License.

CPR Policy

Subject: III. Clinical - C. Credentialing and Licensure

Department: Clinical Affairs

Effective Date: 08/19/2013

Reviewed and/or Revised: 09/01/2017, 2/14/2024, 3/28/2025, 8/13/2025

Purpose: Ensure all clinical personnel are CPR Certified.

Policy and/or Procedure:

The Dental School has implemented a policy that requires all faculty, residents, students and appropriate clinical support staff to be bi-annually renewed in cardiopulmonary resuscitation (Basic Life Support or B.L.S.). The CPR Training Center, in the Dental School, presents the training program.

Clinical Faculty, residents, students and clinical staff are trained in CPR/BLS and must renew their CPR/BLS certification every two years. These CPR/BLS renewal courses are presented by an American Heart Association certified training center. This independent contractor is hired by the school to teach the published standards of the American Heart Association’s CPR course at the “Healthcare Provider” level of training which requires them to administer CPR to adults, infants and children. Prior to the CPR expiration date, the course must be taken in person, completed and passed, and a copy of the renewed CPR is emailed to the Director of Medical Credentialing. In addition, each CPR/BLS course provides school specific information on management of medical emergencies. A list of successful participants is sent to the Director of Medical Credentialing and Quality Assurance. This list is entered into a computerized CPR database by the Director of Medical Credentialing who monitors the renewals of CPRs for liability and accreditation purposes.

DEA Licensure Procedure

Subject: III. Clinical - C. Credentialing and Licensure

Effective Date: September 2016

Reviewed and/or Revised: 09/01/2017, 02/27/2024, 08/13/2025

To complete your DEA Application or Renew your Fee Exempt DEA License online
NOTE: All Fee Exempt License requests are sent to the director of Medial Credential and Quality Assurance in the Office of Clinical Affairs to obtain pre-approval prior to renewing your DEA license.

When you get to the Fee exempt area on the form, you will need to input the following Fee Exempt Information:

Agency:	University of Maryland School of Dentistry
Division:	Office of the Dean
Address:	650 W. Baltimore Street, Suite 6402, Baltimore, MD 21201
Telephone:	410-706-7461
Certifier Name:	Dr. David George, Chief of Staff
Email	DGeorge@umaryland.edu

Please be reminded you are applying as a DDS or DMD provider; not as a Teaching Institution. This is your personal DEA number while you are performing dentistry services at UMSOD only.

Regarding Fee exemption, your Fee exempt DEA can only be used while you are at UMSOD and cannot be used outside of UMSOD.

If renewing your current DEA License to be used while you are only at UMSOD, you would also use the fee exempt information noted above.

Dental License and Limited Dental License Procedure

Subject: II. Clinical - C. Credentialing and Licensure

Effective Date: July 2016

Reviewed and/or Revised: 09/01/2017, 02/28/2024, 8/1/2025

For a Dentist provider to be in the UMSOD clinics either overseeing students or patients, and/or seeing patients, the Dentist would need to have an “active” Maryland Dental License on file with the Director of Medical Credentialing and Quality Assurance for UMSOD for Accreditation and Liability purposes.

The following is the protocol to be followed for obtaining a Limited Dental License:

Complete application front and back per the directions on the license application.
Sign and have the application notarized.
Make sure you have enclosed the non-refundable fee made payable to the Maryland State Board of Dental Examiners. (NOTE: $225 fee if graduated from a US or Canadian Dental School and $300 if from a Dental School outside of the US and Canada)
Enclose one photo that is between 2x2-inches and 3x3-inches with the required notarized Affidavit. Note: The photo will be affixed to your license. The photo must meet the following guidelines: taken within the last 2 years to reflect your current appearance; front view of full face from top of hair to shoulders; a natural expression; no hat; or head covering that obscures the hair or hairline, unless worn daily for religious purposes; no sunglasses, headphones, wireless hands-free devices or similar items; no other individuals or distractions in the photo. Photos copied or digitally scanned from driver’s licenses or other official documents are not acceptable. In addition, low quality vending machine or mobile phone photos are not acceptable. “Passport” photos are acceptable. Unacceptable photos will be returned and shall delay the issuance of your license.
Enclose a certified letter with the State seal affixed from each State in which you hold or have ever held a license verifying that the license is or was in good standing.
Enclose a letter from the hospital, sanitarium, or dental school which the license to practice dentistry is to be limited that indicates that you possess sufficient comprehension and communication skills in written and spoken English to enable you to adequately treat dental patients. NOTE: This letter will be obtained for you by the Director of Medical Credentialing and Quality Assurance.
If applicable, enclose evidence of legal name change, such as a marriage certificate or court documents.
For a Limited Dental License: Enclose evidence satisfactory to the Board that you have completed at least 2 years of formal general clinical training in a United States or Canadian accredited institution.
For a Teacher’s License: Enclose an affidavit indicating that you have been actively practicing dentistry for at least 5 years.

If applying for a Limited Dental License For Graduates of Dental Schools Outside of the US/Canada, you will also need to:

Enclose a copy of the degree or diploma, including an English translation (if applicable), issued to the applicant by the foreign dental school conferring it, properly authenticated by an official of that dental school authorized to make the authentication.
Enclose a copy, including an English translation (if applicable), of the subjects taken and the credits earned at the foreign dental school, properly authenticated by an official of that foreign dental school authorized to make the authentication.
Enclose two letters of recommendation that certify to the Board the good moral character as well as the applicant’s age, qualifications, background, and experience, if any.

APPLICATION FOR DENTAL LICENSURE FOR DENTISTS LICENSED IN ANOTHER STATE

Request that an original National Board score card be forwarded to the Maryland State Board of Dental Examiners.
Enclose a certified report from the North East Regional Board certifying that you have passed the ADLEX Diagnostic Skills Examination (DSE).
Enclose certified proof of your dental education, such as a copy of a diploma or a letter from the school? Please note that the original embossed school seal must be affixed to copies of transcripts and diplomas submitted to the Board.
Enclose certified letters with the state seal affixed from each state in which you hold or have ever held a license, verifying that the license is or was in good standing and that no disciplinary action has ever been taken against the license.
With respect to your work as a dentist attach a separate page identifying your employers for the 5-year period immediately preceding the date of your application beginning with your most recent employer. The document should include the following: (Please print or type) the name of your employer, name of your supervising dentist, street address, dates of employment, and the number of hours worked for each employer. If you owned your own dental practice, please indicate when appropriate.
Enclose documentation of legal name change (i.e. marriage certificate) if the documents sent with the application are in another name.
Enclose the Maryland State Jurisprudence Examination and the notarized affidavit along with the $50.00 non-refundable fee in a check or money order made payable to the Maryland State Board of Dental Examiners.

PATH 1 CANDIDATES ONLY:

Enclose certified examination scores from the North East Regional Board for the ADLEX.

PATH 2 CANDIDATES ONLY:

Enclose evidence that you have an active license to practice dentistry in a state other than Maryland.
Enclose evidence that you were granted a license in another state after having passed an examination with a clinical component as a requirement for licensure in another state.
Enclose an affidavit indicating that you have been actively practicing dentistry for at least 5 years, and that during the 5 year period preceding you application you have been actively engaged in practicing dentistry for at least 850 hours on average per year for a total of at least 4,250 hours.

MAIL APPLICATION AND SUPPORTING DOCUMENTS TO:

Maryland State Board of Dental Examiners

The Benjamin Rush Building, Spring Grove Hospital Center

55 Wade Avenue

Catonsville, MD 21228

ATTN: Licensing Unit

Send your completed application and check to the Director of Medical Credentialing who will send your completed application to the MSBDE via overnight mail.

License Applications mentioned above can be accessed via the MSBDE website.

NOTE: Each application will contain full instructions.

APPLICATION FOR DENTAL LICENSURE FOR DENTISTS LICENSED IN ANOTHER STATE

If graduated from a US or Canadian Dental School

APPLICATION FOR LIMITED DENTAL LICENSE

If graduated from a Dental School outside of the US and Canada)

APPLICATION FOR LIMITED LICENSE TO PRACTICE DENTISTRY FOR GRADUATES OF DENTAL SCHOOLS OUTSIDE THE U.S OR CANADA

APPLICATION FOR TEACHER’S LICENSE

Fee Exempt CDS and DEA License Qualifier

Subject: III. Clinical - C. Credentialing and Licensure

Effective Date: December 2019

Policy/Procedure: Fee Exempt CDS and DEA License Qualifier

Reviewed and/or Revised date: 2/27/2024, 8/13/2025

All Clinical Faculty who prescribe controlled substances need to have their own personal Maryland Controlled and Dangerous Substance (CDS) License and Federal Drug Enforcement (DEA) License. A copy of the CDS and DEA Licenses need to be on file with Clinical Affairs’ Director of Medical Credentialing and Quality Assurance.

Full time providers at State Institutions may have fees waived for their DEA and CDS Licenses. Anyone who is less than Full Time status may not qualify for this fee waiver. Anyone who treats patients outside of the UMSOD umbrella does not qualify. Exceptions for Faculty that are not Full Time and do not see patients outside of UMSOD’s umbrella will be evaluated on a case-by-case basis by either the Associate Dean of Clinical Affairs (Dr. DePaola), Assistant Dean of Clinical Affairs (Dr. Alkhubaizi), or Director of Clinical Operations (Dr. Windsor.)

Prescription Control System Policy

Subject: III. Clinical - C. Credentialing and Licensure

Origination Date: 1/1/10

Effective Date: 8/19/13, revised 5/6/16, 5/22/17

Reviewed and/or Revised: 09/01/2017, 05/16/2022, 1/20/2026

Purpose: The purpose of this policy is to ensure that faculty complies with prescription writing guidelines when prescribing medication for registered patients. This policy also ensures monitoring the type and quantity of medications being prescribed

Policy and/or Procedure:

Faculty appointees with clinical privileges may prescribe controlled and non-controlled substances as allowed by law and if such prescriptions are related to clinical education programs and related patient care activities of the school. The provider would need to use their individual DEA and CDS number where appropriate.

Applicable Regulations:

Annotated Code of Maryland State Law (Criminal Law Article Title 5 subtitles 1 - 11) Drug Enforcement Agency Regulations

Process for Prescriptions:

Prescriptions are sent electronically at the University of Maryland School of Dentistry using a module of axiUm entitled eRx.
Providers are registered with eRx under two categories. EPCS (Electronic Prescribing for Controlled Substances) or non-EPCS
ERx is launched via Axium for every patient when updating the medical history. Medication allergies are reviewed, and current medications can be downloaded to the axiUm patient record. Prescriptions can be sent electronically to the patient’s designated pharmacy. The PDMP (Prescription Drug Monitoring Program) can be accessed through the eRx module
Each clinic is to designate a phone number in their clinic to receive calls specifically for Prescriptions where a live person answers the phone and there is a voicemail message that is checked hourly.
Only Faculty with DEA and CDS Licenses may write and approve prescriptions for controlled substances in Axium. Faculty must be registered for EPCS prescribing.
Dean’s Faculty with DEA and CDS Licenses will be able to write or approve prescriptions for controlled substances in Axium if they are registered as an EPCS provider.

UMB Policy Concerning Licensure of Faculty and Staff Policy

Subject: III. Clinical - C. Credentialing and Licensure

Policy and/or Procedure: UMB Policy Concerning Professional Licensure of Faculty, Provider and Staff

Origination Date: 1/19/96

Reviewed and/or Revised: 01/19/1996, 09/11/2016, 02/01/2021, 03/30/2021, 3//1/12024, 8/5/2024, 3/28/2025, 8/13/2025, 1/08/2026

Purpose: To ensure Maryland State dental licensure according to the MSBDE requirements.

Appropriate licensure under Maryland law and regulations is required by UMB/UMSOD personnel holding any positions with responsibilities involving patient or client services for which licensure is required under State law. The Dean of each professional school, or an appointing authority or administrator designated by the Dean, is responsible for determining which positions in the faculty and staff require licensure and carry out this policy. For the UMSOD, the Director of Medical Credentialing and Quality Assurance is to ensure this policy is followed.
Volunteer personnel in positions requiring licensure shall be advised of this requirement in their appointment letters and shall be required to notify the Director of Medical Credentialing and Quality Assurance for UMSOD immediately upon the nonrenewal, suspension, or termination of a required license.
For salaried personnel in positions requiring licensure, the Director of Medical Credentialing and Quality Assurance for UMSOD should be notified to assure that appointees have and maintain required licenses, NPI and DEA numbers. This procedure may be followed with respect to volunteers and/or visitors in positions requiring licensure.
Licensure requirements should be made known to candidates and appointees to faculty/provider posts and other positions in the UMB employment system. Appointees shall be advised that licensure, including timely renewal of expiring licenses, is a condition of employment.
Any faculty or staff member failing to maintain a required license with the Director of Medical Credentialing and Quality Assurance for UMSOD due to nonrenewal, will be suspended from patient or client activities. Failure to hold and maintain a required license is grounds for termination of employment. To the extent permitted by university policies, compensation will be suspended or reduced if a faculty appointee or staff member is unable to perform employment responsibilities as a result of lack of appropriate licensure or conditions placed upon a license by a licensing body.
This policy shall take effect immediately.

All Department Chairman are to notify the Director of Medical Credentialing and Quality Assurance of any new faculty, residents, staff, and visitors before they are in the clinic(s). All Clinical faculty and staff are to be credentialed by the Director of Medical Credentialing and Quality Assurance before they can be in the clinics.

For visitors to UMSOD Clinics, see policy Titled: Visitors in UMSOD Clinics or NON-UMSOD Student and/or International Scholars Shadowing a Resident in Post Grad and Predoc Clinics.

Faculty Licensure Verification

The School of Dentistry requires that all faculty members and providers of care who are involved in patient care or the supervision of patient care maintain a valid license from the Maryland State Board. As part of the initial appointment process, clinical faculty/providers who will be involved in patient care or the supervision of patient care activities must provide a copy of a current Maryland License, and CPR Certificate. Also, they must provide evidence of continued licensure through submission of copies of all renewal license certificates prior to expiration. Faculty members and/or providers of care without valid proof of licensure are not allowed to participate in patient care or the supervision of patient care activities. The Director of Medical Credentialing and Quality Assurance monitors and keeps on file copies of current state license and CPR Certificate for each faculty member and/or provider who are in the UMSOD Clinic for Accreditation and Liability Insurance purposes.

Basic Life Support

The School of Dentistry has implemented a policy that requires all faculty/provider and appropriate clinical support staff to be bi-annually renewed in cardiopulmonary resuscitation (B.L.S.) which is monitored by the Director of Medical Credentialing and Quality Assurance. The CPR Training Center, in the School of Dentistry, presents the training program and maintains a computerized record of the status of all individuals who are required to be annually renewed.

Faculty, students and staff are trained in CPR/BLS and are required to renew their CPR/BLS certification every two years. These CPR/BLS renewal courses are presented by an American Heart Association certified training center. This independent contractor is hired by the school to teach the published standards of the American Heart Association’s CPR course at the “Healthcare Provider” level of training. In addition, each CPR/BLS course provides school- specific information on the management of medical emergencies. A list of successful participants is sent to the Director of Medical Credentialing and Quality Assurance. This list is entered into a computerized CPR database and monitored by the Director of Medical Credentialing and Quality Assurance.

A written protocol for the prevention and management of medical emergencies was developed for all clinical programs, which is published in the online Clinic Manual. This section includes information on emergency recognition, initial management, and procedures for activating the emergency medical system. Prevention policies are based on appropriate screening and evaluation protocols. There are numerous prevention policies described throughout the online Clinic Manual. Some of the topics included are policy regarding monitoring blood pressure, dental care for pregnant patients, pre-medication policy, and oral medicine screening protocols.

Credentialing information/documents required from each provider cohort

For Clinical Faculty:

Name

Title

Full-/Part-time (FT/PT) or Dean’s Faculty (DF)

Full-time equivalent (FTE)

Start Date

Department (include discipline if AOST)

Copy of Maryland Dental License

DDS or DMD

Specialty

Copy of Specialty Certificate (if applicable)

Copy of CPR for Healthcare Provider

Copy of Federal DEA License* (only needed if prescribing controlled substances)

Copy of CDS License* (only needed if prescribing controlled substances)

NPI Number

Confirmation of registration with Maryland PDMP/CRISP

Personal Email address

Phone Number (cell number for pharmacy to call)

Faculty Responsibility Statement signed by provider and chairman**

Completed Hep B Form

Completed OSHA Questionnaire [page 1, check off both a and b (half face) and sign page 3 of the form] After the form is medically cleared, then a fit test may be scheduled (if for faculty, once appointment letter is signed by the Dean.)**

Signed Subpoena Policy (Only needed for those faculty at Access Carroll and Frederick since information now contained in the HIPAA Blackboard Assessment)

Confirmation of successful completion of Blackboard Clinic Essentials

*For those Faculty or Dean’s Faculty who will not be prescribing controlled substances and who do not and will not have EPCS eRx prescribing privileges, will not need to have a copy of their DEA and CDS License on file with Clinical Affairs. For those providers that prescribe controlled drugs at Access Carroll and Frederick dental clinics, a copy of their current CDS and DEA licenses need to be on UMSOD Clinical Affairs’ file.

** If appointed to work in the Access Carroll or Frederick dental clinics, this information is not needed.

NOTES:

If Faculty is offsite overseeing UMSOD students, who are seeing the Affiliate’s Patients while at the Affiliate’s location, does not use Axium and does not cover any clinics in the UMSOD, Faculty would be trained by the appropriate site and not need to take Blackboard Assessments.
For Full Time Faculty: If Faculty will be in Faculty Practice and billing claims, the Director of Medical Credentialing and Quality Assurance is to be notified at least 3 months prior so a credentialing packet can be sent containing Dental Insurance Company forms to be completed by the Faculty provider and returned to the Director of Medical Credentialing and Quality Assurance.
Notify the Director of Medical Credentialing and Quality Assurance when the faculty provider is no longer in the clinics or employed by UMSOD for Liability Insurance purposes.

For Faculty NOT in the UMSOD clinics and only at the Global Program (Dominican Republic) Site Dean’s Faculty, the following is needed:

Name

Title

Full-/Part-time (FT/PT) or Dean’s Faculty (DF)

Full-time equivalent (FTE)

Start Date

Department (include discipline if AOST)

Copy of Maryland Dental License or Current Dental License in the State they practice dentistry

DDS or DMD

Specialty

Copy of Specialty Certificate (if applicable)

Copy of CPR for Healthcare Provider

Personal Email address

Phone Number (cell number for pharmacy to call)

Completed Hep B Form

Signed Subpoena Policy

For Pre-clinical Faculty:

Name

Title

Full-/Part-time (FT/PT) or Dean’s Faculty (DF)

Full-time equivalent (FTE)

Start Date

Department (include discipline if AOST)

DDS or DMD

Copy of CPR for Healthcare Provider

Personal Email address

Phone Number (cell number for pharmacy to call)

Completed Hep B Form

Completed OSHA Questionnaire [page 1, check off both a and b and half face and ensure to sign page 3 of the form.] After the form is medically cleared, then a fit test may be scheduled (once appointment letter is signed by the Dean.)

Once appointed and has UMB ID:

Confirmation of completed and passed Blackboard Assessments

Notify the Director of Medical Credentialing and Quality Assurance when the faculty provider is no longer in the clinics or employed by UMSOD for Liability Insurance purposes.

For Lecturers and Researchers:

Name

Title

Full-/Part-time (FT/PT) or Dean’s Faculty (DF)

Full-time equivalent (FTE)

Start Date

Department (include discipline if AOST)

DDS or DMD

Personal Email address

NOTE: Notify the Director of Medical Credentialing and Quality Assurance when the Lecturer or Researcher is no longer employed by UMSOD for Liability Insurance purposes.

For Fellows:

FT/PT

Start Date

Department

Copy of Maryland Dental License*

DDS or DMD*

Copy of CPR for Healthcare Provider

NPI Number*

Completed OSHA Questionnaire [page 1, check off both a and b (half face) and ensure to sign page 3 of the form] After the form is medically cleared, a fit test may be scheduled.*

Confirmation of completed and passed Blackboard Assessments

NOTES: Notify the Director of Medical Credentialing and Quality Assurance when the Fellow has graduated or is no longer in the clinics for Liability Insurance purposes.

For ODS Fellows, NPI and Licensure may not be needed for the first year.

*Information not needed for OMFS Fellows.

For Residents and Students:

Copy of CPR for Healthcare Provider

Completed OSHA Questionnaire [page 1, check off both a and b (half face) and ensure to sign page 3 of the form]. After the form is medically cleared, then a fit test may be scheduled. *

Confirmation of completed and passed Blackboard Assessments

NOTE: Notify the Director of Medical Credentialing and Quality Assurance when the resident or student has graduated or is no longer in the clinics for Liability and Insurance purposes.

*Information not needed for OMFS Fellows.

For Staff Dental Hygienists:

Full-/Part-time (FT/PT)

Start Date

Department

Copy of Maryland Dental Hygiene License

Any Certifications held by Dental Hygienists other than license and CPR

Copy of CPR for Healthcare Provider

Completed Hep B Form

Completed OSHA Questionnaire [page 1, check off both a and b (half face) and ensure to sign page 3 of the form]

Confirmation of completed and passed Blackboard Assessments

NOTE: Notify the Director of Medical Credentialing and Quality Assurance when the Dental Hygienist is no longer in the clinics or employed by UMSOD for Liability Insurance purposes.

For Staff Dental Assistants:

Full-/Part-time (FT/PT)

Start Date

Department

Copy of Maryland Dental Radiation Tech Certification (IF TAKING RADIOGRAPHS)

Copy of CPR for Healthcare Provider

If a Qualified or Certified Dental Assistant -Copy of certification

Completed Hep B Form

Completed OSHA Questionnaire [page 1, check off both a and b (half face) and ensure to sign page 3 of the form]. After the form is medically cleared, then a fit test may be scheduled.

Confirmation of completed and passed Blackboard Assessments

NOTE: Notify the Director of Medical Credentialing and Quality Assurance when the Dental Assistant is no longer in the clinics or employed by UMSOD for Liability Insurance purposes.

For Staff Nurses:

Full-/Part-time (FT/PT)

Start Date

Department

Title

Copy of Maryland Nurse’s License

Copy of CPR for Healthcare Provider

Copy of Advanced Cardiac Life Support (ACLS) Certification

Completed Hep B Form

Any Certifications held by Nurses other than license and CPR

Completed OSHA Questionnaire [page 1, check off both a and b (half face) and ensure to sign page 3 of the form]. After the form is medically cleared, a fit test may be scheduled. *

Confirmation of completed and passed Blackboard Assessments

NOTE: Notify the Director of Medical Credentialing and Quality Assurance when the Nurse is no longer in the clinics or employed by UMSOD for Liability Insurance purposes.

D. Dental Laboratory

Dental Laboratory Controls Policy

Subject: III. Clinical - D. Dental Laboratory

Effective Date: July 1 2008

Reviewed and/or Revised: 09/01/2017, 7/31/2025

Purpose

All laboratory cases must be submitted through the in house laboratory office.

Scope (applies to):

This policy applies to: CMS

Faculty/Lab Staff
Resident
Student

Policy and/or Procedure

Policy Statement:

UMSOD will assure that student work is of acceptable quality prior to being sent to a commercial dental laboratory.
All cases are reviewed by the Director of the Laboratory with occasional review by the Director of Undergrad Prosthodontics, if needed.
Faculty shall review and evaluate the quality of submitted case and the finished product of in-house and commercial laboratories. If, as a result of faculty review, work submitted is deemed unsatisfactory for continuation, the Laboratory Director or designee resolves the issue and the work is re-submitted. If, as a result of faculty review, the quality of work returned from a commercial dental laboratory is deemed unsatisfactory, the work shall be re-done and provider notified about the delay. The Laboratory Director shall notify a commercial lab if the quality of work is consistently unsatisfactory.
Beyond the random Faculty review or in the event the Faculty review is not available the Laboratory Director or designee shall review and evaluate the quality of all submitted cases. The Laboratory Director or designee resolves the issues so the work can be re-submitted.
Precious metal inventories shall be safeguarded.
Logs tracking the use of precious metals shall be reviewed for accuracy at least annually and reconciled with inventories.

Purpose:

To ensure that unrecovered costs for manufactured dental prostheses are minimized and the probability of acceptability of manufactured dental prostheses are maximized.

Keywords:

None

Policy Owner(s):

Endodontics, Prosthodontics, Operative Dentistry Chair

Applicable Regulations:

None

Recourse for Non-Compliance:

Judicial Policy

Dispensing Precious Metals Procedures

Subject: III. Clinical - D. Dental Laboratory

Reviewed and/or Revised: 09/01/2017, 02/28/2024, 07/31/2025

Purpose

Assure that UMSOD precious metal inventories are used as intended
Provide a method to cost-out precious metal used in dental prosthetics.

Policy and/or Procedure

Practitioner who will be fabricating a dental prosthetic presents a Prosthodontics Prescription Form (#01.11066 or #01.12013) specifying precious metal as the material
Dental Lab staff weighs precious metal
Dental Lab staff dispenses precious metal
Dental Lab staff records in running gold inventory ledger amount provided to practitioner

Laboratory Quality Controls Policy

Subject: III. Clinical - D. Dental Laboratory

Origination Date:

Effective Date:

Reviewed and/or Revised: 09/01/2017, 02/28/2025, 07/31/2025

Purpose

Facilitate process of delivering dental prosthesis which are appropriate for patient placement; Minimize remakes. All laboratory cases must be submitted through the in house laboratory office.

Policy and/or Procedure

Complete disinfection : performed by student
Complete laboratory prescription form in Axium lab tracking with appropriate patient and clinical information : performed by student
Reception staff : perform financial verification
Note ADA code(s) : performed by reception staff
Indicate that finances are in order : performed by reception staff
Present Axium lab order to supervising faculty : performed by student
Authorize laboratory prescription with swipe card, including provider number : performed by supervising faculty member
Print label then carry completed label and disinfected materials to the office of the Laboratory Director : performed by student
Examine case to insure it is administratively and technically correct : performed by Laboratory Director or his designee
Review quality of materials submitted by student, performed by Laboratory Director or designee, if not part of random Faculty review.
Ship case to commercial dental laboratory : performed by laboratory Staff
Upon return from the commercial dental laboratory perform quality check : performed by Laboratory Director or his designee
Retrieve from the office of the Laboratory Director the completed prosthesis from the dental lab office : performed by student
Post the copy of the laboratory prescription form to the patient record : performed by student

E. Emergencies

Emergency Egress Safety Policy and Procedure

Subject: III. Clinical – E. Emergencies

Department: Clinical (Copy of Policy in section IV. Facilities B. Management)

Effective Date: 06/01/2008

Reviewed and/or Revised: 9/01/2017, 2/13/2026

Purpose

Provide clear, safe exit access for students, faculty, and staff to safely exit campus buildings in case of fire or other emergency. Minimize the hazards to firefighters when doing search and rescue or trying to reach and extinguish fires within University buildings.

Background

The State Fire Marshal's Office has been directed by state law to enforce laws, regulations, and standards pertaining to fire safety. The State Fire Prevention Commission has established a Fire Prevention Code that applies to buildings within the State of Maryland. All University buildings are affected by these fire prevention requirements.

By reference the State Fire Prevention Commission has adopted the National Fire Protection Association (NFPA) Life Safety Code. Section 9-2.5.6.1 of the Life Safety Code, which applies to all campus buildings, states that "a means of egress (exit) is a continuous and unobstructed way of exit travel from any point in a building or structure to a public way." This includes intervening room spaces, doorways, hallways, corridors, passageways, balconies, ramps, stairs, enclosures, and lobbies.

Many buildings are faced with storage problems, and the corridors are being used for storage. In some instances storage has escalated to the point that it presents a fire safety hazard to building occupants and firefighters.

For additional information regarding this policy, please refer to the UMB Occupant Emergency Plan (PDF).

Managing Dental Emergencies after Hours Policy and Procedure

Subject: III. Clinical - E. Emergencies

Department: Oral and maxillofacial surgery

Origination Date: 11/1/2008

Effective Date: 12/1/2008

Reviewed and/or Revised: 09/01/2017, 02/25/2022, 1/28/2024, 2/03/2025, 8/13/2025, 12/10/2025

Purpose:

Qualified dental personnel will be on call after hours to receive and triage emergency phone calls from active patients of record. The qualified dental personnel will be affiliated with the University of Maryland Dental School. This person will be a Dentist, resident, Patient Care Coordinator, or a Dental assistant with a minimum of 10 years of experience. The dental personnel providing this service must be approved by the Clinic Administration Committee.

Active patients of the School of Dentistry who experience a dental emergency “after-hours” or on the weekend may call (443) 827-5011 to speak with a School of Dentistry staff member.

Active patients of record who have a dental emergency during regular business hours may contact the Patient Care Coordinator at their assigned clinic.

Urgent Care / Screening / Orals Surgery / PLUS / Special Care & Geriatrics may call 410-706-8127
Undergraduate Dental Clinics on 1st, 2nd, and 3rd floor may call 410-706-8127
Advanced General Dentistry Clinic on 2nd floor may call 410-706-4428 or 410-706-4156
Orthodontics / Pediatric Dentistry on 3rd floor may call 410-706-0768
Endodontics / Prosthodontics / Periodontics on 4th floor may call 410-706-8111

Definitions:

Active patient of record: A patient that is in current treatment with an Undergraduate Dental Student or Post-Graduate Resident.

Patients who are inactivated or not assigned to a Dental Student are not considered active patients.

Patients who have been treated through the Urgent Care Clinic are not considered active patients unless they have an emergency associated with a recent area of treatment that was performed at the Dental School.

Policy:

This person will be a Dentist, Resident, Patient Care Coordinator, or a Dental Assistant with a minimum of 10 years of experience. The Clinical Affairs Board must approve the dental personnel providing this service.

This on call service is provided for active patients of record only. Patients are considered active patients of record if they are in current treatment with an Undergraduate Dental Student or Post Graduate Resident. Patients who are inactivated or not assigned to a Dental Student are not considered active patients. Patients who have been treated through the Dental School’s Urgent Care Clinic are not considered active patients unless they have an emergency associated with the recent area of treatment at the Dental School.

Procedure:

On call schedule:

Each clinical area has Dental faculty available as a contact for after hour emergencies. Any changes to covering faculty must be reported to the Director of Urgent Care (Dr. Mostoufi) and the person triaging the after hour emergencies.

On call responsibilities:

Be accessible by pager (from 5pm until 9am on weekdays when the dental school clinics are open and 24 hours per day on the weekends and on weekdays when the dental school clinics are closed).
Consult with and triage “emergency” calls for the University of Maryland Dental schools active patients of record.
Affirm that the patient calling is an active patient of record by accessing axium on a laptop computer that is provided by the dental school. Axium may also be used to verify any recent treatment or prescriptions given to the patient.
Assess the situation and manage the treatment of afterhours “emergency” patients during non-clinic hours.
Contact the on call Oral Surgery or Pediatric dental resident for assistance with emergency conditions that may require the patient to be seen in the hospital during non-clinic hours.
Contact the dentist faculty member assigned to the clinic where the patient was treated
Contact pharmacy for any medications prescribed by dental faculty on call.
Maintain a log of all of all phone inquiries which will include the following information:
1. Patient name and telephone number
2. Patient chart number
3. Date and time of call.
4. Dental clinic in which comprehensive treatment is usually provided (name of dental student or resident patient is assigned too).
5. Chief complaint and history of present condition. (Esthetics are not considered an emergency situation.)
6. Name of on call resident patient was referred to if patient is a post-graduate patient.
7. Name of faculty that was contacted to handle the after hour emergency decisions and prescriptions if needed.
8. Treatment advised (referral, medications, immediate clinic evaluation, follow-up appointments)
9. Contact the student or resident that is assigned to the patient and inform them of the situation.
Patients referred to a hospital by the on-call faculty are advised to go to the University of Maryland Medical Center or Sinai Hospital of Baltimore Emergency Room rather than other hospitals if possible. Example of reasons that may require referral to the hospital.
1. Trauma to teeth or the peri-oral area.
2. Fever, swelling, toothache interfering with eating or sleeping
3. Difficulty swallowing, difficulty breathing, or trismus.
When a patient is referred to a hospital, they shall be notified that any costs associated with their visit to the hospital will be the patient’s responsibility and not associated with the School of Dentistry.

Response to Medical Emergency or Adverse Incident Policy and Procedure

Subject: III. Clinical - E. Emergencies

Department: Clinical

Effective Date: 6/1/2008

Reviewed and/or Revised: 9/01/2017, 2/25/2022, 2/03/2025, 3/28/2025, 8/13/2025, 9/16/2025, 12/04/2025, 1/15/2026, 1/20/2026

Purpose:

The primary purpose of this procedure is to ensure any individual experiencing a medical emergency or adverse incident is cared for in an appropriate manner, and that all adverse incidents are reported to an SOD nurse. In addition, the purpose of adverse incident reporting is to identify actual problems or potential risk circumstances that must be eliminated or minimized to prevent personal injury or property loss or damage

Adverse incident reports are to serve as:

An early detection system for problems and compensable occurrences;
A foundation for an early investigation of all potentially serious occurrences;
A database for long-range problem detection, analysis and correction;
A cross-reference with other risk detection systems.
Instances where further training may be necessary.

Definitions:

Adverse Incident: An unexpected event, action, mishap (with or without injury), or serious expression of dissatisfaction related to the perception that there has been or could be an injury, inappropriate treatment, or neglect involving a patient, visitor, student/resident, or employee which either, immediately affects the safety or health of an individual or individuals directly involved, or may affect the safety and/or health of an individual or individuals, if timely appropriate intervention does not occur.

Adverse Incident Classification (5 categories):
1. Behavioral Incident
  1. occurs secondary to psychiatric illness, aggression or behavioral misconduct
2. Clinical Incident
  1. an injury or affliction, or perception of that inappropriate treatment or neglect, that has occurred to a patient secondary to SOD treatment (necessitates notification of the Clinical Supervisor, Department Chair, and the Dean of Clinical Affairs, in addition to an SOD nurse)
  2. any clinical infection control infraction that places a staff or patient at risk for injury and/or exposure (a clinical infection control infraction that results in staff or patient exposure, will be classified as an Exposure)
3. Exposure
  1. needlestick or sharps injury involving blood or other potentially infectious materials (OPIM)
4. Major Injury / Major Medical Emergency
  1. ill or injured individual required emergency medical treatment outside the SOD (if a Major Injury or Major Medical emergency is directly related to the patient’s dental treatment, it is classified as a Clinical Incident)
5. Minor Injury / Minor Medical Emergency
  1. ill or injured person did not require emergency medical treatment outside the SOD (if a Minor Injury or Minor Medical emergency is directly related to a patient’s dental treatment, it is classified as a Clinical Incident)

Adverse Incident Form): Report of Special or Adverse Incident): form located in Injury Packets inside nurses’ door bins, or online via the Clinical and Academic Support Documentation icon on the desktop, should be used to record details on paper until they can be provided to an SOD nurse to be used for an online incident report (done by nurses only)
AED (automated external defibrillator): A device that automatically analyzes the heart rhythm and delivers a shock to restore a normal heart rhythm, if it detects a problem that may respond to an electrical shock. Monitored remotely by Technical Services Department.
Bloodborne: Carried or transmitted by the blood, as in a bloodborne pathogen (BBP).
Campus Police Emergency number: 911 (no need to dial 9 first). Campus police monitor 911 calls from the campus. 911 is the number dialed from any SOD clinic or office phone that links directly to the Campus Police Emergency Response line (no need to dial 9 first). This number is used in the event of a Major Injury/ Major Medical Emergency when an ambulance is required, and also to have an officer arrive to diffuse a behavior situation to maintain safety of all involved (email details of the incident to the Dental-Emergency Response Team at DL-Dental-EmergencyResponseTeam@umaryland.edu as soon as possible whenever there was a need to have campus police intervene)
Emergency Cart: A red portable container holding all the equipment and medicines that a dental school nurse or doctor would need to assist an individual in case of a medical crisis. In addition, there are portable bags in each nurse room that contain all emergency equipment and medications “grab and go” bags. Crash carts and portable bags are checked regularly by SOD nurses to ensure contents are secure and updated as needed.
Emergency Response Team, (SOD ER Team, or ERT): A group of five individuals (nurses and two faculty members) all certified in advanced cardiac life support (ACLS) that are on call via the Emergency Response Team paging (see definition) and available to assist during any type of adverse incident. ERT doctors and nurses are never to be paged individually, with one exception. Faculty can be paged individually for Major Medical Situations when there has been no response from an ER Team member after the Emergency Response paging system has been activated twice. Attending faculty at the scene of the adverse incident/emergency will act as a back-up should ER Team members be unavailable to respond to a page. ER Team nurses may be paged individually for routine glucometer readings and blood pressure checks.

	Phone #	Room
RN II (Oral Surgery Nurse)	6-2057	2325
RN II (Urgent Care Nurse)	6-4026	2325
RN II (Infection Control Nurse)	6-6344	4317
RN II (Dental School Nurse)	6-8991	3322
LPN (Dental School Nurse)	6-7496	2206
Dr. D. Everett (Director, Oral Surgery)	301-801-9091	1208
Dr. G Winter (Anesthesiologist)	6-2012	3215

Emergency Response Team Paging System: Using an SOD phone, dial 6-8128. When the Vocera Genie answers, say “URGENT BROADCAST EMERGENCY TEAM”. Repeat this page if the ER Team has not responded within 5 minutes. Note, it is permissible and encouraged for the Emergency Response Team Paging System to be used to acquire the assistance of a nurse for a non-emergency purpose that cannot be scheduled in advance, rather than time be spent searching for one who is available.
Exposure / Cutaneous Exposure/ Double Exposure / Occupational Exposure / Percutaneous Exposure / Mucocutaneous Exposure:
1. Exposure: contact with (or potential contact with) microorganisms, or pathogens, via blood or other potentially infectious material.
2. Cutaneous Exposure: exposure to the skin surface
3. Double Exposure: occurs when a dental provider sustains a skin puncture/glove breech, by a sharp item contaminated with the patient’s blood or saliva and then reuses that same sharp item on the patient meaning that both individuals are now sources or potential sources of infection for one another.
4. Mucocutaneous Exposure: exposure via a splash to the inside of the eyes, nose or mouth (mucous membranes).
5. Occupational Exposure: refers reasonably anticipated contact with blood or other potentially infectious materials by healthcare workers with non-intact skin, especially as a result of a puncture, bite, cut, or abrasion, or a splash into the eyes, nose, or mouth (mucous membranes), as a result of their job duties.
6. Percutaneous exposure: exposure via a puncture through the skin (also known as parenteral contact or exposure)
HBV: means hepatitis B virus
HCV: means hepatitis C virus
HIV: means human immunodeficiency virus
Injury Packet(s): Large 8" X 11" Manilla envelopes containing directions, and forms designed to assist with Staff with Injury Reporting, if a nurse is not immediately available to provide the necessary forms. They are labeled Student/Resident, Employee (corporate and State), and Volunteer, and in addition there is also a radiology Packet to be used if a patient swallows an object.
Other Potential Infectious Materials (OPIM) in dentistry means:
1. Saliva, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids;
2. Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and
3. HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV.
Pathogen: An agent that causes disease, especially a living microorganism such as a bacteria, virus or fungus.
Source Individual (may be a patient, staff member or student): means any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to the employee.

Procedure:

I. When a patient, visitor, or staff member is in physical distress or in need of immediate assistance because of an adverse incident, getting help is the 1st priority.

Page the SOD, ER Team

Using an SOD phone, dial 6-8128. When the Vocera Genie answers, say “URGENT BROADCAST EMERGENCY TEAM”. Repeat this page if the ER Team has not responded within 5 minutes.
Return to assist with the emergency
1. Make sure the ill or injured person is positioned to prevent further injury; lower head/raise feet if person is feeling faint or has fainted unless doing so will cause further injury
2. Look for the ER Team and escort them to the emergency
3. If not already available, ask someone to get the nearest Emergency Cart/Oxygen tank for oxygen support and/or be prepared to get the AED and begin basic CPR as needed; remember C-A-B (Compressions, Airway, Breathing)
4. Start oxygen with a nasal cannula at 2-4 L/min for oxygen support, or use a non-rebreather mask if patient is distressed due to shortness of breath, set between 10-15 L/min (make sure bag is inflated)
5. Repeat the page if no one arrives in 5 minutes and defer to attending faculty for guidance.
  1. Faculty will manage the adverse incident if no response after the Emergency Response Paging System has been activated twice
6. Report details to an SOD nurse as soon as possible, not to exceed 24 hours.

II. When a patient, visitor, or staff member is unconscious:

Call 911 followed by a page to the SOD Emergency Response Team.
- Using an SOD phone, dial 6-8128. When the Vocera Genie answers, say “URGENT BROADCAST EMERGENCY TEAM”. Repeat this page if the ER Team has not responded within 5 minutes.
Defer to attending faculty for guidance while waiting for emergency responders
Attending Faculty will:
1. Direct someone to the 1st floor lobby to alert the officer, and escort emergency personnel (EMS) when they arrive.
2. Direct someone to retrieve the nearest emergency cart/ Oxygen tank, and AED as needed, and be prepared to perform BLS (a copy of the BLS algorithm is located inside the white folder on top of the emergency cart along with a pen and copies of the Emergency Response Worksheet to record observations and vital signs, to have on hand to report to emergency responders when they arrive.
3. For a patient with minimal respiratory distress, start oxygen with a nasal cannula at 2-4 L/min for oxygen support. Use a non-rebreather mask if patient is breathing normally, if patient appears to be short of breath, but respirations are regular and set, the oxygen delivery rate between 10-15 L/min, making sure bag is inflated. Monitor the patient’s vital signs.
4. If the campus police or an ambulance were needed, email the DL-Dental-Emergency Response Team at DL-Dental-EmergencyResponseTeam@umaryland.edu as soon as possible (this will be done by a member of the Emergency Response Team, if a member is available.)

III. When a patient or visitor is behaving aggressively:

Dial 911, then page the SOD ER team
- Do not try to intervene on your own!
- If a member of the SOD ERT team does not arrive after a repeat page, email details of the incident to the Dental-Emergency Response Team at DL-Dental-EmergencyResponseTeam@umaryland.edu as soon as possible. The team will receive the email ensure an incident report is filed, and follow-up as needed,

IV. Emergency Supply locations:

AEDs
1. AED locations (look for and follow wall mounted AED signs)
  1. Ground floor; next to the School Store
  2. 1st floor: look for AED sign off main corridor in a side hallwayin Urgent Care Clinic. There is a second AED in the Oral Surgery sedation room on the main hallway.
  3. 2nd, 3rd, and 4th floor; look for, and follow wall mounted AED signs
2. Emergency Carts dispersed throughout every clinical and non-clinical area; located:
  1. Adjacent to the AEDs on the lower level through 4th floors and in various hallways off the main corridor on:
    1. 1st thru 4th floors

V. Wheelchair* locations:

*Wheelchairs must be checked out at front desk locations (patients must leave a valid ID until chair is returned). Wheelchairs checked out from a nurse’s office, must be checked out from the nurse, and returned to the same location ASAP.

1st floor in:
- and, in the nurse's room in Faculty Practice
2nd floor:
- In the GP waiting area behind the reception desk
- In GP nurse’s office adjacent to the GP waiting area, room 2318
3rd floor:
- In the GP waiting area behind the reception desk
- In the GP nurse's office adjacent to the GP waiting area, room 3322
4th floor:
- In the nurse’s office, room 4317

VI. Fire Alarms:

If a patient can walk without a cane or need of assistance:
- exit the building though the nearest doorway, using the stairs as necessary
If a patient has been sedated or is unable to walk without assistance:
- have the patient remain in the treatment chair/area, and alert the Fire Warden on patrol regarding the situation, or
- proceed to the nearest stairwell (Area of Rescue Assistance), until help arrives or the all clear has been given.

Ensure all doors are closed to prevent the potential spread of fire.

Do not put yourself, your patient, or others at risk by trying to exit via a stairway

VII. Patient Injury and Sudden Illnesses, Allergic Reaction, or if a Patient Swallows Something:

1.) Patient Injury

No matter how minor and injury may seem, you must inform an SOD nurse as soon as possible if a patient informs you they were injured…
- on the way into the building,
- once inside the building and/or
- if you patient was injured as result dental treatment received
- if a double exposure occurred (patient exposed after student or staff injury with a contaminated instrument or needle)
An SOD nurse will come to the area to assess the injury and record the details in an incident report (minor injuries or non-injuries (for example, a fall with a non-injury) mentioned by a patient will still need to be assessed and the nurse's observations recorded)
- if a dental school nurse or faculty ERT member is not present after a second ERT page, record details of the patient’s incident and your observations, and give the details to an SOD nurse either in a secure email, or in person at the next opportunity
- For double exposures, when a nurse is NOT present:
  - Attending faculty will explain to the patient what happened, and review medical history for risk of Bloodborne infection, i.e., history of IV drug use, dialysis, as well as any recent lab work for BBP screening. Negative HIV and Hepatitis C results within the past 30 days, can be accepted in lieu of Bloodborne pathogen screening at the SOD.
  - The student or faculty with whom the patient was exposed, will be requested to share any personal pertinent medical history with their patient, and shall also explain to the patient that they will be screened for Hepatitis C and HIV as recommended by OSHA, by a School of Dentistry nurse at the earliest opportunity, and the patient will be informed of the results. This can be done in the nearest nurse’s office for privacy as needed (room 4317, and room 2318 are also open at night)
  - Do not intimidate the patient or student/faculty if they refuse screening, contact the Bloodborne Pathogens Exposure Hotline at 667-214-1899 for advice regarding exposure risk, and follow-up. Do not go the ER without a referral from the BBPE Hotline; most dental exposures are low risk, and current guidelines do not recommend prophylaxis medications for exposures of minimal risk (but prophylaxis drugs will not be refused if the exposed person requests them). Likewise, if a patient becomes upset regarding being exposed to a student or staff member, and about having to wait until the next opportunity the nurse is available (i.e., the next day) to receive the source student or staff BBP screening results, then staff manning the BBPE Hotline can also address patient exposure risk and phone ahead to the ER for prophylaxis medications for the patient if requested or recommended by the BBPE hotline. The patient will be informed that any bills received after their insurance is paid will be paid by the School of Dentistry.
  - If the patient is willing to undergo screening, inform the nurse when reporting the incident when the patient’s next appointment is scheduled as they can be screened then. Inform the patient that screening is free of charge and takes approximately 20 minutes. Testing for HIV & Hepatitis C requires a drop of blood from their finger. They will receive a copy of all results for their records. Results are not placed in their dental charts.
    - EXCEPTION: A blood draw is necessary if the source patient is under 17 or pregnant. Rapid HIV & Hepatitis C antibody screening is not approved for children under age 17 and not approved for pregnant women, according to current FDA regulations.

2.) Patient Sudden Acute Illness:

If a patient reports not feeling well, notify attending faculty, and page the SOD Emergency Response Team as previously described, and per faculty assessment
1. Faculty will take command of the situation while SOD ER Team is in route, and/or if the ER Team is unavailable after a second page.
2. Rescue medications (non-narcotic) and supplies are located in the closest emergency cart
  - Emergency cart medications listed below, are only to be administered by a DDS, MD, RN or LPN, if that individual is familiar with the medication and it’s use, and never by a student (SOD nurses will only administer medications under MD or DDS direction)
  - The following supplies are located inside emergency carts (in addition to the medications above), are listed by their intended use (notify an SOD, as soon as possible nurse if one is not present, so supplies used can be replaced).
3. Nurse, or faculty ERT member, is not present after a second ERT page, record details of the incident, and give the details to an SOD nurse either in a secure email, or in person at the next opportunity
4. When attending faculty and/or SOD ER Team members direct an ambulance to be called via the Campus Police at 911, the patient, or parent /guardian of the patient may refuse the ambulance
  - If there is a Refusal of Ambulance, have the individual involved complete the Refusal of Ambulance document for Adults, or Adult or Minor with a Guardian document as applicable; located in a folder on nurses’ office doors and/or in the white binder on top of each emergency cart)

3.) Patient Allergic Reaction:

If a patient reports mild rash and or itching, notify attending faculty, and page the SOD Emergency Response Team as previously described, and per faculty assessment, especially if a reaction to dental materials is known or suspected.
- Faculty will take command of the situation while SOD ER Team is in route, and/or if the ER Team is unavailable after a second page. They will:

Reassure the patient,
Closely monitor vital signs,
Direct someone to retrieve the nearest emergency cart and administer 25-50 mg of Benadryl (diphenhydramine) by mouth, as needed (located inside the emergency cart).
Call 911 immediately to request an ambulance, followed by a page the emergency response team if the SOD ERT has not been paged, and/or If patient’s symptoms progress to swelling or itching of the throat, or breathing difficulty occurs,
Email details of the incident to the Dental-Emergency Response Team at DL-Dental-EmergencyResponseTeam@umaryland.edu as soon as possible if an ambulance was required, and if there was no response from the Emergency Response Team, the ER Team will receive the email, and ensure an incident report is filed, and follow-up as needed.
Report details of any incident that remains a Minor Injury/Minor Medical Incident to any dental school nurse as soon as possible

For Sudden Moderate to Severe Allergic reaction; patient has hives, swelling of face, lips, tongue, or throat; difficulty breathing, chest tightness
- Faculty will direct 911 be called, followed by a page of the ER Team and take command of the situation while SOD ER Team is in route, and/or if the ER Team is unavailable after a second page. They will:
  - Start Oxygen vial mask at 10- 15 L min
  - Ask patient if they have had a similar reaction in the past and if they have an epi pen with them. If not, look inside the cart for an epinephrine auto injector, follow directions on the auto injector for administration, if comfortable doing so (epinephrine 1:1000 in vial form is also available for use by an MD or DDS, and can be administered per Intramuscular injection to the lateral thigh for the quickest absorption or deltoid muscle- the adult dose according to the American Academy of Allergy, Asthma, and Immunology, is 0.3-0.5 cc of 1:1,000 concentration. The dose can be repeated every 5 to 15 minutes depending upon the response for 3 to 4 doses. The same is true for children except the dose is 0.01mg/kg
  - Encourage patient to inhale two puffs of Albuterol Sulfate, waiting 1 minute between inhalations (spacers are available in the emergency cart)

4.) Swallowing foreign body material: Aspiration or Ingestion:

If a patient swallows a foreign body during treatment, or it is thought that they may have swallowed something, notify attending faculty, and page the SOD Emergency Response Team as previously described
- Faculty will take command of the situation while SOD ER Team is in route, and/or if the ER Team is unavailable after a second page.
- If a dental school nurse or faculty ERT member is not present after a second activation of the Emergency Response System, record details of the incident, and give the details to an SOD nurse either in a secure email, or in person at the next opportunity
When the patient is medically stable (no shortness of breath, coughing, etc.) after swallowing or possibly having swallowed something, the student or resident treating the patient will follow the instructions or the nurse/faculty ER team member(s) present, or if none is available after a second ERT page, will obtain a Radiology Request Form from inside the Radiology Request Form Packets available on nurses’ office doors (rooms 2206, 2325, 3322 or 4317). Instructions for x-raying a patient to verify object placement (or no object visible) are located both on the outside and inside of the Radiology Packet.
- If the patient states they do not want an x-ray, document this in the chart and have the note approved by faculty. The patient should be advised to look for the item to pass in their stool, and or to report to their dental provider and their physician if they have any symptoms of increased abdominal pain, or discomfort, or breathing difficulty).
If the patient has shortness of breath, uncontrollable coughing, or any other signs of respiratory involvement, initiate oxygen with a nasal cannula at 2-4 L/min for oxygen support. Use a non-rebreather mask if patient continues to have respiratory distress, set between 10-15 L/min, ensuring bag inflates.
- Attending faculty and/or SOD ER Team members will direct an ambulance to be called via the Campus Police at 911, ONLY if the patient is in respiratory distress or otherwise unstable. The parent/guardian of the patient may refuse the ambulance.
  - If there is a Refusal of Ambulance, have the individual involved complete the Refusal of Ambulance document for Adults, or Adult or Minor with a Guardian document (as applicable; located in a folder on nurses’ office doors and/or in the white binder on top of each emergency cart)
- if a dental school nurse or faculty ERT member, is not present after a second ERT page, record details of the patient’s incident and your observations, and give the details to an SOD nurse either in a secure email, or in person at the next opportunity (email details of the incident to the Dental-Emergency Response Team at DL-Dental-EmergencyResponseTeam@umaryland.edu as soon as possible whenever there was a need to have campus police phone for an ambulance)

5.) Patient Chronic Illness (BP, Glucometer Check or INR check):

For routine checks on asymptomatic patients, it is permissible and encouraged for the Emergency Response Team Paging System be used to get the assistance of a nurse for a non-emergency purpose that cannot be scheduled in advance. Follow instructions on the pink signs above or near clinic wall phones & dial 6-8128. When the Vocera Genie answers, say “URGENT BROADCAST EMERGECY TEAM”. Repeat this page if the ER Team does not respond within 5 minutes.
- Emergency Response team nurses on occasion may be paged individually for routine glucometer readings, INR testing, and blood pressure checks.

	Phone #	Room
RN II (Oral Surgery Nurse)	6-4026	2325
RN II (Infection Control Nurse)	6-6344	4317
RN II (Dental School Nurse)	6-8991	3322
LPN (Dental School Nurse)	6-7496	2206

6.) Reporting General Student and Staff Injuries/Illnesses:

Staff and student injuries that occur INSIDE of the SOD building are ALWAYS to be reported to an SOD nurse, who will make sure that the injury is properly documented and reported.
- Adverse Incident report must be completed and submitted to the SOD Nurse.
- All Faculty and Staff will be supplied with the state/corporation Workers Compensation, Witness statements and Supervisors reports to be completed and submitted to the appropriate HR contact. The Faculty/Staff member and supervisory has 24 hours to complete these forms and submit to HR for appropriate OSHA reporting regardless of if medical treatment is sought or not.
Staff and student injuries and/or illnesses that occur OUTSIDE of the SOD building are to be reported to an SOD nurse if…
- they will or may have an effect on the staff or students' ability to perform their required duties, and/or if the illness may affect the staff or students' ability to perform their required duties (for example flu, “pink eye” or other potentially infectious illness)
Staff and student illnesses that occur INSIDE of the building are to be reported to an SOD nurse if a nurse is needed to supply emergency medication or assistance, or if the ill individual is unable to continue working due to the severity of the illness

7.) Exposure Reporting and Management; Baltimore Campus:

If an exposure has or may have occurred…

STOP and IMMEDIATELY remove item responsible for exposure to prevent a DOUBLE exposure
Note if item is visibly bloody, or if saliva or OPIM involved in a splash to the face, eyes, nose, or mouth, contained blood, and if possible, note how much blood and the duration of contact.
Remove PPE and set aside gloves for checking later if a glove breach is not obvious (SOD nurse can help with this)
- Glove checks are performed while wearing PPE.
- The glove is filled with water past the point of suspected puncture, as much air as possible is removed and the glove is twisted closed at the wrist end and held shut as pressure is applied while looking for a leak (if a leak IS NOT visible, AN EXPOSURE DID NOT OCCUR; sometimes marks do appear on the hand, but a glove remains intact)
Do not force wounds to bleed; wash all wounds, and or exposed areas of the skin (cutaneous exposure) with soap and water, and flush exposed mucous membranes (mucocutaneous exposure) with cool water. DO NOT dismiss source patient/stop patient from leaving (if possible), if discharge has occurred
Prepare to report the incident, make note of patient medical history/risk factors and have patient ID #
Report incident to your attending faculty (student/resident), or department supervisor (staff)
- Attending faculty will act as a liaison between the patient and student (especially if an SOD nurse is not present)
Report exposure to an SOD nurse; the most efficient way to do so is to use the emergency pager system. To place and emergency page:
- Using an SOD phone, dial 6-8128. When the Vocera Genie answers, say “URGENT BROADCAST EMERGENCY TEAM”. Repeat this page if the ER Team has not responded within 5 minutes.
- Nurse(s) will respond to your area within a few minutes. Retrieve a Student and Resident Injury packet from the large envelope of the same name from one of the SOD nurses’ office doors (rooms 2206, 2325, 3322 or 4317). Packets inside contain the instructions and paperwork you will need and the instructions for contacting someone to assist you with post exposure risk management.
  - Students, staff, and residents not affiliated with UMMC hospital, unable to contact an SOD nurse:
    - After obtaining a student injury packet from the envelope on the closest SOD nurse’s door, phone the University of Maryland Immediate Care, Bloodborne Pathogen Exposure Hotline (BBPE Hotline) at 667-214-1886. DO NOT go to the ER without a referral from BBPE staff.
    - If you know the instrument causing the exposure on the patient after you receive a scratch or a skin puncture, quickly review the remaining instructions below (8. Required Injury Reporting Forms), then proceed to section VIII. Patient Injury, Sudden Illnesses, or if Patient Swallows Something, in this document, and follow the instructions under the heading below that titled: For double exposures, when a nurse is not present
  - Residents affiliated with UMMC unable to contact an SOD nurse
    - After retrieving a student/resident injury packet from the envelope on the closest SOD nurse’s door, phone the UMMC: Needlestick Hotline, dial 8-2337 (410-328-2337) if using a cell phone); follow the voice prompts and enter ID#7845 when told to do so, followed by the phone number you are calling from.
Required Injury Reporting Forms: Student/Resident, Staff, Employee and Volunteer forms will be provided by a SOD nurse. When a nurse is not available, forms are found in bins on SOD nurses’ office doors (rooms 1326, 2318, 3322 or 4317) and are in individually labeled manila envelopes (Student/Resident, Corporate Employee, State Employee, and Volunteer. Forms inside these packets and instructions on how to handle these forms are also described immediately below:
1. Students:
  1. University of Maryland Post Occupational Exposure Information Sheet
  2. Adverse Incident Report (included, if necessary for recording important information not already recorded on the University of Maryland Post Occupational exposure information sheet, or if a non-exposure student injury occurs.) NOTE: Never refer to an incident report in the EPR, record incident facts only
2. Employees (Staff and Faculty) department must fax to corporate or state EHS within 24 hours (copy to SOD nurse), unless done online (only state forms can also be done online (http://www.umaryland.edu/ehs/programs/workers-compensation/). If forms are done online, you will not be able print a copy. You must provide a nurse with the details as soon as possible as the nurse must record the incident in the SOD secure online Adverse incident Database.
  1. First Report of Injury (needed for medical follow-up)
  2. Accident Witness Statement (indicate if no witness)
  3. Supervisor’s report of Injury
  4. Adverse Incident Report (included, if necessary for recording important information not already recorded on the Workers injury reporting forms)
3. Volunteers
  1. University of Maryland SOD Post Occupational Exposure Information Sheet
  2. JE Authorization Form (needed to receive treatment at U of MD Immediate Care
  3. Adverse Incident Report

8.) Exposure Reporting and Management or Affiliated Sites:

Students at externship/affiliation sites will contact the school of dentistry nurse at 410-706-8128, after reporting the exposure to their site supervisor, and following the post exposure plan of the affiliated site. Each site has an Exposure Control Plan as part of the affiliation agreement.

Quick Reference Guide for Reporting and Submitting an Adverse Incident at the SOD (PDF)

F. HIPAA

Clinical Information Management System User Security Access Policy

Subject: III. Clinical – F. HIPAA

Effective Date: 09/01/2017

Reviewed and/or Revised: 09/01/2017, 02/28/2025, 07/31/2025

Click the following links to access the User Access Control Procedure (PDF) and the User Access Review Procedure (PDF).

I. Policy Statement

It shall be the policy of the University of Maryland, School of Dentistry that all users of the axiUm application, which houses all of our Patient’s and Faculty’s sensitive information, is regarded as confidential, is secure. Patient care information is the property of the patient with the University of Maryland, School of Dentistry being the gatekeeper of that information and the owner of the medium of storage, our axiUm application. University of Maryland, School of Dentistry shall maintain management processes to ensure that access to axiUm is restricted to authorized users with minimal access rights necessary to perform their role and responsibilities. Account provisioning and monitoring shall be reviewed annually.

II. Policy Purpose

The purpose of this policy is to protect patients from inappropriate dissemination of identifiable information. This policy applies to all clinical staff, employees, vendors, volunteers, students and others who are members of the University of Maryland, School of Dentistry sites and Health Centers, and refers to all information resources, whether verbal, printed, or electronic, and whether individually controlled, shared, stand alone or networked. This policy also provides guidelines on employee access to patient data to ensure confidentiality and integrity of patient information.

Confidentiality of Patient Information Policy

Subject: III. Clinical – F. HIPAA

Effective Date:; 09/01/2017

Reviewed and/or Revised:; 09/01/2017, 02/28/2024, 07/31/2025

I. Policy Statement

It shall be the policy of the University of Maryland, School of Dentistry that all information regarding care of the individual patient be maintained as confidential information. Patient care information is the property of the patient; University of Maryland, School of Dentistry is the steward or caretaker of that information and the owner of the medium of storage.

II. Policy Purpose

The purpose of this policy is to protect the patient, the clinical team, and the University of Maryland, School of Dentistry from inappropriate dissemination of information regarding care of individual and collective patients. This policy applies to all clinical staff, employees, vendors, volunteers, students and others who are members of the University of Maryland, School of Dentistry sites and Health Centers, and refers to all information resources, whether verbal, printed, or electronic, and whether individually controlled, shared, stand alone or networked. Proper handling of external requests for patient information is addressed in the Privacy Policy. This policy also provides guidelines and examples on employee access to patient identifiable information to ensure confidentiality and integrity of patient information.

Credit Card Security Policy

Subject: III. Clinical – F. HIPAA

Reviewed and/or Revised: 09/01/2017, 02/28/2024, 07/31/2025

Introduction and Scope

Introduction

This document explains School of Dentistry, University of Maryland’s credit card security requirements as required by the Payment Card Industry Data Security Standard (PCI DSS) Program. School of Dentistry, University of Maryland management is committed to these security policies to protect information utilized by School of Dentistry, University of Maryland in attaining its business goals. All employees are required to adhere to the policies described within this document.

Scope of Compliance

The PCI requirements apply to all systems that store, process, or transmit cardholder data. Currently, School of Dentistry, University of Maryland’s cardholder environment consists only of imprint machines or standalone dial-out terminals. The environment does not include storage of cardholder data on any computer system.

Due to the limited nature of the in-scope environment, this document is intended to meet the PCI requirements as defined in Self-Assessment Questionnaire (SAQ) B, ver. 2.0, October, 2010. Should School of Dentistry, University of Maryland implement additional acceptance channels, begin storing, processing, or transmitting cardholder data in electronic format, or otherwise become ineligible to validate compliance under SAQ B, it will be the responsibility of School of Dentistry, University of Maryland to determine the appropriate compliance criteria and implement additional policies and controls as needed.

Requirement 3: Protect Stored Cardholder Data

Prohibited Data

Processes must be in place to securely delete sensitive authentication data post-authorization so that the data is unrecoverable. (PCI Requirement 3.2)

Payment systems must adhere to the following requirements regarding non-storage of sensitive authentication data after authorization (even if encrypted):

The full contents of any track data from the magnetic stripe (located on the back of a card, equivalent data contained on a chip, or elsewhere) are not stored under any circumstance. (PCI Requirement 3.2.1)

The card verification code or value (three-digit or four-digit number printed on the front or back of a payment card) is not stored under any circumstance. (PCI Requirement 3.2.2)

The personal identification number (PIN) or the encrypted PIN block are not stored under any circumstance. (PCI Requirement 3.2.3)

Displaying PAN

School of Dentistry, University of Maryland will mask the display of PANs (primary account numbers), and limit viewing of PANs to only those employees and other parties with a legitimate need. A properly masked number will show only the first six and the last four digits of the PAN. (PCI requirement 3.3)

Requirement 4: Encrypt Transmission of Cardholder Data Across Open, Public Networks

Transmission of Cardholder Data

Sending unencrypted PANs by end-user messaging technologies is prohibited. Examples of end-user technologies include email, instant messaging and chat. (PCI requirement 4.2)

Requirement 7: Restrict Access to Cardholder Data by Business Need to Know

Limit Access to Cardholder Data

Access to School of Dentistry, University of Maryland’s cardholder system components and data is limited to only those individuals whose jobs require such access. (PCI Requirement 7.1)

Access limitations must include the following:

Access rights for privileged user IDs must be restricted to the least privileges necessary to perform job responsibilities. (PCI Requirement 7.1.1)

Privileges must be assigned to individuals based on job classification and function (also called “role-based access control). (PCI Requirement 7.1.2)

Requirement 9: Restrict Physical Access to Cardholder Data

Physically Secure all Media Containing Cardholder Data

Hard copy materials containing confidential or sensitive information (e.g., paper receipts, paper reports, faxes, etc.) are subject to the following storage guidelines:

All media must be physically secured. (PCI requirement 9.6)

Strict control must be maintained over the internal or external distribution of any kind of media containing cardholder data. These controls shall include:

Media must be classified so the sensitivity of the data can be determined. (PCI Requirement 9.7.1)

Media must be sent by a secure carrier or other delivery method that can be accurately tracked. (PCI Requirement 9.7.2)

Logs must be maintained to track all media that is moved from a secured area, and management approval must be obtained prior to moving the media. (PCI Requirement 9.8)

Strict control must be maintained over the storage and accessibility of media containing cardholder data. (PCI Requirement 9.9)

Destruction of Data

All media containing cardholder data must be destroyed when no longer needed for business or legal reasons. (PCI requirement 9.10)

Hardcopy media must be destroyed by shredding, incineration or pulping so that cardholder data cannot be reconstructed. Container storing information waiting to be destroyed must be secured to prevent access to the contents. (PCI requirement 9.10.1)

Requirement 12: Maintain a Policy that Addresses Information Security for Employees and Contractors

Security Policy

School of Dentistry, University of Maryland shall establish, publish, maintain, and disseminate a security policy that addresses how the company will protect cardholder data. (PCI Requirement 12.1)

This policy must be reviewed at least annually, and must be updated as needed to reflect changes to business objectives or the risk environment. (PCI requirement 12.1.3)

Critical Technologies

School of Dentistry, University of Maryland shall establish usage policies for critical technologies (for example, remote-access technologies, wireless technologies, removable electronic media, laptops, tablets, personal data/digital assistants (PDAs), email, and internet usage. (PCI requirement 12.3)

These policies must include the following:

Explicit approval by authorized parties to use the technologies (PCI Requirement 12.3.1)

A list of all such devices and personnel with access (PCI Requirement 12.3.3)

Acceptable uses of the technologies (PCI Requirement 12.3.5)

Security Responsibilities

School of Dentistry, University of Maryland’s policies and procedures must clearly define information security responsibilities for all personnel. (PCI Requirement 12.4)

Incident Response Policy

The IT Security Officer shall establish, document, and distribute security incident response and escalation procedures to ensure timely and effective handling of all situations. (PCI requirement 12.5.3)

Incident Identification

Employees must be aware of their responsibilities in detecting security incidents to facilitate the incident response plan and procedures. All employees have the responsibility to assist in the incident response procedures within their particular areas of responsibility. Some examples of security incidents that an employee might recognize in their day to day activities include, but are not limited to,

Theft, damage, or unauthorized access (e.g., papers missing from their desk, broken locks, missing log files, alert from a security guard, video evidence of a break-in or unscheduled/unauthorized physical entry)
Fraud – Inaccurate information within databases, logs, files or paper records

Reporting an Incident

The IT Security Officer should be notified immediately of any suspected or real security incidents involving cardholder data:

Contact the IT Security Officer to report any suspected or actual incidents. The Internal Audit’s phone number should be well known to all employees and should page someone during non-business hours.

No one should communicate with anyone outside of their supervisor(s) or the IT Security Officer about any details or generalities surrounding any suspected or actual incident. All communications with law enforcement or the public will be coordinated by the IT Security Officer .

Document any information you know while waiting for the IT Security Officer to respond to the incident. If known, this must include date, time, and the nature of the incident. Any information you can provide will aid in responding in an appropriate manner.

Incident Response

Responses can include or proceed through the following stages: identification, severity classification, containment, eradication, recovery and root cause analysis resulting in improvement of security controls.

Contain, Eradicate, Recover and perform Root Cause Analysis

Notify applicable card associations.
Visa

Provide the compromised Visa accounts to Visa Fraud Control Group within ten (10) business days. For assistance, contact 1-(650)-432-2978. Account numbers must be securely sent to Visa as instructed by the Visa Fraud Control Group. It is critical that all potentially compromised accounts are provided. Visa will distribute the compromised Visa account numbers to issuers and ensure the confidentiality of entity and non-public information. See Visa’s “What to do if compromised” documentation for additional activities that must be performed. That documentation can be found at

MasterCard

Contact your merchant bank for specific details on what to do following a compromise. Details on the merchant bank (aka. the acquirer) can be found in the Merchant Manual. Your merchant bank will assist when you call MasterCard at 1-(636)-722-4100.

Discover Card

Contact your relationship manager or call the support line at 1-(800)-347-3083 for further guidance.
Alert all necessary parties. Be sure to notify:
1. Merchant bank
2. Local FBI Office
3. U.S. Secret Service (if Visa payment data is compromised)
4. Local authorities (if appropriate)
Perform an analysis of legal requirements for reporting compromises in every state where clients were affected. The following source of information must be used:
Collect and protect information associated with the intrusion. In the event that forensic investigation is required the IT Security Officer will work with legal and management to identify appropriate forensic specialists.
Eliminate the intruder's means of access and any related vulnerabilities.
Research potential risks related to or damage caused by intrusion method used.

Root Cause Analysis and Lessons Learned

Not more than one week following the incident, members of the IT Security Officer and all affected parties will meet to review the results of any investigation to determine the root cause of the compromise and evaluate the effectiveness of the Incident Response Plan. Review other security controls to determine their appropriateness for the current risks. Any identified areas in which the plan, policy or security control can be made more effective or efficient, must be updated accordingly.

Security Awareness

School of Dentistry, University of Maryland shall establish and maintain a formal security awareness program to make all personnel aware of the importance of cardholder data security. (PCI Requirement 12.6)

Service Providers

School of Dentistry, University of Maryland shall implement and maintain policies and procedures to manage service providers. (PCI requirement 12.8)

This process must include the following:

Maintain a list of service providers (PCI requirement 12.8.1)
Maintain a written agreement that includes an acknowledgement that the service providers are responsible for the security of the cardholder data the service providers possess (PCI requirement 12.8.2)
Implement a process to perform proper due diligence prior to engaging a service provider (PCI requirement 12.8.3)
Monitor service providers’ PCI DSS compliance status (PCI requirement 12.8.4)

Health Record Amendment Correction Policy

Subject: III. Clinical – F. HIPAA

Effective Date: March 2016

Reviewed and/or Revised: 09/01/2017, 02/28/2024, 07/31/2025

I. Policy Statement

It shall be the policy of the University of Maryland, School of Dentistry to capture, share, secure, maintain, and enhance health information assets in all mediums through appropriate information management policies. Our system shall meet applicable Federal, State, and regulatory requirements in support of the University of Maryland, School of Dentistry’s mission, vision, and values. Furthermore, it shall be the policy of University of Maryland, School of Dentistry to support and adhere to the rights and responsibilities of patients as specified in the State of Maryland Public Health and Mental Health Codes. It is the responsibility of the University of Maryland, School of Dentistry to ensure that these principles and policies are upheld. Patients have the right to request that information contained in their patient record be updated. If information in the custody of University of Maryland, School of Dentistry is requested to be updated it will be done through a formal process which provides documentation to support the inclusion or denial of these requests.

II. Policy Purpose

The purpose of this policy is to inform University of Maryland, School of Dentistry personnel of the procedures that must be followed when a patient requests that their Health Record be amended or corrected.

III. Standards

Patients have the right to request an amendment of their health information.
1. Patients must complete the "Amendment Correction of Health Record Request" form.
2. Requests should be sent to the:
  Associate Dean of Clinical Affairs,
  Room 5209,
  650 West Baltimore Street,
  Baltimore, MD 21201
3. A response is required within 60 days from the date the request was received. A one-time extension of 30 days may be granted under extenuating circumstances. The patient should be notified via the "30-Day Extension to Respond to Amendment/Correction Request" form.
If the responsible faculty determines that the amendment is appropriate and the current information is incomplete or inaccurate without the patient’s requested amendment, the amendment should be made in the patient’s record.
1. The "Acceptance of Amendment/Correction Request" form should be sent to the patient.
2. Standard medical record procedures should be followed when making an amendment to a patient’s record.
3. Any future disclosures of the amended PHI must include the amended information or a link to the amended information.
The responsible faculty may deny a patient’s request to amend his/her health information.
1. Clinic Administration staff should send the "Denial of Amendment/Correction Request" form to the patient, indicating the grounds for the denial..
2. The patient may submit a statement of disagreement, limited to two pages.
3. The responsible faculty, in conjunction with Clinic Administration staff, may prepare a rebuttal statement, if necessary to clarify School of Dentistry’s position. A copy of the rebuttal must be provided to the patient.
4. The following documents must be included in any future disclosures of the patient’s information:
  1. Patient’s written amendment request;
  2. School of Dentistry’s Notice of Denial;
  3. Patient’s statement of disagreement (if any) and rebuttal statement (if any)

HIPAA-Related Forms

Subject: III. Clinical – F. HIPAA

Effective Date: 09/01/2017

Reviewed and/or Revised: 09/01/2017, 02/28/2024, 07/31/2025

The following are University of Maryland, School of Dentistry HIPAA-related Forms:

Information Management Policy

Subject: III. Clinical – F. HIPAA

Effective Date: March 2016

Reviewed and/or Revised: 09/01/2017, 2/13/2026

I. Policy Statement

II. Policy Purpose

The purpose of this policy is to identify and disseminate the University of Maryland, School of Dentistry’s framework and principles for information management that guide our institutional actions and operations in protecting, generating, and sharing individually identifiable health information in support of the University of Maryland, School of Dentistry’s mission, vision, and values.

Click the following link to access the full Information Management Policy (PDF).

Information Management Policy – Sharing Data with External Entities

Subject: III. Clinical – F. HIPAA

Effective Date: March 2016

Reviewed and/or Revised: 09/01/2017, 02/28/2024, 07/31/2025

I. Policy Statement

It shall be the policy of the University of Maryland, School of Dentistry to capture, share, secure, maintain, and enhance the value of University of Maryland, School of Dentistry health information assets in all mediums through appropriate information management policies and actions that meet applicable Federal, State, regulatory, or contractual requirements and support the University of Maryland, School of Dentistry mission, vision, and values. Furthermore, it shall be the policy of University of Maryland, School of Dentistry to support and adhere to the rights and responsibilities of patients as specified in the State of Maryland Public Health and Mental Health Codes. It is the responsibility of the University of Maryland, School of Dentistry to ensure that these principles and policies are upheld even when individually identifiable health information in the custody of University of Maryland, School of Dentistry needs to be shared with other entities. Sharing of data shall be done by requiring potential data sharing partners to execute a Business Associate agreement which obliges them to handle the data in a manner consistent with Federal and State laws.

II. Policy Purpose

The purpose of this policy is to inform University of Maryland, School of Dentistry personnel of the procedures that must be followed if individually identifiable health information is to be shared with an external entity.

III. Standards

External data users must not be permitted to access University of Maryland, School of Dentistry data assets unless the external users have completed a Business Associate Agreement with University of Maryland, School of Dentistry.
There may be cases in which a state, federal, or regulatory agency requires that access be granted to it under law or regulation. In such cases, to the extent possible, a Business Associate Agreement meeting the criteria above shall be negotiated between University of Maryland, School of Dentistry and the agency before access is granted to the University of Maryland, School of Dentistry data assets.

G. Infection Control

General Patient Care Protocol

General Patient Care Protocol
Subject: III. Clinical – G. Infection Control
Effective Date: July 20, 2021
Reviewed or Revised Date: 08/17/2021, 02/25/2022, 02/28/2025, 07/31/2025

UMSOD adheres to OSHA and CDC Guidelines: CDC Guidance for Dental Settings
OSHA Guidance on Preparing Workplaces for COVID-19

Hand Hygiene

Ensure HCP practice strict adherence to CDC Hand Hygiene in Healthcare Settings, including:

Before and after all patient contact, contact with potentially infectious material, and before putting on and after removing personal protective equipment (PPE), including gloves. Hand hygiene after removing PPE is particularly important to remove any pathogens that might have been transferred to bare hands during the removal process.
Use Alcohol-Based Hand Sanitizer (ABHS) with 60-95% alcohol or wash hands with soap and water for at least 20 seconds. If hands are visibly soiled, use soap and water before returning to ABHS.

Facility Considerations

Take steps to ensure patients and staff adhere to respiratory hygiene and cough etiquette, as well as hand hygiene, and all patients follow triage procedures throughout the duration of the visit.
Post visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, break rooms) to provide instructions (in appropriate languages) about hand hygiene and respiratory hygiene and cough etiquette. Instructions should include wearing a cloth face covering or facemask for source control, and how and when to perform hand hygiene.
Provide supplies for respiratory hygiene and cough etiquette, including alcohol-based hand rub (ABHR) with 60– 95% alcohol, tissues, and no-touch receptacles for disposal, at healthcare facility entrances, waiting rooms, and patient check-ins.
Install physical barriers (e.g., glass or plastic windows) at reception areas to limit close contact between triage personnel and potentially infectious patients.
Place chairs in the waiting room at least three feet apart.
Remove toys, magazines, and other frequently touched objects that cannot be regularly cleaned or disinfected from waiting areas.
Minimize the number of persons waiting in the waiting room.
Patients may opt to wait in a personal vehicle or outside the dental facility where they can be contacted by mobile phone when it is their turn for dental care.
Minimize overlapping dental appointments.
Ideally, dental treatment should be provided in individual patient rooms whenever possible.
For dental facilities with open floor plans, to prevent the spread of pathogens there should be:
- At least 3 feet of space between patient chairs.
Patient volume - Ensure to account for the time required to clean and disinfect operatories between patients when calculating your daily patient volume.

Universal Source Control - When required by the Maryland Department of Health

As part of source control efforts, Healthcare Providers (HCP) should wear a facemask at all times while they are in the dental setting.

HCP whose job duties do not require PPE (such as clerical personnel) will wear regular facemasks for source control while in the dental setting.
Other HCP (such as dentists, dental hygienists, dental assistants) will wear regular facemasks for source control when they are not engaged in direct patient care activities and then switch to UMSOD approved respirator when PPE is required.
HCP should remove their respirator, perform hand hygiene, and put on their cloth face covering when leaving the facility at the end of their shift.
HCP should also be instructed that if they must touch or adjust their mask or cloth face covering, they should perform hand hygiene immediately before and after.

Because facemasks and cloth face coverings can become saturated with respiratory secretions, HCP should take steps to prevent self-contamination:

HCP should change facemasks and coverings if they become soiled, damp, or hard to breathe through.
Cloth face coverings should be laundered daily and when soiled.
HCP should perform hand hygiene immediately before and after any contact with the facemask or cloth face covering.

Using Personal Protective Equipment (PPE)

For all dental procedures, HCP should wear:

Gown
Head Cover – highly recommended
N95 Respirator or Equivalent with Surgical Mask Over the Respirator Mask for known or suspected COVID-19 cases
KN95 for all other patients
Full-Face Shield
Gloves

Sequence for HCP includes:

Before entering a patient room or care area:

Perform hand hygiene.
Put on head cover
Put on a clean gown or protective clothing that covers personal clothing and skin (e.g., forearms) likely to be soiled with blood, saliva, or other potentially infectious materials.
- Gowns, protective clothing, and head cover should be changed:
  - If they become soiled
  - Between patients if exposed to aerosol
Put on N95 respirator or equivalent.
- Mask ties should be secured on the crown of the head (top tie) and the base of the neck (bottom tie). If mask has loops, hook them appropriately around your ears.
- Respirator straps should be placed on the crown of the head (top strap) and the base of the neck (bottom strap). Perform a user seal check each time you put on the respirator.
- A surgical mask should be worn over the N95 mask
Put on eye protection.
- Personal eyeglasses and contact lenses are NOT considered adequate eye protection.
- Put on face shield (full-face shield is also required for all procedures
Perform hand hygiene.
Put on clean non-sterile gloves.
- Gloves should be changed if they become torn or heavily contaminated.
Enter the patient room. After completion of dental care:

After completion of dental care:

Exit the patient room or care area.
Remove gloves and discard in medical waste.
Remove face shield carefully by grabbing the back and pulling upwards and away from head. Do not touch the front of face shield.
Remove gown and discard in a dedicated container for waste or linen.
- If they become soiled
- Between patients if exposed to aerosol
Perform hand hygiene.
Remove eye protection (loupes) carefully by grabbing the back and pulling upwards and away from head. Do not touch the front of any eye protection.
Remove respirator.
- Do not touch the front of the respirator.
- Surgical mask: Carefully untie the mask (or unhook from the ears) and pull it away from the face without touching the front.
- Respirator: Remove the bottom strap by touching only the strap and bring it carefully over the head. Grasp the top strap and bring it carefully over the head, and then pull the respirator away from the face without touching the front of the respirator.
Remove head cover and discard in a dedicated container for waste or linen.
- If they become soiled
- Between patients if exposed to aerosol
Perform hand hygiene.
Put on clean non-sterile gloves to disinfect reusable face shield and loupes according to manufacturer’s instructions prior to reuse.
Remove gloves and discard in medical waste.
Perform hand hygiene.

Pre-Appointment Screening

Contact all patients prior to dental treatment.
- Telephone screen all patients for symptoms consistent with COVID-19. If the patient reports symptoms of COVID-19, avoid non-emergent dental care and use the Phone Advice Line Tool for Possible COVID-19 patients. If possible, delay dental care until the patient has recovered.
- Telephone triage all patients in need of dental care. Assess the patient’s dental condition and determine whether the patient needs to be seen in the dental setting. Use tele dentistry options as alternatives to in-office care when possible.
- Inform patient of the limit of visitors accompanying the patient to the dental appointment to only those people who are necessary.
- Advise patients that they, and anyone accompanying them to the appointment, will be requested to wear a cloth face covering or facemask when entering the facility and will undergo screening for fever and symptoms consistent with COVID-19.

Arrival at School

Patients should not attempt entry into the school until 15 minutes before appointed time
Entry – first floor entrance; need physical distancing in the line
Screening at School Entrance - Systematically assess all patients and visitors upon arrival. Step by step procedure, see COVID Screening - Triage Procedure
- Ensure that the patient and visitors have donned their own cloth face covering. Provide a facemask if supplies are adequate.
- Screening questions; temperature taken; mask required; UMSOD will provide mask as needed; hand gel available.
  - Pass – patient permitted to enter school and proceed to proper clinic
  - Fail – patient referred to personal physician for evaluation; medical clearance will be required for future appointments
- Ask about the presence of fever or other symptoms consistent with COVID-19
- *For the general population, fever is measured as a temperature ≥100.4˚F. Fever may be subjective or confirmed. If the patient has a fever strongly associated with a dental diagnosis (e.g., pulpal and periapical dental pain and intraoral swelling is present), but no other symptoms consistent with COVID-19 are present, care can be provided with appropriate protocols.
- Escorts – must wear mask
  - One escort is permitted if patient has need
    - Language interpreter at the front desk for financial and appointment related communication
      - Language line interpreter service should be utilized in the treatment areas
    - Guardian or parent (one parent only)
- Children are not permitted to accompany patients past the front door entrance; patient will need to re-schedule appointments if they have children.
- Spouse / partner – may accompany to clinic wait room; may not go into treatment area.
- Vulnerable adults who have a medical aid or power of attorney

Reception Area

Rearrange seating to ensure 3-foot social distancing. For seats that cannot be split up, block off neatly ensuring 3-foot social distancing.
Remove all magazines, books, etc.
Patients and escorts must wear masks.
Hand sanitizer is available.
Arm rests and tables wiped down every morning and periodically during the workday.
Goal is to be timely with appointments to minimize presence in reception areas.

Patient Check-in at Reception

Physical distancing in effect – need to mark floor
Students / residents should be ready to receive patient as soon as they arrive.
Patients can sit in reception room chairs – avoid chairs that are marked off.
Restrooms – patient restrooms with physical distancing marked; recommend that patient use facilities if they need as they will not be able to leave treatment area.

Operatory Protocol

Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly after each patient. Clean and disinfect the room and equipment according to the Guidelines for Infection Control in Dental Health-Care Settings – 2003.
Limit clinical care to one patient at a time whenever possible.
Set up operatories so that only the clean or sterile supplies and instruments needed for the dental procedure are readily accessible. All other supplies and instruments should be in covered storage, such as drawers and cabinets, and away from potential contamination. Any supplies and equipment that are exposed but not used during the procedure should be considered contaminated and should be disposed of or reprocessed properly after completion of the procedure.
Avoid aerosol-generating procedures whenever possible. Avoid the use of dental handpieces and the air/water syringe.
If aerosol-generating procedures are necessary for dental care, use four-handed dentistry, high evacuation suction and dental dams to minimize droplet spatter and aerosols. The number of Healthcare Providers (HCP) present during the procedure should be limited to only those essential for patient care and procedure support.
If possible, all aerosolizing procedures should be performed with the Ajax Extraoral Evacuation Device.
Preprocedural mouth rinses (PPMR) - All patients will rinse with 20 ml of Listerine for 30 seconds prior to every dental appointment.
Clean and disinfect room surfaces.
- ALL clinical contact surfaces will be disinfected with EPA approved surface disinfectant.

Treatment Areas

Patients should continue to wear masks until instructed to remove mask
Patients may not leave treatment area once procedure begins
Student or Resident provider should remain in treatment bay until procedure is completed
Employ runners to bring additional supplies – students not involved in active treatment can perform that function

Additional Precautions or Strategies for Treating Patients with Suspected or Confirmed COVID-19

If a patient arrives at your facility and is suspected or confirmed to have COVID-19, defer dental treatment and take the following actions:
If the patient is not already wearing a cloth face covering give the patient a facemask to cover his or her nose and mouth.
If the patient is not acutely sick, send the patient home, and instruct the patient to call their primary physician.
Provide patient with handout INFORMATION FOR INDIVIDUALS DENIED ACCESS TO SCHOOL OF DENTISTRY DUE TO COVID SCREENING.
Patient will have to provide written medical clearance from their physician that their patient is clear of the virus before the patient can be treated in any clinic in the school.
If the patient is acutely sick (for example, has trouble breathing), refer the patient to a medical facility, or call 911 as needed and inform them that the patient may have COVID-19.

Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel (HCP) with Potential Exposure to COVID-19.

CDC Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19.

“Prolonged” is defined as a time period of 15 or more minutes.
Any duration of exposure should be considered prolonged if the exposure occurred during performance of an aerosol-generating procedure.
The time period that should be used for contact tracing after exposure to asymptomatic individuals who test positive for SARS-CoV-2 is 2 days. Recent data suggest that asymptomatic persons may have a lower viral burden at diagnosis than symptomatic persons.
Work Restrictions
- Exclude from work for 14 days after last exposure and/or what the current CDC guidelines instruct.
- Advise HCP to monitor themselves for fever or symptoms consistent with COVID-19.
- Any HCP who develop fever or symptoms consistent with COVID-19 should immediately contact their established point of contact (e.g., direct supervisor) and arrange for medical evaluation and testing.

Monitor and Manage Health Care Personnel

As part of routine practice, HCP should be asked to regularly monitor themselves for fever and symptoms consistent with COVID-19.
- HCP should be reminded to stay home when they are ill.
- If HCP develop fever (T≥100.0˚F) or symptoms consistent with COVID-19 while at work, they should keep their cloth face covering or facemask on, inform their supervisor, and leave the workplace.
Screen all HCP at the beginning of their shift for fever and symptoms consistent with COVID-19.
- Actively measure their temperature and document absence of symptoms consistent with COVID-19.
- Clinical judgement should be used to guide testing of individuals in such situations.
- Medical evaluation may be warranted for lower temperatures (<100.4˚F) or other symptoms based on assessment by occupational health personnel. Additional information about clinical presentation of patients with COVID-19 is available.
If HCP experience a potential work exposure to COVID-19, follow CDC’s Healthcare Personnel with Potential Exposure Guidance.
- If HCP suspect they have COVID-19:
- Notify direct supervisor and DO NOT come to work.
- If HCP are ill at work, have them keep their cloth face covering or facemask on and leave the workplace.
- Notify their primary healthcare provider to determine whether medical evaluation is necessary.
- HCP with suspected COVID-19 should be prioritized for diagnostic testing.
- Information about when HCP with suspected or confirmed COVID-19 may return to work is available in the Interim Guidance on Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19.
For information on work restrictions for health care personnel with underlying health conditions who may care for COVID-19 patients, see CDC's FAQs.

Policy for Providers and Staff with Respiratory Infections: Students/Residents, Faculty, and Staff

Subject: III. Clinical – G. Infection Control

Origination Date: 07/01/2025

Effective Date: 11/03/2025

Reviewed and/or Revised: 2/13/2026

Purpose: N/A

Policy and/or Procedure:

Providers/Staff exposed to COVID-19, Influenza, RSV, pertussis or other respiratory pathogens** are not required to quarantine but should wear a KN95 or N95 mask for 7 days from last day of exposure and should self-monitor for symptoms.
Providers/Staff with acute respiratory illness will remain out of work until afebrile for at least 24 hours without the use of fever-reducing medication, and at least 24 hours of improvement in respiratory symptoms (if afebrile). Note the following exception to this are:
1. Providers/Staff who have a respiratory infection and who experience severe or critical illness should remain out of work through day 3 and/or can return to work once fever-free x 24 hours off fever-reducing medications and improvement of symptoms.
2. Providers/Staff who have a respiratory infection who are moderately to severely immunocompromised (includes conditions such as being on chemotherapy for cancer, untreated HIV infection with CD count of less than 200, combined primary immunodeficiency disorder, or receipt of prednisone 20 mg/day for more than 14 days), are required to follow a test-based strategy. They should be out of work for a minimum of 7 days and prior to returning to work require the following: fever resolution 24 hours prior to return-to-work (without fever-reducing medication), improvement of symptoms and two consecutive negative tests performed at least 24 hours apart.
Providers/Staff returning to work following an acute respiratory infection are required to wear a KN95 mask for a total of 7 days from symptom onset or positive test.
If symptoms start while at work, Providers/Staff will stop patient care activity and notify appropriate personnel, leave work, and follow return to work guidance as described in this policy.
Providers/Staff with ongoing symptoms should follow up with their PCP or Urgent Care. Providers/Staff with ongoing symptoms with questions pertaining to return to work guidance should contact Employee Health to determine appropriateness of contact with patients.

* Updated MDH Healthcare Provider Respiratory Illness Return to Work Guidance

** Does not apply to novel influenza A viruses (including H5N1 avian influenza), Middle East Respiratory Syndrome (MERS)

UMSOD Face Mask Policy

Subject: III. Clinical – G. Infection Control

Effective Date: July 12, 2021

Reviewed or Revised: 08/30/2021, 02/28/2024, 8/15/2025, 09/02/2025, 02/13/2026, 02/18/2026

Policy or Procedure: UMSOD Face Mask Policy

General Clinical Mask and Face shield Requirements:

Required use during patient care and procedures
1. All dental healthcare professionals (DHCP) must wear a surgical mask that covers both the nose and mouth
  1. Masks must be KN-95, ASTM level 3
2. All DHCP must wear face shields during procedures that are likely to generate splashes or spattering of blood or other bodily fluids.
Mask and Shield Replacement
1. The outer surface of a mask and/or may become contaminated by infectious droplets from oral fluids or by contact with contaminated hands
2. Masks must be changed:
  1. Between each patient encounter; and/or
  2. If the mask becomes moist or visibly contaminated during treatment
3. Face shields must be disinfected or changed between each patient encounter
Providers/Staff exposed to COVID-19, Influenza, RSV, pertussis or other respiratory pathogens
1. are not required to quarantine but should wear a KN95 or N95 mask for 7 days from last day of exposure and should self-monitor for symptoms.
2. Must wear an appropriate face-mask the entire time they are in any are of UMSOD
3. For additional details, refer to the University of Maryland School of Dentistry - Policy for Providers and Staff with Respiratory Infections: Students/Residents, Faculty, and Staff

UMSOD GENERAL NON-COMPLIANCE STATEMENT:

Faculty, staff, and students who are non-compliant will receive warnings, reprimands, or other appropriate disciplinary action. Individuals who do not comply with this policy will be asked to leave the School of Dentistry clinic. Faculty, supervisors, and administrators are responsible for monitoring and encouraging compliance with UMSOD-UMB policies and procedures.

UMSOD Policy and Procedure on Infection Control, Exposure Prevention and Management

Subject: III. Clinical – G. Infection Control

Effective Date: July 2016

Reviewed and/or Revised: 10/7/16, 09/01/2017, 01/18/2024, 8/15/2025, 9/02/2025

Purpose: The purpose of exposure reporting and management is to ensure a prompt response from SOD nurses trained to act in a supportive manner with both the exposed individual and exposure source individual to facilitate post exposure follow-up; if an exposure to bloodborne pathogens is not reported, it cannot be managed appropriately. Reporting and managing bloodborne pathogen exposures is necessary to comply with the OSHA Bloodborne Pathogens standard found in Title 29 of the Code of Federal Regulations at 29 CFR 1910.1030.

A secondary purpose of exposure reporting and management is to identify actual problems or potential risks of occupational exposure, and circumstances that must be eliminated or modified to prevent personal injury resulting in an exposure to pathogens from blood or other potentially infectious materials.

Definitions:

Bloodborne: Carried or transmitted by the blood, as in a bloodborne pathogen (BBP).
Exposure / Double Exposure / Occupational Exposure / Percutaneous Exposure / Mucocutaneous Exposure:
- Exposure: Contact with microorganisms, or pathogens, via blood or other potentially infectious material.
- Double Exposure: Occurs when an exposure with a contaminated item occurs to a healthcare worker, and subsequently to the patient as well.
- Mucocutaneous Exposure: Exposure via a splash to the inside of the eyes, nose or mouth (mucous membranes).
- Occupational Exposure: Refers to reasonably anticipated contact with blood or other potentially infectious materials by healthcare workers with non-intact skin, especially as a result of a puncture, bite, cut, or abrasion, or a splash into the eyes nose or mouth (mucous membranes), as a result of their job duties.
- Percutaneous Exposure: Exposure via a puncture through the skin (also known as parenteral contact or exposure)
Pathogen: An agent that causes disease, especially a living microorganism such as a bacteria, virus or fungus.
Source Individual: means any individual, living or dead, whose blood or other potentially infectious materials may be a source of occupational exposure to the employee.

Policy: UMSOD will educate all staff (employees, dean’s faculty, residents and undergraduate students) with occupational exposure to pathogens, via blood or other infectious materials, regarding the importance of the proper management and prompt reporting of any exposure.

Note: This procedure is posted on each SOD nurse’s door, and on each clinical computer desktop under the Clinical and Academic Support Documents icon. It was created to be a a quick reference document, for the UMSOD, in the event of exposure. Click the following link to access the Exposure Reporting and Management Procedure, Baltimore Campus (PDF)

Infection Control Compliance

To prevent exposures to Bloodborne Pathogens, it is the responsibility of all faculty, clinical staff and students to be compliant with UMB and UMSOD Infection control standards and to report infractions to a G.P. Manager or Program Director. Dental assistants will report incidents of non-compliance directly to the infection control nurse.

Infection Control, Areas of Non-Compliance

Attending faculty will notify and counsel the student about the infection control violation. Faculty should enter an "F" grade for professionalism and describe the violation in the dialogue box on the grade card. Alternatively, a counseling report could be sent to the student and the G. P. Director or Program Director by the Infection Control Nurse. Violations will be monitored by G. P. Directors and Program Directors and be reported to a dental school nurse so they may be recorded in the dental school infection control compliance database and receive re-education regarding proper procedure. Individuals with multiple violations will be referred to the Associate Dean of Clinical Affairs for counseling and disciplinary action, as necessary. Please refer to the Flowchart of Infection Control Areas of Non-Compliance PDF.

Click on the following link to access the UMB Student Health BBP & Exposure information and resources.

UMB Policy on Prevention and Management of Student and Employee Infection with Bloodborne Pathogens

Subject: III. Clinical – G. Infection Control

Effective Date: 2008

Reviewed and/or Revised: 10/7/16, 09/01/2017, 2/28/2024, 2/28/2025, 8/13/2025

Policy and/or Procedure:

This Policy sets forth the principles and general practices of UMB with respect to prevention and management of infection with bloodborne pathogens. All related policies, guidelines and practices of UMB's schools and other units are expected to be consistent with this Policy. This Policy shall be communicated to the UMB community and to prospective students and employees. Notice of this Policy and the opportunity to review it upon request shall be afforded to current and potential clients and patients through appropriate means.

As an employer, UMB must comply with the laws and regulations relating to bloodborne pathogens which have been enacted or issued by the United States Government and by the State of Maryland. Other UMB policies specifically address compliance with those regulations. This Policy shall be interpreted to be consistent with State and Federal law and regulations in all respects. This Policy also shall be interpreted and applied consistent with the applicable Maryland and federal laws of professional licensure, informed consent, and confidentiality of student and other personally identifiable records. The President of UMB may waive or modify this Policy as required to attain compliance with such other laws and regulations.

Definitions:

In this Policy, the following terms have the meanings set forth in this paragraph:

Bloodborne Pathogens: Hepatitis B virus, human immunodeficiency virus, and hepatitis C virus. In the future, the President of UMB may identify additional pathogens as Bloodborne Pathogens if such pathogens are identified by the Occupational Safety and Health Administration, the Centers for Disease Control, or a relevant State or federal law or regulation as requiring control or prevention measures similar to those required for HIV, HBV or HCV under the OSHA Standard.
Confirmed Source Individual: A Source Individual known, as a result of pre-exposure or post-exposure testing, to be infected with a Bloodborne Pathogen.
Exposure Incident: A specific eye, mouth, other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious materials that results from the performance of the duties or assignments of any UMB Personnel.
HBV: hepatitis B virus.
HCV: hepatitis C virus.
HIV: human immunodeficiency virus.
Occupational Exposure: Reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of UMB Personnel's duties or assignments, including assigned work, volunteer tasks, academic programs, and practicum experiences. Occupational Exposure may occur in many contexts, including but not limited to, patient care, client services, research activities, classroom work, housekeeping, maintenance and security services.
OSHA Standard: The Bloodborne Pathogens Standard issued by the Occupational Safety and Health Administration, United States Department of Labor, as amended from time to time and published as 29 CFR 1910.1030.
School: Any of the following schools which comprise UMB's educational units: School of Medicine, School of Nursing, School of Social Work, School of Law, Dental School, School of Pharmacy, University of Maryland Graduate School - Baltimore.
Source Individual: Any individual, living or dead, whose blood or other potentially infectious materials may be a source of Occupational Exposure to UMB personnel. Examples include, but are not limited to, hospital and clinic patients; clients in institutions for the developmentally disabled; trauma victims; clients of drug and alcohol treatment facilities; residents of hospices and nursing homes; human remains; and individuals who donate or sell blood or blood components.
UMB Personnel: (i) all part-time and full-time students of UMB, as well as any special students who are not registered; (ii) all employees of UMB, including full-time, part-time, temporary, contractual, and visiting personnel in any employment category; and (iii) all volunteers participating in UMB activities.
Unit: Any administrative, service, or research unit of UMB which does not report, directly of indirectly, to the Dean of a School.
Universal Precautions: An approach to infection control according to which all human blood and certain human body fluids are treated as if known to be infectious for Bloodborne Pathogens. More specifically, Universal Precautions means the universal precautions recommended by the Center for Communicable Diseases, U.S. Public Health Service.
Any term used in this Policy which is defined in paragraph (b) of the OSHA Standard shall have the meaning set forth in the OSHA Standard unless a different meaning is set forth in this part of this Policy.

Non-Discrimination

All Schools and Units of UMB shall make their facilities and services for health care and client services available to patients and clients without regard to their status as Source Individuals or Confirmed Source Individuals. However, as medically appropriate, some Source Individuals and Confirmed Source Individuals may be referred to treatment in special settings or denied access to some programs in order to safeguard their welfare, the health of other patients or clients, and the safety of UMB Personnel. All UMB Personnel who provide health care, counseling or other client services are required to provide services to all eligible patients and clients.

All program brochures, catalogues, and other materials for clients, patients, students and employees shall provide notice of the policy of non-discrimination and the expectation that UMB Personnel will provide service to all patients and clients.

Universal Standard Precautions

Each School and Unit is responsible to identify its UMB Personnel who have Occupational Exposure and are at risk of an Exposure Incident; to ensure that these UMB Personnel receive training in Universal Precautions; and to require the use of Universal Precautions by these UMB Personnel. Failure to use Universal Precautions as required is grounds for dismissal or discipline.

Education and Communication on Bloodborne Pathogens

Each UMB School and Unit shall communicate with its UMB Personnel concerning known biohazards and shall educate its UMB Personnel on aspects of HIV infection, Acquired Immune Deficiency Syndrome, and HBV and HCV infection appropriate to expected educational and job-related behaviors. The requirements of paragraph (g) of the OSHA Standard shall be followed for employees and, to the fullest extent practical and appropriate, shall be followed for other UMB Personnel.

Admissions and Hiring Practices

Inquiries about infection with HBV, HCV or HIV will not be made of prospective UMB Personnel. Neither admission nor employment will be denied for any otherwise qualified individual on the basis of infection with Bloodborne Pathogens. However, limitations on the training and professional activities which may result from infection with Bloodborne Pathogens will be communicated to prospective students and employees. (See next section.)

Advice on Risks and Limitations

Each School and Unit in which UMB Personnel have Occupational Exposure will provide advice to those UMB Personnel having Occupational Exposure concerning risk of infection with Bloodborne Pathogens and, for health care students and employees, possible relationships between infection and career opportunities for health care workers. Such advice will also be provided to applicants for the benefit of applicants who know themselves to be infected with Bloodborne Pathogens. This will include information on possible limitations resulting from infection with Bloodborne Pathogens as a health care worker in the specific profession or pursuit to which the application is being directed.

Advice will include notice that modifications of activities may be necessary for infected individuals engaged in patient care activities at UMB or at affiliated training or employment sites. Although UMB has no policies limiting the health care activities of individuals infected with Bloodborne Pathogens who have no physical or mental impairment as a result of their infection, some affiliated health care sites have imposed restrictions, and it is possible that State licensing bodies will limit health care activities of infected individuals

Applicants who are infected with Bloodborne Pathogens are not required to identify themselves to UMB. Advice to applicants will be provided in a general form available to all applicants.

If infection with a specific Bloodborne Pathogen (e.g., HBV) could prevent a person from completing the curriculum or subsequently practicing the intended profession as a result of scientifically established contagion risk, this information will be included in the general information which the school distributes to applicants.

Testing

Testing for infection with Bloodborne Pathogens is not required for employment or admission or as a condition of continued enrollment or employment. Absence of infection with Bloodborne Pathogens is not utilized as a criterion in selecting successful applicants for academic enrollment or employment.

Voluntary testing is strongly encouraged for prospective students or employees who will have Occupational Exposure. These persons are well advised to be aware of their status with respect to Bloodborne Pathogens infection and should be advised that free testing is available through local government health testing facilities. Knowledge of status is valuable baseline information for evaluating outcomes of Exposure Incidents.

UMB Personnel who are or will be engaged in invasive procedures in the course of caring for patients have Occupational Exposure and should be aware of their status with respect to infection with Bloodborne Pathogens. Such personnel are encouraged to maintain awareness through periodic voluntary testing.

Voluntary testing will be available to UMB Personnel on request through Student and Employee Health. Any costs incurred must be covered by health insurance or by the tested individual. Free testing is available through other local health testing facilities.

Student and Employee Health will not inform School or Unit administrators of positive HIV, HBV or HCV tests of UMB Personnel unless the tested individuals provide written consent.

Immunization Against HBV

Students enrolling in academic programs that will involve participating in invasive or exposure-prone procedures must be vaccinated against HBV at their own expense unless an individual School has elected to provide vaccination at no cost to its students. Students may be vaccinated at Student and Employee Health. Those who were immunized prior to enrollment must provide evidence of immunization to the enrolling School. Immunization can be waived only for documented medical contraindications. Each School, in consultation with Student and Employee Health, will establish the schedule for students to obtain vaccination or present evidence of immunization.

As required by the OSHA Standard, UMB shall make available the HBV vaccine and vaccination series to all UMB employees who have Occupational Exposure or have had an Exposure Incident. The vaccination shall be offered at no cost to employees. Employees who decline the vaccination must sign a Hepatitis B Vaccine Declination Statement.

Any UMB Personnel who are neither students nor employees, and who have Occupational Exposure, shall be offered the HBV vaccine and vaccination at their own expense. Alternatively, the School or Unit in which such personnel work may support the cost of vaccination, at the discretion of the responsible administrator.

Voluntary Disclosures; Confidentiality

Persons who are not engaged or to be engaged in invasive patient care activities are not required or encouraged to disclose infection with a Bloodborne Pathogen. Prospective or current students, employees, or other UMB Personnel who are infected with a Bloodborne Pathogen, and whose work or academic program does or will include invasive procedures, are strongly encouraged but not required to disclose infection to the appropriate School- or Unit- specific Bloodborne Pathogens Review Panel described under section 12 below. Any person's disclosure of infection will be maintained in confidence by the individual affiliated with UMB to whom the disclosure was made unless other persons must be informed in order to implement this Policy.

A statement encouraging disclosures by persons who may or will be involved in invasive procedures may be included in School and Unit bulletins that advertise or describe academic programs to prospective and current students. Information regarding Review Panels and disclosures may be provided at enrollment, or soon thereafter, and at employee orientations. By one of these means it is expected that all students, employees, and other UMB Personnel currently or prospectively involved in invasive procedures will be informed by their School or Unit that:

Voluntary disclosure is encouraged;
The health status of a person who discloses infection will be held in confidence by UMB, and only persons who have a need to know the status in order to implement this Policy will be made aware of the status;
Voluntary and timely disclosure permits the School or Unit to assist in developing appropriate accommodations of maximum benefit to the disclosing individual; and
Disclosure itself cannot be the basis for academic dismissal or termination of employment, which would only follow careful consideration of a person's situation as discussed in this Policy.

Ombudsman

Each School and Unit will appoint a standing ombudsman or advocate to whom any applicant, student or employee can go in confidence for advice on policies and procedures related to infection with Bloodborne Pathogens and on the implications of testing and disclosure for enrollment or employment status.

Review Panels

UMB Personnel infected with a Bloodborne Pathogen who will be engaged in invasive procedures as a part of employment, educational program, or volunteer activities, are encouraged to disclose their status to their School or Unit Review Panel rather than to an administrative or academic official of the School or Unit. Each School or Unit will have a Bloodborne Pathogen Review Panel whose core membership will be determined under procedures developed by that School or Unit. Core membership should include: an individual knowledgeable about modes and risks of transmission of infection by Bloodborne Pathogens; a person expert in the practice of the professional discipline or work activities of the School or Unit; and a representative of the School's or Unit's infection-control group (where such a group exists). This membership may be drawn from individuals appointed or employed in other Schools or Units as well as from the School or Unit of the infected person.

To facilitate availability of qualified individuals for Review Panels, especially the panels of Schools or Units that may have an insufficient number of persons with the necessary experience or knowledge to serve on Review Panels, each School and Unit will compile a list of qualified individuals in its employ who would be available for service on its own Review Panel and other UMB Review Panels.

For each case pending before a Review Panel, the panel may seek information and recommendations from the infected person's personal physician (if available and authorized by the person to participate); a discipline-specific consultant if the infected individual is engaged in specialized work; and other consultants as needed to provide informed evaluation and recommendations.

The Bloodborne Pathogen Review Panel, after confidential review and deliberation, will recommend one or more of the following:

No restriction of activities;
Appropriate accommodation through changing the conditions of academic program or employment;
Restrictions of permitted activities;
Discontinuance of enrollment or employment. Recommendation (d) will be made only if the infected individual is physically or mentally incapable of performing required work related or academic activities or, although capable, poses a medically determined risk of transmission to patients, and there are no reasonable means by which accommodation and changes of activities could be devised which would allow continued employment or enrollment and completion of the academic program or employment responsibilities.

Review Panels will function under the general principle that not all health care workers infected with HIV, HBV or HCV need be prohibited from engaging in all invasive procedures; rather, each case will be individually considered, taking account of the skills and possible impairment of the individual.

For a student, the Review Panel's recommendations will be transmitted confidentially to the Dean of the student's School, who will develop a plan of action in consultation with the Review Panel, UMB legal counsel and the UMB President. The Dean may consult other University administrators, School faculty, licensing bodies, and medical consultants before reaching a decision concerning the Review Panel's recommendations or other actions. With respect to all consultations, the Dean shall preserve the confidentiality of the student. In determining whether to permit a student to continue in an educational program, the Dean will take into account the policies of affiliated teaching sites where the student would be assigned to complete educational requirements. The Dean's decision, i.e., the final plan, will be transmitted confidentially to the student and, with anonymity preserved, to the President and University legal counsel.

For an employee or other member of UMB Personnel, the Review Panel's recommendation will be transmitted to the concerned Dean or Unit head. The Dean or Unit head may consult with intermediate supervisors, University legal counsel, other University administrators, licensing bodies, and medical consultants before reaching a decision concerning the Review Panel's recommendation or other action. With respect to all consultations, the Dean or Unit head shall preserve the confidentiality of the individual under consideration. In determining whether to permit an individual to continue in employment or volunteer activities, the Dean or Unit Head will take into account the policies of affiliated sites where the individual would be assigned. The Dean or Unit head's decision will be transmitted confidentially to the infected individual and, with anonymity preserved, to the President and University legal counsel.

Accommodations

When necessary and reasonable, appropriate accommodations, including modifications of activities, curriculum, and job responsibilities, may be made for infected students or employees who otherwise would be engaged in invasive procedures or exposed to medically unacceptable risks of opportunistic infection. Inquiries with respect to competencies of prior performances by such individuals may be made by a Review Panel, a Dean, or a Unit head as an aid to designing appropriate accommodations.
Curriculum modifications will be subject to decisions of each School's advancement or curriculum committee (as determined by the School) and the School's Dean.

Monitoring

If any restriction of activity is imposed as a result of considering recommendations from a Bloodborne Pathogen Review Panel, the Dean or Unit head imposing the restriction will assign (an) individual(s) to monitor compliance with the restrictions. The individual(s) ordinarily will be selected from among those who have significant responsibility for supervision of the person whose activities are restricted. Assignment of monitoring responsibilities will be in accordance with a plan that is to be included in recommendations from the Review Panel.
Non-compliance with any approved restrictions or with a monitoring plan shall be reported to the Dean or Unit head, who, using the Review Panel as an advisory body, will decide whether further restrictions, modifications of activities, or discipline are warranted. The affected individual will be given full information about alleged violations of restrictions and the opportunity to present arguments to the Dean or Unit head before a decision is imposed. Due to confidentiality concerns, violations of monitoring requirements will not be referred for action under regular misconduct or disciplinary policies of the Schools or the UMB campus unless the infected individual requests such action.

Affiliated Institutions

Many UMB Personnel perform health care services in affiliated institutions having their own infection control policies and, in some cases, their own policies concerning the scope of activities allowed for health care workers infected with Bloodborne Pathogens. Most of the affiliated institutions require that UMB Personnel assigned to them be subject to the institutions' infection control and Bloodborne Pathogens policies. UMB Personnel assigned temporarily or permanently to affiliated institutions are expected to know and follow the policies of those institutions concerning disclosure of health care workers' infections to the institution. If an affiliated institution places restrictions on the activities of UMB Personnel infected with a Bloodborne Pathogen, and those restrictions if any, exceed those of UMB, imposed by an individual's Dean or Unit head, the School or Unit will attempt to reassign the individual to a site where he or she can carry out activities permitted by UMB.

Look-Back Studies

The utility of look-back studies after potential exposure of patients to HIV-infected health care workers is not supported by the evidence from previous studies. Therefore, UMB will not conduct such look-back studies except in extraordinary cases as determined by the President of the campus. With respect to other Bloodborne Pathogens, look-back studies may have medical value and will be given consideration.

Notification to Patients and Clients

UMB patients and clients who have been served by an individual among the UMB Personnel who is known, or becomes known, to be infected by a Bloodborne Pathogen, may be informed of the individual's infectious status if there was an Exposure Incident involving the blood or other body fluids of the individual. In such cases, testing and pre-test and post-test counseling will be made available without cost to the patient or client. Under other circumstances, patients ordinarily would not be contacted.

Management of Exposure Incidents

Management of Exposure Incidents of UMB Personnel will comply with the OSHA Standard. Exposure Incidents involving students during experiences that are required or are otherwise part of their UMB educational program will be managed under the OSHA Standard notwithstanding that the Standard applies only to employees. Occupational Exposure plans shall be developed by schools and publicized among students. These plans shall provide information about the steps to be followed in the event of an Exposure Incident.
Following a suspected or known Exposure Incident, the affected UMB Personnel should report the incident to the appropriate School or Unit authority identified in the Occupational Exposure plan. Testing of UMB Personnel following a reported Exposure Incident will be available through Student and Employee Health. Testing is the option of the exposed individual and will be performed only after obtaining written informed consent. It is recommended that a blood sample for testing be drawn immediately after an Exposure Incident, even if a decision to consent to testing of the sample has not been made. Pre-test and post-test counseling will be provided.
Costs of testing, counseling and treatment for students, other than AZT prophylaxis or other anti-viral medications, are covered under the Student Health fee. Testing, counseling and treatment, other than AZT prophylaxis or other anti-viral medications, will be provided at no cost to UMB employees. Costs for other UMB Personnel are the responsibility of the individuals being tested unless a School or Unit agrees to assume such costs.
Counseling will include a review of the advantages and disadvantages of AZT prophylaxis or administration of other currently appropriate anti-viral preventive medication, which generally can be offered by (but usually is not paid for by) UMB. It will be available at the individual's cost if it is desired. The individual's School or Unit will be responsible for any uninsured cost of AZT or other recommended medication administered to UMB Personnel upon medical recommendation immediately following a massive exposure to blood of a Source Individual or Confirmed Source Individual during a work or education activity.
If UMB students choose to be tested and receive care off campus, UMB will not be responsible for costs, even in instances of massive exposure.
Exposure Incidents of UMB personnel while at affiliated sites optimally should be handled by an appropriate exposure control plan and procedures in place at that site; however, if appropriate procedures are not available, Student and Employee Health will provide testing, counseling and treatment services as specified above.
If an Exposure Incident involves a patient in a Maryland hospital which is an affiliated site, the exposed UMB Personnel can request that the Source Individual be tested (with consent) for Bloodborne Pathogens. In order for the Source Individual to be tested, the exposed UMB Personnel must agree to be tested for Bloodborne Pathogens. If hospital infection control staff do not offer assistance in securing patient testing, the exposed UMB Personnel should notify Student and Employee Health and seek assistance.
If an Exposure Incident involves as the Source Individual a patient or client who is not in a Maryland hospital, Student and Employee Health will assist in seeking consent of the Source Individual for testing.
To the extent permitted by law, UMB will provide to exposed UMB Personnel, and will ask its affiliates to provide to exposed UMB Personnel, information about the infectious status of Confirmed Source Individuals involved in Exposure Incidents with UMB Personnel.

Respective Roles of Schools and Units and the Office of Environmental Health and Safety (EHS) in UMB Policies for Bloodborne Pathogens

In general, it will be the responsibility of Schools and Units of UMB to implement and monitor compliance with the OSHA Standard, this Policy, and other UMB, School and Unit policies (as applicable in specific cases) related to Bloodborne Pathogens. Each School or Unit required to do so by the nature of its activities will develop an exposure control plan. The plan should be developed in consultation with, and subject to approval by, the UMB Biosafety Committee. A single, campus-wide exposure control plan applicable in its entirety to all Schools and Units is not feasible.

Each School or Unit will be responsible for identifying its personnel having Occupational Exposure (such identification to be made on the basis of job responsibilities, not job title), communicating that determination to EHS for approval, and maintaining a list of such positions.

Each School or Unit should develop for its internal purposes a list of procedures within its educational or patient service purview that it considers to be invasive procedures as discussed above in this Policy.

Schools and Units will arrange with EHS appropriate training programs as required by the OSHA Standards. Such training may be accomplished either by course(s) developed and given by EHS, or by courses developed and given by the School or Unit after review and approval of course content and format by EHS. Development and conduct of training by Schools or Units, rather than by EHS, is preferred.

EHS will keep Schools and Units informed of changes in law and regulations pertinent to infection with or exposure to Bloodborne Pathogens.

Disability Insurance

UMB will review markets and opportunities for disability insurance at reasonable cost that insures UMB Personnel against loss of income due to disability resulting from infection by Bloodborne Pathogens. UMB will request that the State Department of Personnel likewise attempt to secure such coverage to protect UMB Personnel who are State of Maryland employees. However, UMB may not be able to make available policies that provide such coverage. UMB recommends that each student or employee who is not covered by appropriate disability insurance through the State of Maryland or University of Maryland System benefit system, or through an insurance plan through the individual's School or Unit, consider obtaining individual insurance.

H. Patient Administration

Admissions/Screening Policy

Subject: Clinical III. – H. Patient Administration

Department: Oncology and Diagnostic Sciences

Effective Date: 5/6/16

Reviewed and/or Revised: 09/01/2017, 02/28/2025, 07/31/2025

Additional Resource: Screening Flow Chart (PDF)

Policy and/or Procedure:

The dental student will begin working up the screening patient during their block assignment. Patient will be assigned to a primary student provider preferably, the student who is performed the screening, as well as a secondary student provider for co-therapy if indicated. The dental student will complete and have a faculty approve the medical history form in EPR. All pertinent findings will be explained and detailed in the EPR.
If indicated by the medical history, a medical consult form will be completed and approved by faculty in the EPR. This form will be printed and given to the patient to be completed by his/her physician, or the form can be emailed or faxed to the physician.
The dental student will perform a thorough extra and intra oral examination on the patient and findings will be recorded and approved by a faculty in EPR. All lesions must be described using the drop down in the EPR. Findings can also be described on the diagram in EPR as well as an intraoral photo.
Any patient with a lesion that warrants evaluation and/or follow up must be informed and referred to the oral medicine clinic. Appointments in the oral medicine clinic can be scheduled by calling 410-706-7956 or by emailing oralmedicine@umaryland.edu.
Any patient that has an urgent need (pain, swelling, infection) must be referred as soon as possible for treatment. This may include a referral to oral surgery or endodontics. The appropriate referral to specialty clinic form must be completed and authorized in EPR.
All appropriate radiographs must be planned in Axium by a faculty to be exposed by the student in Infinitt on each patient. All radiographs must be diagnostic and approved by a faculty member. If faculty deems it necessary, a Panorex would be exposed in addition to the CRS. There are instances where a Panorex and bitewings may be the standard of care.
If the patient has had radiographs available from an outside office, the student should instruct the office to send the radiographs to oralrad@umaryland.edu. They will then be uploaded to Infinitt by the radiology staff. These radiographs need to be evaluated for diagnostic quality and any supplemental films need to be exposed at that point. See radiology section.
The student will enter and have a faculty approve the appropriate screening and treatment planning macrocodes.
The patient assignment form will be completed and approved by a faculty member. This form will indicate if the patient should be assigned to a third year dental student, fourth year dental student, AGD resident, SCG clinic or post-graduate resident. The reason for referral to another clinic must be indicated on the patient assignment form. The patient care coordinator assigns the patient to the appropriate provider.
If a student wants to screen their own patient, the patient can be registered and appointed in the predoctoral clinic.
If a student does not report to block, he or she must make up two sessions for each one missed. A missed block will also result in a U grade in professionalism, which will have a negative impact on their Comprehensive Care and Patient Management course grade. If a student is not needed in the screening clinic, he/she must report to urgent care and/or oral surgery.

Each student must report to clinic on time. Tardiness is not accepted. If a student is late, they will receive an N grade in professionalism. If they are more than 15 minutes late, it constitutes a missed session and will result in a U grade for professionalism.

After Hours Access to Clinical Spaces Policy

Subject: III – Clinical – H. Patient Administration

Department: Clinical Affairs

Origination Date: December 1, 2023

Effective Date: December 1, 2023

Review and/or Revise Date: 02/28/2024, 7/31/2025

Policy and/or Procedure:

To ensure building safety and minimize risk all dental chairs/units, unless specifically designated for emergency use, will be automatically turned off every evening 1.5 hours past the end of normal clinic hours, on weekends and during holiday breaks. All dental chairs/units will be turned on 1 hour before the start of normal clinic hours.

Consequently, except for chairs specifically designated for emergency use, no students or residents should be in the clinical spaces during off hours. Students should only use clinical operatories that they have been designated for their program.
Please note, this does not apply to student/resident labs spaces.

Clinics are only OPEN during the following hours:

General Practice Clinics, SC & G, and First Floor OMFS

Monday & Friday: 8am – 6pm
Tuesday & Thursday: 8am – 8pm
Wednesday: 6am – 6pm

AEGD

Monday through Friday: 6:30am – 8pm

ASE Programs and PLUS Clinic

Monday through Thursday: 6:30am – 8pm
Friday: 6:30am – 6pm

Clinical operatories MAY NOT BE USED outside of these normal business hours.

Appointment Recall Process (Pre-Doctoral Clinic) Policy

Subject: III. Clinical – H. Patient Administration #2

Effective Date: July 2016

Reviewed and/or Revised: 12/05/2016, 09/01/2017, 12/08/2025, 2/18/2026

Purpose: To ensure that the patient’s oral health is properly maintained through appropriate recall intervals. Recall intervals are determined at the treatment planning appointments and/or the evaluation of initial periodontal therapy by the GP Director, Assistant GP Director, or Periodontal faculty.

Policy and/or Procedure

Recall appointments are set in Axium according to their predetermined interval (3, 4, 6 months or 12-month denture recall). Students are expected to adhere to prescribed recall intervals when possible. Reports can be queried to ensure that the indicated recall interval is being met. Some patients may require a customized recall strategy to ensure optimal oral health is maintained.

Clinical courses including Comprehensive Care and Patient Management and Periodontics have certain requirements regarding recall status. Periodic chart audits are performed by the Patient Care Coordinators to ensure that the patients are appointed appropriately for treatment. GP Directors and Assistant GP Directors periodically review patient lists with students to ensure compliance with our recall policy.

Auditing Patient Records Policy and Procedure

Subject: III. Clinical – H. Patient Administration

Origination Date: 01/01/2010

Reviewed and/or Revised: 09/01/2016, 09/01/2017, 02/28/2024, 07/31/2025

Purpose:

To provide data as a basis for recommending approaches to problems and improving the overall operations of University of Maryland School of Dentistry (UMSOD).

Policy and/or Procedure

UMSOD will conduct objective and systematic audits using explicit criteria to assure that accepted business processes are followed, that the patient receives appropriate care, and the results of such audits shall guide actions to improve business practices, improve patient care, address organizational concerns, and correct other deficiencies.

Director of Medical Credentialing runs monthly audit reports via the computer patient records system for unapproved or unsigned items such as consents, treatment plans and general policy and informed consent policy. Results of these audits are reported monthly to the Quality Assurance Committee.

Booking an Appointment Pre-doctoral Dental and Dental Hygiene Students Procedure

Subject: III. Clinical – H. Patient Administration

Department: Periodontics/Dental Hygiene Division

Effective Date: August 7, 2013

Reviewed and/or Revised: 09/01/2017, 2/20/2024, 8/13/2025

Purpose: To assist students regarding scheduling an appointment in Axium

Policy and/or Procedure:

Booking Appointments:

You will be able to see both floors on the chair view.

You will only be able to see one floor at a time from your “chair” view. In the bottom row of chairs, you will see each GP labeled and your chair reserves within that GP. In the top row, you will see the various treatment disciplines noted, and the faculty coverage listed on the bottom.
Once you have a chair reserved to book the appointment, it will be noted in the appropriate color in the bottom row within your GP. You must click and drag the appointment and drop in the appropriate place in the top row to reserve your spot.
The chair you selected will be your chair to work in. There will be no more daily seating assignments; they will not be noted on the chair view.
Once the treatment discipline has been filled, you cannot book another chair. Therefore, if there is a blank box in the top row, that chair should remain empty.
It is very important to use the “reason” section of the appointment request to write specifically what you are doing for that appointment. Do not write “operative”. Write “#2 DO” or “#12 post and core”. It is also important to enter in the “appt status” on your request so show if it is a GD, Perio, or Prosth appointments. This is much easier for faculty to check at a glance. Faculty coverage will be determined on a daily basis depending on specific procedures.
You will notice that each floor is symmetrical.
- TP/GD chairs are on floor 3 which are GP’s 1&2 you can book any of the chairs in the top left section for Treatment planning and General Dentistry. GP3&4 you can book any of the chairs in the top right section for Treatment planning and General Dentistry.
- TP/GD chairs are on floor 2 are GP’s 5&6 you can book any of the chairs in the bottom left section for Treatment planning and General Dentistry. GP7&8 you can book any of the chairs in the bottom right section for Treatment planning and General Dentistry.
- Perio chairs are on each floor which is GP 2 on the 3rd floor and GP6 on the second floor. You cannot switch floors unless it is 48 hours prior to the date of the appointment.
- Prosth chairs are on both floor which is usually GP3 on the 3rd floor and GP7 on the second floor. Those chair are request by the students using the “Make appt request” form. Prosth chairs are label for D3 and D4 students. Any “GD” chairs noted that are not within a specific GP and are sometimes bonus chairs are based on first come first serve chairs. These chairs are not available each session so please look carefully.
TP chairs should be reserved for TPU’s and TXP’s. GD chairs should be used for operative, perio, prosth that you would do with GD and TPW’s
There are also some chairs listed for GDFX and GDREMO, follow the guidelines to use those chairs.
If there is an opening on the opposite side of the floor for TP/GD, you may use the 48-hour rule to schedule after obtaining permission from the appropriate director. Example: If you are GP1 or GP2, and you are seeing and opening in GP3&4 and it is within 48 hours, you may book that chair with permission. You can never switch floors.

Chart Documentation for Insurance Submission Procedure

Subject: III. Clinical – H. Patient Administration

Origination Date:

Effective Date:

Reviewed and/or Revised: 09/01/2017, 2/24/2024, 8/13/2025

Purpose

To ensure that much of the required information that has not been provided by the requestor of the pre-authorization is received. Also because many charts are kept out for extended periods of time and thus copies of charting can not be made, progress notes etc., that may be required as part of the claims submission are also received.

Policy and/or Procedure

All missing teeth numbers
Dates of extractions (does not have to be the month, day, but definitely has to be a year, or the insurance company will continue to ask for it and we will never get it processed until we give them a year) of any extractions not done here.
Actual teeth numbers for Osseous surgery, gingival flaps, alveoplastys, bone grafts. Insurance will not accept LL, LR, UR or UL anymore for these procedures, they keep coming back and asking for actual teeth numbers.
Is it first time for crowns, implants, bridges etc.?
If not, what is the original date of placement for those procedures?
Why are they being replaced if not first time?
IF there is a crown being done and there is no endo on the tooth, insurance requires a narrative as to why a crown is being done without endo (if there is endo, this is not a problem)
Are there pre-operative x-rays in Romexis? (most of the time, a pan or CRS is the best, but sometimes they do want pre-op periapicals of the tooth) We will print them, but we just need to make sure the provider knows this is needed so he/she can take one if needed.
For veneers - a short narrative as to why they are being done and, they ask for pre-op x-rays for that too.
The pre-authorization has to be swiped into Axium.

Also, they will not accept a pre-authorization that has alternate treatment plans (such as implants/denture) to see which one pays more. You can only request one tx plan at a time. So, if you got a denial for implants, then we can submit one for dentures, but never both together (if they encompass the same teeth, that is.)

Clinic Fee Courtesies for Employees and Their Families

Subject: Class III – Clinical – H. Patient Administration

Policy Owner: Executive Director of Clinic Administration

Effective Date: July 1, 2023

Reviewed and/or Revised: 07/01/2023, 2/24/2024, 8/13/2025, 12/01/2026, 3/06/2026

Purpose

The purpose of this policy is to allow special financial arrangements for employees and their families.

Policy Statement

School of Dentistry / UMFDSP Employee Fee Courtesy

For dental care regardless of type of employee.
- This courtesy cannot be applied to procedures when insurance is used to pay for the procedure.
- 20% fee reduction as a courtesy for all School of Dentistry / UMFDSP staff and their immediate family to include only their spouse and children.
- The maximum annual accumulated courtesies are $2,000 per employee.

Clinic Fee Courtesies for Students, Residents and Their Families

Subject: Class III – Clinical – H. Patient Administration

Policy Owner: Director of Finance

Effective Date: July 1, 2023

Reviewed and/or Revised: 07/01/2023, 2/24/2024, 8/13/2025, 12/01/2025, 3/06/2026

Purpose

The purpose of this policy is to allow special financial arrangements for students, residents, and their families.

Policy Statement

“Immediate Family” is defined as spouses, children, siblings, and parents.

“Children” means a natural child, adopted child, stepchild or legal guardianship or custody of.

The student needs to sign an attestation for each family member. This signed document will be added to the patient chart in Axium. A current attestation on file is the prerequisite for application of the family code to be used on the account. The attestation will include language in reference to consequence of falsifying the information, the signer will be subject to disciplinary action, and be responsible for the full charges, if information is found to be false. The School of Dentistry reserves the right to deny treatment or require full charges for those treatments.

Student Fee Courtesy

Educational fee courtesy for students treating students and their immediate family members.
- Only allowed for patients who are DDS or DH students and their immediate family
- Care must be provided by pre-doctoral DDS or DH students in the pre-doctoral clinic.
- Patient will receive an 80% reduction of clinic fees exclusive of direct costs such as lab fees or clinic materials (e.g. bone graft, etc.).
- Patient will be responsible for paying direct costs (e.g. lab fees or graft material).
- Implants are not included in this program.

Resident Fee Courtesy

Educational fee courtesy for residents treating their immediate family members.
- Residents should meet with the program business manager about possible patient care fee reduction for treating their immediate family. The program director must approve the courtesy based upon the program’s ability to cover the expense.

Educational fee courtesy for students and residents receiving treatment in postgraduate residency programs

Only allowed for current DDS or DH students and residents.
Treatment of DDS or DH students and residents will not supplant treatment of regular patients.
Care must be provided by residents in the postgraduate program.
DDS or DH students and residents will receive a 50% reduction of clinic fees exclusive of direct costs such as lab fees or clinic materials (e.g. bone graft, etc.).
DDS or DH students and residents will be responsible for paying direct costs (e.g. lab fees or graft material).
Implants are not included in this program.

Clinical Financial Management Policy - Predoctoral Clinics and AGD/ASE Clinics

Subject: III. Clinical – H. Patient Administration

Effective Date: July 20 2009

Reviewed and/or Revised: 09/01/2017, 2/24/2024. 8/13/2025

Policy Statement for Predoctoral Clinics

All treatment must be paid in full at each treatment appointment unless a Patient Financial Agreement (contract) or other arrangements have been approved. If dental insurance, third-party coverage, or other prepaid financing covers the patient, pre-authorization approval must be obtained before treatment is initiated. A General Practice Director or Business Manager must approve exceptions to this policy. Typically, forty percent of the estimated total case fee must be collected at the time the Agreement is signed. Each student is responsible for overseeing patient compliance with the Agreement. The G.P. Director will be notified of each account that had a balance more than 60 days in arrears. Elective treatment may be discontinued, at the direction of the G.P. Director, for patients whose balance is unpaid or overdue for 60 days or more. Year IV students may not place active patients on a financial contract after February 1, in the year in which graduation is expected, unless approved in writing by a G.P. Director.

Dental and dental hygiene students, their spouses and children are eligible for special fee reductions in the predoctoral program. Graduate students and Dental School employees may also qualify for fee reductions. Please refer to the policy below:

Policy Statement for Advanced General Dentistry and Post-Graduate Clinics

All treatment must be paid in full at each treatment appointment unless a Patient Financial Agreement (contract) or other arrangements have been approved. If dental insurance, third-party coverage, or other prepaid financing covers the patient, pre-authorization approval must be obtained before treatment is initiated. A Director or Business Manager must approve exceptions to this policy. Typically, thirty (30) percent of the estimated total case fee must be collected at the time the Agreement is signed and the balance to be paid over the estimated length of treatment. Each student is responsible for overseeing patient compliance with the Agreement. The Director will be notified of each account that had a balance more than 60 days in arrears. Elective treatment may be discontinued, at the direction of the Director, for patients whose balance is unpaid or overdue for 60 days or more.

Clinic Missteps and Sanctions Policy

Subject: Class III – Clinical – H. Patient Administration

Department: Pre-Doctoral Clinics

Effective Date: 8/28/13

Reviewed and/or Revised: 05/31/2016, 09/01/2017, 12/08/2025

For additional information, refer to the Student Responsibility Statement in section 1. Academic, A. Student Affairs.

Clinic Missteps and Sanctions

Clinic Missteps	Expected Sanctions
Deliberate failure to follow faculty/auxiliary staff instruction in clinic:	1st instance – warning **2nd instance – Failing grade in Professionalism; failure for procedure; Academic Counseling Form
Running over >20 minutes beyond scheduled clinic time: if a Time Mgt/Preparedness Issue:	1st instance – warning 2nd instance – Failing grade in Professionalism; failure for procedure 3rd instance – Failing grade in Professionalism; failure for procedure; and Academic Counseling Form
Starting additional procedures without faculty authorization:	1st instance – warning 2nd instance – Failing grade in Professionalism; failure for procedure 3rd instance – Failing grade in Professionalism; failure for procedure; and Academic Counseling Form
Patient dismissed from clinic before procedures and medical history are swiped into Axium without communicating with covering faculty (Swiping in treatment after the patient has left clinic):	1st instance – warning **2nd instance – -Failing grade in Professionalism the procedure(s); Write a one page report on Accounts Receivable (A/R)
Patient identifiers and/ or prescriptions left in clinic or other public areas of the building:	Write a one page report on HIPAA regulations with copies to GP director, and vice-chair of the Department of General Dentistry.
Failure to review medical history, take blood pressure, know drugs patient is taking, or ensure that medical consult has been returned and scanned into Axium:	**1st instance – - Failure in professionalism; Additional sanctions are at the discretion of the supervising faculty.
Failure to know minimum basic information about the procedure to be performed:	Student receives a “U” for procedure (sanction applied at the discretion of faculty). Student needs to submit written report detailing the armamentarium and step-by-step technique required for procedure.
Treating patient without a “start”:	1st instance – -U for professionalism and procedure Academic Counseling Form; 1st instance –** for rising D3-Warning -at discretion of covering faculty
Dismissing patient without a “final check”:	1st instance – - warning 2nd instance – -U for professionalism and procedure; Academic Counseling Form 3rd instance – - U for professionalism and procedure; Academic Counseling Form; Judicial Board
Student presents in inappropriate attire; does not follow school dress code:	1st instance – warning 2nd instance – Student is dismissed from clinic
Failure to present a “Block” assignment. Late arrival or early departure to/from a block:	1st instance – Repeat the Block + one additional Block; Academic Counseling Form; 2nd instance – 3-day suspension in addition to repeat block+1.
Bringing in a patient without an appointment in Axium - attempting to “add-on” w/o prior approval – scheduling pt. in wrong discipline:	Failing grade Professionalism/procedure(s), Academic Counseling Form
Bringing in a patient while scheduled on Block assignment:	Repeat Block plus one; Academic Counseling Form; failing grade Professionalism/procedure(s)
D3s bringing in a patient to clinic during designated class time:	Academic Counseling Form; Failing grade in professionalism/procedure(s)
D3s/ Seniors bringing a patient to clinic when scheduled for senior case or translational conferences:	Academic Counseling Form; Failing grade professionalism and procedure(s)
Performing treatment on a patient with a “frozen” account:	At discretion of Assistant Dean of Clinical Affairs – Academic Counseling Form; Failing grade in professionalism/procedure(s)
Performing treatment without signed consent**:	Academic Counseling Form; Failing grade in professionalism/procedure(s)
Performing prosthetic procedures without having completed the Pre-prosthetic Audit:	No credit for the prosthetic procedure; Failure Professionalism
Failure to check in or check out the patient at the reception area:	Warning, Failure in professionalism, Failure for procedure
Failure to appoint patients/provide care in a timely manner within 3 weeks after assignment:	**Failure in Professionalism; Academic Counseling Form
Inappropriate attire in the clinic, whether treating a patient or not:	Refer to school dress code; Failure in professionalism
Failure to obtain starting and finishing swipes as well as lab orders from the same faculty member:	**Failure in professionalism/procedure
Seeing a patient in the clinic despite clinic suspension:	Additional Clinic Suspension; refer to Dean of Clinical Affairs; Judicial Board
“Ghost Booking” and/or failure to cancel in Axium any patient who needs to reschedule; Scheduling > the allowed # of appointments for any patient:	**Failure in Professionalism; 1 week clinic suspension; Academic Counseling form; Judicial Board Action
Failure to return materials/equipment to Prep-Dispense at the end of session:	Clinic Suspension of 1 – 5 days and academic counseling report at faculty discretion

*Clinic Suspension: If you are suspended from clinic, you will not be allowed to see or treat your patients of record. You will however be assigned at the discretion of your GP Director and the Assistant Dean of Predoctoral Clinical Education

Be assigned to a Block based on operational need,
Shadow a GP Director or clinic faculty for the day,
Be assigned to assist another pre-doctoral student or AEGD resident in clinic.

Failure to comply with clinic suspension will result in referral of the matter to the Judicial Board.

**Affects CCPM grade – Any negative grade in Professionalism will be reflected in the CCPM grade as detailed in syllabus for CCPM.

***Signed Informed Consent (in Axium): Consent for treatment must be signed by the patient, in Axium, before any treatment is initiated! This refers to:

All assigned comprehensive care patients
Modification/Addendum to an existing treatment plan
“Limited” or “Urgent Care” treatment plans

The treatment plan must contain the appropriate codes, descriptions (including materials to be used), and fees for that procedure. Each procedure is to be listed individually on the treatment plan (no bundling of codes). The treatment plan consent form must be signed by the patient, and subsequently the GP Director who evaluated the proposed treatment.

I have read and understand the above-mentioned clinic policies as relates to unacceptable behavior and expected sanctions:
____________________________________________	_________	_________	_____
Student Name (Print & Signature)	Student #	Date	GP

Commercial Dental Insurance Policy

Subject: Class III – Clinical – H. Patient Administration

Effective Date: July 20 2009

Reviewed and/or Revised: 09/01/2017, 2/27/2024, 8/13/2025

Purpose

To ensure that proper information is collected if the patient indicated that they carry dental insurance.

Policy Statement

Patients who indicate upon registration or at any time during the course of treatment that they carry dental insurance must provide a copy of their insurance card and the following information by completing the Insurance Information Form.

Information needed: name of policy holder, group and policy identification numbers, employer data, insurance company data, dental benefit information, deductible amounts (if known), and effective policy date.

The registrar reviews the employer data and checks it against our published employer data file. If there is no match, all information is forwarded to the Business Office for inclusion in the Insurance/Employer database.

The patient must provide the insurance office with a copy of their company's insurance form at the initiation of care and each new calendar year with all pertinent employee and patient information provided. The form must also contain the patient's signature authorizing submission and designation to pay benefits.

For patients whose treatment plan exceeds $250.00, a preauthorization request must be forwarded to the insurance company for determination of benefits. When presenting the record for preauthorization to the insurance clerk, the following must be present:

Completed treatment plan (signed by patient and faculty); completed dental charting including pocket depth readings and with all missing teeth crossed out; and appropriate radiographic images. Provider should indicate whether the proposed bridges or prosthetic appliance(s) are initial or replacement devices. If appropriate, indicate the age of existing prosthesis and the reason for replacement.

Treatment should not commence until a confirming authorization has been received. A duplicate copy of the authorization will be forwarded to the provider of care for information purposes and discussion with the patient of their finical obligation for those services not covered by insurance.

As treatment is completed, the insurance form will be executed as part of the charge out procedure. Providers are requested to advise the insurance clerk when prosthetic devices have been delivered so he/she may complete the preauthorization form and forward it for payment.

The business Office will post all insurance payments directly to the patient account.

Any inquiries received by our office for additional information from the insurance carrier may be forwarded to the provider of service for appropriate response. All requests should be returned to the Business Office within 5 working days.

Consents Policy and Procedure – Initial Consent (SC & G)

Subject: Class III – Clinical – H. Patient Administration

Department: Special Care and Geriatrics Clinic / Department of Periodontology

Origination Date: 7/31/15

Effective Date: 7/31/15

Reviewed and/or Revised: 09/01/2017, 1/26/2024, 8/13/2025

Purpose: To ensure that prior to providing non-emergency oral health care services to a patient, informed consent is obtained from the patient if the patient is capable of making an informed decision, or a legal guardian or individual authorized to make health care decisions for the patient.

Definitions:

Legal Guardian: An individual appointed by the court through a guardianship proceeding to make decisions on behalf of a person who has been certified incapable of making their own informed decisions.

Policy and/or Procedure:

At the time of scheduling an appointment, all patients will be asked to identify whether they are capable of making their own informed decisions, or whether they have a legal guardian or an individual who is authorized to make health care decisions on their behalf. Documentation of guardianship is required.

An Informed Consent form(s) signed by the legal guardian or an individual authorized to make health care decisions for the patient must be in the record before the patient can receive any services in the Clinic.

Consents Policy - Urgent Care and SCG Clinic Inability to Consent

Subject: Class III – Clinical – H. Patient Administration

Department: Oral & Maxillofacial Surgery – Urgent Care Clinic and Special Care and Geriatrics Clinic

Origination Date: 4/24/2025

Effective Date: 4/24/2025

Reviewed and/or Revised: 4/24/2025

Purpose: To ensure that prior to providing emergency oral health care services to a patient, informed consent is obtained from the patient if the patient is capable of making an informed decision, or a legal guardian or individual authorized to make health care decisions for the patient.

Definitions:

Legal Guardian: An individual appointed by the court through a guardianship proceeding to make decisions on behalf of a person who has been certified incapable of making their own informed decisions.

Patients may be incapable of making their own informed decisions due to intellectual disabilities or for other reasons. Consent from a legal guardian or individual authorized to make health care decisions for the patient is required before such patients may receive care. If this is not possible, then implied consent may be assumed in emergency situations where immediate care is necessary to preserve life or prevent serious harm, in accordance with applicable laws and ethical standards.

Policy and/or Procedure:

An Informed Consent form(s) signed by the patient or legal guardian or an individual authorized to make health care decisions for the patient must be in the record before the patient can receive any services in the Clinic. If this is not possible, the provider of care has to make a reasonable determination if the patient is competent to consent. Non-verbal is not a basis to say that they cannot consent. If the patient is autistic or mute, that alone is not reason enough to say that they cannot consent.

During an emergency visit:

Explain the procedure and have the patient sign the consent.
If they are unable to sign the consent and there is no legal guardian or individual authorized to make health care decisions, you would do the following:
- Place a progress note to the patient’s file, for example: “Attempts to give the patient informed consent were futile. No legal guardian or individual authorized to make health care decisions is present. In our professional judgment, this was an emergency situation and requires immediate care.”

Creating a Payment Plan Policy and Procedure

Subject: Class III – Clinical – H. Patient Administration

Effective Date: July 21 2009

Reviewed and/or Revised: 09/01/2017, 1/26/2024, 8/13/2025

Policy Statement

Patients to go on a payment for planned treatment.

Purpose

To have payment before treatment for lab fees.

Definitions

Contract/financial agreement - a binding agreement between two or more persons or parties; especially: one legally enforceable b: a business arrangement for the supply of dental services at a fixed price.

Policy and/or Procedure

Discuss contract, down payment, timeframe and with patient in order to arrive at the terms of the financial contract.

Establish down payment and plan timeframe.

Enter information into patient record via computer program. Note: information will not be in the patient record chart.

Dispensing Preventive Products Procedure

Subject: Class III – Clinical – H. Patient Administration

Department: All Clinical Departments

Origination Date: January 27, 2016

Effective Date: February 1, 2016

Reviewed and/or Revised: 09/01/2017, 8/25/2025

Purpose: To dispense preventive products at the UMSOD to our patients in lieu of having patients have to go to their pharmacy—if they so desire.

Scope (applies to): Dental and Dental Hygiene Students/Faculty

Definitions: Prescription products such as MI Paste, MI Paste Plus, Prevident 5000 Plus, Chlorhexidine

Policy and/or Procedure:

Provider/faculty use existing drug selection list to order Rx (current protocol). This ensures the data is in Axium under the patient's EPR as prior.
Student should enter the prescription in eRx from the approved list and have the covering dentist sign. Once signed electronically, send to the School Store via eFax.
If patient elects to fill the prescription at the School Store, the student can accompany the patient to fill the prescription once received via eFax. The School Store Manager and team accept payment in the form of electronic payments (debit or credit). The School Store Manager will provide the patient with the product along with a receipt.
The School Store manager maintains a list on file of the following information and submit a copy to the General Anesthesia Administrator for records purposes:
- Date of Prescription
- Name of Patient
- Name of Provider prescribing
- Name of Student
- Name of product prescribed
- Price charged to patient
- Date prescription is given to student to give to patient

Products that can be dispensed through the School Store:

Prevident 5000 Plus
MI Paste products
Chlorhexidine: Small and large bottle

Fee Schedule

Subject: III. Clinical, H. Patient Administration

Origination Date: 9/1/2027

Revisions Date: 2/29/2024, 8/1/2025

Treatment Group	Code	Axium Description	AGD	ASE	FDS	FDS+	UG	SC&G

Other	C1000	Positional Conditions	0	0	0	0	0	0
Other	C1001	Rotated Mesially	0	0	0	0	0	0
Other	C1002	Rotated Distally	0	0	0	0	0	0
Other	C1003	Tipped Mesially	0	0	0	0	0	0
Other	C1004	Tipped Distally	0	0	0	0	0	0
Other	C1005	Tipped Buccally	0	0	0	0	0	0
Other	C1006	Tipped Lingually	0	0	0	0	0	0
Other	C1007	Shifted Mesially	0	0	0	0	0	0
Other	C1008	Shifted Distally	0	0	0	0	0	0
Other	C2000	Orientation Conditions	0	0	0	0	0	0
Other	C2001	Partial Erruption	0	0	0	0	0	0
Other	C2002	Extruded	0	0	0	0	0	0
Other	C2003	Impacted	0	0	0	0	0	0
Other	C2004	Diasthemas	0	0	0	0	0	0
Other	C2005	Crowding	0	0	0	0	0	0
Diagnostic	D0110.1	- Medical History Analysis	0	0	0	0	0	0
Diagnostic	D0110.2	- Soft Tissue Exam	0	0	0	0	0	0
Diagnostic	D0110.3	- Hygiene Assessment	0	0	0	0	0	0
Diagnostic	D0110.4	- Manual BP	0	0	0	0	0	0
Diagnostic	D0120	Periodic oral evaluation	69	69	69	70	45	45
Diagnostic	D0120.1	- Endo Recall Performed	0	0	0	0	0	0
Diagnostic	D0120.2	- Annual Periodontal Evaluation	0	0	0	0	0	0
Diagnostic	D0120.8	- Annual AGC Evaluation	0	0	0	0	0	0
Diagnostic	D0120.9	- Implant Recall Performed	0	0	0	0	0	0
Diagnostic	D0140	Limited oral eval-prob focused	78	78	104	115	52	52
Diagnostic	D0145	ORAL EVAL.PATIENT UNDER 3YRS	78	78	90	97	45	45
Diagnostic	D0150	Comprehensive oral evaluation	92	92	121	132	65	65
Diagnostic	D0150.1	BOARDS ONLY Screening	0	0	0	0	0	0
Diagnostic	D0150.2	BOARDS ONLY PAN	0	0	0	0	0	0
Diagnostic	D0150.3	BOARDS ONLY FMX	0	0	0	0	0	0
Diagnostic	D0160	Detailed & extensive oral eval	155	155	207	229	104	104
Diagnostic	D0170	Re-eval-limited-prob focused	44	44	69	90	44	44
Diagnostic	D0170.1	- Patient Therapy Complete	0	0	0	0	0	0
Diagnostic	D0170.2	- EIT Periodontal Case	0	0	0	0	0	0
Diagnostic	D0170.3	- Scaling Complete or Competency	0	0	0	0	0	0
Diagnostic	D0170.4	Evaluation of Limited Periodontal Therapy	0	0	0	0	0	0
Diagnostic	D0170.5	- Pre-Prosth Audit	0	0	0	0	0	0
Diagnostic	D0170.6	Case Complete - Simple	0	0	0	0	0	0
Diagnostic	D0170.7	Case Complete - Complex	0	0	0	0	0	0
Diagnostic	D0170.8	- EIT Gingivitis Case	0	0	0	0	0	0
Diagnostic	D0170.9	- Comp Care Outcome Assmt	0	0	0	0	0	0
Diagnostic	D0171	Re-evaluation - post-operative office visit	35	35	47	53	18	18
Diagnostic	D0180	Comprehensive perio evaluation	123	123	133	173	72	72
Diagnostic	D0180.1	Referral of co-therapy	0	0	0	0	0	0
Diagnostic	D0180.2	- Referral to Perio Sophomore block	0	0	0	0	0	0
Diagnostic	D0180.3	- Localized Periodontal Evaluation	0	0	0	0	0	0
Diagnostic	D0190	Screening of a New Patient	0	0	0	0	0	0
Diagnostic	D0191	Assessment of a Patient	0	0	0	0	0	0
Diagnostic	D0210	Intraoral - comprehensive series of radiographic images	166	166	166	166	166	166
Diagnostic	D0210I	- FMX (imported)	0	0	0	0	0	0
Diagnostic	D0220	Intraoral-periapical 1st image	34	34	34	34	34	34
Diagnostic	D0230	Intraoral-periapical addl film	31	31	31	31	31	31
Diagnostic	D0240	Intraoral - occlusal film	47	47	47	47	47	47
Diagnostic	D0250	Extraoral radiographic images	68	68	68	68	68	68
Diagnostic	D0251	Extra-oral posterior radiograph	56	56	56	56	56	56
Diagnostic	D0260	Extraoral - each add film	0	0	0	0	0	0
Diagnostic	D0270	Bitewing - single film	35	35	35	35	35	35
Diagnostic	D0272	Bitewing - 2 films	43	43	43	43	43	43
Diagnostic	D0273	Bitewing - 3 films	49	49	49	49	49	49
Diagnostic	D0274	Bitewing - 4 films	58	58	58	58	58	58
Diagnostic	D0274I	- BW (imported)	0	0	0	0	0	0
Diagnostic	D0277	Vertical bitewing - 7-8 films	111	111	111	111	111	111
Diagnostic	D0290	Post.-ant. Skull & facial bone	0	0	0	0	0	0
Diagnostic	D0310	Sialography	302	302	302	302	302	302
Diagnostic	D0320	TMJ arthrogram, incl injection	616	616	616	616	616	616
Diagnostic	D0321	Other TMJ films, by report	212	212	212	212	212	212
Diagnostic	D0322	Tomographic survey	0	0	0	0	0	0
Diagnostic	D0330	Panoramic film	122	122	152	152	108	108
Diagnostic	D0330I	- PAN (imported)	0	0	0	0	0	0
Diagnostic	D0330S	- PAN(Imported\withScout)	0	0	0	0	0	0
Diagnostic	D0340	Cephalometric radiograph 2D	141	141	141	141	141	141
Diagnostic	D0340I	- CEPH (imported)	0	0	0	0	0	0
Diagnostic	D0350	- Oral/facial images	0	0	0	0	0	0
Diagnostic	D0350.1	- Oral/facial images (intraoral)	0	0	0	0	0	0
Diagnostic	D0351	3D photographic image	0	0	0	0	0	0
Diagnostic	D0360	Cone Beam ct-Craniofacial data capture	0	0	0	0	0	0
Diagnostic	D0360.1	Cone Beam-Single Arch	0	0	0	0	0	0
Diagnostic	D0360.2	Cone Beam Single Tooth or Site	0	0	0	0	0	0
Diagnostic	D0362	Cone Beam-two dimensional image recon.using exist.data.	0	0	0	0	0	0
Diagnostic	D0363	Cone Beam-three dimensional image recons. unsing exist. data	0	0	0	0	0	0
Diagnostic	D0364	Cone Beam CT - less than one jaw w interpretation	272	272	272	272	272	272
Diagnostic	D0365	Cone Beam CT - mandible with interpretation	383	383	383	383	383	383
Diagnostic	D0366	Cone Beam CT - maxilla with interpretation	383	383	383	383	383	383
Diagnostic	D0367	Cone Beam CT - maxilla & mandible w interpretation	433	433	433	433	433	433
Diagnostic	D0367I	- CBCT (imported)	0	0	0	0	0	0
Diagnostic	D0368	Cone Beam CT for TMJ series incl 2 /more exposures	358	358	358	358	358	358
Diagnostic	D0372	Intraoral tomosynthesis - comprehensive radiograph series	220	220	220	220	99999	99999
Diagnostic	D0373	Intraoral tomosynthesis - bitewing radiographic image	47	47	47	47	99999	99999
Diagnostic	D0374	Intraoral tomosynthesis - periapical radiographic image	46	46	46	46	99999	99999
Diagnostic	D0387	Comprehensive radiograph series - image capture only	0	0	0	0	99999	99999
Diagnostic	D0388	Bitewing radiographic image - image capture only	0	0	0	0	99999	99999
Diagnostic	D0389	Periapical radiographic image - image capture only	0	0	0	0	99999	99999
Diagnostic	D0391	Interpretation of diagnostic image including report	134	134	134	134	134	134
Diagnostic	D0393	Virtual treatment simulation using 3D volume or surface scan	166	166	166	166	166	166
Diagnostic	D0394	Digital subtraction of 2 + images of the same modality	0	0	0	0	0	0
Diagnostic	D0395	Fusion of 2+ 3D image volumes of one or more modalities	166	166	166	166	166	166
Diagnostic	D0396	3D Printing of a 3D surface scan to obtain a physical model	141	141	151	151	81	81
Diagnostic	D0411	HbA1c - In Office Testing	29	29	29	29	29	29
Diagnostic	D0412	Glucose Level in office w/meter	11	11	11	11	11	11
Diagnostic	D0414	Lab Process Microbial Speciman w/report	0	0	0	0	0	0
Diagnostic	D0415	Bact. studies for path. agents	174	174	232	255	116	116
Diagnostic	D0416	Viral Culture	197	197	197	197	103	103
Diagnostic	D0417	Collection/prep of saliva sample for lab testing	162	162	199	232	108	108
Diagnostic	D0418	Analysis of saliva sample	161	161	198	224	104	104
Diagnostic	D0419	- Assessment of salivary flow	0	0	0	0	0	0
Diagnostic	D0421	Genetic Test to Oral Disease	0	0	0	0	0	0
Diagnostic	D0422	Collect/prep genetic sample for lab analysis/report	146	146	146	146	146	146
Diagnostic	D0423	Genetic test for disease susceptibility/specimen analysis	146	146	146	146	146	146
Diagnostic	D0425	Caries susceptibility tests	97	97	97	109	75	75
Diagnostic	D0431	Adj.Pre-Diag Test/Not Biop/Cyt	88	88	88	98	55	55
Diagnostic	D0460	Pulp vitality tests	78	78	78	85	44	44
Diagnostic	D0470	Diagnostic casts	141	141	151	151	81	81
Diagnostic	D0471	- Oral Pathology Laboratory	0	0	0	0	0	0
Diagnostic	D0472	Accession of tissue-gross exam	152	152	152	152	110	110
Diagnostic	D0473	Accession of tissue	197	197	197	197	110	110
Diagnostic	D0474	Accession of tissue, w/ assess	236	236	236	236	125	125
Diagnostic	D0475	Decalcification Proc.	262	262	262	272	142	142
Diagnostic	D0476	Spec. Stains Microorganisms	379	379	379	416	220	220
Diagnostic	D0477	Spec. Stns. Not Microorganisms	388	388	388	425	224	224
Diagnostic	D0478	Immunohistochemical Stains	218	218	218	222	157	157
Diagnostic	D0479	Tissue In-Situ Hybridization	301	301	301	330	168	168
Diagnostic	D0480	Process & interp-cytol. smears	218	218	218	236	125	125
Diagnostic	D0481	Electron Microscop-Diag.	228	228	262	288	125	125
Diagnostic	D0482	Direct Immunofluorescence	105	105	142	155	71	71
Diagnostic	D0483	Indirect Immunoflurescence	157	157	163	179	87	87
Diagnostic	D0484	Consult on slides Elsewhere	212	212	219	242	116	116
Diagnostic	D0485	Consult.Incl. Prep of Slides	220	220	252	275	121	121
Diagnostic	D0486	Accession of Brush Biopsy, sample Micro. Exam, Prep.Trans.	207	207	207	228	168	168
Diagnostic	D0501	Histopathologic Exam	0	0	0	0	0	0
Diagnostic	D0502	Other oral pathology proc.	218	218	218	241	127	127
Diagnostic	D0600	Non-ionizing Dx Tx/changes in structure	62	62	62	68	62	62
Diagnostic	D0601	- Caries risk assessment and documentation - low risk	0	0	0	0	0	0
Diagnostic	D0602	- Caries risk assessment and documentation - moderate risk	0	0	0	0	0	0
Diagnostic	D0603	- Caries risk assessment and documentation - high risk	0	0	0	0	0	0
Diagnostic	D0604	Antigen testing for a pathogen, including coronavirus	0	0	0	0	0	0
Diagnostic	D0605	Antibody testing for a pathogen, including coronavirus	0	0	0	0	0	0
Diagnostic	D0701	- Panoramic radiographic image - image capture only	0	0	0	0	0	0
Diagnostic	D0702	- 2-D cephalometric radiographic image - image capture only	0	0	0	0	0	0
Diagnostic	D0703	2-D oral/facial photo image - image capture only	0	0	0	0	0	0
Diagnostic	D0704	3-D photographic image - image capture only	0	0	0	0	0	0
Diagnostic	D0705	- Extra-oral posteri dental radio image - image capture only	0	0	0	0	0	0
Diagnostic	D0706	- Intraoral - occlusal radiograph image - image capture only	0	0	0	0	0	0
Diagnostic	D0707	- Intraoral - periapi radiographic image - img capture only	0	0	0	0	0	0
Diagnostic	D0708	- Intraoral - bitewing radiograp image - image capture only	0	0	0	0	0	0
Diagnostic	D0709	- Comprehensive intraoral radiographs - image capture only	0	0	0	0	0	0
Diagnostic	D0801	3D dental surface scan - direct	141	141	151	151	81	81
Diagnostic	D0802	3D dental surface scan - indirect	141	141	151	151	81	81
Diagnostic	D0803	3D facial surface scan - direct	0	0	0	0	0	0
Diagnostic	D0804	3D facial surface scan - indirect	0	0	0	0	0	0
Diagnostic	D0999	- Unspecified Diagnostic Procedure by report	0	0	0	0	0	0
Diagnostic	D0999I	- Intraoral Series (imported)	0	0	0	0	0	0
Preventive	D1110	Prophy - adult	123	123	123	134	84	84
Preventive	D1120	Prophy - child	90	90	90	98	62	62
Preventive	D1201	Fluoride, incl. prophy - child	0	0	0	0	0	0
Preventive	D1203	Fluoride, topical-child	0	0	0	0	0	0
Preventive	D1204	Fluoride,topical - adult	0	0	0	0	0	0
Preventive	D1205	Fluoride, incl. prophy - adult	0	0	0	0	0	0
Preventive	D1206	Topical Application of Fluoride Varnish	53	53	53	53	21	21
Preventive	D1208	Topical Application of Fluoride-Excluding Varnish	50	50	50	55	32	32
Preventive	D1301	- Immunization Counseling	0	0	0	0	0	0
Preventive	D1310	- Nutritional counseling	0	0	46	52	0	0
Preventive	D1320	- Tobacco counseling	0	0	46	52	0	0
Preventive	D1321	Counseling - high-risk substance use	0	0	46	52	0	0
Preventive	D1330	Oral hygiene instructions	24	24	66	66	0	0
Preventive	D1351	Sealant - per tooth	77	77	77	82	40	40
Preventive	D1352	Preventative Resin Restoration	112	112	135	150	112	112
Preventive	D1353	- Sealant repair - per tooth	0	0	0	0	0	0
Preventive	D1354	Interim caries arresting medicament application	52	52	52	66	32	32
Preventive	D1355	Caries preventive medicament application - per tooth	52	52	52	66	32	32
Preventive	D1510	Space maint - fixed-unilateral	432	432	432	476	243	243
Preventive	D1515	Space maint - fixed-bilateral	0	0	0	0	0	0
Preventive	D1516	Space Maintainer Fixed Bi-lateral Maxillary	574	574	574	630	379	379
Preventive	D1517	Space Maintainer Fixed Bilateral Mandibular	576	576	576	633	379	379
Preventive	D1520	Space maint - remov-unilateral	515	515	515	568	307	307
Preventive	D1525	Space maint - remov-bilateral	0	0	0	0	0	0
Preventive	D1526	Space Maintainer Removable Bi-lateral Maxillary	629	629	629	692	377	377
Preventive	D1527	Space Maintainer Removable Bi-lateral Mandibular	629	629	629	692	377	377
Preventive	D1550	Re-cementation of space maint	0	0	0	0	0	0
Preventive	D1551	Re-cmt Max space maintainer	112	112	112	123	62	62
Preventive	D1552	Re-cmt Mand space maintainer	112	112	112	123	62	62
Preventive	D1553	Re-cmt unilat space maintainer	112	112	112	123	62	62
Preventive	D1555	Removal of Fixed Space Maintainer	0	0	0	0	0	0
Preventive	D1556	Remove fixed Unilat space main	110	110	110	121	67	67
Preventive	D1557	Remove Max fixed space main	110	110	110	121	67	67
Preventive	D1558	Remove Mand fixed space main	110	110	110	121	67	67
Preventive	D1575	Fixed, unilateral, Distal shoe space maintainer	436	436	436	436	243	243
Preventive	D1701	Vaccine administration - Pfizer COVID-19, first dose	0	0	0	0	0	0
Preventive	D1702	Vaccine administration - Pfizer COVID-19, second dose	0	0	0	0	0	0
Preventive	D1703	Vaccine administration - Moderna COVID-19, first dose	0	0	0	0	0	0
Preventive	D1704	Vaccine administration - Moderna COVID-19, second dose	0	0	0	0	0	0
Preventive	D1705	Vaccine administration - Astrazeneca COVID-19, first dose	0	0	0	0	0	0
Preventive	D1706	Vaccine administration - Astrazeneca COVID-19, second dose	0	0	0	0	0	0
Preventive	D1707	Vaccine administration - Janssen COVID-19, single dose	0	0	0	0	0	0
Preventive	D1708	Vaccine administration - Pfizer COVID-19, third dose	0	0	0	0	0	0
Preventive	D1709	Vaccine administration - Pfizer COVID-19, booster dose	0	0	0	0	0	0
Preventive	D1710	Vaccine administration - Moderna COVID-19, third dose	0	0	0	0	0	0
Preventive	D1711	Vaccine administration - Moderna COVID-19, booster dose	0	0	0	0	0	0
Preventive	D1712	Vaccine administration - Janssen COVID-19, booster dose	0	0	0	0	0	0
Preventive	D1713	Vaccine administration - Pfizer pediatric, first dose	0	0	0	0	0	0
Preventive	D1714	Vaccine administration - Pfizer pediatric, second dose	0	0	0	0	0	0
Preventive	D1781	Vaccine administration - human papillomavirus - Dose 1	0	0	0	0	0	0
Preventive	D1782	Vaccine administration - human papillomavirus - Dose 2	0	0	0	0	0	0
Preventive	D1783	Vaccine administration - human papillomavirus - Dose 3	0	0	0	0	0	0
Preventive	D1999	Unspecified procedure, by report	11	11	11	11	11	11
Restorative	D2140	Amalgam - 1 surface	148	148	196	213	93	93
Restorative	D2150	Amalgam - 2 surfaces	193	193	244	269	112	112
Restorative	D2160	Amalgam - 3 surfaces	232	232	297	311	142	142
Restorative	D2161	Amalgam - 4 or more surfaces	275	275	344	373	167	167
Restorative	D2330	Resin-based comp-1 surf, ant.	176	176	228	244	107	107
Restorative	D2331	Resin-based comp-2 surf, ant.	220	220	258	282	135	135
Restorative	D2332	Resin-based comp-3 surf, ant.	272	272	301	331	165	165
Restorative	D2335	Resin-based composite - Four or more surfaces (Anterior)	339	339	393	433	208	208
Restorative	D2390	Resin-based comp crown, ant.	495	495	602	657	288	288
Restorative	D2391	Resin-based comp-1 surf, post.	199	199	247	273	126	126
Restorative	D2392	Resin-based comp-2 surf, post.	263	263	317	349	151	151
Restorative	D2393	Resin-based comp-3 surf, post.	328	328	389	428	192	192
Restorative	D2394	Resin-based comp-4+surf, post.	381	381	465	504	235	235
Restorative	D2410	Gold foil - 1 surface	641	641	773	822	401	401
Restorative	D2420	Gold foil - 2 surfaces	712	712	884	901	473	473
Restorative	D2430	Gold foil - 3 surfaces	836	836	1030	1127	546	546
Restorative	D2510	Inlay - metallic - 1 surface	1137	1137	1311	1430	676	676
Restorative	D2520	Inlay - metallic - 2 surfaces	1137	1137	1311	1430	676	676
Restorative	D2530	Inlay - metallic - 3 or more	1137	1137	1311	1430	676	676
Restorative	D2542	Onlay - metallic - 2 surfaces	1137	1137	1311	1430	676	676
Restorative	D2543	Onlay - metallic - 3 surfaces	1137	1137	1311	1430	676	676
Restorative	D2544	Onlay - metallic - 4 or more	1137	1137	1311	1430	676	676
Restorative	D2610	Inlay - porc/cer - 1 surface	1137	1137	1311	1430	676	676
Restorative	D2620	Inlay - porc/cer - 2 surfaces	1137	1137	1311	1430	676	676
Restorative	D2630	Inlay - porc/cer - 3 or more	1137	1137	1311	1430	676	676
Restorative	D2642	Onlay - porc/cer - 2 surfaces	1137	1137	1311	1430	676	676
Restorative	D2643	Onlay - porc/cer - 3 surfaces	1137	1137	1311	1430	676	676
Restorative	D2644	Onlay - porc/cer - 4 or more	1137	1137	1311	1430	676	676
Restorative	D2650	Inlay - resin - 1 surface	1137	1137	1311	1430	345	345
Restorative	D2651	Inlay - resin - 2 surfaces	1137	1137	1311	1430	345	345
Restorative	D2652	Inlay - resin - 3 or more	1137	1137	1311	1430	345	345
Restorative	D2662	Onlay - resin - 2 surfaces	1137	1137	1311	1430	345	345
Restorative	D2663	Onlay - resin - 3 surfaces	1137	1137	1311	1430	345	345
Restorative	D2664	Onlay - resin - 4 or more	1137	1137	1311	1430	345	345
Restorative	D2700.1	CDCA/ADEX #3	0	0	0	0	0	0
Restorative	D2710	Crown - resin (indirect)	1144	1144	1409	1534	696	696
Restorative	D2710.1	Start Procedure	0	0	0	0	0	0
Restorative	D2710.2	Lab Procedure	0	0	0	0	0	0
Restorative	D2710.3	Completed Procedure	0	0	0	0	0	0
Restorative	D2712	Crown Resin-Bsd Comp.Indirect	0	0	0	0	0	0
Restorative	D2720	Crown - resin, high noble mtl	0	0	0	0	0	0
Restorative	D2721	Crown - resin, predom base mtl	0	0	0	0	0	0
Restorative	D2721.1	Start Procedure	0	0	0	0	0	0
Restorative	D2721.2	Lab Procedure	0	0	0	0	0	0
Restorative	D2721.3	Completed Procedure	0	0	0	0	0	0
Restorative	D2722	Crown - resin, noble metal	0	0	0	0	0	0
Restorative	D2722.1	Start Procedure	0	0	0	0	0	0
Restorative	D2722.2	Lab Procedure	0	0	0	0	0	0
Restorative	D2722.3	Completed Procedure	0	0	0	0	0	0
Restorative	D2740	Crown - porcelain/ceramic subs	1194	1194	1492	1680	696	696
Restorative	D2740.1	Start Procedure	0	0	0	0	0	0
Restorative	D2740.2	Lab Procedure	0	0	0	0	0	0
Restorative	D2740.3	Completed Procedure	0	0	0	0	0	0
Restorative	D2750	Crown - PFM high noble metal	1196	1196	1460	1581	717	717
Restorative	D2750.1	Start Procedure	0	0	0	0	0	0
Restorative	D2750.2	Lab Procedure	0	0	0	0	0	0
Restorative	D2750.3	Completed Procedure	0	0	0	0	0	0
Restorative	D2751	Crown - PFM predom. base metal	1144	1144	1409	1534	696	696
Restorative	D2751.1	Start Procedure	0	0	0	0	0	0
Restorative	D2751.2	Lab Procedure	0	0	0	0	0	0
Restorative	D2751.3	Completed Procedure	0	0	0	0	0	0
Restorative	D2752	Crown - PFM noble metal	1196	1196	1460	1581	717	717
Restorative	D2752.1	Start Procedure	0	0	0	0	0	0
Restorative	D2752.2	Lab Procedure	0	0	0	0	0	0
Restorative	D2752.3	Completed Procedure	0	0	0	0	0	0
Restorative	D2753	Crown porc fused to titanium	0	0	0	0	0	0
Restorative	D2780	Crown - 3/4 cast high noble mt	1196	1196	1460	1581	717	717
Restorative	D2780.1	Start Procedure	0	0	0	0	0	0
Restorative	D2780.2	Lab Procedure	0	0	0	0	0	0
Restorative	D2780.3	Completed Procedure	0	0	0	0	0	0
Restorative	D2781	Crown - 3/4 cast pred base mtl	0	0	0	0	0	0
Restorative	D2781.1	Start Procedure	0	0	0	0	0	0
Restorative	D2781.2	Lab Procedure	0	0	0	0	0	0
Restorative	D2781.3	Completed Procedure	0	0	0	0	0	0
Restorative	D2782	Crown - 3/4 cast noble metal	0	0	0	0	0	0
Restorative	D2782.1	Start Procedure	0	0	0	0	0	0
Restorative	D2782.2	Lab Procedure	0	0	0	0	0	0
Restorative	D2782.3	Completed Procedure	0	0	0	0	0	0
Restorative	D2783	Crown - 3/4 porcelain/ceramic	1144	1144	1409	1534	696	696
Restorative	D2790	Crown -Full cast high noble mt	1196	1196	1460	1581	717	717
Restorative	D2790.1	Start Procedure	0	0	0	0	0	0
Restorative	D2790.2	Lab Procedure	0	0	0	0	0	0
Restorative	D2790.3	Completed Procedure	0	0	0	0	0	0
Restorative	D2791	Crown -Full cast pred base mtl	1144	1144	1409	1534	696	696
Restorative	D2791.1	Start Procedure	0	0	0	0	0	0
Restorative	D2791.2	Lab Procedure	0	0	0	0	0	0
Restorative	D2791.3	Completed Procedure	0	0	0	0	0	0
Restorative	D2792	Crown -Full cast noble metal	1196	1196	1460	1581	717	717
Restorative	D2792.1	Start Procedure	0	0	0	0	0	0
Restorative	D2792.2	Lab Procedure	0	0	0	0	0	0
Restorative	D2792.3	Completed Procedure	0	0	0	0	0	0
Restorative	D2794	Crown-Titanium	0	0	0	0	0	0
Restorative	D2799	Provisional Crown	457	457	575	625	260	260
Restorative	D2910	Recement Inlay	125	125	152	162	78	78
Restorative	D2915	Recement Cast/Prefab P&C	128	128	151	162	80	80
Restorative	D2920	Recement crown	116	116	155	170	77	77
Restorative	D2921	Reattachment of tooth fragment, incisal edge or cusp	84	84	178	196	81	81
Restorative	D2928	Prefabricated porcelain/ceramic crown - permanent tooth	342	342	409	433	319	319
Restorative	D2929	Prefab Proc/Cer crown - Prim Tooth	342	342	409	433	227	227
Restorative	D2930	Prefab SS crown - prim. tooth	310	310	365	403	191	191
Restorative	D2931	Prefab SS crown - perm. tooth	374	374	424	466	231	231
Restorative	D2932	Prefab resin crown	396	396	466	513	242	242
Restorative	D2933	Prefab SS crown - resin window	418	418	477	524	253	253
Restorative	D2934	Pref.Esth.Coated SS Crn Prim.T	0	0	0	0	0	0
Restorative	D2940	Protective Restoration	128	128	166	181	80	80
Restorative	D2941	Interim therapeutic restoration – primary dentition	0	0	0	0	0	0
Restorative	D2949	Restorative foundation for an indirect restoration	224	224	298	327	146	146
Restorative	D2950	Core buildup - including pins	312	312	365	403	194	194
Restorative	D2951	Pin retention - per tooth	76	76	100	109	45	45
Restorative	D2952	Cast post and core	486	486	552	607	345	345
Restorative	D2953	Addl. cast post - same tooth	0	0	0	0	0	0
Restorative	D2954	Prefab post and core	384	384	459	506	237	237
Restorative	D2955	Post removal	338	338	396	434	207	207
Restorative	D2957	Addl prefab post - same tooth	175	175	215	219	104	104
Restorative	D2960	Labial veneer, resin-direct	676	676	848	901	401	401
Restorative	D2961	Labial veneer, resin-lab	1050	1050	1292	1333	600	600
Restorative	D2962	Labial veneer, porcelain-lab	1212	1212	1545	1632	707	707
Restorative	D2970	Temporary crown, fractured tth	0	0	0	0	0	0
Restorative	D2971	Add'l Procedures to Construct New Crn Under Existing Partial	88	88	118	125	87	87
Restorative	D2971.1	Additional Procedure-Survey to Crown	0	0	0	0	0	0
Restorative	D2975	Coping - Cvring of tooth	617	617	822	903	403	403
Restorative	D2976	- Band Stabilization - per tooth	0	0	0	0	0	0
Restorative	D2980	Crown repair	322	322	383	422	196	196
Restorative	D2981	Inlay repair of restorative material failure	282	282	378	415	185	185
Restorative	D2982	Onlay repair of restorative material failure	287	287	383	422	187	187
Restorative	D2983	Veneer repair of restorative material failure	293	293	389	428	193	193
Restorative	D2989	Excavation of a tooth determination of non-restorability	128	128	166	181	80	80
Restorative	D2990	Resin infiltration of incipient smooth lesions	166	166	220	243	108	108
Restorative	D2991	Application of Hydroxyapatite Regeneration Medic - per tooth	52	52	52	66	32	32
Restorative	D2999	Unspecified Restorative Procedure, by report	67	67	67	67	60	60
Restorative	D2999.1	Surveyed to Crown Lab Fee	88	88	118	125	87	87
Restorative	D2999.2	Diagnostic Waxing Per Tooth	44	44	44	44	42	42
Restorative	D2999.3	-Cadcam fabricated	0	0	0	0	0	0
Restorative	D2999.4	-CADCAM fabricated sent to lab	0	0	0	0	0	0
Restorative	D2999A	Porcelain Butt Margin Lab Fee (Crown)	46	46	46	46	43	43
Endodontics	D3000.1	Endo Assist Diag Only	0	0	0	0	0	0
Endodontics	D3110	Pulp cap - direct	87	87	116	128	56	56
Endodontics	D3120	Pulp cap - indirect	92	92	112	125	55	55
Endodontics	D3220	Therapeutic pulpotomy	226	226	275	301	136	136
Endodontics	D3221	Pulpal debridement, prim/perm	245	245	309	340	149	149
Endodontics	D3222	Partial Pulp. for Apexogenesis-pmnt tth w/incom.root develop	307	307	408	449	201	201
Endodontics	D3230	Pulpal therapy - ant, primary	301	301	371	407	185	185
Endodontics	D3240	Pulpal therapy - post, primary	351	351	408	449	215	215
Endodontics	D3310	Endo therapy - anterior	575	575	1018	1120	487	487
Endodontics	D3310.1	Start Procedure	0	0	0	0	0	0
Endodontics	D3310.2	Complete Procedure	0	0	0	0	0	0
Endodontics	D3310.A	-Max Anterior Endodontic PA - image capture only	0	0	0	0	0	0
Endodontics	D3310.B	-Man Anterior Endodontic PA - image capture only	0	0	0	0	0	0
Endodontics	D3320	Endo therapy - bicuspid	680	680	1168	1285	570	570
Endodontics	D3320.1	Start Procedure	0	0	0	0	0	0
Endodontics	D3320.2	Complete Procedure	0	0	0	0	0	0
Endodontics	D3320.C	-Premolar Upper Right Endodontic PA - image capture only	0	0	0	0	0	0
Endodontics	D3320.D	-Premolar Upper Left Endodontic PA - image capture only	0	0	0	0	0	0
Endodontics	D3320.E	-Premolar Lower Right Endodontic PA - image capture only	0	0	0	0	0	0
Endodontics	D3320.F	-Premolar Lower Left Endodontic PA - image capture only	0	0	0	0	0	0
Endodontics	D3330	Endo therapy - molar	832	832	1411	1551	696	696
Endodontics	D3330.1	Start Procedure	0	0	0	0	0	0
Endodontics	D3330.2	Complete Procedure	0	0	0	0	0	0
Endodontics	D3330.C	-Molar Upper Right Endodontic PA - image capture only	0	0	0	0	0	0
Endodontics	D3330.D	-Molar Upper Left Endodontic PA - image capture only	0	0	0	0	0	0
Endodontics	D3330.E	-Molar Lower Right Endodontic PA - image capture only	0	0	0	0	0	0
Endodontics	D3330.F	-Molar Lower Left Endodontic PA - image capture only	0	0	0	0	0	0
Endodontics	D3331	Endo-Rt canal obstruc-non surg	568	568	757	833	372	372
Endodontics	D3332	Endo-Incompl inop/fract tooth	355	355	584	614	285	285
Endodontics	D3332.1	ENDO-INCOMP(PT.DID NOT RTN)	355	355	579	587	285	285
Endodontics	D3333	Endo - internal root repair	306	306	405	433	187	187
Endodontics	D3346	Endo retreatment - anterior	751	751	1188	1307	612	612
Endodontics	D3346.1	Start Procedure	0	0	0	0	0	0
Endodontics	D3346.2	Complete Procedure	0	0	0	0	0	0
Endodontics	D3347	Endo retreatment - bicuspid	854	854	1315	1447	646	646
Endodontics	D3347.1	Start Procedure	0	0	0	0	0	0
Endodontics	D3347.2	Complete Procedure	0	0	0	0	0	0
Endodontics	D3348	Endo retreatment - molar	982	982	1607	1767	788	788
Endodontics	D3348.1	Start Procedure	0	0	0	0	0	0
Endodontics	D3348.2	Complete Procedure	0	0	0	0	0	0
Endodontics	D3351	Apex/recalc - initial visit	243	243	374	401	237	237
Endodontics	D3352	Apex/recalc-interim med replac	174	174	201	267	170	170
Endodontics	D3353	Apex/recalc - final visit	404	404	494	620	322	322
Endodontics	D3354	Pulpal Regeneration	0	0	0	0	0	0
Endodontics	D3355	Pulpal regeneration – initial visit	345	345	449	482	218	218
Endodontics	D3356	Pulpal regeneration – interim medication replacement	167	167	209	226	134	134
Endodontics	D3357	Pulpal regeneration – completion of treatment	374	374	557	600	218	218
Endodontics	D3410	Apicoectomy - anterior	751	751	1188	1307	612	612
Endodontics	D3421	Apicoectomy - bicusp(1st root)	854	854	1315	1447	646	646
Endodontics	D3425	Apicoectomy - molar (1st root)	982	982	1607	1767	788	788
Endodontics	D3426	Apicoectomy - addl roots	406	406	507	540	246	246
Endodontics	D3427	Periradicular surgery without apicoectomy	0	0	0	0	0	0
Endodontics	D3428	Bone graft in conjunction with periradicular surgery	345	345	375	431	345	345
Endodontics	D3429	Bone graft w/periradicular surg–each adl tooth in surg site	226	226	270	361	216	216
Endodontics	D3430	Retrograde filling - per root	308	308	379	416	187	187
Endodontics	D3431	Biologic mat soft and osse tiss regen w/periradicular surg	524	524	544	597	321	321
Endodontics	D3432	Guided tiss regen resorb barr, per site w/periradicular surg	345	345	572	613	345	345
Endodontics	D3450	Root amputation - per root	500	500	703	792	327	327
Endodontics	D3460	Endo endosseous implant	0	0	0	0	0	0
Endodontics	D3470	Intentional reimplantation	941	941	1041	1146	574	574
Endodontics	D3471	Surgical repair of root resorption - anterior	648	648	865	952	425	425
Endodontics	D3472	Surgical repair of root resorption - premolar	648	648	865	952	425	425
Endodontics	D3473	Surgical repair of root resorption - molar	648	648	865	952	425	425
Endodontics	D3501	Surg exp of root surf without apico or repair of root - ant	648	648	865	952	425	425
Endodontics	D3502	Surg exp of root surf without apico or repair of root - pre	648	648	865	952	425	425
Endodontics	D3503	Surg exp of root surf without apico or repair of root - mol	648	648	865	952	425	425
Endodontics	D3910	Surg isolate of tth,rubber dam	226	226	294	331	137	137
Endodontics	D3911	Intraorifice barrier	128	128	166	181	80	80
Endodontics	D3920	Hemisection, incl root removal	524	524	617	678	321	321
Endodontics	D3921	Decoronation or submergence of an erupted tooth	155	155	201	220	98	98
Endodontics	D3950	Canal prep with dowel or post	288	288	329	362	177	177
Endodontics	D3999	- Unspecified endo procedure	0	0	0	0	0	0
Periodontics	D4000	- Surgical Services	0	0	0	0	0	0
Periodontics	D4000.1	- Surgical Workup-Part C	0	0	0	0	0	0
Periodontics	D4000.2	- Performance of Surgery	0	0	0	0	0	0
Periodontics	D4000.3	- Post Surgical Evaluation & Sum	0	0	0	0	0	0
Periodontics	D4000.4	- Surgical Assist	0	0	0	0	0	0
Periodontics	D4000.5	- Interactive Surgical Assist	0	0	0	0	0	0
Periodontics	D4000.6	-Nonsurgical Assist Perio	0	0	0	0	0	0
Periodontics	D4200.1	Barrier	0	0	0	0	0	0
Periodontics	D4200.2	Bone Screw & Tack	345	345	375	431	345	345
Periodontics	D4200.3	PRP Kit	0	0	0	0	0	0
Periodontics	D4200.4	Surgi-Guide	0	0	0	0	0	0
Periodontics	D4210	Gingivectomy/plasty -4 of more	721	721	840	925	441	441
Periodontics	D4211	Gingivectomy/plasty - 1-3 tth	322	322	378	458	228	228
Periodontics	D4212	Gingivectomy or gingivoplasty for restoration per tooth	302	302	312	344	185	185
Periodontics	D4220	Ging curettage surg per quad	0	0	0	0	0	0
Periodontics	D4230	Anatom.Crn.Exp. 4 or More TTH	685	685	844	863	561	561
Periodontics	D4231	Anatom.Crn Expo. 1-3 TTH	654	654	800	859	487	487
Periodontics	D4240	Gingival flap - 4 of more/quad	850	850	997	1097	520	520
Periodontics	D4241	Gingival flap - 1-3 teeth/quad	717	717	834	918	440	440
Periodontics	D4245	Apically positioned flap	1008	1008	1069	1177	616	616
Periodontics	D4249	Clinical crown elong, hard tis	867	867	1043	1147	529	529
Periodontics	D4260	Osseous surgery-4 or more/quad	1218	1218	1445	1588	846	846
Periodontics	D4261	Osseous surgery - 1-3 tth/quad	1010	1010	1179	1296	617	617
Periodontics	D4263	Bone Repl Graft - first site	403	403	591	673	403	403
Periodontics	D4263.1	Bone Replacement Material	517	517	522	688	0	0
Periodontics	D4263.2	Bio oss 2.0c/4.2ccbone	570	570	575	584	0	0
Periodontics	D4263.3	10mmJblock	0	0	0	0	0	0
Periodontics	D4263.4	15mmJblock	0	0	0	0	0	0
Periodontics	D4264	Bone Repl Graft - add'l site	403	403	591	673	403	403
Periodontics	D4265	Biologic materials-tissue regn	345	345	454	488	345	345
Periodontics	D4265.1	Osteocel 1 cc	947	947	99999	99999	99999	99999
Periodontics	D4266	GTR, natural teeth - resorbable barrier, per site	345	345	575	632	345	345
Periodontics	D4267	GTR, natural teeth - non-resorbable barrier, per site	345	345	666	718	345	345
Periodontics	D4267.1	- Barrier Removal	0	0	0	0	0	0
Periodontics	D4268	Surg. revision proc. - per tth	942	942	1041	1146	574	574
Periodontics	D4270	Pedicle soft tissue graft	957	957	1127	1236	585	585
Periodontics	D4271	Free soft tissue graft	0	0	0	0	0	0
Periodontics	D4273	autogenous connective tissue graft, first site in graft	902	902	1449	1593	721	721
Periodontics	D4274	Distal or proximal wedge	546	546	896	986	315	315
Periodontics	D4275	non-autogenous connective tissue graft, first site in graft	1159	1159	1346	1481	674	674
Periodontics	D4276	Comb. connective tissue/graft	1310	1310	1464	1611	762	762
Periodontics	D4277	free soft tissue graft (recipient & donor sites); first site	1018	1018	1258	1349	620	620
Periodontics	D4278	Free soft tissue graft (recipient & donor sites); addtl site	477	477	666	708	411	411
Periodontics	D4283	Autogenous connective tissue graft, each addtl site	652	652	756	810	639	639
Periodontics	D4285	non-autogenous connective tissue graft, each addtl site	621	621	756	810	361	361
Periodontics	D4286	Removal of non-resorbable barrier	0	0	0	0	99999	99999
Periodontics	D4320	Provisional Splint Intracoronal	584	584	683	752	357	357
Periodontics	D4321	Provisional Splint Extracoronal	524	524	624	686	321	321
Periodontics	D4322	Splint - intra-coronal; natural teeth or prosthetic crowns	584	584	683	752	357	357
Periodontics	D4323	Splint - extra-coronal; natural teeth or prosthetic crowns	524	524	624	686	321	321
Periodontics	D4341	Scaling/rt planing 4 or more	243	243	352	388	112	112
Periodontics	D4342	Scaling/rt planing 1-3 teeth	153	153	246	280	90	90
Periodontics	D4346	Scaling generalized mod/sev gingival inflammation after eval	170	170	201	220	97	97
Periodontics	D4355	Full mouth debridement for next visit comp perio eval & diag	215	215	247	273	135	135
Periodontics	D4381	Antimicrobial Agent- per site	88	88	107	116	84	84
Periodontics	D4910	Periodontal maintenance	158	158	185	204	110	110
Periodontics	D4920	Unscheduled dressing change	116	116	132	146	75	75
Periodontics	D4921	Gingival irrigation with a medicinal agent - per quadrant	23	23	69	76	23	23
Periodontics	D4999	- Unspecified periodontal proc.	0	0	0	0	0	0
Periodontics	D4999.1	Laser application, Diode	0	0	0	0	0	0
Periodontics	D4999.2	Laser application, Er-Cr-YSGG	0	0	0	0	0	0
Prosthodontics (Removable)	D5110	Complete denture - maxillary	1869	1869	2294	2478	1060	1060
Prosthodontics (Removable)	D5110.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5110.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5110.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5120	Complete denture - mandibular	1869	1869	2305	2512	1060	1060
Prosthodontics (Removable)	D5120.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5120.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5120.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5130	Immediate denture - maxillary	2021	2021	2472	2701	1143	1143
Prosthodontics (Removable)	D5130.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5130.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5130.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5140	Immediate denture - mandibular	2021	2021	2472	2701	1143	1143
Prosthodontics (Removable)	D5140.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5140.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5140.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5211	Max. part denture - resin base	788	788	1357	1465	481	481
Prosthodontics (Removable)	D5212	Mand Part denture - resin base	788	788	1357	1465	481	481
Prosthodontics (Removable)	D5213	Max partial - cast metal frame	1934	1934	2409	2547	1145	1145
Prosthodontics (Removable)	D5213.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5213.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5213.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5214	Mand partial -cast metal frame	1934	1934	2409	2547	1145	1145
Prosthodontics (Removable)	D5214.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5214.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5214.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5221	Immediate maxillary partial denture – resin base	788	788	1357	1465	481	481
Prosthodontics (Removable)	D5222	Immediate mandibular partial denture – resin base	788	788	1357	1465	481	481
Prosthodontics (Removable)	D5223	Immediate maxillary partial denture – cast metal framework	1934	1934	2409	2547	1145	1145
Prosthodontics (Removable)	D5224	immediate mandibular partial denture – cast metal framework	1934	1934	2409	2547	1145	1145
Prosthodontics (Removable)	D5225	Max Partial Dent. Flex Base	804	804	1310	1522	488	488
Prosthodontics (Removable)	D5226	Mand. Partial Dent. Flex Base	804	804	1310	1522	488	488
Prosthodontics (Removable)	D5227	Immediate maxillary partial denture - flexible base	804	804	1310	1522	488	488
Prosthodontics (Removable)	D5228	Immediate mandibular partial denture - flexible base	804	804	1310	1522	488	488
Prosthodontics (Removable)	D5281	Unil. partial-1 pce cast metal	0	0	0	0	0	0
Prosthodontics (Removable)	D5282	Removable Unilateral Partial Denture Cast Metal Maxillary	0	0	0	0	0	0
Prosthodontics (Removable)	D5283	Removable Unilateral Partial Denture Cast Metal Mandibular	0	0	0	0	0	0
Prosthodontics (Removable)	D5284	Unilat part dent flexible base	0	0	0	0	0	0
Prosthodontics (Removable)	D5286	Unilat part dent resin base	0	0	0	0	0	0
Prosthodontics (Removable)	D5410	Adjust complete denture - max	100	100	121	132	62	62
Prosthodontics (Removable)	D5411	Adjust complete denture - mand	100	100	119	131	62	62
Prosthodontics (Removable)	D5421	Adjust partial denture - max	100	100	119	131	62	62
Prosthodontics (Removable)	D5422	Adjust partial denture - mand	100	100	119	131	62	62
Prosthodontics (Removable)	D5510	Repair denture base	0	0	0	0	0	0
Prosthodontics (Removable)	D5511	Repair denture base Mand	228	228	285	315	161	161
Prosthodontics (Removable)	D5512	Repair denture base Max	228	228	285	315	161	161
Prosthodontics (Removable)	D5520	Replace teeth - per tooth	208	208	258	282	130	130
Prosthodontics (Removable)	D5610	RPD: Repair Resin denture base	0	0	0	0	0	0
Prosthodontics (Removable)	D5611	RPD: Repair Resin dent base Mand	220	220	277	303	145	145
Prosthodontics (Removable)	D5612	RPD: Repair Resin dent base max	220	220	277	303	145	145
Prosthodontics (Removable)	D5620	RPD: Repair Cast framework	0	0	0	0	0	0
Prosthodontics (Removable)	D5621	RPD: Repair Cast framework Mand	325	325	387	424	200	200
Prosthodontics (Removable)	D5622	RPD: Repair Cast framework Max	325	325	387	424	200	200
Prosthodontics (Removable)	D5630	RPD:Repair or replace broken clasp per tooth	302	302	364	401	185	185
Prosthodontics (Removable)	D5640	RPD:Broken teeth - per tooth	200	200	260	284	126	126
Prosthodontics (Removable)	D5650	RPD:Add tooth - existing partial	249	249	309	340	151	151
Prosthodontics (Removable)	D5660	RPD:Add clasp - existing partial per tooth	302	302	366	405	185	185
Prosthodontics (Removable)	D5670	RPD:Replace all teeth - max	842	842	975	1082	479	479
Prosthodontics (Removable)	D5671	RPD:Replace all teeth - mand	842	842	975	1082	479	479
Prosthodontics (Removable)	D5700	- Denture Rebase & Reline Procedures	0	0	0	0	0	0
Prosthodontics (Removable)	D5710	Rebase complete max. denture	676	676	811	892	412	412
Prosthodontics (Removable)	D5711	Rebase complete mand. denture	676	676	808	889	412	412
Prosthodontics (Removable)	D5720	Rebase max. partial denture	645	645	779	857	393	393
Prosthodontics (Removable)	D5721	Rebase mand. partial denture	645	645	779	857	393	393
Prosthodontics (Removable)	D5725	Rebase hybrid prosthesis	645	645	779	857	393	393
Prosthodontics (Removable)	D5730	Reline comp max - direct	431	431	508	558	263	263
Prosthodontics (Removable)	D5731	Reline comp mand - direct	431	431	505	555	263	263
Prosthodontics (Removable)	D5740	Reline max part - direct	431	431	495	545	263	263
Prosthodontics (Removable)	D5741	Reline mand part - direct	431	431	495	545	263	263
Prosthodontics (Removable)	D5750	Reline comp max - laboratory	551	551	636	700	337	337
Prosthodontics (Removable)	D5751	Reline comp mand - laboratory	551	551	643	708	337	337
Prosthodontics (Removable)	D5760	Reline max part - laboratory	551	551	627	689	337	337
Prosthodontics (Removable)	D5761	Reline mand part - laboratory	551	551	625	687	337	337
Prosthodontics (Removable)	D5765	Soft liner for complete or partial removable denture - indir	551	551	636	700	337	337
Prosthodontics (Removable)	D5810	Interim complete denture - Max	876	876	1086	1218	509	509
Prosthodontics (Removable)	D5810.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5810.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5810.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5811	Interim complete denture -Mand	876	876	1086	1218	509	509
Prosthodontics (Removable)	D5811.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5811.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5811.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5820	Interim partial denture - Max	788	788	952	1046	452	452
Prosthodontics (Removable)	D5820.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5820.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5820.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5821	Interim partial denture - Mand	788	788	947	1040	452	452
Prosthodontics (Removable)	D5821.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5821.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5821.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5850	Tissue conditioning - Max.	226	226	277	306	132	132
Prosthodontics (Removable)	D5851	Tissue conditioning - Mand.	226	226	276	303	132	132
Prosthodontics (Removable)	D5860	Overdenture - complete	0	0	0	0	0	0
Prosthodontics (Removable)	D5860.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5860.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5860.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5861	Overdenture - partial	0	0	0	0	0	0
Prosthodontics (Removable)	D5861.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5861.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5861.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Removable)	D5862	Precision attachment	632	632	936	1030	358	358
Prosthodontics (Removable)	D5862.1	- Prec.Attach. Locator	0	0	0	0	0	0
Prosthodontics (Removable)	D5862.2	Prec-Attach-ERA	0	0	0	0	0	0
Prosthodontics (Removable)	D5863	Overdenture - Complete Maxillary	1869	1869	2373	2499	1060	1060
Prosthodontics (Removable)	D5864	Overdenture - Partial Maxillary	1934	1934	2409	2547	1145	1145
Prosthodontics (Removable)	D5865	Overdenture – complete mandibular	1869	1869	2373	2499	1060	1060
Prosthodontics (Removable)	D5866	Overdenture – partial mandibular	1934	1934	2409	2547	1145	1145
Prosthodontics (Removable)	D5867	Replace, part of semi-prec att	422	422	476	505	303	303
Prosthodontics (Removable)	D5867.1	Replace Locator Male	67	67	67	67	65	65
Prosthodontics (Removable)	D5867.2	Replace ERA Male	0	0	0	0	0	0
Prosthodontics (Removable)	D5875	Mod of rem prosth after implnt	0	0	0	0	0	0
Prosthodontics (Removable)	D5876	Add Metal Substructure to acrylic full denture (per arch)	423	423	522	591	293	293
Prosthodontics (Removable)	D5899	Unspec removable prosth proc.	596	596	764	840	393	393
Prosthodontics (Maxillifacial)	D5911	Facial moulage - sectional	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5912	Facial moulage - complete	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5913	Nasal Prosthesis	3614	3614	4950	5199	2380	2380
Prosthodontics (Maxillifacial)	D5914	Auricular prosthesis	3186	3186	4947	5197	2379	2379
Prosthodontics (Maxillifacial)	D5915	Orbital prosthesis	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5916	Ocular prosthesis	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5919	Facial prosthesis	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5922	Nasal septal prosthesis	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5923	Ocular prosthesis - int.	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5924	Cranial prosthesis	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5925	Facial augment implant prosth	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5926	Nasal prosthesis - replacement	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5927	Auricular prosthesis - replace	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5928	Orbital prosthesis - replace	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5929	Facial prosthesis - replace	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5931	Obturator prosthesis - surg.	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5932	Obturator prosthesis - def.	2697	2697	2738	3011	0	0
Prosthodontics (Maxillifacial)	D5933	Obturator prosthesis - mod.	495	495	495	545	485	485
Prosthodontics (Maxillifacial)	D5934	Mand. resection prosth, flange	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5935	Mand. resection prosthesis	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5936	Obturator prosthesis - int.	1367	1367	1367	2341	0	0
Prosthodontics (Maxillifacial)	D5937	Trismus appliance	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5951	Feeding aid	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5952	Speech aid prosthesis - ped.	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5953	Speech aid prosthesis - adult	1855	1855	3267	3602	0	0
Prosthodontics (Maxillifacial)	D5954	Palatal augmentation prosthesi	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5955	Palatal lift prosthesis - def.	1514	1514	3890	4502	0	0
Prosthodontics (Maxillifacial)	D5958	- Palatal lift prosthesis - int.	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5959	Palatal lift prosthesis - mod.	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5960	Speech aid prosthesis - mod.	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5982	Surgical stent	474	474	561	620	287	287
Prosthodontics (Maxillifacial)	D5983	Radiation carrier	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5984	Radiation shield	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5985	Radiation cone locator	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5986	Fluoride gel carrier	215	215	273	300	132	132
Prosthodontics (Maxillifacial)	D5987	Commissure splint	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5988	Surgical splint	889	889	912	1002	509	509
Prosthodontics (Maxillifacial)	D5991	Topical Medicament Carrier	215	215	276	315	132	132
Prosthodontics (Maxillifacial)	D5992	Adjust Maxillofacial Prostethic Appl, by report	90	90	119	138	55	55
Prosthodontics (Maxillifacial)	D5993	Maint/Cleaning of Maxillofac Prosth, by report (no adj)	78	78	123	134	59	59
Prosthodontics (Maxillifacial)	D5994	Periodontal medicament carrier w/peripheral seal – lab proc	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5995	Perio medicament carrier /w periph seal - lab process - max	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5996	Perio medicament carrier /w periph seal - lab process - mand	0	0	0	0	0	0
Prosthodontics (Maxillifacial)	D5999	Unspecified max. prosthesis	850	850	1110	1220	559	559
Prosthodontics (Maxillifacial)	D5999.1	Denture follow-up	0	0	0	0	0	0
Implant Services	D6010	Surg placement, endosteal impl	1362	1362	2486	2786	1362	1362
Implant Services	D6010.2	- IMPLT SURG. ASSIST	0	0	0	0	0	0
Implant Services	D6010.3	- STAGE 2 IMPLANT SURGERY	0	0	0	0	0	0
Implant Services	D6011	Second stage implant surgery	283	283	378	416	183	183
Implant Services	D6012	Surg Plcmnt Intrm Endo Implt	503	503	1507	1728	482	482
Implant Services	D6013	Surgical placement of mini implant	652	652	1255	1303	625	625
Implant Services	D6020	Abut placement, endosteal impl	0	0	0	0	0	0
Implant Services	D6040	Surg placement, eposteal impl	9246	9246	9246	10172	5739	5739
Implant Services	D6050	Surg placemnt, transosteal imp	6585	6585	6812	7494	3941	3941
Implant Services	D6051	Interim abutment includes placement & removal	457	457	562	605	260	260
Implant Services	D6051.1	Start Procedure	0	0	0	0	0	0
Implant Services	D6051.2	Lab Procedure	0	0	0	0	0	0
Implant Services	D6051.3	Completed Procedure	0	0	0	0	0	0
Implant Services	D6052	Semi-precision attachment abutment	0	0	0	0	0	0
Implant Services	D6053	Implt/abut denture, comp edent	0	0	0	0	0	0
Implant Services	D6053.1	Spark Erosion Prosthesis	0	0	0	0	0	0
Implant Services	D6053.2	Retrofit Denture to Impl	933	933	1155	1176	570	570
Implant Services	D6054	Implt/abut denture, part edent	0	0	0	0	0	0
Implant Services	D6054.1	Retrofit Partial Dent to Impl	0	0	0	0	0	0
Implant Services	D6055	Dental implant supported bar	2685	2685	3534	4445	1636	1636
Implant Services	D6055.1	1 Addl Component	0	0	0	0	0	0
Implant Services	D6055.2	2 Addl Components	0	0	0	0	0	0
Implant Services	D6055.3	3 Addl Components	0	0	0	0	0	0
Implant Services	D6055.4	4 Addl Components	0	0	0	0	0	0
Implant Services	D6056	Prefabricated abutment	575	575	781	857	437	437
Implant Services	D6056.0	- Prefab abutment (Implant Crown)	0	0	0	0	0	0
Implant Services	D6056.1	Prefab Abutment-Study	0	0	0	0	0	0
Implant Services	D6057	Custom abutment	767	767	1039	1302	509	509
Implant Services	D6057.0	Custom Abutment (Implant Crown)	764	764	1216	1340	438	438
Implant Services	D6057.1	Custom Abutment-Titanium	804	804	1313	1473	464	464
Implant Services	D6057.2	Custom Abutment-Zirconium	804	804	1313	1473	464	464
Implant Services	D60571A	Custom abut. Titanium-Study	0	0	0	0	0	0
Implant Services	D6058	Abut supported - porc/ceramic crown	1340	1340	1759	2022	793	793
Implant Services	D6059	Abutment - PFM,high noble metl	1365	1365	1749	1949	994	994
Implant Services	D6060	Abutment - PFM, based metal	1340	1340	1759	2022	793	793
Implant Services	D6061	Abutment - PFM, noble metal	1433	1433	1851	2037	849	849
Implant Services	D6062	Abutment-cast metal,high noble	1365	1365	1749	1949	994	994
Implant Services	D6062.1	Start Procedure	0	0	0	0	0	0
Implant Services	D6062.2	Lab Procedure	0	0	0	0	0	0
Implant Services	D6062.3	Completed Procedure	0	0	0	0	0	0
Implant Services	D6063	Abutment-cast metal,based metl	0	0	0	0	0	0
Implant Services	D6064	Abutment-cast metal,noble metl	1433	1433	1851	2037	849	849
Implant Services	D6065	Implant - porc/ceramic crown	1643	1643	1938	2139	854	854
Implant Services	D6065.1	Start Procedure	0	0	0	0	0	0
Implant Services	D6065.2	Implant Retained Temporary	0	0	0	0	0	0
Implant Services	D6065.3	Implant Rtnd Temp. Labport	0	0	0	0	0	0
Implant Services	D6065.4	Lab Procedure	0	0	0	0	0	0
Implant Services	D6065.5	NG Zirconium Tooth	0	0	0	0	0	0
Implant Services	D6066	Implant - PFM,high noble metal	1609	1609	2062	2267	1029	1029
Implant Services	D6066.1	Start Procedure	0	0	0	0	0	0
Implant Services	D6066.2	Lab Procedure	0	0	0	0	0	0
Implant Services	D6066.3	Completed Procedure	0	0	0	0	0	0
Implant Services	D6066.4	NG Titanium Tooth	0	0	0	0	0	0
Implant Services	D6067	Implant -metal crwn,high noble	1609	1609	2062	2267	1029	1029
Implant Services	D6067.1	Start Procedure	0	0	0	0	0	0
Implant Services	D6067.2	Lab Procedure	0	0	0	0	0	0
Implant Services	D6067.3	Completed Procedure	0	0	0	0	0	0
Implant Services	D6068	Abutment-retainer,porc/cer FPD	1340	1340	1759	2022	793	793
Implant Services	D6068.1	Start Procedure	0	0	0	0	0	0
Implant Services	D6068.2	Lab Procedure	0	0	0	0	0	0
Implant Services	D6068.3	Completed Procedure	0	0	0	0	0	0
Implant Services	D6069	Abutment-ret,PFM FPD,high nobl	1365	1365	1749	1949	994	994
Implant Services	D6069.1	Start Procedure	0	0	0	0	0	0
Implant Services	D6069.2	Lab Procedure	0	0	0	0	0	0
Implant Services	D6069.3	Completed Procedure	0	0	0	0	0	0
Implant Services	D6070	Abutment-ret,PFM FPD,base metl	1340	1340	1759	2022	793	793
Implant Services	D6071	Abutment-ret,PFM FPD,noble met	1433	1433	1851	2037	849	849
Implant Services	D6072	Abut-ret,cast metal-high noble FPD	1365	1365	1749	1949	994	994
Implant Services	D6073	Abut-ret,cast metal-base metal FPD	1340	1340	1759	2022	793	793
Implant Services	D6074	Abut-ret,cast metal-noble metl FPD	1433	1433	1851	2037	849	849
Implant Services	D6075	Implant -retainer for cer. FPD	1460	1460	1944	2144	872	872
Implant Services	D6076	Implant - retainer for PFM FPD	1460	1460	1944	2144	872	872
Implant Services	D6076.1	Start Procedure	0	0	0	0	0	0
Implant Services	D6076.2	Lab Procedure	0	0	0	0	0	0
Implant Services	D6076.3	Completed Procedure	0	0	0	0	0	0
Implant Services	D6077	Implant - ret, cast metal FPD	1431	1431	1938	2139	854	854
Implant Services	D6077.1	Start Procedure	0	0	0	0	0	0
Implant Services	D6077.2	Lab Procedure	0	0	0	0	0	0
Implant Services	D6077.3	Completed Procedure	0	0	0	0	0	0
Implant Services	D6078	Hybrid4 implt/abut.eden.arch	0	0	0	0	0	0
Implant Services	D6078.1	Start Procedure	0	0	0	0	0	0
Implant Services	D6078.2	Lab Procedure	0	0	0	0	0	0
Implant Services	D6078.3	Completed Procedure	0	0	0	0	0	0
Implant Services	D6078.4	NG Temporary Prosthesis	0	0	0	0	0	0
Implant Services	D6079	Hybrid4 imp./abut.part eden.ar	0	0	0	0	0	0
Implant Services	D6080	Implant maintenance proc.	310	310	383	383	273	273
Implant Services	D6080.1	ATTACHMENT REPLACEMENT	0	0	0	0	0	0
Implant Services	D6081	Scaling single implant w/inflammation of mucositis	206	206	243	268	117	117
Implant Services	D6082	Impl crown porc to base metal	1431	1431	1938	2139	854	854
Implant Services	D6083	Impl crown porc to noble alloy	1609	1609	1912	2102	1148	1148
Implant Services	D6084	Impl crown porc to titanium	0	0	0	0	0	0
Implant Services	D6085	Provisional Implant Crown	457	457	564	623	260	260
Implant Services	D6086	Implant crown base alloys	1431	1431	1938	2139	854	854
Implant Services	D6087	Implant crown noble alloys	1609	1609	2006	2208	1148	1148
Implant Services	D6088	Implant crown titanium	0	0	0	0	0	0
Implant Services	D6089	Accessing and Retorquing Loose Implant Screw - per screw	99	99	124	136	63	63
Implant Services	D6090	Repair implant -prosthesis	862	862	964	1062	500	500
Implant Services	D6091	Replace Implt Supptd Attachmen	443	443	776	844	374	374
Implant Services	D6092	Recement Implt Supp Crn	158	158	209	231	103	103
Implant Services	D6093	Recement Implt Supp FPD	173	173	229	269	104	104
Implant Services	D6094	Abut. Supported Crn Titanium	0	0	0	0	0	0
Implant Services	D6095	Repair implant abutment	862	862	947	1040	500	500
Implant Services	D6096	Remove Broken Impl Screw	348	348	464	510	228	228
Implant Services	D6097	Abut suptd cr porc to titanium	0	0	0	0	0	0
Implant Services	D6098	Impl ret porc to base alloys	1431	1431	1938	2139	854	854
Implant Services	D6099	Impl ret FPD porc noble alloys	1431	1431	1938	2139	854	854
Implant Services	D6100	Implant removal by report	889	889	1235	1465	889	889
Implant Services	D6100.1	- Implant Removal by Rpt	0	0	0	0	0	0
Implant Services	D6101	debride of a periimpl defect of exp imp surf incl flap	717	717	757	832	440	440
Implant Services	D6102	debrid oss contr periimplant defect; inc surf exp impl flap	859	859	1072	1181	552	552
Implant Services	D6103	bone graft for repair of periimplant defect – w/o flap	345	345	591	650	345	345
Implant Services	D6104	bone graft at time of implant placement	345	345	546	586	345	345
Implant Services	D6105	Implant body removal without bone removal or flap elevation	269	269	269	269	99999	99999
Implant Services	D6106	Guided tissue regeneration - resorbable barrier, per implant	345	345	575	632	99999	99999
Implant Services	D6107	GTR - non-resorbable barrier, per implant	345	345	666	718	99999	99999
Implant Services	D6110	Impl/Abut Supported Remv Denture Edentulous arch maxillary	1869	1869	2294	2478	1060	1060
Implant Services	D6111	Impl/Abut Supported Remv Denture Edentulous arch mandibular	1869	1869	2294	2478	1060	1060
Implant Services	D6112	Impl/Abut Supported Remv Dent Part Edentulous arch maxillary	1934	1934	2418	2547	1093	1093
Implant Services	D6113	Impl/Abut Supported Remv Dent Part Edentulous arch mandibulr	1934	1934	2418	2547	1093	1093
Implant Services	D6114	Hybrid4 Impl/Abut Supported Fixd Denture Edent maxillary	13422	13422	13422	13422	99999	99999
Implant Services	D6115	Hybrid4 Impl/Abut Supported Fixd Denture Edent mandibular	13422	13422	13422	13422	99999	99999
Implant Services	D6116	Hybrid4 Impl/Abut Supported Fixd Dent Part Edent maxillary	13422	13422	13422	13422	99999	99999
Implant Services	D6117	Impl/Abut Supported Fixd Dent Part Edentulous arch mand	6200	6200	6200	6821	5961	5961
Implant Services	D6118	Abutment Supp Interim Fix Dent Mand	2904	2904	2904	3193	2847	2847
Implant Services	D6119	Abutment Supp Interim Fix Dent Max	2500	2500	2500	2751	2451	2451
Implant Services	D6120	Impl retainer porc to titanium	0	0	0	0	0	0
Implant Services	D6121	Impl retainer FPD base alloys	1431	1431	1938	2139	854	854
Implant Services	D6122	Impl ret metal FPD noble alloy	1431	1431	1938	2139	854	854
Implant Services	D6123	Impl ret metal FPD titanium	0	0	0	0	0	0
Implant Services	D6190	Radio/Surg Implt Index(stent)by rpt	480	480	511	561	228	228
Implant Services	D6190.1	Nobelbiocare Stent	782	782	792	808	535	535
Implant Services	D6190.2	NG Stereolithographic Stent	0	0	0	0	0	0
Implant Services	D6190.3	Radiographic Guide	0	0	0	0	0	0
Implant Services	D6190.4	Verification of Surgical Stent	0	0	0	0	0	0
Implant Services	D6190.5	Xnav Virtual Guidance	0	0	0	0	0	0
Implant Services	D6191	Semi-precision abutment - Locator	328	328	414	414	175	175
Implant Services	D6192	Semi-precision attachment - Ret Housing	328	328	414	414	175	175
Implant Services	D6194	Abut.Sup.Rtnr Crn Titanium FPD	0	0	0	0	0	0
Implant Services	D6195	Abut retainer porc to titanium	0	0	0	0	0	0
Implant Services	D6197	Screw-retained implant access hole restoration per implant	199	199	247	273	126	126
Implant Services	D6198	Remove interim implant component	98	98	144	159	65	65
Implant Services	D6199	Unspec. implant proc by report	458	458	603	658	301	301
Prosthodontics (Fixed)	D6205	Pontic Indirect Resin Bds Com	1144	1144	1409	1534	696	696
Prosthodontics (Fixed)	D6210	Pontic - cast high noble metal	1196	1196	1460	1581	717	717
Prosthodontics (Fixed)	D6210.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6210.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6210.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6211	Pontic - cast predom base metl	1144	1144	1409	1534	696	696
Prosthodontics (Fixed)	D6211.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6211.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6211.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6212	Pontic - cast noble metal	1196	1196	1460	1581	717	717
Prosthodontics (Fixed)	D6214	Pontic Titanium	0	0	0	0	0	0
Prosthodontics (Fixed)	D6240	Pontic-porc fuse to high noble	1196	1196	1460	1581	717	717
Prosthodontics (Fixed)	D6240.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6240.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6240.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6241	Pontic-porc fuse to base metal	1144	1144	1409	1534	696	696
Prosthodontics (Fixed)	D6241.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6241.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6241.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6242	Pontic-porc fuse to noble metl	1196	1196	1460	1581	717	717
Prosthodontics (Fixed)	D6243	Pontic porcelain to titanium	0	0	0	0	0	0
Prosthodontics (Fixed)	D6245	Pontic-porcelain/ceramic	1144	1144	1409	1534	696	696
Prosthodontics (Fixed)	D6245.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6245.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6245.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6250	Pontic-resin, high noble metal	1196	1196	1460	1581	717	717
Prosthodontics (Fixed)	D6251	Pontic-resin, predom base metl	1144	1144	1409	1534	696	696
Prosthodontics (Fixed)	D6251.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6251.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6251.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6252	Pontic-resin with noble metal	1196	1196	1460	1581	717	717
Prosthodontics (Fixed)	D6253	Provisional pontic	415	415	893	984	255	255
Prosthodontics (Fixed)	D6254	Interim Pontic	0	0	0	0	0	0
Prosthodontics (Fixed)	D6545	Retainer, metal, resin bond FP	862	862	1062	1218	490	490
Prosthodontics (Fixed)	D6548	Retainer, porc/cera, bonded FP	862	862	1062	1218	490	490
Prosthodontics (Fixed)	D6549	Resin retainer - for resin bonded fixed prosthesis	862	862	1062	1218	490	490
Prosthodontics (Fixed)	D6600	Inlay - porc/ceramic, 2 surf	1137	1137	1311	1430	676	676
Prosthodontics (Fixed)	D6601	Inlay - porc/ceramic, 3+ surf	1137	1137	1311	1430	676	676
Prosthodontics (Fixed)	D6602	Inlay - high noble mtl, 2 surf	1348	1348	1348	1483	849	849
Prosthodontics (Fixed)	D6603	Inlay - high noble mtl, 3+ sur	1348	1348	1348	1483	849	849
Prosthodontics (Fixed)	D6604	Inlay - pred. base mtl, 2 surf	1137	1137	1311	1430	676	676
Prosthodontics (Fixed)	D6605	Inlay - pred. base mtl, 3+ sur	1137	1137	1311	1430	676	676
Prosthodontics (Fixed)	D6606	Inlay - cast noble mtl, 2 surf	1229	1229	1310	1447	675	675
Prosthodontics (Fixed)	D6607	Inlay - cast noble mtl, 3+ sur	1229	1229	1310	1447	675	675
Prosthodontics (Fixed)	D6608	Onlay - porc/ceramic, 2 surf	1137	1137	1311	1430	676	676
Prosthodontics (Fixed)	D6609	Onlay - porc/ceramic, 3+ surf	1137	1137	1311	1430	676	676
Prosthodontics (Fixed)	D6610	Onlay - high noble mtl, 2 surf	0	0	0	0	0	0
Prosthodontics (Fixed)	D6611	Onlay - high noble mtl, 3+ sur	1348	1348	1348	1483	849	849
Prosthodontics (Fixed)	D6612	Onlay - pred. base mtl, 2 surf	0	0	0	0	0	0
Prosthodontics (Fixed)	D6613	Onlay - pred. base mtl, 3+ sur	0	0	0	0	0	0
Prosthodontics (Fixed)	D6614	Onlay - cast noble mtl, 2 surf	0	0	0	0	0	0
Prosthodontics (Fixed)	D6615	Onlay - cast noble mtl, 3+ sur	0	0	0	0	0	0
Prosthodontics (Fixed)	D6624	Inlay Titanium	0	0	0	0	0	0
Prosthodontics (Fixed)	D6634	Onlay-Titanium	0	0	0	0	0	0
Prosthodontics (Fixed)	D6710	Crown, indirect resin bsd comp	0	0	0	0	0	0
Prosthodontics (Fixed)	D6720	Retainer Crown - resin, high noble metl	1196	1196	1460	1581	717	717
Prosthodontics (Fixed)	D6721	Retainer Retainer Crown - resin, predom base mtl	1144	1144	1409	1534	696	696
Prosthodontics (Fixed)	D6722	Retainer Crown - resin, noble metal	1196	1196	1460	1581	717	717
Prosthodontics (Fixed)	D6740	Retainer Crown - porcelain/ceramic	1144	1144	1409	1534	696	696
Prosthodontics (Fixed)	D6740.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6740.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6740.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6750	Retainer Crown Porcelain fused - high noble	1196	1196	1460	1581	717	717
Prosthodontics (Fixed)	D6750.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6750.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6750.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6751	Retainer Crown - porcelain to base metl	1144	1144	1409	1534	696	696
Prosthodontics (Fixed)	D6751.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6751.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6751.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6752	Retainer Crown - porcelain to noble mtl	1196	1196	1460	1581	717	717
Prosthodontics (Fixed)	D6753	Ret crown porc to titanium	0	0	0	0	0	0
Prosthodontics (Fixed)	D6780	Crown- 3/4 cast high noble mtl	0	0	0	0	0	0
Prosthodontics (Fixed)	D6780.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6780.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6780.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6781	Crown- 3/4 cast pred. base mtl	0	0	0	0	0	0
Prosthodontics (Fixed)	D6781.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6781.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6781.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6782	Crown - 3/4 cast noble metal	0	0	0	0	0	0
Prosthodontics (Fixed)	D6783	Retainer Crown - 3/4 porcelain/ceramic	1144	1144	1409	1534	696	696
Prosthodontics (Fixed)	D6784	Retainer 3/4 crown titanium	0	0	0	0	0	0
Prosthodontics (Fixed)	D6790	Retainer Crown-full cast high noble mtl	1144	1144	1409	1534	696	696
Prosthodontics (Fixed)	D6790.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6790.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6790.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6791	Retainer Crown-full cast pred. base mtl	1144	1144	1409	1534	696	696
Prosthodontics (Fixed)	D6791.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6791.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6791.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6792	Retainer Crown - full cast noble metal	1196	1196	1460	1581	717	717
Prosthodontics (Fixed)	D6792.1	Start Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6792.2	Lab Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6792.3	Completed Procedure	0	0	0	0	0	0
Prosthodontics (Fixed)	D6793	Provisional retainer crown	533	533	692	761	348	348
Prosthodontics (Fixed)	D6794	Crown-Titanium	0	0	0	0	0	0
Prosthodontics (Fixed)	D6795	Interim Retainer Crown	0	0	0	0	0	0
Prosthodontics (Fixed)	D6900	- Other FPD Services	0	0	0	0	0	0
Prosthodontics (Fixed)	D6900.1	Clips (Hader bar)	125	125	149	208	119	119
Prosthodontics (Fixed)	D6900.2	Replace Prosth. Screw	125	125	149	208	119	119
Prosthodontics (Fixed)	D6900.3	Replace Locator or ERA male	85	85	108	146	67	67
Prosthodontics (Fixed)	D6920	Connector bar	1038	1038	1384	1523	679	679
Prosthodontics (Fixed)	D6930	Recement FPD	192	192	234	259	111	111
Prosthodontics (Fixed)	D6940	Stress breaker	744	744	862	949	299	299
Prosthodontics (Fixed)	D6950	Precision attachment	744	744	862	949	299	299
Prosthodontics (Fixed)	D6970	Cast post & core - add. to FPD	0	0	0	0	0	0
Prosthodontics (Fixed)	D6971	Cast post - part of FPD ret	0	0	0	0	0	0
Prosthodontics (Fixed)	D6972	Pref post & core - add. to FPD	0	0	0	0	0	0
Prosthodontics (Fixed)	D6973	Core build up for ret. w/ pins	0	0	0	0	0	0
Prosthodontics (Fixed)	D6975	Coping - metal	0	0	0	0	0	0
Prosthodontics (Fixed)	D6976	Each add cast post - same tth	0	0	0	0	0	0
Prosthodontics (Fixed)	D6977	Each add prefab post -same tth	0	0	0	0	0	0
Prosthodontics (Fixed)	D6980	FPD repair	386	386	514	567	252	252
Prosthodontics (Fixed)	D6985	Pediatric partial denture	0	0	0	0	0	0
Prosthodontics (Fixed)	D6999	Unspecified fixed pros. proc.	234	234	322	337	152	152
Prosthodontics (Fixed)	D6999 A	- Porcelain Butt Margin Lab Fee (Bridge)	0	0	0	0	0	0
Prosthodontics (Fixed)	D6999.1	$50 Add'tl Dental Lab Cost for Prosth Procedure	50	50	50	50	50	50
Prosthodontics (Fixed)	D6999.2	$100 Add'tl Dental Lab Cost for Prosth Procedure	100	100	100	100	100	100
Prosthodontics (Fixed)	D6999.3	$105 Add'tl Dental Lab Cost for Prosth Procedure	105	105	105	105	105	105
Prosthodontics (Fixed)	D6999.4	$250 Add'tl Dental Lab Cost for Prosth Procedure	250	250	250	250	250	250
Prosthodontics (Fixed)	D6999.5	$315 Add'tl Dental Lab Cost for Prosth Procedure	315	315	315	315	315	315
Prosthodontics (Fixed)	D6999.6	$500 Add'tl Dental Lab Cost for Prosth Procedure	500	500	500	500	500	500
Prosthodontics (Fixed)	D6999.7	$750 Add'tl Dental Lab Cost for Prosth Procedure	750	750	750	750	750	750
Prosthodontics (Fixed)	D6999.8	$1000 Add'tl Dental Lab Cost for Prosth Procedure	1000	1000	1000	1000	1000	1000
Prosthodontics (Fixed)	D6999.9	$1200 Add'tl Dental Lab Cost for Prosth Procedure	1200	1200	1200	1200	1200	1200
Prosthodontics (Fixed)	D69991A	Lab Fee $55	0	0	0	0	0	0
Prosthodontics (Fixed)	D69992A	Lab Fee $80	0	0	0	0	0	0
Oral Surgery	D7111	Coronal remnants - decid. tth	149	149	183	202	94	94
Oral Surgery	D7140	Extraction, eruptd tth/ exp rt	168	140	256	270	105	105
Oral Surgery	D7140.1	Extraction, eruptd tth/ exp rt	0	0	0	0	0	0
Oral Surgery	D7210	Surg removal of erupted tooth	252	206	381	420	174	174
Oral Surgery	D7220	Rem of impacted tth, soft tiss	314	226	432	476	188	188
Oral Surgery	D7230	Rem of impacted tth, part bony	362	273	539	592	241	241
Oral Surgery	D7240	Rem of impacted tth, comp bony	455	333	653	717	298	298
Oral Surgery	D7241	Rem of impacted tth, surg comp	676	676	764	840	500	500
Oral Surgery	D7250	Removal of residual tth roots	344	344	412	455	211	211
Oral Surgery	D7251	Coronectomy - intentional partial removal of impacted teeth	489	489	578	634	434	434
Oral Surgery	D7260	Oroantral fistula closure	1031	1031	1044	1202	591	591
Oral Surgery	D7261	Primary closure of sinus perf.	834	834	1018	1063	609	609
Oral Surgery	D7270	Tooth reimplantation/stabilize	614	614	749	823	376	376
Oral Surgery	D7272	Tooth transplantation	786	786	950	1044	580	580
Oral Surgery	D7280	Surg exposure - ortho reasons	544	544	647	712	323	323
Oral Surgery	D7281	Surg exposure - aid erruption	0	0	0	0	0	0
Oral Surgery	D7282	Mobilization of tth for erupt	597	597	647	712	335	335
Oral Surgery	D7283	Plcmt device facil. eruption	476	476	634	699	311	311
Oral Surgery	D7284	Excisional Biopsy of Minor Salivary Glands	344	344	438	496	99999	99999
Oral Surgery	D7285	Biopsy of oral tissue - hard	586	586	890	977	586	586
Oral Surgery	D7286	Biopsy of oral tissue - soft	344	344	438	496	237	237
Oral Surgery	D7287	Cytology sample collection	163	163	228	268	100	100
Oral Surgery	D7288	Brush biopsy transepithelial	192	192	237	288	165	165
Oral Surgery	D7290	Surgical reposition of teeth	538	538	638	701	335	335
Oral Surgery	D7291	Transseptal fiberotomy	301	301	400	440	197	197
Oral Surgery	D7292	Sur.Plcmt Tmp Anch. Flap(plt&	2866	2866	3533	3958	1747	1747
Oral Surgery	D7293	Surg.plcmt tmp anchor w/flap	652	652	1255	1303	625	625
Oral Surgery	D7294	Surg Plcmt Tmp Anch. w/o Flap	503	503	1507	1728	482	482
Oral Surgery	D7295	Harvest of Bone (autogenous grafting)	418	418	556	612	273	273
Oral Surgery	D7296	Corticotomy 1-3 teeth	1218	1218	0	0	0	0
Oral Surgery	D7297	Corticotomy 4 or More in Quad	0	0	0	0	0	0
Oral Surgery	D7298	Removal of temp anch dev [screw ret plate], requiring flap	2866	2866	3533	3958	1747	1747
Oral Surgery	D7299	Removal of temporary anchorage device, requiring flap	652	652	1255	1303	625	625
Oral Surgery	D7300	Removal of temporary anchorage device without flap	503	503	1507	1728	482	482
Oral Surgery	D7310	Alveoloplasty with extractions	330	330	407	450	202	202
Oral Surgery	D7311	Alveoplasty w/1-3 ext.per quad	305	305	405	445	199	199
Oral Surgery	D7320	Alveoloplasty w/o ext 4 tth sp	474	474	590	652	287	287
Oral Surgery	D7321	Alveoplasty not w/1-3 ext quad	418	418	556	612	273	273
Oral Surgery	D7330	- Vestibuloplasty	0	0	0	0	0	0
Oral Surgery	D7340	Vestibuloplasty - second epith	1104	1104	1364	1441	740	740
Oral Surgery	D7350	Vestibuloplasty -tissue grafts	2149	2149	2650	2701	1251	1251
Oral Surgery	D7410	Excision, benign lesion<1.25cm	432	432	556	612	265	265
Oral Surgery	D7411	Excision, benign lesion>1.25cm	676	676	1207	1349	409	409
Oral Surgery	D7412	Excision, ben lesion complicat	889	889	1437	1557	571	571
Oral Surgery	D7413	Excision, malig lesion>1.25cm	755	755	929	1052	497	497
Oral Surgery	D7414	Excision, malig lesion>1.25cm	1130	1130	1258	1441	744	744
Oral Surgery	D7415	Excision, malig lesion complic	1264	1264	1547	1663	832	832
Oral Surgery	D7420	Rad excision - lesion > 1.25cm	0	0	0	0	0	0
Oral Surgery	D7425	- Removal, Tumor, Cyst, Neoplasm	0	0	0	0	0	0
Oral Surgery	D7430	Exc benign tumor-lesion<1.25cm	0	0	0	0	0	0
Oral Surgery	D7431	Exc benign tumor-lesion>1.25cm	0	0	0	0	0	0
Oral Surgery	D7440	Exc malign tumor-lesion<1.25cm	745	745	967	1064	490	490
Oral Surgery	D7441	Exc malign tumor-lesion>1.25cm	1318	1318	1687	1855	867	867
Oral Surgery	D7450	Rem odonto cyst/tumor < 1.25cm	570	570	718	776	390	390
Oral Surgery	D7451	Rem odonto cyst/tumor > 1.25cm	728	728	1132	1264	536	536
Oral Surgery	D7460	Rem nonodonto cyst < 1.25cm	580	580	753	816	386	386
Oral Surgery	D7461	Rem nonodonto cyst > 1.25cm	786	786	1171	1264	594	594
Oral Surgery	D7465	Destruction of lesion	382	382	487	553	235	235
Oral Surgery	D7470	- Excision of Bone Tissue	0	0	0	0	0	0
Oral Surgery	D7471	Removal of lateral exostosis	712	712	884	961	434	434
Oral Surgery	D7472	Removal of torus palatinus	838	838	1137	1264	511	511
Oral Surgery	D7473	Removal of torus mandibularis	782	782	1028	1082	476	476
Oral Surgery	D7480	Partial ostectomy	0	0	0	0	0	0
Oral Surgery	D7485	Surg reduct of osseous tuberos	699	699	925	1055	428	428
Oral Surgery	D7490	Resection, mandible-bone graft	7726	7726	9819	10802	5087	5087
Oral Surgery	D7509	Marsupialization of odontogenic cyst	350	350	438	507	99999	99999
Oral Surgery	D7510	Incision/drainage,abscess-intr	258	258	322	365	157	157
Oral Surgery	D7510.1	- Incision/drainage,abscess-intr	0	0	0	0	0	0
Oral Surgery	D7511	I&D intraoral sft tiss. compl.	350	350	438	507	215	215
Oral Surgery	D7520	Incision/drainage,abscess-extr	431	431	977	1063	301	301
Oral Surgery	D7521	I&D extraoral sft tiss compli.	552	552	873	959	552	552
Oral Surgery	D7530	Removal of foreign body/skin	377	377	471	517	278	278
Oral Surgery	D7540	Removal-musculoskeletal system	691	691	851	935	455	455
Oral Surgery	D7550	Part. stectomy/sequestrectomy	572	572	679	764	376	376
Oral Surgery	D7560	Max. sinusotomy - removal	2012	2012	2298	2528	2012	2012
Oral Surgery	D7610	Maxilla - open reduction	4853	4853	5683	6250	2960	2960
Oral Surgery	D7620	Maxilla - closed reduction	3842	3842	4386	4823	2344	2344
Oral Surgery	D7630	Mandible - open reduction	4856	4856	5955	6550	2964	2964
Oral Surgery	D7640	Mandible - closed reduction	3749	3749	4431	4876	2291	2291
Oral Surgery	D7650	Malar/zygo arch - open reduct	4369	4369	4854	5338	2664	2664
Oral Surgery	D7660	Malar/zygo arch -closed reduct	3592	3592	4063	4468	2193	2193
Oral Surgery	D7670	Alveolus - closed reduction	1522	1522	1880	1916	931	931
Oral Surgery	D7671	Alveolus - open reduction	967	967	1189	1336	590	590
Oral Surgery	D7680	Facial bones-complicatd reduct	7278	7278	8498	9348	4438	4438
Oral Surgery	D7710	Maxilla - open reduction	5059	5059	5708	6277	3086	3086
Oral Surgery	D7720	Maxilla - closed reduction	3781	3781	4359	4795	2307	2307
Oral Surgery	D7730	Mandible - open reduction	5360	5360	6174	6792	3268	3268
Oral Surgery	D7740	Mandible - closed reduction	4037	4037	4574	5033	2462	2462
Oral Surgery	D7750	Malar/zygo arch - open reduct	4614	4614	5311	5841	2816	2816
Oral Surgery	D7760	Malar/zygo arch -closed reduct	5350	5350	6597	7393	3263	3263
Oral Surgery	D7770	Alveolus - open reduction	3015	3015	3460	3805	1841	1841
Oral Surgery	D7771	Alveolus - closed reduction	1894	1894	2336	2616	1157	1157
Oral Surgery	D7780	Facial bones-complicatd reduct	9013	9013	10563	11619	5498	5498
Oral Surgery	D7810	Open reduction of dislocation	4756	4756	5436	5980	2900	2900
Oral Surgery	D7820	Closed reduction of dislocatio	642	642	792	884	392	392
Oral Surgery	D7830	Manipulation under anesthesia	853	853	1052	1179	523	523
Oral Surgery	D7840	Condylectomy	5984	5984	6753	7429	3649	3649
Oral Surgery	D7850	Surg discectomy w/ w/o implant	6018	6018	6618	7280	3671	3671
Oral Surgery	D7852	Disc repair	6315	6315	7248	7972	3854	3854
Oral Surgery	D7854	Synovectomy	6236	6236	6967	7663	3806	3806
Oral Surgery	D7856	Myotomy	3944	3944	4648	5114	2407	2407
Oral Surgery	D7858	Joint reconstruction	99999	99999	99999	99999	99999	99999
Oral Surgery	D7860	Arthrotomy	0	0	0	0	0	0
Oral Surgery	D7865	Arthroplasty	99999	99999	99999	99999	99999	99999
Oral Surgery	D7870	Arthrocentesls	459	459	567	637	278	278
Oral Surgery	D7871	Non-arthroscopic lysis, lavage	734	734	863	950	706	706
Oral Surgery	D7872	Arthroscopy-diag w/ w/o biopsy	0	0	0	0	0	0
Oral Surgery	D7873	Arthroscopy-surg:lavage,lysis	0	0	0	0	0	0
Oral Surgery	D7874	Arthroscopy-surg:disc repositn	0	0	0	0	0	0
Oral Surgery	D7875	Arthroscopy - surg:synovectomy	0	0	0	0	0	0
Oral Surgery	D7876	Arthroscopy - surg:discectomy	0	0	0	0	0	0
Oral Surgery	D7877	Arthroscopy - surg:debridement	0	0	0	0	0	0
Oral Surgery	D7880	Occlusal orthotic device	1130	1130	1198	1317	827	827
Oral Surgery	D7881	Occlusal orthotic device adjustment	150	150	150	166	147	147
Oral Surgery	D7899	Unspecified TMD therapy	0	0	0	0	0	0
Oral Surgery	D7910	Suture of recent small wounds	333	333	405	445	202	202
Oral Surgery	D7911	Complicated suture - up to 5cm	499	499	650	715	329	329
Oral Surgery	D7912	Complicated suture - > 5cm	748	748	921	1070	457	457
Oral Surgery	D7915	- Other Repair Procedures	0	0	0	0	0	0
Oral Surgery	D7920	Skin Graft	2718	2718	3350	3736	1658	1658
Oral Surgery	D7921	Col/app of Autologous bld conc (PRP)	474	474	474	479	455	455
Oral Surgery	D7922	Bio dressing hemostasis - site	136	136	168	194	84	84
Oral Surgery	D7939	Indexing for Osteotomy using robotic assisted or dynamic nav	480	480	511	561	99999	99999
Oral Surgery	D7940	Osteoplasty-orthognath deforms	4113	4113	4968	5464	2507	2507
Oral Surgery	D7941	Osteotomy - mandibular rami	10578	10578	11253	12379	6451	6451
Oral Surgery	D7943	Osteotomy - mand rami w/ graft	9736	9736	10752	11827	5939	5939
Oral Surgery	D7944	Osteotomy - segment/subapical	7855	7855	8840	9724	4792	4792
Oral Surgery	D7945	Osteotomy - body of mandible	7987	7987	8911	9800	4869	4869
Oral Surgery	D7946	LeFort I - max. total	9418	9418	10766	11842	5745	5745
Oral Surgery	D7947	LeFort I - max. segmented	9798	9798	10871	11958	5979	5979
Oral Surgery	D7948	LeFort II/III - w/o bone graft	11168	11168	12412	13653	6814	6814
Oral Surgery	D7949	LeFort II/III - w/ bone graft	13061	13061	14885	16374	7969	7969
Oral Surgery	D7950	Oss.,ost., or cart graft, mand	2194	2194	3206	3528	2083	2083
Oral Surgery	D7951	Sinus Aug. w/bone or sub.	1848	1848	3217	3309	1658	1658
Oral Surgery	D7952	Sinus Aug-vertical approach	987	987	1735	1906	878	878
Oral Surgery	D7953	Bone replcmt graft ridge site	345	345	528	575	345	345
Oral Surgery	D7955	Repair - max. tissue defect	3122	3122	3287	3614	2056	2056
Oral Surgery	D7956	GTR, edentulous area - resorbable barrier, per site	345	345	575	632	99999	99999
Oral Surgery	D7957	GTR edentulous area - non-resorbable barrier, per site	345	345	666	718	99999	99999
Oral Surgery	D7960	Frenulectomy - separate proc.	0	0	0	0	0	0
Oral Surgery	D7961	Buccal / labial frenectomy (frenulectomy)	513	513	610	673	314	314
Oral Surgery	D7962	Lingual frenectomy (frenulectomy)	513	513	610	673	314	314
Oral Surgery	D7963	Frenuloplasty	567	567	667	735	346	346
Oral Surgery	D7970	Excision - hyperplastic tiss	570	570	668	736	348	348
Oral Surgery	D7971	Excision - pericoronal gingiva	270	270	357	394	165	165
Oral Surgery	D7972	Surg reduct, fibrs. tuberosity	820	820	942	1037	500	500
Oral Surgery	D7979	Non-Surgical Sialolithotomy	0	0	0	0	0	0
Oral Surgery	D7980	Sialolithotomy	767	767	950	1062	471	471
Oral Surgery	D7981	Excision of salivary gland	0	0	0	0	0	0
Oral Surgery	D7982	Sialodochoplasty	1917	1917	2145	2360	1169	1169
Oral Surgery	D7983	Closure of salivary fistula	1393	1393	1717	1924	851	851
Oral Surgery	D7990	Emergency tracheotomy	1442	1442	1782	1995	882	882
Oral Surgery	D7991	Coronoidectomy	4433	4433	5089	5600	2707	2707
Oral Surgery	D7993	Surgical placement of craniofacial implant - extra oral	2298	2298	3142	3441	2298	2298
Oral Surgery	D7994	Surgical placement: zygomatic implant	2298	2298	3303	3631	2298	2298
Oral Surgery	D7995	Synthetic graft - mand/face	0	0	0	0	0	0
Oral Surgery	D7996	Impant-mand. - augmentation	0	0	0	0	0	0
Oral Surgery	D7997	Appliance removal, w/ archbar	312	312	397	481	194	194
Oral Surgery	D7998	Intraoral Plcmt Fixation Device Not in Conj. w/Fracture	2346	2346	2892	3242	1433	1433
Oral Surgery	D7999	Unspecified oral surgery proc.	99999	99999	99999	99999	99999	99999
Orthodontics	D8010	Limited ortho - primary	1988	1988	2275	2275	1264	1264
Orthodontics	D8010.1	Start Procedure	0	0	0	0	0	0
Orthodontics	D8010.2	Treatment Complete	0	0	0	0	0	0
Orthodontics	D8010.6	Limited ortho - primary 6 Month Treatment	0	0	0	0	0	0
Orthodontics	D8010.C	Limited ortho - primary 12 Month Treatment	0	0	0	0	0	0
Orthodontics	D8020	Limited ortho - transitional	2166	2166	2598	2598	1379	1379
Orthodontics	D8020.1	Reduced transitional orthodontics	99999	437	99999	99999	99999	99999
Orthodontics	D8020.2	Treatment Complete	0	0	0	0	0	0
Orthodontics	D8020.6	Limited ortho - transitional 6 Month Treatment	0	0	0	0	0	0
Orthodontics	D8020.C	Limited ortho - transitional 12 Month Treatment	0	0	0	0	0	0
Orthodontics	D8030	Limited ortho - adolescent	2303	2303	2762	2762	1632	1632
Orthodontics	D8030.1	Start Procedure	0	0	0	0	0	0
Orthodontics	D8030.2	Treatment Complete	0	0	0	0	0	0
Orthodontics	D8030.6	Limited ortho - adolescent 6 Month Treatment	0	0	0	0	0	0
Orthodontics	D8030.C	Limited ortho - adolescent 12 Month Treatment	0	0	0	0	0	0
Orthodontics	D8040	Limited ortho - adult	2728	2728	3136	3136	1648	1648
Orthodontics	D8040.1	Start Procedure	0	0	0	0	0	0
Orthodontics	D8040.2	Treatment Complete	0	0	0	0	0	0
Orthodontics	D8040.3	Invisalign Surcharge	0	0	0	0	0	0
Orthodontics	D8040.6	Limited ortho - adult 6 Month Treatment	0	0	0	0	0	0
Orthodontics	D8040.C	Limited ortho - adult 12 Month Treatment	0	0	0	0	0	0
Orthodontics	D8050	Interceptive ortho - primary	2183	2183	2321	2321	1632	1632
Orthodontics	D8050.1	Start Procedure	0	0	0	0	0	0
Orthodontics	D8050.2	Tx Complete	0	0	0	0	0	0
Orthodontics	D8060	Interceptive ortho-transitionl	2728	2728	3071	3071	1816	1816
Orthodontics	D8060.1	Reduced transitional orthodontics	99999	437	99999	99999	99999	99999
Orthodontics	D8060.2	Tx Complete	0	0	0	0	0	0
Orthodontics	D8070	Comprehensive ortho-transition	4021	4021	4826	4826	3814	3814
Orthodontics	D8070.1	Start Procedure	0	0	0	0	0	0
Orthodontics	D8070.2	Tx Complete	0	0	0	0	0	0
Orthodontics	D8070.3	- Bands Placed	0	0	0	0	0	0
Orthodontics	D8070.4	Active treatment complete	0	0	0	0	0	0
Orthodontics	D8080	Comprehensive ortho - adolesce	4021	4021	4826	4826	3872	3872
Orthodontics	D8080.1	Start Procedure	0	0	0	0	0	0
Orthodontics	D8080.2	Tx Complete	0	0	0	0	0	0
Orthodontics	D8080.3	- Bands Placed	0	0	0	0	0	0
Orthodontics	D8080.4	- Active treatment complete	0	0	0	0	0	0
Orthodontics	D8090	Comprehensive ortho - adult	4625	4625	4826	4826	4090	4090
Orthodontics	D8090.1	Start Procedure	0	0	0	0	0	0
Orthodontics	D8090.2	Tx Complete	0	0	0	0	0	0
Orthodontics	D8090.3	- Bands Placed	0	0	0	0	0	0
Orthodontics	D8090.4	- Active treatment complete	0	0	0	0	0	0
Orthodontics	D8090.5	Comprehensive ortho - adult Extensive Treatment	6331	6331	6986	6986	0	0
Orthodontics	D8210	Removable appliance therapy	1092	1092	1097	1207	575	575
Orthodontics	D8220	Fixed appliance therapy	1217	1217	1259	1379	666	666
Orthodontics	D8660	Pre-ortho Treatment Visit (Records)	413	413	482	528	397	397
Orthodontics	D8660.1	- PEDS/Ortho Screening Visit	0	0	0	0	0	0
Orthodontics	D8660.2	- Ortho Screening Visit	0	0	0	0	0	0
Orthodontics	D8660.3	- Ortho Tx Plan Presentation	0	0	0	0	0	0
Orthodontics	D8660.4	- Ortho/OS Case Conference	0	0	0	0	0	0
Orthodontics	D8670	- Periodic ortho treatment visit	0	0	0	0	0	0
Orthodontics	D8680	- Orthodontic retention	0	0	0	0	0	0
Orthodontics	D8680.1	Ortho RETEN Eval	35	35	35	35	34	34
Orthodontics	D8681	- Removable orthodontic retainer adjustment	0	0	0	0	0	0
Orthodontics	D8690	- Orthodontic treatment	0	0	379	413	0	0
Orthodontics	D8691	Repair of ortho appliance	0	0	0	0	0	0
Orthodontics	D8691.1	Level 2 Repair Cost	0	0	0	0	0	0
Orthodontics	D8691.2	Level 3 Repair Cost	0	0	0	0	0	0
Orthodontics	D8692	Replace - lost/broken retainer	0	0	0	0	0	0
Orthodontics	D8692.1	Replace lost/broken ESSIX	212	212	231	231	64	64
Orthodontics	D8693	Rebond.,recem.,rep.,fixed ret	0	0	0	0	0	0
Orthodontics	D8694	Repair of fixed retainers, includes reattachment	0	0	0	0	0	0
Orthodontics	D8695	Removal of Fixed Ortho Appl Not at Completion of Treatment	300	300	328	362	182	182
Orthodontics	D8696	Repair Max ortho appl	243	243	283	319	157	157
Orthodontics	D8697	Repair Mand ortho appl	243	243	283	319	157	157
Orthodontics	D8698	Re-cmt Max fixed retainer	207	207	340	375	157	157
Orthodontics	D8699	Re-cmt Mand fixed retainer	207	207	261	287	157	157
Orthodontics	D8701	Repair/reattach Max fixed ret	247	247	268	295	148	148
Orthodontics	D8702	Repair/reattach Mand fixed ret	247	247	268	295	148	148
Orthodontics	D8703	Replace Max retainer	397	397	425	431	397	397
Orthodontics	D8704	Replace Mand retainer	397	397	425	431	397	397
Orthodontics	D8999	- Unspecified ortho procedure	0	0	194	212	0	0
Orthodontics	D8999.1	ESSIX retainer,vac. fab.	275	275	275	275	263	263
Orthodontics	D8999.2	Positioners	0	0	0	0	0	0
Orthodontics	D8999.3	Ceramic bracket surcharge	494	494	519	519	494	494
Orthodontics	D8999.4	Invisalign in add to comp adult ortho	1142	0	2170	2170	1120	1120
Orthodontics	D8999.5	Harmony in add to comp ortho	2260	2260	2260	2195	2173	2173
Orthodontics	D8999.6	Herbst Appl Lab Cost	470	470	643	700	0	0
Orthodontics	D8999.7	- Presurgical Ortho DX	0	0	0	0	0	0
Orthodontics	D8999.8	Spring Aligner	378	378	418	418	265	265
Orthodontics	D8999.9	Ortho TADS (mini-implant screws)	147	147	170	170	0	0
Orthodontics	D8999.A	Harmony in add to comp ortho	0	0	0	0	0	0
Orthodontics	D8999.B	Rebanding	289	289	289	289	99999	99999
Orthodontics	D8999.C	InvisalignSingle Arch	99999	99999	1154	1154	99999	99999
Orthodontics	D8999.D	Invisalign Express 10	99999	99999	1131	1131	99999	99999
Orthodontics	D8999.E	Invisalign Express 5	99999	99999	838	838	99999	99999
Orthodontics	D8999.F	Vivera Retainers Dual Arch	490	490	510	526	99999	99999
Orthodontics	D8999.G	Vivera Retainers Single Arch	348	348	373	373	99999	99999
Orthodontics	D8999.H	Replace lost/broken ESSIX	99999	207	207	207	99999	99999
Orthodontics	D8999.J	MARPE	456	456	456	456	456	456
Orthodontics	D8999.K	Lightforce clear brackets	258	258	258	258	258	258
Adjunctive General Services	D9110	Palliative treatment of dental pain - per visit	136	136	168	194	84	84
Adjunctive General Services	D9120	Sectioning of FPD	291	291	299	329	171	171
Adjunctive General Services	D9130	TMJ Non-Invasive Physical Therapy	0	0	0	0	0	0
Adjunctive General Services	D9210	Local anesthesia - w/o surg	18	18	18	18	18	18
Adjunctive General Services	D9211	Regional block anesthesia	111	111	117	129	65	65
Adjunctive General Services	D9212	Trigeminal division block anes	244	244	325	358	160	160
Adjunctive General Services	D9215	- Local anesthesia w/ surg proc	0	0	0	0	0	0
Adjunctive General Services	D9219	Evaluation for deep sedation or general anesthesia	122	122	122	133	117	117
Adjunctive General Services	D9220	General anesthesia -1st 30 min	0	0	0	0	0	0
Adjunctive General Services	D9221	General anesthesia -add 15 min	0	0	0	0	0	0
Adjunctive General Services	D9222	General anesthesia -1st 15 min	291	291	291	321	284	284
Adjunctive General Services	D9223	Deep sedation/general anesthesia – each 15 minute	224	224	272	307	215	215
Adjunctive General Services	D9230	Analg, anxiolysis, inhal of N2O	94	94	103	112	92	92
Adjunctive General Services	D9230.1	-First Nitrous Experience (video & quiz)	0	0	0	0	0	0
Adjunctive General Services	D9239	Interv sedate/analg-1st 15 min	430	430	520	614	430	430
Adjunctive General Services	D9241	Intrav sedate/analg-1st 30 min	0	0	0	0	0	0
Adjunctive General Services	D9241.1	Interv sedate/analg - sedation experience	0	0	99999	99999	99999	99999
Adjunctive General Services	D9241.2	- Interv sedate/analg - sedation assist	0	0	0	0	0	0
Adjunctive General Services	D9241.3	IV -Sedation Appt canceled	0	0	99999	99999	99999	99999
Adjunctive General Services	D9242	Intrav sedate/analg-add 15 min	0	0	0	0	0	0
Adjunctive General Services	D9243	Intravenous mod (conscious) sedation/analgesia each 15min	235	235	235	259	99999	99999
Adjunctive General Services	D9248	Non-intrav conscious sedation	300	300	300	306	300	99999
Adjunctive General Services	D9248.1	Non-interv conscious sedation - sedation experience	0	0	99999	99999	99999	99999
Adjunctive General Services	D9248.2	Non-interv conscious sedation - sedation assist	0	0	99999	99999	99999	99999
Adjunctive General Services	D9248.3	Non IV -Sedation Appt canceled	0	0	99999	99999	99999	99999
Adjunctive General Services	D9310	Consultation	135	135	168	184	94	94
Adjunctive General Services	D9310.1	Ortho Consult	35	35	35	35	34	34
Adjunctive General Services	D9311	Consultation with medical health care professional	0	0	0	0	0	0
Adjunctive General Services	D9410	House/ext. care facility call	237	237	300	330	153	153
Adjunctive General Services	D9420	- Hospital call	0	0	0	0	0	0
Adjunctive General Services	D9430	- Office visit -observation only	0	0	0	0	0	0
Adjunctive General Services	D9430.1	- Endo-Off Visit	0	0	0	0	0	0
Adjunctive General Services	D9430.2	- Ortho-Off Visit	0	0	0	0	0	0
Adjunctive General Services	D9430.3	- Oral Surg-Off Visit	0	0	0	0	0	0
Adjunctive General Services	D9430.4	- Perio-Off Visit	0	0	0	0	0	0
Adjunctive General Services	D9430.5	- PEDS/Dx Preventative-Off Visit	0	0	0	0	0	0
Adjunctive General Services	D9430.6	- Prosth-Off Visit	0	0	0	0	0	0
Adjunctive General Services	D9430.7	- Oper/Fixed-Off Visit	0	0	0	0	0	0
Adjunctive General Services	D9430.8	- Patient of Record-Off Visit	0	0	0	0	0	0
Adjunctive General Services	D9430.9	- Special Care Services Visit	0	0	0	0	0	0
Adjunctive General Services	D9440	Office visit - after hours	192	192	233	258	112	112
Adjunctive General Services	D9450	Case present, subsequent to detailed and extensive tx plan	100	100	195	213	0	0
Adjunctive General Services	D9450.1	- Endo, Case Presentation	0	0	0	0	0	0
Adjunctive General Services	D9450.2	- Periodontal Treatment Plan Presentation	0	0	0	0	0	0
Adjunctive General Services	D9450.3	- Fixed, Case Presentation	0	0	0	0	0	0
Adjunctive General Services	D9450.4	- Removable, Case Presentation	0	0	0	0	0	0
Adjunctive General Services	D9450.5	- Ortho Screening, Case Presentati	0	0	0	0	0	0
Adjunctive General Services	D9450.6	- TPU Transfer Patient Update	0	0	0	0	0	0
Adjunctive General Services	D9450.7	- TPW Treatment Plan Workup	0	0	0	0	0	0
Adjunctive General Services	D9450.8	- Pre-Implant Perio review	0	0	0	0	0	0
Adjunctive General Services	D9450.9	- Pre-Implant Prosth review	0	0	0	0	0	0
Adjunctive General Services	D9610	Therap.drug inject, single adm	111	111	132	146	68	68
Adjunctive General Services	D9612	Therp.drug inj, 2 or more admn	186	186	228	232	111	111
Adjunctive General Services	D9613	Infiltration of Sustained Release Therapy Drug	0	0	0	0	0	0
Adjunctive General Services	D9630	Other drugs/medicaments	36	36	36	40	31	31
Adjunctive General Services	D9910	Applicate desensitizing medica	67	67	77	83	42	42
Adjunctive General Services	D9911	Applicate desens resin-per tth	87	87	100	111	50	50
Adjunctive General Services	D9912	-Pre-visit patient screening	0	0	0	0	0	0
Adjunctive General Services	D9920	Behavior management	144	144	175	178	92	92
Adjunctive General Services	D9920.1	- Protective Stabilization	0	0	0	0	0	0
Adjunctive General Services	D9930	Tx,complications-unusual circs	158	158	167	183	97	97
Adjunctive General Services	D9931	Cleaning and inspection of a removable appliance	0	0	0	0	0	0
Adjunctive General Services	D9932	Cleaning/inspection removable complete denture, max	66	66	68	75	42	42
Adjunctive General Services	D9933	Cleaning/inspection removable complete denture, man	66	66	68	75	42	42
Adjunctive General Services	D9934	Cleaning/inspection removable partial denture, max	66	66	68	75	42	42
Adjunctive General Services	D9935	Cleaning/inspection removable partial denture, man	66	66	68	75	42	42
Adjunctive General Services	D9938	Fabrication of a custom removable clear plastic temporary	35	35	35	35	34	34
Adjunctive General Services	D9939	- Placement of a custom removable clear plastic temporary ae	0	0	0	0	0	0
Adjunctive General Services	D9940	Occlusal guard	0	0	0	0	0	0
Adjunctive General Services	D9940.1	Significant Adjustment	0	0	0	0	0	0
Adjunctive General Services	D9940.2	Minimum Adjustment	0	0	0	0	0	0
Adjunctive General Services	D9941	Fabrication of athl mouthguard	267	267	318	350	176	176
Adjunctive General Services	D9941.1	Mold for Athletic Mouthguards	52	52	52	52	49	49
Adjunctive General Services	D9942	Repair/reline Occl Guard	263	263	325	357	176	176
Adjunctive General Services	D9943	Occlusal guard adjustment	94	94	112	123	52	52
Adjunctive General Services	D9944	Occlusal Guard Hard Appliance Per Full Arch	678	678	767	844	394	394
Adjunctive General Services	D9945	Occlusal Guard Soft Appliance Per Full Arch	0	0	0	0	0	0
Adjunctive General Services	D9946	Occlusal Guard Hard Appliance Partial Arch	678	678	719	791	394	394
Adjunctive General Services	D9947	Custom sleep apnea appliance fabrication and placement	1447	1447	1609	1770	1166	1166
Adjunctive General Services	D9948	Adjustment of custom sleep apnea appliance	137	137	173	191	78	78
Adjunctive General Services	D9949	Repair of cust sleep apnea app	299	299	374	411	168	168
Adjunctive General Services	D9950	Occlusion analysis-mountd case	374	374	462	473	219	219
Adjunctive General Services	D9951	Occlusal adjustment - limited	196	196	242	265	112	112
Adjunctive General Services	D9952	Occlusal adjustment - complete	766	766	895	985	448	448
Adjunctive General Services	D9953	Reline custom sleep apnea appliance (indirect)	303	303	374	411	99999	99999
Adjunctive General Services	D9954	Fabrication and delivery of OAT morning reposition appliance	1447	1447	1609	1770	99999	99999
Adjunctive General Services	D9955	Oral Appliance Therapy (OAT) Titration Visit	137	137	173	191	99999	99999
Adjunctive General Services	D9956	- Administration of Home Sleep Apnea Test	0	0	0	0	0	0
Adjunctive General Services	D9957	Screening for Sleep Related Breathing Disorders	123	123	133	173	99999	99999
Adjunctive General Services	D9961	Duplicate/Copy Patient Records	0	0	0	0	0	0
Adjunctive General Services	D9970	Enamel microabrasion	201	201	268	295	131	131
Adjunctive General Services	D9971	Odontoplasty - per tooth	169	169	222	244	110	110
Adjunctive General Services	D9972	In-office External bleaching - per arch	349	349	381	421	203	203
Adjunctive General Services	D9972.1	In-office One Hour Bleaching per arch	575	575	707	721	334	334
Adjunctive General Services	D9972.2	At Home Bleaching	0	0	0	0	0	0
Adjunctive General Services	D9973	In-office External bleaching - per tooth	232	232	282	311	151	151
Adjunctive General Services	D9974	Internal bleaching - per tooth	322	322	383	422	187	187
Adjunctive General Services	D9975	At home External bleaching per arch	309	309	309	340	232	232
Adjunctive General Services	D9985	Sales Tax	0	0	0	0	0	0
Adjunctive General Services	D9986	- Missed appointment	0	0	61	67	0	0
Adjunctive General Services	D9987	- Cancelled appointment	0	0	0	0	0	0
Adjunctive General Services	D9990	Certified Translation or Sign Langage Services Per Visit	0	0	0	0	0	0
Adjunctive General Services	D9991	Dental case mgmt- addressing appt compliance barriers	0	0	0	0	0	0
Adjunctive General Services	D9992	Dental case mgmt - care coordination	0	0	0	0	0	0
Adjunctive General Services	D9993	- Dental case mgmt - motivational interviewing	0	0	0	0	0	0
Adjunctive General Services	D9994	Dental case mgmt - education to improve oral health literacy	0	0	0	0	0	0
Adjunctive General Services	D9995	- Teledentistry - Real Time Encounter	0	0	0	0	0	0
Adjunctive General Services	D9996	- Teledentistry - Asynchronous	0	0	0	0	0	0
Adjunctive General Services	D9997	Dental case management	0	0	0	0	0	0
Adjunctive General Services	D9999	- Unspecified adjunctive proc.	0	0	0	0	0	0
Adjunctive General Services	D9999.1	No Charge Office Visit	0	0	0	0	0	0
Adjunctive General Services	D9999.2	No Treatment Provided-FXCM#10Qpts	0	0	0	0	0	0
Other	DAEN01	- Endo Assist - Diagnosis Only	0	0	0	0	0	0
Other	DAEN02	- Endo Assist - Access Only	0	0	0	0	0	0
Other	DAEN03	- Endo Assist - Access and Working Length	0	0	0	0	0	0
Other	DAEN04	- Endo Assist - Access and Instrumentation	0	0	0	0	0	0
Other	DAEN05	- Endo Assist - Instrumentation Only	0	0	0	0	0	0
Other	DAEN06	- Endo Assist - Instrumentation and Obturation	0	0	0	0	0	0
Other	DAEN07	- Endo Assist - Obturation Only	0	0	0	0	0	0
Other	DAEN08	- Endo Assist - Access/Instrument'n/Obturation	0	0	0	0	0	0
Other	DAEN09	- Endo Assist - Other	0	0	0	0	0	0
Other	DAFXR	- FX Postdoc Assist	0	0	0	0	0	0
Other	DAFXS	- FX Predoc Assist	0	0	0	0	0	0
Other	DAHY01	1/2 session Assist Hygiene	0	0	0	0	0	0
Other	DAHY02	Full Session Assist Hygiene	0	0	0	0	0	0
Other	DAOP01	- Operative Assist	0	0	0	0	0	0
Other	DAOR01	- Ortho Assist	0	0	0	0	0	0
Other	DAPE01	Predoc Periodontal Assisting	0	0	0	0	0	0
Other	DARMR	- RM Postdoc Assist	0	0	0	0	0	0
Other	DARMS	- RM Predoc Assist	0	0	0	0	0	0
Other	DATP01	- Assist TP	0	0	0	0	0	0
Other	DCDC	Case Report Denture – Complete	0	0	0	0	0	0
Other	DCDP	Case Report Denture – Partial	0	0	0	0	0	0
Other	DCF	Case Report Fixed	0	0	0	0	0	0
Other	DCMP1.1	Operative Class II Dx Competency	0	0	0	0	0	0
Other	DCMP1.2	Operative Class III Dx Competency	0	0	0	0	0	0
Other	DCMP10	Soft Tissue Exam Competency	0	0	0	0	0	0
Other	DOFXCR1	Co-therapy Crown	0	0	0	0	0	0
Other	DOFXIM1	Co-Therapy Implant	0	0	0	0	0	0
Other	DOFXPN1	Co-therapy Pontic	0	0	0	0	0	0
Other	DORMCD1	Co-Therapy Complete Denture	0	0	0	0	0	0
Other	DORMPD1	Co-Therapy RPD	0	0	0	0	0	0
Other	E0485	Oral Device/Adjustable, Prefabricated	627	627	627	627	0	0
Other	E0486	Oral Device/Appliance Custom Fab	3432	3432	3432	3432	99999	99999
Other	E0486.1	Oral Device/Appliance - TAP	591	591	591	591	99999	99999
Other	E0486.2	Oral Device/ Appl Custom Fab-AGD	0	0	0	0	0	0
Other	E0486.3	Oral Device/Appliance Custom Fab - Faculty	0	0	0	0	0	0
Other	E1001	Gold	0	0	0	0	99999	99999
Other	E1002	Amalgam	0	0	0	0	99999	99999
Other	E1003	Composite	0	0	0	0	99999	99999
Other	E1004	Miscellaneous Metallic	0	0	0	0	99999	99999
Other	E1005	Porcelain	0	0	0	0	99999	99999
Other	E1006	Sedative	0	0	0	0	99999	99999
Other	M10021	Fine Needle Aspiration	0	0	0	0	0	0
Other	M10060	I&D simple	0	0	229	250	0	0
Other	M10061	I&D complicated	0	0	401	441	0	0
Other	M10120	FB, rmv subq tiss:s.	0	0	288	317	0	0
Other	M10121	FB, rmv subq tiss:c.	0	0	585	642	0	0
Other	M10140	I&D hematoma:simple	0	0	313	346	0	0
Other	M10160	Punture Aspiration	0	0	294	323	0	0
Other	M10180	Wound I & D	582	582	642	707	99999	99999
Other	M11000	Debridement Eczematous or Infe	0	0	0	0	99999	99999
Other	M11001	DEBRIDEMNT ADD'L 10% BODY SURF	0	0	0	0	0	0
Other	M11004	DEBRIDEMENT OF SKIN, SUBU	0	0	0	0	0	0
Other	M11010	Debridement w/removal foreign	0	0	0	0	0	0
Other	M11011	Debridement skin,sub tis,muscl	0	0	0	0	0	0
Other	M11012	Debridement-skin,subcutaneous	0	0	0	0	99999	99999
Other	M11040	CODE DELETED 2011	0	0	0	0	0	0
Other	M11042	Skin/Subcut tissue	0	0	222	244	0	0
Other	M11043	Skin/Subcut/muscle	0	0	477	524	0	0
Other	M11044	Skin/Subct/musc/bone	0	0	842	926	0	0
Other	M11100	Biopsy of skin,subcutaneous ti	170	170	199	219	99999	99999
Other	M11200	Removal up to 15 skin tags	0	0	0	0	0	0
Other	M11400	Ex lesion >.5cm trunk	0	0	0	0	0	0
Other	M11406	Exc bngn lesion trunk, arm leg	0	0	0	0	0	0
Other	M11420	Exc benign 0.5 cm neck,scalp	0	0	0	0	0	0
Other	M11421	Excision, benign lesion	0	0	0	0	0	0
Other	M11423	Excision benign lesion neck	0	0	0	0	0	0
Other	M11424	Exc benign lesion 3.1-4 cm	0	0	0	0	0	0
Other	M11426	Exc be lesion over 4 cm neck,s	0	0	0	0	0	0
Other	M11440	Exc lesion .5cm/less	0	0	284	313	0	0
Other	M11441	Exc lesion .6-1cm	0	0	361	398	0	0
Other	M11442	Exc lesion 1.1-2cm	0	0	427	471	0	0
Other	M11443	Exc lesion 2.1-3cm	0	0	533	586	0	0
Other	M11444	Exc lesion 3.1-4cm	0	0	628	691	0	0
Other	M11446	Exc lesion over 4cm	0	0	846	932	0	0
Other	M11622	Excmal lesion 1.1-2cm	0	0	0	0	0	0
Other	M11640	Exc malig tmr <.5cm	0	0	432	476	0	0
Other	M11641	Exc malig tmr .6-1cm	0	0	526	580	0	0
Other	M11642	Exc mal les 1.1-2cm	0	0	600	660	0	0
Other	M11643	Exc mal les 2.1-3cm	0	0	757	833	0	0
Other	M11644	Exc mal tmr 3.1-4cm	0	0	931	1024	0	0
Other	M11646	Exc mal les over 4cm	0	0	1339	1472	0	0
Other	M11900	Intralesional lesion<>	85	85	92	97	99999	99999
Other	M11901	Intralesional>>	0	0	0	0	99999	99999
Other	M12001	Simple repair of superficial w	127	127	134	141	99999	99999
Other	M12002	Simple repair;2.6 cm to 7.5 cm	127	127	134	141	99999	99999
Other	M12004	Simple repair;7.6 to 12.5 cm	0	0	0	0	99999	99999
Other	M12005	Simple repair;12.6 to 20.0 cm	0	0	0	0	99999	99999
Other	M12011	Simple repair;2.5 cm or less	401	401	476	523	99999	99999
Other	M12013	Simple repair;2.6 to 5.0 cm	430	430	495	545	99999	99999
Other	M12014	Simple repair;5.1 to 7.5 cm	517	517	607	667	99999	99999
Other	M12015	Simple repair;7.6 to 12.5 cm	646	646	743	818	99999	99999
Other	M12016	Suture s. 12.6-20cm	0	0	971	1068	0	0
Other	M12017	Simple Repair Wounds:20.1 CM	959	959	1133	1246	99999	99999
Other	M12018	Simple repair;over 30.0 cm	1053	1053	1407	1545	99999	99999
Other	M12020	Simple repair;over 30.0 cm	486	486	626	688	99999	99999
Other	M12031	Layer Closure;2.5 cm or less	0	0	0	0	99999	99999
Other	M12032	Intermediate closure 2.6-7.5 c	0	0	0	0	0	0
Other	M12034	Layer Closure of Wounds:7.6CM	0	0	0	0	99999	99999
Other	M12051	Layer Closure;2.5 cm or less	475	475	584	641	99999	99999
Other	M12052	Layer Closure;2.6 to 5.0 cm	528	528	633	697	99999	99999
Other	M12053	Layer Closure;5.1 to 7.5 cm	643	643	733	805	99999	99999
Other	M12054	Layer Closure;7.6 to 12.5 cm	800	800	918	1011	99999	99999
Other	M12055	Layer Closure;12.6 to 20.0 cm	1011	1011	1174	1292	99999	99999
Other	M12056	Suture i. 20.1-30cm	0	0	1296	1426	0	0
Other	M12057	Suture i. over 30cm	0	0	1438	1582	0	0
Other	M13100	CompSuture 1.1 cm to 2.5cm	0	0	0	0	0	0
Other	M13101	Complex repair 2.6 cm-7.5	0	0	0	0	0	0
Other	M13102	Add'l 5 cm complex closure tru	0	0	0	0	0	0
Other	M13120	Repair,comp.,scalp;1.1to 2.5	0	0	274	301	99999	99999
Other	M13121	Repair,comp.,scalp,2.6to7.5	789	789	916	1007	99999	99999
Other	M13122	Repair,comp.,scalp,add 5/les	313	313	313	346	99999	99999
Other	M13131	Repair,comp.,mouth,1.1to2.5	625	625	777	855	99999	99999
Other	M13132	Repair,comp.,mouth, 2.6to7.5 c	1028	1028	1121	1234	99999	99999
Other	M13133	Repair,comp.,mouth, add 5/less	405	405	405	445	99999	99999
Other	M13150	Repair,comp.,lips, 1.0/less	693	693	924	1016	99999	99999
Other	M13151	Repair,comp.,lips,1.1to2.5 cm	806	806	906	997	99999	99999
Other	M13152	Repair,comp.,lips,2.6to7.5 cm	1257	1257	1257	1381	99999	99999
Other	M13153	Repair,comp.,lips,add 5/less	470	470	504	554	99999	99999
Other	M13160	Secondary closure of surgical	0	0	2243	2468	0	0
Other	M13300	Suture unsul >7.5cm	0	0	0	0	0	0
Other	M14001	Adjacent tissue rearrangement	0	0	0	0	0	0
Other	M14020	Adjacent tissue transfer	0	0	1480	1626	0	0
Other	M14040	Adj tiss:defct 10cm<	0	0	1590	1749	0	0
Other	M14041	Adj tiss: 10.1-30cm	0	0	2288	2516	0	0
Other	M14060	Adj tiss: 10cm/less	0	0	1853	2039	0	0
Other	M14300	DELETED CODE 2010	0	0	0	0	0	0
Other	M14350	Filleted finger flap	0	0	0	0	0	0
Other	M15000	Ex Prep Site w/ FSG	0	0	0	0	0	0
Other	M15100	Split graft	0	0	2477	2724	0	0
Other	M15120	Split graft:100sqcm<	0	0	2677	2945	0	0
Other	M15200	Full thickness skin graft free	0	0	0	0	0	0
Other	M15220	Full thickness graft arm 20 sq	0	0	1937	2131	0	0
Other	M15221	EAC ADD'T 20 SQ CM FULL SKIN F	0	0	502	551	0	0
Other	M15240	Full thick graft,20 sq cm/less	2019	2019	2384	2625	99999	99999
Other	M15260	Fullthck gft:20sqcm<	0	0	2471	2718	0	0
Other	M15261	Fullthck gft20+sq cm	0	0	685	754	0	0
Other	M15330	DELETED CODE 2012	0	0	0	0	0	0
Other	M15335	DELETED CODE 2012	0	0	0	0	0	0
Other	M15570	Formation pedicle flap, trunk	0	0	0	0	0	0
Other	M15574	Form direct pedicle mouth	0	0	2402	2643	0	0
Other	M15576	FM PEDICLE FLAP EARS, NOSE LIP	0	0	2107	2320	0	0
Other	M15732	Head and Neck Flap	0	0	0	0	0	0
Other	M15734	Trunk Myocutaneous flap	0	0	0	0	0	0
Other	M15740	Flap; island pedicle	0	0	3029	3331	0	0
Other	M15750	Flap neurovascular pedicle	0	0	0	0	0	0
Other	M15756	Free muscle/myocutaneous flap	0	0	0	0	0	0
Other	M15757	Free Skin Flap w/ Microvascula	0	0	0	0	0	0
Other	M15758	Free fascial flap w/microvascu	0	0	0	0	0	0
Other	M15770	Flap,derma fat fascia	0	0	2516	2769	0	0
Other	M15780	Dermabrasion, total face	0	0	0	0	0	0
Other	M15781	Dermabrasion segmental face	0	0	0	0	0	0
Other	M15782	Dermabrasion region other tha	0	0	0	0	0	0
Other	M15820	Blepharoplasty,Lower Eyelid	0	0	0	0	99999	99999
Other	M15822	Blepharoplasty, upper eyelid	0	0	0	0	0	0
Other	M15825	RHYTIDECTOMY	0	0	0	0	0	0
Other	M15828	Rhytidectomy, cheek chin, neck	0	0	0	0	0	0
Other	M15829	Rhytidectomy SMAS flap	0	0	0	0	0	0
Other	M15838	Excision lipectomy submental f	0	0	0	0	0	0
Other	M15839	Excision exc. skin lipectomy	0	0	0	0	0	0
Other	M15876	Submental Lipectomy head/neck	0	0	0	0	0	0
Other	M17000	Destruction lesion,first lesio	123	123	148	163	99999	99999
Other	M17003	Destr 2-14 lesions	0	0	29	31	0	0
Other	M17010	Dstrc any mth:c. les	0	0	0	0	0	0
Other	M17110	Destruction benign lesion up t	0	0	0	0	0	0
Other	M20000	Musculoskeletal System (incisi	0	0	0	0	99999	99999
Other	M20005	Incis sf tiss:cmplic	0	0	803	884	0	0
Other	M20100	Exploration of wound	0	0	0	0	0	0
Other	M20220	Biopsy; superficial	447	447	447	491	99999	99999
Other	M20225	Biopsy bn,ndle:deep	0	0	793	873	0	0
Other	M20240	Biopsy,bone	648	648	648	713	99999	99999
Other	M20245	Biopsy bn,excs:deep	0	0	1852	2038	0	0
Other	M20520	FB, musc/ten shth:s.	0	0	509	559	0	0
Other	M20550	Trigger Point Injection	157	157	174	193	99999	99999
Other	M20605	Arthrocentesis aspiration	159	159	170	186	99999	99999
Other	M20615	Aspr/Injc bone cyst	0	0	647	712	0	0
Other	M20650	Osteosynthesis,wire	0	0	618	679	0	0
Other	M20670	Impl't rmv:superf'l	0	0	999	1098	0	0
Other	M20680	Removal of implant,deep	1240	1240	1622	1785	99999	99999
Other	M20690	Application of synthes externa	0	0	0	0	0	0
Other	M20692	Application multiplane externa	0	0	0	0	0	0
Other	M20694	Rmv ext fxt w/ anest	0	0	1371	1508	0	0
Other	M20900	Bone graft,any,minor,small	1268	1268	1295	1423	99999	99999
Other	M20902	Bone graft,major,any	0	0	1522	1674	0	0
Other	M20910	Cartilage grft,costo	0	0	1483	1630	0	0
Other	M20926	Tissue grafts,other	1220	1220	1427	1571	99999	99999
Other	M20955	Bn gft microv anast	0	0	10959	12054	0	0
Other	M20956	Bone Graft w/micro; iliac cres	0	0	11657	12821	0	0
Other	M20962	Bone graft scapula w/micr anas	0	0	0	0	0	0
Other	M20969	Free osteocutaneous flap	0	0	0	0	0	0
Other	M20970	Free Flap micro/iliac	0	0	0	0	0	0
Other	M20985	Comp Assisted surg navigation	0	0	0	0	0	0
Other	M20999	Unlisted Procedure, musculoske	99999	99999	99999	676	99999	99999
Other	M21010	Arthrotomy,temporomandibular j	3011	3011	3391	3731	99999	99999
Other	M21013	Ex soft tis face, subfascial>2	0	0	0	0	0	0
Other	M21015	Radical tumor resect.,soft,fac	1749	1749	2007	2209	99999	99999
Other	M21025	Excision of bone,mandible	2055	2055	2472	2719	99999	99999
Other	M21026	Excis bone Facial	0	0	2179	2398	0	0
Other	M21029	Rmv ben tumor fac bn	0	0	2414	2655	0	0
Other	M21030	Excision of Benign Tumor	1264	1264	1264	1391	99999	99999
Other	M21031	Excision of torus mandibularis	774	774	1017	1118	99999	99999
Other	M21032	Exc Max Tor/Tor Pala	0	0	1181	1299	0	0
Other	M21034	Exc mal fcl,not mand	0	0	3863	4249	0	0
Other	M21040	Exc. benign cyst/tumor,mandibl	1345	1345	1381	1520	99999	99999
Other	M21041	Exc. benign cy/tu,mand., compl	0	0	0	0	99999	99999
Other	M21044	Exc mal tmr mandible	0	0	3356	3693	0	0
Other	M21045	Ex mal mand:rad rsct	0	0	5475	6022	0	0
Other	M21046	Exc of mandible	0	0	0	0	0	0
Other	M21047	Exc of mandible w/osteotomy	0	0	0	0	0	0
Other	M21048	Excison benign tumor maxillary	0	0	0	0	0	0
Other	M21049	Excision of benign maxilla	0	0	0	0	0	0
Other	M21050	Arthrectomy, TMJ; unilateral	3512	3512	4680	5151	99999	99999
Other	M21060	Meniscectomy TMJ	0	0	3795	4175	0	0
Other	M21070	Coronoidectomy;separate proc	2807	2807	3740	4114	99999	99999
Other	M21079	Impression & Custom Prep;Inter	4847	4847	5453	5998	99999	99999
Other	M21080	Definitive Obtruator Pros.	5276	5276	7034	7736	99999	99999
Other	M21081	Mandib resect. pros.	0	0	6248	6873	0	0
Other	M21083	Palat lift prosthes.	0	0	5165	5683	0	0
Other	M21084	Speech aid prosthes.	0	0	5396	5935	0	0
Other	M21085	Impres/cust prep; o.s. splint	1575	1575	1575	1989	99999	99999
Other	M21088	Impres&Cust Prep:Facial Pros	2276	2276	3033	3338	99999	99999
Other	M21089	Unlisted Maxillofacial Prosthe	99999	99999	99999	99999	99999	99999
Other	M21110	Interdental fixation device	1556	1556	2047	2251	99999	99999
Other	M21116	TMJ arthro:injc proc	0	0	319	351	0	0
Other	M21120	Genioplasty,Augmentation	2083	2083	2629	2890	99999	99999
Other	M21121	Sliding osteo. singl	0	0	3269	3596	0	0
Other	M21122	Sliding osteo. 2 or>	0	0	2635	2898	0	0
Other	M21123	Ost w/ intrpos bn gr	0	0	3795	4175	0	0
Other	M21125	Augmentation,mand. body;prosth	3306	3306	3723	4097	99999	99999
Other	M21127	Mand aug w/ bn grft.	0	0	4508	4959	0	0
Other	M21137	Reduc forehd contour	0	0	3145	3460	0	0
Other	M21138	Red forehd cntr & bn	0	0	3787	4166	0	0
Other	M21139	Countoring & setback ant. Sinu	4009	4009	4511	4962	99999	99999
Other	M21141	Reconstruct. midface, lefort I	5826	5826	6560	7216	99999	99999
Other	M21142	Reconstruct. midface,lefort I	6080	6080	6845	7529	99999	99999
Other	M21143	Reconstruc midface,lefort I	6264	6264	7050	7756	99999	99999
Other	M21144	Rec LeFort I sngl pc	0	0	0	0	0	0
Other	M21145	Rec w/ Bn Grft,singl	0	0	7075	7783	0	0
Other	M21146	Reconstruct midface,lefort I	6348	6348	7428	8171	99999	99999
Other	M21147	Reconstruct Midface Lefort 1	7259	7259	8751	9627	99999	99999
Other	M21150	Rec LeFortII ant int	0	0	8332	9164	0	0
Other	M21151	Rec. LeFortII w/ bn.	0	0	9752	10728	0	0
Other	M21154	LeFtIII BnGt w/o LF1	0	0	9686	10655	0	0
Other	M21155	LeF III BGft w/ Le 1	0	0	10583	11641	0	0
Other	M21159	LeFrt III w/o LeFt I	0	0	13509	14861	0	0
Other	M21160	LeFrt III w/ LeFrt I	0	0	15231	16754	0	0
Other	M21172	Recon orb rim,forehd	0	0	9603	10565	0	0
Other	M21175	Rec bifrntl orb rim/	0	0	11455	12601	0	0
Other	M21179	Rec fhd orb rms w gr	0	0	8087	8894	0	0
Other	M21180	Rec frhd w/ autogr.	0	0	8280	9109	0	0
Other	M21181	Rmv ben tmr, cran bn	0	0	3846	4230	0	0
Other	M21182	Rec w/ bn grft <40cm	0	0	10293	11323	0	0
Other	M21183	Rec bn gr 40 to 80cm	0	0	11600	12759	0	0
Other	M21184	Rec w/bn grft >80 cm	0	0	12280	13508	0	0
Other	M21188	Reconstruct Midface Osteotomie	6557	6557	8381	9220	99999	99999
Other	M21193	Reconstruct of MandibularRamus	5367	5367	6041	6646	99999	99999
Other	M21195	Reconstruct mand ramus,sagitt	5850	5850	6715	7385	99999	99999
Other	M21196	Reconstruct mand. ramus sagitt	6075	6075	8099	8910	99999	99999
Other	M21198	Osteotomy-segm/subcl	0	0	5865	6452	0	0
Other	M21199	Osteotomy w/genioglossus advan	0	0	5274	5801	0	0
Other	M21206	Osteotomy:Max,segmt	0	0	5375	5912	0	0
Other	M21208	Osteoplasty:Augment	0	0	4249	4673	0	0
Other	M21209	Osteoplasty,facial bones,reduc	2312	2312	2871	3157	99999	99999
Other	M21210	Graft,Bone:Nasal,Maxillary &	4057	4057	5410	5948	99999	99999
Other	M21215	Graft, bone, mandible	4233	4233	5644	6209	99999	99999
Other	M21230	Graft:rib cart, auto	0	0	3334	3667	0	0
Other	M21235	Graft,Ear Cartilage,Autograft,	0	0	0	0	99999	99999
Other	M21240	Arthroplasty, TMJ; autograft	4797	4797	4797	5276	99999	99999
Other	M21242	Arthro,TMJ-allograft	0	0	4425	4868	0	0
Other	M21243	Arthro,TMJ-prosth jt	0	0	7341	8075	0	0
Other	M21244	Mand,Ex,Tx bone plt	0	0	5926	6518	0	0
Other	M21245	Mand/Max,Subper:prtl	0	0	6096	6705	0	0
Other	M21246	Mand/Max,Subper Impl	0	0	4806	5286	0	0
Other	M21247	Rec mand cond w auto	0	0	8014	8817	0	0
Other	M21248	Reconstruct mx/md,endosteal im	3404	3404	3404	3745	99999	99999
Other	M21249	Reconstruct mx/md,endosteal im	6345	6345	7052	7758	99999	99999
Other	M21255	Rec zyg arch w autog	0	0	6209	6830	0	0
Other	M21270	Malar augmentation	0	0	4658	5124	0	0
Other	M21275	Orb'tCranf'l Recnstr	0	0	4461	4906	0	0
Other	M21280	Medial Canopexy	0	0	0	0	0	0
Other	M21282	Canthopexy, lateral	0	0	0	0	0	0
Other	M21299	Unlisted craniofacial procedur	99999	99999	99999	99999	99999	99999
Other	M21310	Nasal fx w/o manip	0	0	301	330	0	0
Other	M21315	Manipulative tx, nasal bone fr	582	582	709	781	99999	99999
Other	M21320	Manipulative tx, nasal bone fr	839	839	839	924	99999	99999
Other	M21325	Open Treatment of Nasal Fractu	1501	1501	1740	1915	99999	99999
Other	M21330	Nasal fx, O tx Compl	0	0	2815	3098	0	0
Other	M21335	Nasal sept fx, O tx	0	0	3056	3362	0	0
Other	M21336	Open tx, nasal fx, stabilizati	1845	1845	2117	2328	99999	99999
Other	M21337	Nasal septal fx,clsd	0	0	1063	1169	0	0
Other	M21338	Open tx, nasoethmoid fracture	2496	2496	2725	2998	99999	99999
Other	M21339	Open tx, nasoethmoid fracture	2908	2908	3271	3599	99999	99999
Other	M21340	Nasoethmd,o/c cmplx	0	0	3149	3463	0	0
Other	M21343	Frontal sinus fx, op	0	0	4235	4659	0	0
Other	M21344	Open tx, comp. front sinus fra	4799	4799	5883	6471	99999	99999
Other	M21345	Nasomaxill-LeFort II	0	0	3378	3714	0	0
Other	M21346	Open Treatment Nasomaxillary	4016	4016	4342	4776	99999	99999
Other	M21347	Nasomax opn,cmplx fx	0	0	5125	5637	0	0
Other	M21355	Malar/Zygo-open rdct	0	0	1551	1707	0	0
Other	M21356	Open tx, depressed zygomatic a	1765	1765	2047	2251	99999	99999
Other	M21360	Open tx,closed/open malar frac	2221	2221	2499	2750	99999	99999
Other	M21365	Open tx,closed/open comp malar	4118	4118	4303	4734	99999	99999
Other	M21366	Open tx, comp frac malar,bone	4405	4405	4711	5183	99999	99999
Other	M21385	Orbtl FB,trans appr	0	0	2985	3283	0	0
Other	M21386	Open tx, orbital floor blowout	3074	3074	3255	3580	99999	99999
Other	M21387	Orbrl FB,combd appr	0	0	3700	4071	0	0
Other	M21390	Open tx, orbital blowout fract	3831	3831	3890	4279	99999	99999
Other	M21395	Orbtl,peri bone gft	0	0	4519	4971	0	0
Other	M21400	Orbit fx w/o manip	0	0	697	766	0	0
Other	M21401	Orbit fx w/ manip	0	0	1833	2017	0	0
Other	M21406	Open tx, fracture orbit w/o bl	2568	2568	2568	2825	99999	99999
Other	M21407	Orb,not BO:w/ implnt	0	0	3125	3437	0	0
Other	M21408	Open treatment orbital floor f	0	0	4227	4649	0	0
Other	M21421	Palatal or Alveolar Ridge Frac	2405	2405	3096	3405	99999	99999
Other	M21422	Open tx, palatal/alveo ridge f	2928	2928	3091	3401	99999	99999
Other	M21423	Open tx, palatal mx fracture	3359	3359	3877	4266	99999	99999
Other	M21431	Cran-Fac'l-LeFort 3	0	0	3084	3393	0	0
Other	M21432	Cran-Fac'l - LeFort3	0	0	3255	3580	0	0
Other	M21433	Open tx, craniofacial separati	5915	5915	7633	8397	99999	99999
Other	M21435	Complicated, fixation by head	5386	5386	6063	6668	99999	99999
Other	M21440	Manipulative tx alveolar ridge	1593	1593	2073	2280	99999	99999
Other	M21445	Alveolar, open tx	0	0	2808	3088	0	0
Other	M21450	Mandibular w/ manip	0	0	1824	2006	0	0
Other	M21451	Closed/open md fracture	2141	2141	2508	2758	99999	99999
Other	M21452	Mandibular w/o manip	0	0	2253	2478	0	0
Other	M21453	Open Mandibular Fracture/Manip	2374	2374	2745	3020	99999	99999
Other	M21454	Open tx closed/open md fractur	2746	2746	2759	3035	99999	99999
Other	M21461	Open tx, closed/open md fractu	3763	3763	4363	4799	99999	99999
Other	M21462	Open tx, closed/open md frac	4109	4109	5101	5610	99999	99999
Other	M21465	Mandibular Condylar	0	0	4227	4649	0	0
Other	M21470	Open tx, comp closed/open md	4869	4869	4869	5355	99999	99999
Other	M21480	Uncomplicated treatment of TMJ	297	297	365	403	99999	99999
Other	M21485	Compli. treat. TMJ	0	0	306	1902	0	0
Other	M21497	Inter.wire other fx.	0	0	1912	2103	0	0
Other	M21499	Unlisted musculoskeletal proce	99999	99999	99999	672	99999	99999
Other	M21501	I&D, neck or thorax	0	0	0	0	0	0
Other	M21550	Biopsy, neck or thorax	0	0	0	0	0	0
Other	M21552	Ex neck subcu > 3cm	0	0	0	0	0	0
Other	M21555	Excision benign tumor;subcutan	0	0	0	0	99999	99999
Other	M21556	Excision tumor neck,deep subfa	0	0	0	0	0	0
Other	M21557	Radical Resection of neck	0	0	0	0	0	0
Other	M21685	Hymoid myotomy suspension	0	0	0	0	0	0
Other	M23030	I & D shoulder area deep	0	0	0	0	0	0
Other	M26990	I&D of pelvis or hip joint	0	0	0	0	0	0
Other	M27323	Biopsy soft tissue thigh super	0	0	0	0	0	0
Other	M27603	I&D leg hematoma	0	0	0	0	0	0
Other	M29800	Arth-diag w w/o biop	0	0	2591	2850	0	0
Other	M29804	Arthroscopy TMJ; surgical	3032	3032	3336	3670	99999	99999
Other	M30000	Respiratory System (drainag	0	0	0	0	99999	99999
Other	M30100	Biopsy intranasal	0	0	0	0	0	0
Other	M30115	Exc nasal polyp extensive	0	0	0	0	0	0
Other	M30118	Lateral Rhinotomy external app	0	0	0	0	0	0
Other	M30124	Excision Dermoid Cyst;nose sim	0	0	0	0	0	0
Other	M30130	EXCISION OF INF TURBINATE	0	0	0	0	0	0
Other	M30400	Rhinoplasty prim, ele tip	0	0	0	0	0	0
Other	M30410	Rhinoplasty	0	0	0	0	0	0
Other	M30420	SEPTORHINOPLASTY OPEN	0	0	0	0	0	0
Other	M30430	Rhinoplast secondary	0	0	0	0	0	0
Other	M30435	Rhinoplasty 2nd intermed	0	0	0	0	0	0
Other	M30450	Rhinoplasty 2nd major revision	0	0	0	0	0	0
Other	M30460	Rhin dfrm w/col tip only	0	0	0	0	0	0
Other	M30462	Rhin DFRM COLL LEN TIP SEPT OS	0	0	0	0	0	0
Other	M30465	Vestibular Stenosis	0	0	0	0	0	0
Other	M30520	Septoplasty resection	0	0	0	0	0	0
Other	M30580	Repair fistula;oromaxillary	1810	1810	2091	2300	99999	99999
Other	M30600	Fist, oronasal: rpr	0	0	2012	2212	0	0
Other	M30630	Repair nasal septal perforatio	0	0	0	0	0	0
Other	M30901	Control nasal hemorrhage packi	0	0	0	0	0	0
Other	M30903	Control nasal hem cmplex	0	0	0	0	0	0
Other	M30915	Ligation ethmoidal artery	0	0	0	0	0	0
Other	M30920	Ligation int max artery	0	0	0	0	0	0
Other	M30930	Therapeutic fx turbinate	0	0	0	0	0	0
Other	M31000	Lavage by cannulation maxillar	0	0	414	456	0	0
Other	M31020	Sinusotomy,mx,intranasal	877	877	1143	1259	99999	99999
Other	M31030	Sinusotomy mx,intranasal radic	2033	2033	2172	2392	99999	99999
Other	M31075	Sinusotomy Frontal	0	0	0	0	0	0
Other	M31081	Sinus oblit w/o ost flap corno	0	0	0	0	0	0
Other	M31085	Sinusotomy coronal incision	0	0	0	0	0	0
Other	M31090	SINUSOTOMY UNILATERAL	0	0	0	0	0	0
Other	M31225	Max-tomy w/o orb ext	0	0	0	0	0	0
Other	M31230	Maxillectomy w/orbital exenter	0	0	0	0	0	0
Other	M31231	Nasal endoscopy	0	0	0	0	0	0
Other	M31233	Nasal/sinus endoscpy	0	0	0	0	0	0
Other	M31256	Nasal/sinus endosw/antrostomy	0	0	0	0	0	0
Other	M31288	Nasl endo w tiss rmv	0	0	0	0	0	0
Other	M31367	Larngtom supraglot w/o rnd	0	0	0	0	0	0
Other	M31420	Epiglottidectomy	0	0	0	0	0	0
Other	M31500	Intubation, endotracheal	0	0	0	0	0	0
Other	M31502	Tracheotomy tube change	0	0	0	0	0	0
Other	M31505	Laryngoscopy	0	0	220	243	0	0
Other	M31510	Laryngoscopy,diag, w/biopsy	0	0	521	574	0	0
Other	M31515	Laryng w/wo trac asp	0	0	0	0	0	0
Other	M31525	Laryngoscopy diagnostic	0	0	0	0	0	0
Other	M31535	Laryngoscopy, direct, opw/biop	0	0	0	0	0	0
Other	M31575	Fiberoptic laryngoscopy	0	0	0	0	0	0
Other	M31600	Trach plan(sep proc)	0	0	0	0	0	0
Other	M31603	Trach ER:Transtrache	0	0	1065	1171	0	0
Other	M31610	Trachn w/skin flap	0	0	0	0	0	0
Other	M31613	Tracheostoma revision	0	0	0	0	0	0
Other	M31615	Tracheobronchoscopy	0	0	0	0	0	0
Other	M31622	Bronchoscopy	0	0	0	0	0	0
Other	M31624	Broncoscope w/lavage	0	0	0	0	0	0
Other	M31800	Suture of tracheal wound cervi	0	0	0	0	0	0
Other	M31820	SURGICAL CLOSURE TRACHESOTOMY	0	0	0	0	0	0
Other	M31825	Surg cls trac fistula w/plasti	0	0	0	0	0	0
Other	M31830	Revision of trach scar	0	0	0	0	0	0
Other	M32551	Chest tube insertion	0	0	0	0	0	0
Other	M35201	Repair blood vessel direct nec	0	0	0	0	0	0
Other	M35231	Repiar w/vein graft neck	0	0	0	0	0	0
Other	M35701	Explore w or w/out lysis arter	0	0	0	0	0	0
Other	M35800	Exploration of postop hem/infe	0	0	0	0	0	0
Other	M35875	Thrombectomy of venous graft	0	0	0	0	0	0
Other	M35901	Excision of infected neck graf	0	0	0	0	0	0
Other	M35903	Excision of infected leg graf	0	0	0	0	0	0
Other	M37615	Ligation maj art neck	0	0	0	0	0	0
Other	M38300	Drain Lymph.:simple	0	0	679	748	0	0
Other	M38305	Drain Lymph,:extens	0	0	1131	1244	0	0
Other	M38500	BxExc Lymph:sep proc	0	0	931	1024	0	0
Other	M38505	BxExc Lymph:ndl,spfl	0	0	396	434	0	0
Other	M38510	BxExc Lymph:deep CN	0	0	1497	1647	0	0
Other	M38520	Bx Lymph Ex CN,fatpd	0	0	1603	1762	0	0
Other	M38700	Suprahyoid Lymphadenectomy	0	0	0	0	0	0
Other	M38720	Cervical Lymphad(complete)	0	0	0	0	0	0
Other	M38724	Cervical Lymphadenectomy	0	0	0	0	0	0
Other	M40000	Digestive System	0	0	0	0	99999	99999
Other	M40490	Biopsy of lip	226	226	285	314	99999	99999
Other	M40500	Vermillionectomy/Lip Shave	0	0	1275	1405	0	0
Other	M40510	Excision Lip/closure	1544	1544	1544	1700	99999	99999
Other	M40520	Exc lip:v-exc w/d.cl	0	0	1455	1601	0	0
Other	M40525	Exc lip:rcstr w/flap	0	0	1939	2133	0	0
Other	M40527	Excision of lip	0	0	2377	2614	0	0
Other	M40530	Resect>1/4 w/o rcstr	0	0	1750	1925	0	0
Other	M40650	Cheiloplasty full	0	0	1357	1492	0	0
Other	M40654	Complex lip repair	0	0	1841	2024	0	0
Other	M40700	Cleft:comp/unilat	0	0	3220	3542	0	0
Other	M40701	Cleft:prim bilat 1sg	0	0	3815	4196	0	0
Other	M40720	Cleft: unilat/recrtn	0	0	3171	3489	0	0
Other	M40800	Drainage of abscess,cyst,hemat	347	347	460	509	99999	99999
Other	M40801	Drainage Abscess,Cyst,Hematoma	676	676	812	893	99999	99999
Other	M40804	Removal of embedded foreign bo	379	379	509	557	99999	99999
Other	M40806	Frenotomy-incis labl	0	0	371	407	0	0
Other	M40808	Biopsy,vestibule of mouth	351	351	423	465	99999	99999
Other	M40810	Excision of lesion of mucosa/s	390	390	515	568	99999	99999
Other	M40812	Excision, vestibule closure	512	512	682	751	99999	99999
Other	M40814	Excision lesion of mucosa/subm	877	877	950	1043	99999	99999
Other	M40816	Complex exc. Of muscle	1022	1022	1088	1196	99999	99999
Other	M40818	Exc.mucosa,vest.donor	699	699	931	1024	99999	99999
Other	M40819	Exc. Frenum,lab.or buc.	575	575	765	842	99999	99999
Other	M40820	Destruction of lesion or scar	456	456	606	668	99999	99999
Other	M40830	Closure of laceration,vestibul	445	445	592	653	99999	99999
Other	M40831	Closure laceration,vestibule m	616	616	820	903	99999	99999
Other	M40840	Vestblplty:anterior	0	0	2128	2341	0	0
Other	M40842	Vestblplty:post,unil	0	0	1995	2195	0	0
Other	M40843	Vestblplty:post,bil	0	0	2650	2916	0	0
Other	M40844	Vestblplty:entr arch	0	0	3299	3629	0	0
Other	M41000	Intraoral incision/drainage to	323	323	428	473	99999	99999
Other	M41005	Intraoral incision/drainage to	393	393	524	578	99999	99999
Other	M41006	I&D sublingual:deep	0	0	0	1019	0	0
Other	M41007	Intraoral incision/drainage to	767	767	926	1019	99999	99999
Other	M41008	Intraoral incision/drainage to	764	764	1018	1121	99999	99999
Other	M41009	Intraoral incision/drainage to	892	892	1041	1146	99999	99999
Other	M41010	Frenotomy-inc lingl	0	0	529	584	0	0
Other	M41015	I&D extraoral:sublng	0	0	1084	1193	0	0
Other	M41016	Extraoral Incision & Drainage	881	881	1168	1285	99999	99999
Other	M41017	Extraoral incision/drainage fl	931	931	1146	1262	99999	99999
Other	M41018	I&D extraoral:mastsp	0	0	1339	1472	0	0
Other	M41100	Biopsy tongue;anterior 2/3	368	368	456	503	99999	99999
Other	M41105	Biopsy tongue;post 1/3	378	378	449	495	99999	99999
Other	M41108	Biopsy floor of mouth	318	318	421	462	99999	99999
Other	M41110	Excision of Lession of Tougue	425	425	536	588	99999	99999
Other	M41112	Excision,ant 2/3 closoure	722	722	803	884	99999	99999
Other	M41113	Excision, post. 1/3 closure	870	870	895	985	99999	99999
Other	M41114	Exc les tong w/flap	0	0	1618	1779	0	0
Other	M41115	Frenectomy-exc lingl	0	0	642	707	0	0
Other	M41116	Excision, Lesion flloor Mouth	793	793	951	1044	99999	99999
Other	M41120	Glossectomy ,1/2 tng	0	0	3543	3896	0	0
Other	M41130	Gloss/Hemigls-ectomy	0	0	4236	4660	0	0
Other	M41135	Gloss:prtl rad diss	0	0	6603	7266	0	0
Other	M41140	Gloss:totl w/o rad d	0	0	7524	8277	0	0
Other	M41145	Gloss:totl w/ rad di	0	0	9041	9946	0	0
Other	M41150	Gloss:w/ rsc w/o dis	0	0	8766	9644	0	0
Other	M41153	Gloss:w/rsc w/sprdis	0	0	7842	8627	0	0
Other	M41155	Gloss:w/mand/rad dis	0	0	10370	11406	0	0
Other	M41250	Repair laceration 2.5 cm/less	476	476	637	700	99999	99999
Other	M41251	Lac 2.5cm:1/3 tongue	0	0	760	836	0	0
Other	M41252	Repair Laceration Tongue,Floor	907	907	1136	1249	99999	99999
Other	M41510	SutureTng Micro-Doug	0	0	1396	1537	0	0
Other	M41520	Frenuloplasty	759	759	888	977	99999	99999
Other	M41800	Drainage abs,cy,hema	0	0	579	637	0	0
Other	M41805	Remov of Foreign body, soft ti	373	373	499	549	99999	99999
Other	M41806	Remov of Foreign body, bone	515	515	687	756	99999	99999
Other	M41820	Gingivectomy,excision gingiva	654	654	787	866	99999	99999
Other	M41821	Operculectomy,exc.pericoronal	161	161	215	235	99999	99999
Other	M41822	Excision of fibrous tuberositi	455	455	604	666	99999	99999
Other	M41823	Excision of osseous tuberositi	805	805	1038	1143	99999	99999
Other	M41825	Excision, alveolus closure	445	445	506	556	99999	99999
Other	M41826	Excision, alveolus closure	645	645	798	877	99999	99999
Other	M41827	Exc les dent,complex	0	0	1101	1211	0	0
Other	M41828	Excision hyperplastic alveo mu	781	781	839	924	99999	99999
Other	M41830	Alveol.Incl Curr. Of Osteitis	737	737	898	987	99999	99999
Other	M41850	Destruction of lesion,dentoalv	322	322	425	472	99999	99999
Other	M41870	Periodontal mucosal grafting	802	802	981	1078	99999	99999
Other	M41872	Gingivoplasty,each quadrant	901	901	1003	1104	99999	99999
Other	M41874	Alveoplasty	815	815	815	896	99999	99999
Other	M41899	Unspecified proc., dentoalveol	99999	99999	99999	99999	99999	99999
Other	M42000	Drain abscess of palate	380	380	494	544	99999	99999
Other	M42100	Biopsy of palate, uvula	361	361	421	462	99999	99999
Other	M42104	Excision, palate	490	490	597	658	99999	99999
Other	M42106	Excision, palate closure	620	620	776	854	99999	99999
Other	M42107	Excision lesion platale w/loca	1323	1323	1323	1455	99999	99999
Other	M42120	Resect palate/Les	0	0	3322	3657	0	0
Other	M42140	Uvulectomy	0	0	0	0	0	0
Other	M42145	Palatopharyngoplasty	0	0	2781	3059	0	0
Other	M42160	Destruction of lesion, palate	519	519	621	682	99999	99999
Other	M42180	Repair laceration palate up to	552	552	735	808	99999	99999
Other	M42182	Lac palate 2cm/compl	0	0	974	1070	0	0
Other	M42200	Palatplsty s/h only	0	0	4141	4554	0	0
Other	M42205	Palatplsty w/clo rdg	0	0	4429	4873	0	0
Other	M42210	Palatoplasty cleft palate w/bo	4467	4467	5053	5559	99999	99999
Other	M42215	Palatplsty:major rev	0	0	3418	3760	0	0
Other	M42220	Palatplsty:lngth pro	0	0	2567	2824	0	0
Other	M42225	Palatoplasty flap	0	0	4053	4460	0	0
Other	M42226	Palate,Pharyngeal Fp	0	0	4250	4675	0	0
Other	M42227	Palate w/IslandFlap	0	0	4065	4471	0	0
Other	M42235	Palate(ant)VomerFlap	0	0	2985	3283	0	0
Other	M42260	Nasolabial fist repr	0	0	2568	2825	0	0
Other	M42280	Max imprs palat pros	0	0	464	510	0	0
Other	M42281	Insertion of Obutrator	0	0	629	692	0	0
Other	M42300	I&D parotid simple	0	0	559	616	0	0
Other	M42305	I&D parotid complic	0	0	1185	1303	0	0
Other	M42310	Drain of absc.sub max or subli	405	405	439	482	99999	99999
Other	M42320	I&D submax extrnl	0	0	625	687	0	0
Other	M42325	Fistulization of subling. Sali	0	0	0	0	99999	99999
Other	M42326	Fistuliz ran:w/proth	0	0	0	0	0	0
Other	M42330	Sumbandibular,sublingual or	537	537	715	787	99999	99999
Other	M42335	Sial'y:s-man/max,c,i	0	0	1076	1183	0	0
Other	M42340	Sialolith'my:partoid	0	0	1541	1694	0	0
Other	M42400	Biopsy salv gld:ndle	0	0	305	334	0	0
Other	M42405	Biopsy salv gld:inci	0	0	803	884	0	0
Other	M42408	Exc subling sal cyst	0	0	1168	1285	0	0
Other	M42409	Marsup slng sal cyst	0	0	850	934	0	0
Other	M42410	Ex paratid: w/o nrv	0	0	2130	2343	0	0
Other	M42415	Ex paratid:save nrv	0	0	3815	4196	0	0
Other	M42420	Exc parotid w pres nerve	0	0	4340	4775	0	0
Other	M42425	Exc parati:sacrf nrv	0	0	3101	3410	0	0
Other	M42426	Exc parotid tumor, total	0	0	4866	5353	0	0
Other	M42440	Exc submaxillary gld	0	0	1825	2007	0	0
Other	M42450	Exc sublingual gland	0	0	1484	1632	0	0
Other	M42500	Sialodochoplasty Sal	0	0	1566	1722	0	0
Other	M42505	Saliv'y dt,pl rpr:s.	0	0	1981	2178	0	0
Other	M42507	PAROTID SIALODUCLCHOPLASTY	0	0	0	0	0	0
Other	M42508	Parotid Duct Diversion	0	0	0	0	0	0
Other	M42510	Repair of savilary duct	0	0	0	0	0	0
Other	M42600	Salivary fistula,cls	0	0	0	0	0	0
Other	M42650	Dilation saliv. duct	0	0	232	255	0	0
Other	M42700	I&D Peritonsillar	0	0	525	578	0	0
Other	M42720	Incision/drain abs;intraoral	951	951	1179	1297	99999	99999
Other	M42725	I&D retro/para phary	0	0	2235	2459	0	0
Other	M42800	Biopsy: Oropharynx	0	0	431	474	0	0
Other	M42808	Exc les pharynx	0	0	741	816	0	0
Other	M42809	FB, rmv from pharynx	0	0	0	0	0	0
Other	M42815	Exc branchial cleft cyst be su	0	0	0	0	0	0
Other	M42842	Resection tonsil,tonsil pillar	0	0	0	0	0	0
Other	M42844	Resection of RMF w/buccal	0	0	0	0	0	0
Other	M42845	Resection RMF w/ other flap	0	0	0	0	0	0
Other	M42894	Resect phar wall w/microvascul	0	0	0	0	0	0
Other	M42900	Wound-Pharynx	0	0	1245	1369	0	0
Other	M42950	Pharyngoplasty	0	0	0	0	0	0
Other	M42960	Oroph-Hemorr,simple	0	0	526	580	0	0
Other	M42961	Oroph-Hemr,compl,IH	0	0	1357	1492	0	0
Other	M42962	Oroph-Hem,w/2nd surg	0	0	1533	1687	0	0
Other	M42970	Nas-Phar,Hem,simple	0	0	1061	1167	0	0
Other	M43200	Esophagoscopy	0	0	0	0	0	0
Other	M43450	Dilation of esophagus	0	0	0	0	0	0
Other	M43458	Esoph dil w bal	0	0	0	0	0	0
Other	M43752	Nasogastric tube placement	0	0	0	0	0	0
Other	M60000	Thyroglossal I & D	0	0	0	0	99999	99999
Other	M60100	Bx thyroid per core needle	0	0	0	0	0	0
Other	M60220	TOT THYR LOBEC	0	0	0	0	0	0
Other	M60271	THYROIDECTOMY CERVICAL APPROAC	0	0	0	0	0	0
Other	M60280	Ex thytoglossal dux cyst	0	0	0	0	0	0
Other	M61332	Explo orbit transcrnl bx	0	0	0	0	0	0
Other	M61500	CRANECTOMY W/EXCISION OF BONE	0	0	0	0	0	0
Other	M61557	Craniotomy bifrontal bone flap	0	0	0	0	0	0
Other	M61592	ORBITOCRANIAL ZYGOMATIC APP	0	0	0	0	0	0
Other	M62005	Elevation of compound skull fx	0	0	0	0	0	0
Other	M62140	Cranioplasty; Skull, 5cm	0	0	0	0	0	0
Other	M62141	Crainoplasty 5cm diameter	0	0	0	0	0	0
Other	M62143	Replacement of bone flap/plate	0	0	4429	4873	0	0
Other	M62147	Cranioplastyw/atuogr	0	0	0	0	0	0
Other	M64400	Trigeminal Anesthesia	334	334	334	433	99999	99999
Other	M64402	Local, facial nerve	0	0	365	403	0	0
Other	M64450	Local Anesthesia	0	0	0	0	0	0
Other	M64550	Application of surface neurost	60	60	62	68	99999	99999
Other	M64611	Botox salivary gland	0	0	0	0	0	0
Other	M64612	BOTOX facial nerve muscle	0	0	244	515	0	0
Other	M64716	Neuropl'y:cranial nv	0	0	2538	2793	0	0
Other	M64722	Decompression;unspec. nerve	0	0	0	0	99999	99999
Other	M64738	Trsct/Avulsn:nrv-ost	0	0	1787	1966	0	0
Other	M64740	Trnsc/Avulsn:lingual	0	0	1514	1667	0	0
Other	M64864	Suture fac'l:extcran	0	0	3304	3634	0	0
Other	M64885	Nerve Graft, head/Neck	0	0	4576	5035	0	0
Other	M65000	Eye and Ocular Adnexa	0	0	0	0	99999	99999
Other	M65110	Exenteration of Orbit	0	0	0	0	0	0
Other	M65210	Remov fb from eyelid	0	0	0	0	0	0
Other	M67405	Orbitotomy w/drainage only	0	0	0	0	0	0
Other	M67413	Orbitotomy w/removal foreign b	0	0	0	0	0	0
Other	M67500	Retobulbar njx	0	0	0	0	0	0
Other	M67700	Blepharotomy, eyelid	0	0	0	0	0	0
Other	M67715	Canthotomy	0	0	0	0	0	0
Other	M67875	Temp closure of eyelids	0	0	0	0	0	0
Other	M67880	MEDICAN TARSORRHAPHY	0	0	0	0	0	0
Other	M67900	Brow Lift	0	0	0	0	0	0
Other	M67914	Repair of Extropion;suture	0	0	0	0	99999	99999
Other	M67916	EXCISION OF TARSAL WEDGE	0	0	0	0	0	0
Other	M67917	Bleoharoptosis extensive	0	0	0	0	0	0
Other	M67924	Repair entropion extensive	0	0	0	0	0	0
Other	M67961	Excision/Repair eyelid w/margi	0	0	0	0	0	0
Other	M68500	Exc lacriminal gland	0	0	0	0	0	0
Other	M68811	Probing lacrimal duct w/anesth	0	0	0	0	0	0
Other	M68815	Dilation lacrimal puctum tube	0	0	0	0	0	0
Other	M69000	Evacuation of hematoma ear	0	0	0	0	0	0
Other	M69005	Drain ext ear hematoma simple	0	0	0	0	0	0
Other	M69990	Microsurgical techniques	0	0	0	0	0	0
Other	M70000	Diagnostic Radiology	0	0	0	0	99999	99999
Other	M70100	Panogram, mandible	33	33	42	45	99999	99999
Other	M70140	Radiograph, facial bones	117	117	117	129	99999	99999
Other	M70250	Skull, less than 4 views	43	43	55	62	99999	99999
Other	M70300	Radiologic exam, teeth;single view	14	14	23	23	99999	99999
Other	M70310	Radiologic exam;teeth,partial	14	14	15	19	99999	99999
Other	M70320	Radiologic exam, complete, full mouth	130	130	130	130	99999	99999
Other	M70328	Radio,Exam,TMJ, open&clsd unil	34	34	43	46	99999	99999
Other	M70330	Radio.,Exam,TMJ,open&clsd bila	43	43	55	62	99999	99999
Other	M70350	Cephalogram,Orthodontic	128	128	128	128	99999	99999
Other	M70355	Orthopantogram (Panoramic)	110	110	110	110	99999	99999
Other	M70380	Radiology Exam. Salivary	31	31	39	43	99999	99999
Other	M70486	Cat MaxFac w/o contr	0	0	251	277	0	0
Other	M76100	Radiological exam, single plan	207	207	228	249	99999	99999
Other	M76101	Cross-sec. Oblique tomogram, i	306	306	312	344	99999	99999
Other	M76140	Radiology Consult	83	83	110	122	99999	99999
Other	M76175	Duplicate Films	0	0	36	36	99999	99999
Other	M76376	3D RNDR ICAT SCAN	0	0	337	369	0	0
Other	M76449	Duplication/records	0	0	88	88	99999	99999
Other	M76999	Unlisted Ultrasound Procedure	0	0	0	0	99999	99999
Other	M78300	Bone and/or joint imaging	0	0	0	0	99999	99999
Other	M80000	Pathologic Examination	0	0	0	0	99999	99999
Other	M87070	Culture, bacterial, any other	66	66	87	96	99999	99999
Other	M87072	Cul. Or direct bacterial Iden.	0	0	0	0	0	0
Other	M87205	SMEAR,PRIMARY SOURCE W/INT.	32	32	40	44	99999	99999
Other	M87210	Culture,bacterial screening on	85	85	176	274	99999	99999
Other	M88304	Surgical Path, Gross & Microsc	122	122	149	165	99999	99999
Other	M88305	Surgical Path., Gross & Micros	209	209	232	255	99999	99999
Other	M88311	Decalcification Procedure	43	43	55	62	99999	99999
Other	M90000	Evaluation and Management	0	0	0	0	99999	99999
Other	M90782	IV sympathetic Blockade	0	0	0	0	99999	99999
Other	M90784	Therapeutic/Diagnostic Injecti	127	127	134	284	99999	99999
Other	M90792	Therapeutic/Diagnostic Injecti	0	0	0	0	99999	99999
Other	M90830	Review of Records	72	72	84	85	99999	99999
Other	M90901	Biofeedback	67	67	88	97	99999	99999
Other	M91480	Manipulation	0	0	135	136	99999	99999
Other	M92502	Otolaryng exam under anesthesi	0	0	0	0	0	0
Other	M92511	Endoscopy; larynx	0	0	0	0	0	0
Other	M94762	Noninvasive Pulse Oximetry (Overnight monitoring)	75	75	75	75	99999	99999
Other	M95868	Electromyography,bilateral	0	0	0	0	99999	99999
Other	M95999	Unspecified neurological	99999	99999	99999	99999	99999	99999
Other	M96360	Iv infusion hydration	0	0	0	0	0	0
Other	M96372	Therapeutic Injection	0	0	58	65	0	0
Other	M96405	Intralesional Chemotherapy	127	127	127	0	99999	99999
Other	M97026	Infrared	0	0	49	49	99999	99999
Other	M97032	Application Of Modality To One	45	45	46	50	99999	99999
Other	M97110	Physical medicine treatment	66	66	66	72	99999	99999
Other	M97139	Unlisted procedure	99999	99999	99999	99999	99999	99999
Other	M97140	Manual Therapy	0	0	72	72	99999	99999
Other	M97260	Refrigerant Spray/Stretch	0	0	44	55	99999	99999
Other	M97265	Joint Mobilization	0	0	88	88	99999	99999
Other	M97540	Train/Daily Living	0	0	134	134	99999	99999
Other	M97605	Vac placement >50scm	0	0	0	0	0	0
Other	M97606	Wiound vac >50 sq cm	0	0	0	0	0	0
Other	M97780	Acupuncture	0	0	126	126	99999	99999
Other	M97781	Acupuncture (E.S.)	0	0	159	159	99999	99999
Other	M97799	Unlisted procedure	99999	99999	99999	66	99999	99999
Other	M97810	Initial Acupuncture Therapy (W/O) stim	0	0	72	72	99999	99999
Other	M97811	Acupuncture Therapy Addl 15 mins (W/O stim)	0	0	37	37	99999	99999
Other	M97813	Initial Acupuncture Therapy (W stim)	0	0	94	94	99999	99999
Other	M97814	Acupuncture Therapy Addl 15 mins (W/stim)	0	0	43	43	99999	99999
Other	M99002	Adjustment	35	35	37	42	99999	99999
Other	M99024	OV-Post OP	58	58	62	68	99999	99999
Other	M99050	OV-after hrs-basic service	75	75	75	81	99999	99999
Other	M99058	Office Emerg. Basis	67	67	88	97	42	42
Other	M99070	Supplies & Materials, Provided	99999	99999	99999	99999	0	0
Other	M99141	IVsedation 30 mins.	0	0	0	0	0	0
Other	M99142	Iv Sedation 15 minutes	0	0	0	0	0	0
Other	M99143	IV Sedation 30 minutes	0	0	0	0	0	0
Other	M99144	IV Sedation 30 minutes	0	0	0	0	0	0
Other	M99145	IV Sedation add'l 15 minutes	0	0	0	0	0	0
Other	M99149	SEDATION BY OTHER PHYSICIAN	0	0	0	0	0	0
Other	M99150	Mseda by other phy add 15 min	0	0	0	0	0	0
Other	M99201	Office or outpatient visit	88	88	90	100	55	55
Other	M99202	Office or outpatient visit	123	123	147	171	80	80
Other	M99203	Office or outpatient visit	191	191	191	273	121	121
Other	M99204	Office or outpatient visit	277	277	329	404	178	178
Other	M99205	Office or outpatient visit	362	362	580	580	231	231
Other	M99211	Exam, Est. Pt. Brief	47	47	53	60	31	31
Other	M99212	Office or other outpatient visit	76	76	94	103	47	47
Other	M99213	Office or outpatient visit	110	110	147	162	72	72
Other	M99214	Exam, Est. Pt. Ext.	168	168	354	354	105	105
Other	M99215	Office or other ouptatient vis	233	233	309	340	148	148
Other	M99217	Observation care discharge	0	0	0	0	99999	99999
Other	M99218	Initial observation care	161	161	215	235	99999	99999
Other	M99219	Init Obsv-Mod Complx	0	0	321	352	0	0
Other	M99220	Init Obsv-High Cmplx	0	0	457	504	0	0
Other	M99221	Initial hospital care	199	199	259	283	99999	99999
Other	M99222	Init Hosp Care Modrt	0	0	330	363	0	0
Other	M99223	Init Hosp Care High	0	0	481	529	0	0
Other	M99231	Subsequent hospital care	95	95	105	116	99999	99999
Other	M99232	Subsequent hospital care	138	138	178	196	99999	99999
Other	M99233	Additional Hosp Care	0	0	261	285	0	0
Other	M99238	Hos Dis day < 30 min	0	0	181	199	0	0
Other	M99239	Hos dis day > 30 min	0	0	274	301	0	0
Other	M99241	Office consultation	119	119	119	131	99999	99999
Other	M99242	Office consultation	198	198	224	245	99999	99999
Other	M99243	Office consultation	255	255	255	329	99999	99999
Other	M99244	Comprehensive history consult	363	363	365	476	99999	99999
Other	M99245	Off Cons. New/Est 80	0	0	427	578	0	0
Other	M99251	Initial inpatient consultation	148	148	167	183	99999	99999
Other	M99252	Initial inpatient consultation	233	233	233	258	99999	99999
Other	M99253	Initial inpatient consultation	297	297	312	344	99999	99999
Other	M99254	Initial inpatient consultation	364	364	410	452	99999	99999
Other	M99255	Init Inpt Cons. 110	0	0	513	563	0	0
Other	M99261	F/U Inpt Consult 10	0	0	0	0	0	0
Other	M99262	Consult, FollowUP In Pt.	0	0	0	0	99999	99999
Other	M99263	F/U Inpt Consult 30	0	0	0	0	0	0
Other	M99271	Confirming Cons. P. O.	0	0	0	0	99999	99999
Other	M99272	Conf.Conslt NE Expnd	0	0	0	0	0	0
Other	M99273	Confirm Conslt,Ext.	0	0	0	0	0	0
Other	M99274	Conf Cnslt NE Compr.	0	0	0	0	0	0
Other	M99275	Conf Cnslt NE Cmplex	0	0	0	0	0	0
Other	M99281	ER Exam Straightfrwd	0	0	129	143	0	0
Other	M99282	ER Exam Low Complex	0	0	201	222	0	0
Other	M99283	ER Ex. Low-Mid Cmplx	0	0	424	466	0	0
Other	M99284	ER Exam Modrt Cmplex	0	0	693	762	0	0
Other	M99285	ER Exam High Complex	0	0	1252	1378	0	0
Other	M99302	Eval./manage;nursing facility	0	0	0	0	99999	99999
Other	M99354	OutPt Prolng Srv-60	0	0	0	0	0	0
Other	M99358	Prolng Eval&Mgmt- 60	0	0	0	0	0	0
Other	M99401	Preventive Counseling	83	83	92	101	99999	99999
Other	M99402	Preventive Counseling Expaned	130	130	167	183	99999	99999
Other	M99406	Smoking cessation counseling 3	0	0	35	39	0	0
Other	M99999	Unspecified Adjunctive Proc	0	0	0	0	0	0
Other	STUDY	PARTICIPANT	0	0	0	0	0	0

Formulary and Best Practices Review Committee Forms Policy

Subject: Class III – Clinical – H. Patient Administration

Effective Date: 03/01/2023

Reviewed and/or Revised: 02/24/2024, 02/28/2024, 07/31/2025, 12/04/2025, 2/11/2026

Purpose

The Formulary Committee reviews departmental requests for newer technologies/ products, Standard of Practice Guidelines, patient treatment and new devices/equipment used to teach and provide patient care and recommends/approves them if they are evidence-based. The committee recognizes the need to bridge the gap between research and clinical dental practice and recommends utilizing evidence-based clinical guidelines for best practice. The American Dental Association (ADA) defines the term “evidence-based dentistry (EBD),” as an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating the patient’s oral and medical condition and history, with the dentist’s clinical expertise and the patient’s treatment needs and preferences. This Committee will look at devices and materials.

Policy and/or Procedure:

This policy is to review clinic devices and materials. The request forms for the replacement and purchase of new and different items to replace current items are linked within this policy.

A faculty member would introduce the material, speak with the Program Director, and then their Department Chair would approve or disapprove. If approving, there must be justification for using this new material with an explanation as to why this material is superior to the materials currently being used. A cost analysis needs to be performed and noted on the form. The appropriate form is to be sent to the appropriate persons (see below) for approval. If the Formulary Committee approves, the Director of Medical Credentialing and Quality Assurance would notify the requesting Program Director, Department Chair and Director of CMS and/or School Store Manager.

Faculty training of the product/device submitted for approval must be done to show how the product will be implemented. The new materials and new products should be discussed at the Department meetings. These meetings need to record minutes.

If the product is a replacement, one of the requirements is to use the current item first. Faculty inform CMS/School Store who are responsible for checking inventory to assure the current item is used before ordering the new item.

The necessary forms are as follows:

Formulary and Best Practices Review Committee Submission Form (DOC): The Formulary Committee utilizes a comprehensive request form that includes clinical indications, financial considerations, supporting scientific evidence, and justification for use within the institution. If the request is for a new product or device, the Formulary and Best Practices Review Committee Submission Form is to be used.

This form also shows that we are using new material for educational purposes. The instructions for completing the form are below.

The Formulary Form includes the following mandatory fields:

Submitting Faculty/Staff:
Department/Program:
Is this a gift or donation? ______Yes ______No
Product/Device:
Justification: (Provide an evidence-based justification of the product/device using current literature)
Proposed Faculty Training
Cost: (Explain the cost of the new product/device)
Replacement Information: If this item is replacing another currently used item, please specify.
Requester’s name, signature and title
Requester's Chairperson’s name and signature

The submitter forwards the completed and signed request form to the Director of Credentialing and Quality Assurance. The committee developed a process to streamline the procurement of materials and devices to address the need and urgency of these items throughout the academic year. To expedite processing, the form is reviewed by the Executive Formulary Committee for approval. Once approved, the request is shared electronically with members of the Formulary Committee for final confirmation and acknowledgement.

If consensus is not reached, the submitter may be asked to attend the Formulary Committee meeting to present and discuss the request. The Formulary Committee meets two to three times annually with additional meetings scheduled on an ad-hoc basis.

This is the first form that must be completed by the Faculty member, which is used to request using a new product or device.
1. There must be justification for using this new material with an explanation as to why this material is superior to the materials being used.
2. A Cost Analysis must be included.
3. The Form and back up documentation is reviewed/approved and signed by the Faculty Provider’s Department Chairperson. Once approved, it is sent to the Director of Medical Credentialing and Quality Assurance to be logged and sent to the Executive Formulary Committee.
4. The Executive Formulary Committee reviews the form to ensure it is clinically relevant and for any gift component or IT component. (NOTE: If replacing a current item, the inventory supply would be checked by the School Store Manager.)
5. If approved, the request is shared electronically with members of the Formulary Committee for final confirmation and acknowledgement.
Clinic Supplies not Currently Available from the School Store Form: If the product is a supply, a Clinic Supplies Not Currently Available from the School Store Form must be completed in addition to the Formulary and Best Practices Review Committee Submission Form when requesting the replacement of existing clinic supplies or materials, or when requesting new clinic supplies or materials. The process outlined above should be followed.
1. Formulary Form for Gifts Received: If gifts from a vendor, a Formulary and Best Practices Review Committee Submission Form must be completed and follow the above-mentioned process.

Inactivation of Patient Account Procedure

Subject: Class III – Clinical – H. Patient Administration

Reviewed and/or Revised: 09/01/2017, 2/20/2024, 8/13/2025

Policy and/or Procedure

Before inactivating a patient chart, the student must check axiUm to ensure that all fees have been paid, there are NO Unapproved items, Missing Treatment or Notes or In-Process treatment in the student's name.
The student places an Inactivation Note in patient’s EHR with the reason for Inactivation and then swiped by G.P. Director.
The completed inactivation letter and signed chart must be brought to the Patient Care Coordinator to process the inactivation where they will update the Patient’s status before mailing out the inactivation letter as well as unassign the student.

Pediatric patients

All inactivations must be recorded in the patient's record and signed by a Pediatric Dentistry instructor.
Students will then complete an inactivation letter and bring it to a Patient Care Coordinator.
The student should inform the Patient Care Coordinator if a replacement is needed.
Any special requests for patient assignments should be made to the Predoctoral Pediatric Dentistry Director.

Informed Consent Policy and Procedure

Subject: Class III – Clinical – H. Patient Administration

Department: Office of Information Technology

Origination Date: July 16, 2013

Effective Date: July 16, 2013

Reviewed and/or Revised: 09/01/2017, 02/28/2024, 07/31/2025

Purpose: The purpose of this policy is to ensure that no treatment is administered to a patient without complete disclosure or without signed authorization by the patient or patient's guardian.

Definitions: Axium – School of Dentistry’s electronic patient record system.

Approval - Approval is needed for the tasks mentioned. Click the Approve button to complete Approval. If the user has forgotten to approve an item, follow the directions below.

The Teal Box on the footer indicates something needs approval. Click the box to see what needs approval.
The user may approve all of the items listed or approve each individually. Click the first Line Item that needs approval.
Click the Approve button.

Notice all text is in Black. Remember the Teal and Blue = Approval Needed.

Policy and/or Procedure: Providers will obtain written informed consent from patients (or patient's guardian) prior to treatment. Initial informed consent is obtained during patient registration and subsequently during the presentation of a treatment plan and when the proposed treatment is modified or when additional treatment is proposed.

In order to follow the procedures below, the user must log into Axium with their specific username and password, or swipe card.

To Enter an Informed Consent

Select a patient.
1. For faculty, students, and residents, the default start page is the Personal Planner.
2. To search for a patient, click the Assigned Patients tab then the Search icon. (Magnifying glass).
3. Right click on the Item Line of your patient and click Select Patient.
4. At this point, you have selected your patient. To ensure you have selected the correct patient, check if the patient’s name and chart number are on the footer bar.
Click the Electronic Health Record module.
Click the Tx History tab.
Click the Add Patient Tx Consent button. (Button that looks like a clipboard to the right of the lower section of Treatment History screen).
Click the ... Box button.
There are multiple types of consents: Day of Treatment Consent, Prosth Delivery Consent, Refusal of Recommended Tx, Treatment Plan Consent, Termination of Tx Release. Double-click one of the consent Line Items.
Click the OK button.
Click all the Treatment Line Items the consent is needed for. Note: the treatment must be approved.
Click the OK button.
Additional comments may be added in the free text field.
Click the OK button.
Notice that the form is automatically pre-populated with information from previous forms. After reviewing with the patient, click the Close button.
Depending on the type of consent executed, specific signatures are needed. The signatures needed include the patient, witness, and/or faculty. Signatures are gained through the signature pad connected to the PC. The required signatures window will automatically open. The user must gain the required signatures now.
If the patient/guardian is not fluent in English, Language Line translation and/or language competent student/faculty/staff must be used to obtain Informed Consent.

Interpretation and Hearing

Subject: Class III – Clinical – H. Patient Administration

Department: Clinical Affairs

Origination Date: February 21, 2024

Effective Date: February 28, 2024

Reviewed and/or Revised: 8/13/2025

Interpretation and Hearing

Language Line Machines

Language translation services are offered through LanguageLine for patients that request services. The LanguageLine machines are in the Patient Care Coordinator’s office. Residents and students can schedule a machine in advance of an appointment for service for the machine.

THE HEARING AND SPEECH AGENCY (HASA)

Interpreting Interpretation and Hearing Services

The Language Line machines are provided by LanguageLine Solutions.

LanguageLine services are provided to the students on a reserved basis. The Language Lines have American Sign Language for the hearing impaired, as well as 43 different languages accessible for the patients that require its services.

OSX/Urgent Care, Post grad clinics, Pediatric, Ortho clinics, and the Pre-Doc clinics on the 2nd and 3rd floors all have access to LanguageLine.

The students in need of a LanguageLine machine MUST contact the PCCs at DL-Dental-GP PCC to reserve the machine for the 2nd & 3rd floor clinic. Students MUST put in their email, the day and time the LL is needed, as well as the GP they will be in.
Students MUST return the LanguageLine machine to the PCC office when they are finished with it.
Students may NOT keep the LanguageLine machine out on the clinic floor in between 2 clinic sessions.

Medical Assistance – Maryland Healthy Smiles Program

Subject: Class III – Clinical – H. Patient Administration

Effective Date: July 20, 2009

Reviewed and/or Revised: 09/01/2017, 2/26/2024, 8/13/2025

Purpose

To recognize that the Dental School participates with the Maryland Healthy Smiles Program and to provide an overview of the program to students, staff, and faculty.

Policy Statement

The Dental School is a provider with the Maryland Healthy Smiles Program and as such accepts patients for treatment who are actively registered in the program. These patients may receive emergency or comprehensive dental care upon presentation of a valid Maryland Healthy Smiles Card.

The eligible patient must present a valid Maryland Healthy Smiles card at each visit. At the time of registration, the Maryland Healthy Smiles card number will be verified and recorded. If the patient presents a valid card during the course of treatment, it is the provider's responsibility to take the card to the reception staff or business manager for proper documentation in Axium.

The eligible patient is entitled to necessary dental care, excluding fixed prosthodontics, and cast gold procedure, as indicated in the treatment plan. Pit an fissure sealants are covered only for the occlusal surface of posterior permanent teeth that are without restorations or decay. Gold restorations, gold crowns, gold replacement appliances, and bridges are not covered service. Orthodontic service is considered on a case-by-case basis.

Preauthorization is required for the following procedures:

Removable prosthodontics
Single crowns
Rebasing full or partial dentures
Periodontal therapy
Athletic Mouth Guard, and
Orthodontics

Requests for preauthorization are completed prior to initialing treatment. Treatment may not be started on the above procedures until the approval has been received and notifications sent to the provider. Requests for orthodontics begin with the request to take ortho records. This authorization must be received before any treatment is initiated.

Failure to comply with the above will delay treatment for your patients, since approvals may take up to two weeks. Performance of unauthorized care may result in withholding credit. Preauthorization requests are completed with MA staff. Orthodontic pre-authorizations are completed with MA staff or designated person.

Other Third Party Payers – Dental Grant Programs Policy

Subject: Class III – Clinical – H. Patient Administration

Effective Date: July 20 2009

Reviewed and/or Revised: 09/01/2017, 2/21/2024, 8/13/2025

Purpose

To ensure that patients with other third-party payers are given the proper and appropriate care at the time of their visit. Also, the formal estimate for dental care must be sent to the sponsoring agency. Also, all billing information must be sent within one fiscal year.

Policy Statement

From time-to-time patents are referred to the Dental School for care by outside agencies who are willing to accept financial responsibility for their care. The initial contact is usually made by an agency, social worker, or patient. A letter of confirmation or purchase order is received prior to the initial examination of the patient. The patient is not liable for fees at that time.

After assignment, a plan of treatment should be formulated with a formal estimate form the Business Office presented to the sponsoring agency. All therapy should cease until a confirming purchase order of letter of authorization is received designating to what extent the patient is being financially supported. The Business Office on a timely basis will bill the agency for service rendered. Most agencies request only one billing at the end of treatment. It is important that treatment is completed in one fiscal year as these purchase orders are only valid for that time and any service not completed must be preauthorized via the preceding process. Changes in treatment must be reported and approval received before additional services are delivered. Agencies will only pay for what is listed on the confirming order form. See Grant Specialist for a list of participating grants.

Patient Administration Policy – Dental Hygiene

Subject: Class III – Clinical – H. Patient Administration

Department: Endodontics, Prosthodontics, Periodontics: Dental Hygiene Program

Subject: Patient Administration

Origination Date: 7/18/13

Effective Date: 7/18/13

Reviewed and/or Revised: 09/01/2017, 12/22/2025

Purpose: To expedite treatment and ensure timeliness of care.

Policy and/or Procedure:

Patient recruitment

Dental hygiene students may recruit their own patients to receive dental hygiene-only services. All ‘hygiene only’ patients must have a dental home (primary care provider) who oversees care of the patient. Hygiene students must ensure that a G.P. Director examines and informs each patient about the limited nature of the treatment for patients in this category. Patients may later be assigned to a dental student for comprehensive care. Dental Students may recruit and screen their own patients and provide comprehensive care. If the ‘hygiene only’ patient does not have a dental home, s/he must first go through the dental school screening process prior to receiving dental hygiene services.

Transfer

Patients for comprehensive care may be transferred from one assigned student to another.

Dental Hygiene students may transfer patients to another dental hygiene or dental student.
The G.P. Director or the Dental Hygiene Faculty must approve transfers.
Director of Special Patient Clinic must approve special Patient Clinic transfers in the chart.
The individual advanced specialty education clinic will contact the patient about procedures for acceptance.
A patient may be referred to another student for a limited treatment.
The original student remains primarily responsible for the patient even though both students may now treat the patient concurrently. The second student should render only those services indicated in the referral entry.

Inactivation

Patient record archiving

When an adult patient has not returned to the School of Dentistry for a period of 18-months, the record will be purged from the System and forwarded to the State of Maryland Archives.
For a minor, the record will be retained in the system until the minor reaches age twenty-one or for two years after the last appointment, at which time the parent or legal guardian is notified of our intent to forward the record to the Archives and is given thirty days to advise us that he/she wishes for us to retain the record in the System until the minor reaches age twenty-one. After five years, records at the Archives are destroyed
Inactive records that exceed retention limits are purged on a biannual basis and are given an “archived” status in the AxiUm systems.
Archived records are sent to State of Maryland record storage facility in Jessup, where they are retained for a period of five years, after which time, they are destroyed.

Radiographs taken outside the School of Dentistry require patient consent before they can be requested from the practitioner (patient consent should be noted in the chart). Patient consent form can be obtained from the Chart Room Supervisor.

Patient Appointment Policy

Subject: Clinical III. – H. Patient Administration

Department: Clinic Administration

Effective Date: 01/30/2023, 3/1/2024, 8/13/2025

Policy and/or Procedure:

Patients must be reachable by the Provider to schedule, confirm, and cancel/reschedule appointments. Arrangements must be agreed upon mutually at the intimation of the Patient-Provider Relationship.

>48h/2 days before the appointment OR before the first Intiveo confirmation is made

Provider communicates with the patient to cancel and reschedule the appointment.
Provider documents the communication in Contact Notes
Provider cancels the appointment in axiUm and indicates >48h reason code

<48h/2 days before appointment AND after Intiveo confirmation has been made

Provider communicates with the patient to cancel and reschedule the appointment.
Provider has response from patient via voice or message acknowledging cancelation and rescheduled appointment.
Provider documents the communication in Contact Notes
Provider cancels the appointment in axiUm and indicates <48h reason code
The patient’s appointment should NOT be canceled unless there is confirmation that the patient received notice of the cancelation

If the Provider does not have acknowledgement from the Patient:

Provider must present for the appointment in the SOD
- If there is an emergency or conflict, the Provider must make arrangements for another provider to see the patient.
- PCC and GP Director must be informed.

Appointment Confirmation Policy

All patient appointments should be confirmed 48h in advance of the scheduled date and time.
- Automated process via Intiveo AND/OR communication between provider and patient.
- If the Provider cannot get in touch with the patient, they must still be present for the appointment and wait the appropriate amount of time (30 minutes) before failing the appointment.
  - They should cancel the appointment in axiUm and document the failed appointment as a general note which the faculty must approve.

Patient Care Finances Policy

Subject: Class III – Clinical – H. Patient Administration

Reviewed and/or Revised: 09/01/2017, 2/21/2024, 8/13/2025

Purpose

To inform the patient of their financial obligation should they obtain treatment

Policy Statement

All treatment must be paid in full at each treatment appointment unless a Patient Financial Agreement or other arrangements have been approved.
An emergency patient without immediate funds will be treated only with an instructor's written authorization in the record.
If dental insurance, third-party coverage, or other prepaid financing covers the patient, procedures requiring preauthorization approval must be obtained before treatment is initiated.
Dental students are responsible for collecting the full fee and informing each patient about payment procedures.
Elective treatment may be discontinued, at the direction of the G.P. Manager, for patients whose balance is unpaid or overdue for 60 days or more.

Patient Check In and Out Policy and Procedure

Subject: Class III – Clinical – H. Patient Administration

Policy Reviewed and/or Revised: 09/01/2017, 2/20/2024, 8/13/2025

Policy Statement

To ensure that all patients who present with an appointment for the day are checked into and checked out of the system.

Purpose

To ensure that all patients who present with an appointment for the day are checked into and checked out of the system at the conclusion of their visit.

Policy and/or Procedure

Patient Check In:

The patient is greeted by the Front Desk Staff.
1. Front Desk Staff verifies that the Patient is presenting to the correct clinic.
  1. If patient is presenting to the correct clinic, proceed to number 2.
  2. If patient presents to the incorrect clinic and is unsure as to which clinic to present to, via scheduler, locate the “correct” clinic for the patient’s appointment and assist the patient with reporting to the “correct” clinic.
    Note: The treating clinic is to check- in the patient. If it is a Pre-doctoral Student seeing a patient in the Endodontics Clinic, the Pre-doctoral Clinic is to check-in the patient.
The appropriate Front Desk Clinic Staff will check the Patient into the Axium System from:
1. Scheduler (insert document)
  Note: Rolodex (insert document) is only to be used in the Screening Department, new patients that are not currently in Axium and for any unscheduled or walk in appointments. Checking the patient in by using Rolodex will show patient as being checked in for all appointments scheduled for that day.
2. Patient may be added as a new patient (take to registering a new patient link)
  1. In the scheduling database, the receptionist right clicks on the patient’s name and chooses “check- in“. This turns the patient’s name to “red”, which alerts the provider their patient has arrived and is in the waiting area.
  2. To check a patient in from Rolodex:
    1. Locate the patient via Rolodex.
    2. Double click on today’s scheduled appointment. This will take you to scheduler.
    3. In the scheduling database, the receptionist right clicks on the patient’s name and chooses “check- in“. This turns the patient’s name to “red”, which alerts the provider their patient has arrived and is in the waiting area.
  3. Front Desk Staff confirms Patient’s personal information such as:
    1. Address
    2. Phone number
    3. Insurance information
  4. Front Desk Staff are responsible for correcting any changes noted.
  5. Front Desk Staff will check the patient’s financial account status, advise patient of any balance due and to please request to remit payment via cash, check or credit card.
  6. Patients with balances over 60 days old, may be put in contact with a Business Manager or Patient Account Specialist to make payment arrangements.
The provider or assistant greets the patient and walks the patient back to the clinic for services to be rendered.
The patient is seated.
In Axium, the provider right clicks onto the patient’s name and selects ”patient seated”, which turns the patient’s name from red to black.
Receptionist is to monitor the waiting area to ensure that all patients have been assisted and their providers are aware they are waiting (via check in).

Patient Check Out:

Prior to dismissing a patient, an Axium treatment code must be entered and approved by Faculty as appropriate.
The Patient is escorted back to the Reception Desk to be checked out of Axium.
Front Desk Staff will review treatment transactions and requests payment as appropriate.
The Front Desk Staff will right click onto that patient’s name, chooses “check out”, which turns name from black to gray, signifying that all dental and financial transactions have been completed.
The next appointment is scheduled (if applicable). Note: This may be done at the Reception Desk or at the chair by the Student/Resident depending on the guidelines for that clinic.
Patient is directed to parking self-validation machine, if needed, and dismissed.

Patient Complaints and Grievances Procedure

Subject: III. Clinical – H. Patient Administration

Effective Date: 7/28/15

Reviewed and/or Revised: 08/26/2015, 09/11/2016, 05/26/2017, 09/01/2017, 12/17/2018, 04/18/2019, 02/28/2024, 01/30/2025, 07/31/2025

Definitions:

Complaint: A written or oral expression that indicates a dispute with the Dental School or a Dental School Policy.

Grievance: Refers to a verbal or written statement by the Patient that expresses dissatisfaction with some aspect of service(s) received that the Patient wants to resolve, which has not been resolved between Student, Resident, Faculty, Staff and Patient

Policy and/or Procedure:

Complaints/Grievances regarding non-treatment issues which involve staff/faculty behavior/professionalism may be forwarded to the employee's supervisor or to the Director, Medical Credentialing and Quality Assurance. When received by either the Director of Medical Credentialing and Quality Assurance or the employee’s supervisor, it will be coordinated with the Faculty who handles complaints and GP/Program Directors with a copy to HR. The employee will be notified by the supervisor and appropriate actions taken.
Complaints/grievances are usually communicated to the Faculty who handles complaints and the GP/Program Director. Complaints/grievances of a confidential nature may be communicated directly to the GP/Program Director or to the Director, Medical Credentialing and Quality Assurance, which will be sent to the Faculty who handles complaints and the GP/Program Director for resolution.
A notice is visible in the reception area giving the phone number that Patients can call inviting them to share their experience and/or register a complaint/grievance. This number is for the Patient Care Coordinator who will refer them to the appropriate GP/Program Director.
GP/Program Directors will assist with resolving the issue before it becomes a formal complaint.
If the GP/Program Director cannot resolve patient’s issues at hand, the GP/Program Director notifies the appropriate Faculty member who handles complaints, Department Chairman via email with a copy to the Business/Office Manager and the Director, Medical Credentialing and Quality Assurance. Complaints regarding Faculty or Students will be given to the Department Chairman with copies to the Director, Medical Credentialing and Quality Assurance and the GP Director/Program Director. Complaints regarding Staff persons will be sent to Faculty member who handles complaints with a copy to the GP/Program Directors for resolution with a copy to HR and the Director, Medical Credentialing and Quality Assurance. A written acknowledgement will be sent by the Director, Medical Credentialing and Quality Assurance, and a phone call to the patient may be made by the Faculty member who handles complaints. The Faculty member who handles complaints will review the patient’s file with the GP/Program Directors, and advise the students/residents.
If the complaint/grievance involves a business matter, then it is sent to the Business/Office Manager to take action by the Faculty Member/GP/Program Director, with a copy to the Director, Medical Credentialing and Quality Assurance. Once the complaint reaches the Director, Medical Credentialing and Quality Assurance, the Director, Medical Credentialing and Quality Assurance logs the complaint and/or grievance. The complainant may leave a verbal complaint but will be requested to send the complaint in writing via USPS, email or fax to the Director, Medical Credentialing and Quality Assurance. Information to be logged would include date received, date complaint is acknowledged, patient name, confirm address in system, Axium ID number, phone number, email address, description of complaint/grievance, resolution requested by patient, action taken to resolve, date resolved. Data is to be gathered for QA purposes and reported to the QA Committee by the Director, Medical Credentialing and Quality Assurance.
Once the complaint/grievance reaches the Director, Medical Credentialing and Quality Assurance, it will be logged in (as per section 6) and reviewed by the Faculty member handling complaints and the GP/Program Director. The Faculty member handling complaints using the gathered information he/she received directly from the patient’s record, providers, discussions with Students, Residents, Staff, and Faculty who were involved with treating the patient, will develop and write a resolution letter to the patient regarding the complaint/grievance with a copy to all necessary parties. Resolution letters may not be written for less complex complaints. These less complex complaints are resolved verbally with the patient. If a financial adjustment to the patient’s account is to be performed, the Faculty member handling complaints and/or the Director, Medical Credentialing and Quality Assurance, will notify the Senior Business Manager of Business Operations so they may ensure that the financial adjustment has been made to the patient’s account. Clinic Business Manager(s) will complete financial adjustments according to policy and procedure.
The Faculty member handling the complaints and the GP/Program Directors will notify the Director, Medical Credentialing and Quality Assurance of all actions toward resolution as they are completed and give copies of documentation to that effect. All actions taken toward resolution will be given to the Director, Medical Credentialing and Quality Assurance by the Faculty member handling complaints and the GP/Program Director who will add a copy of resolution letter to the Patient’s Record.
If a patient is not satisfied with the resolution, they may appeal the resolution. The Faculty member handling complaints will review the complaint/grievance and resolution with the Associate Dean of Clinical Affairs. The Associate Dean of Clinical Affairs will consider the information that has been reviewed and any new information that may have been presented (including additional review with UMSOD personnel). The Associate Dean of Clinical Affairs will either support the original resolution, modify the resolution, or propose a new resolution. The decision of all appeals will be in writing.
Patients may appeal the decision of the Associate Dean of Clinical Affairs to the UMSOD Dean. The UMSOD Dean will confer with the Associate Dean of Clinical Affairs to determine if additional review is warranted. The UMSOD Dean will review pertinent documentation as listed in #7 above and other information associated with the complaint and render a decision to support or propose an alternative resolution.
Patient complaints received from external agencies are to be sent to the Director of Credentialing and Quality Assurance with a copy to the Clinical Affairs’ Program Management Specialist. If a copy of the patient’s record is requested, Clinical Affairs will make this request and coordinate a copy of the records to be sent to the external requesting agency/company. The record copy is reviewed by the Director of Clinical Operations prior to records being sent to the external agency/company.

Patient Records Policy

Subject: III. Clinical – H. Patient Administration

Policy/Procedure: Patient Records Policy

Effective Date: 8/19/13

Reviewed and/or Revised: 09/01/2016, 09/01/2017, 2/24/2024, 8/13/2025

Policy and/or Procedure:

All current patient records are maintained by the IT Department via Axium, Romexis and INFINITT. Pre EPR records can be ordered from storage.
The patient EPR is the official document for patient history, provision of care, and documentation of patient progress. As such, it is critical that all entries be accurate and current. The EPR is designed to confirm the most recent criteria for standards of care.
Patient disposition notations and provider changes are noted in the EPR.
Referral notes are made in the EPR.
Patients have access to complete and current information about their dental conditions.
The EPR will include all diagnostic and treatment services provided by UMSOD.
Upon receipt of a written request from a patient or parent/guardian and payment of a reasonable fee, the record and radiographs will be duplicated and provided by the Medical Records Supervisor (Room 5201).
Patient records are the property of the UMSOD.
When a record request is made by an attorney or through a court ordered subpoena or by the Board of Dental Examiners, the subpoena is sent to Clinical Affairs to the attention of Director, Medical Credentialing and Quality Assurance to be logged and coordinated. Records are reviewed by Faculty prior to forwarding.

Only members of the Clinic Administration are authorized to correct EPR errors in patient records. Errors corrected may include entries made into wrong EPR charts, duplicate entries, and blank EPR forms.

Records must be handled in full compliance with HIPAA regulations.
Recourse for non-compliance is academic counseling.

Patient Records – Entering Treatment into Axium

Subject: Class III – Clinical – H. Patient Administration

Reviewed and/or Revised: 09/01/2017, 8/18/2025

Purpose

Support policies: Patient Care Finances, Record treatment planned and/or delivered

Policy and/or Procedure

1. For treatment as planned performed by student providers

Student opens screen
Student selects planned treatment
Student changes status from planned to "In process" or "Complete"
Faculty swipes-approves to complete

Definition of Successful Execution

This procedure step has concluded successfully when Faculty swipe-approves deleted treatment and completed treatment

Definition of Successful Execution

This procedure step has concluded successfully when Faculty swipes-approves to complete

3. For treatment with minor change performed by student providers

Student opens screen
Student selects planned treatment
Student deletes planned treatment
Student adds new treatment
Faculty swipe-approves deleted treatment and completed treatment

Definition of Successful Execution

This procedure step has concluded successfully when Faculty swipe-approves deleted treatment and completed treatment

4. For new treatment performed by student Treatment Planning.

5. To Delete treatment performed by student providers

Student opens screen
Student selects treatment
Student deletes treatment
Faculty swipe-approves deleted treatment

Definition of Successful Execution

This procedure step has concluded successfully when Faculty swipe-approves deleted treatment

To All Students/Residents/Faculty:

The Dental School is taking an important step in moving towards more complete and accurate chart notes.

Specifying Faculty supervisor name:

All residents and student providers are required to select the name of the “Covering Faculty” for all procedures on the “Visit Form” or “Template notes”. Resident and student providers may select additional faculty on the “Visit Form” only. Covering faculty selections must be reflective of the faculty coverage duties on the progress note entry date. For faculty performing a procedure, they may select their own name.

Notes can be created in several ways:

1. Note manually typed freehand via Template Notes

Select Tx History tab

Tx History Tab

Click on the “add a new note” symbol (second green PLUS sign)
A box will pop up; click on the square next to CODE
The dropdown list of type of template notes to select from will appear

“General Note” or “SOAP/ATEN Note”

To enter the note, click on {*Required} which will bring up

Template Note- Patient

Clinical Note Codes List

Enlarged Template Note-Patient

Click on Covering Faculty {*Required}, type first character of last name then select from the dropdown list of faculty.

2. Note via multi-disciplinary VISIT form.

Appointment Provider must add the form. Go to Forms tab , click on “add a new record” icon
An “Add Form” box will pop up; click on the dropdown list in “Form” and select the “VISIT Form ” and hit “ok”
This “Visit Form” is a fill-in-the-blank / dropdown multidisciplinary question set that automatically creates a progress note. After the form is reviewed and approved, the progress note is added to the patient’s chart under the Tx History tab.
**A Built in option for addendum and/or corrections to this note is available when you scroll down to the bottom of the Visit Form.

For additional information and an online demo of the complete process for creating a progress note using the VISIT form, access “Visit Form Progress Note” via Axium Links

3. Treatments and visit notes must be completed and approved by midnight of the day after the treatment appointment.

Thank you for your anticipated cooperation!

Patient Records – Progress Notes

Subject: III. Clinical - H. Patient Administration

Effective Date: 06/07/2016

Reviewed and/or Revised: 09/01/2017, 8/28/2025, 2/04/2026

All residents and student providers are required to select the name of the “Covering Faculty” for all procedures on the “Visit Form” or “Template Note”. Resident and student providers may select additional faculty on the “Visit Form” only. Covering faculty selections must be reflective of the faculty coverage duties on the Progress Note entry date. For Faculty performing a procedure, they may select their own name.

Notes can be created in several ways:

1. Note manually typed freehand via Template Notes

Select Tx History tab

Tx History Tab

Click on the “add a new note” symbol (second green PLUS sign)
A box will pop up; click on the square next to CODE
This will give the dropdown list of type of template notes to select from

Template Note- Patient

Clinical Note Codes List

If you wish to enter your chart note free-hand click on “General Note” or “SOAP/ATEN Note”

To enter the note, click on {*Required} which will bring up a box to type in your chart note

Enlarged Template Note-Patient

Click on Covering Faculty {*Required}, type first character of last name then select from the dropdown list of faculty.

2. Note via multi-disciplinary VISIT form.

Appointment Provider must add the form. Go to Forms tab, click on “add a new record” icon
An “Add Form” box will pop up; click on the dropdown list in “Form” and select the “VISIT Form” and hit “ok”
This “Visit Form” is a fill-in-the-blank / dropdown multidisciplinary question set that automatically creates a progress note. After the form is reviewed and approved, the progress note is added to the patient’s chart under the Tx History tab. Pink highlighted areas are required to be filled out in order to complete the form. Entering the Covering Faculty is one of the areas that is required in order to complete this note successfully.
**A Built-in option for addendum and/or corrections to this note is available when you scroll down to the bottom of the Visit Form.

For additional information and an online demo of the complete process for creating a progress note using the VISIT form, access “Visit Form Progress Note” via Axium Links.

3. Notes must be completed and approved by midnight of the day following the treatment.

Patient Treatment Redo’s – Patient Complaint Policy

Subject: III. Clinical - H. Patient Administration

Department: Clinical Affairs

Reviewed and/or Revised: 09/01/2017, 3/01/2024, 8/13/2025

Purpose: Addressing deficient dental care.

Policy and/or Procedure:

From time to time it becomes necessary to redo, repair, modify or replace failed or failing dental treatment. If the treatment under consideration was inadequate upon placement, or if it failed shortly after placement, the UMSOD may decide to modify, replace, or repair it at a reduced fee or at no charge to the patient. In such cases, the faculty involved will prepare an adjustment form stating the problem, the recommended corrective measures, and recommended fee adjustments.

Patients shall be told the situation is being referred for faculty review to consider corrective measures, however, no one should mention any specific remedy to the patient at this time. If the recommendations of the Faculty handling complaints are accepted by the patient, treatment may begin. If results are not accepted by the patient, the patient will have the right to file a formal complaint for further review.

This policy applies in the UG and PG clinics. In the Undergraduate (UG) Clinics the GP Directors should sign the adjustment forms.

If the amount of the adjustment is over $1500, the adjustment form will be presented to the Director, Medical Credentialing and Quality Assurance who will submit it to the Associate Dean of Clinical Affairs for review, appropriate approval, or modification.

Patients Accompanied by Non-Patients and/or Minors While in Dental Operatories or Surgical Areas

Subject: Class III – Clinical – H. Patient Administration

Department: Oral Surgery

Effective Date: 9/13/13

Reviewed and/or Revised: 09/01/2017, 8/13/2025, 3/25/2026

Purpose: Accompanied and/or Unaccompanied Children in Clinical Areas

Policy and/or Procedure:

For privacy and safety reasons, only the patient scheduled for dental treatment is permitted in the dental operatory during the delivery of care. However, if extenuating circumstances warrant, a clinical faculty member may determine that an individual other than the scheduled patient may also be present in the dental operatory during treatment. Relatives, friends, and children accompanying scheduled patients should wait in the reception area. Children under the age of 12 cannot wait in the reception area unsupervised. UMB School of Dentistry faculty, staff, residents, or students are not responsible for the welfare or supervision of unaccompanied children in the reception area.

Phone Calls Processing Procedure: a. Office of Attorney General and; b. Patient Calls

Subject: III. Clinical - H. Patient Administration

Effective Date: July 2016

Reviewed and/or Revised: 05/26/2017, 09/01/2017, 8/15/2025, 12/4/2025

Office of the Attorney General (OAG) phone calls:

All Office of the Attorney General (OAG) phone calls are to come thru the Director of Medical Credentialing and Quality Assurance and sent to 410-706-7306.
The patient or the Office of Attorney General’s Office may also leave a voicemail message which will be acknowledged by email or letter. They will also receive a phone call within 24-business day hours from the Director of Medical Credentialing & Quality Assurance or the Faculty who handles complaints. It would be helpful if the OAG office left the times they would be able to receive a phone call back and their email address.

Patient Complaint Calls:

The protocol in place for patient complaint phone calls to be handled in a most efficient manner and also for legal and liability purposes is as follows:

All patient complaint phone calls are to come thru the Director of Medical Credentialing and Quality Assurance and sent to 410-706-7306, or they may email their complaint to: emarkwitz@umaryland.edu.
The patient may also leave a voicemail message which will be acknowledged by email or letter. They will also receive a phone call within 24-business day hours from the Director of Medical Credentialing or the Faculty who handles complaints. It would be helpful if the patient left the times they would be able to receive a phone call back and their email address.
When a patient leaves a voicemail message, they will be sent an acknowledgement email, usually within 24-business hours, or a letter via Federal Express, usually the same day, so they receive it the next business day.
The patient will be informed of the protocol and requested to put the complaint in writing and email it to: emarkwitz@umaryland.edu or UMSOD, 650 W. Baltimore St., Suite 5201, Baltimore, MD 21201 to Director of Medical Credentialing and Quality Assurance’s attention.
The Director of Medical Credentialing & Quality Assurance will log the complaint.
An acknowledgment email will be sent to the complainant.
The Director of Medical Credentialing and Quality Assurance will refer the complaint and information to the appropriate Faculty who handles complaints with copies to providers and/or staff as necessary to provide further information for resolution.
The Faculty who handles complaints will review the information with Faculty, providers and staff and contact the patient via a phone call(s). A letter with a resolution will be sent to the patient when the complaint is resolved.
If the patient is appealing or still not satisfied with the resolution provided, the complaint would again come thru the Director of Medical Credentialing and Quality Assurance who would log it as an Appeal. Appeals would be sent to the Associate Dean for Clinical Affairs for further consideration and/or resolution. A letter and/or email of the decision would be sent to the patient.

Policy For Treating Patients Under the Influence of Alcohol and or Drugs (including marijuana/cannabis)

Subject: III. Clinical – H. Patient Administration

Effective Date: 09/14/2022

Reviewed and/or Revised: 09/14/2022, 1/28/2024, 8/13/2025, 11/19/2025

Policy and/or Procedure:

Patients who are under the influence of alcohol and/or drugs (including marijuana/cannabis) are incapable of providing Informed Consent. Therefore, unless it is a life-threatening emergency; dental treatment at the UMSOD should be deferred until the patient is no longer under the influence of alcohol and/or drugs (including marijuana/cannabis) and the patient is capable of providing Informed Consent.

UMB/UMSOD Policy For Known or Suspected Monkeypox Cases: August 2022

First priority is to prevent exposure of employees or patients!

Immediately Isolate patient to dental chair
Keep patient seated
Patient should wear a mask and cover all skin lesions, as much as possible
Anyone with contact should don gown, gloves, face shield, and N95 or equivalent respirator
Provide medical consultation including stressing the importance of prompt follow-up with a physician, and dismiss patient ASAP
Immediately contact the Baltimore City Health Department (BCHD) or Maryland State Department of Health (MDH) to report the case, including providing patient contact information
BCHD: (410) 396-4436, or after hours: (410) 396-3100
MDH: (410) 767-6700, or after hours: (410) 795-7365
CDC: (770) 488-7100, if additional clinical guidance is needed CDC: (770) 488-7100, if additional clinical guidance is needed
Do not take samples of lesions or make direct skin contact as part of the physical exam
Contact 410-328-2637 or UMBOccupationalHealth@som.umaryland.edu for additional assistance, including to discuss any potential exposure concerns
Once patient leaves the operatory/clinic, consult EHS for proper decontamination protocols (410-706-7055 from 8-4 M-F, otherwise 410-706-6665). Per EHS instructions, perform surface disinfection to all operatory surfaces and dispose of all PPE, including gowns, in the special medical waste containers surfaces
More information on waste management can be found here: Infection Prevention and Control of Monkeypox in Healthcare Settings
For those working in UMMS sites, please follow UMMS guidance

Policy on Photography Recording and Videotaping in the UMSOD Clinics

Subject: III. Clinical - H. Patient Administration

Department: Clinical Affairs

Effective Date: 02/13/2024

Reviewed and/or Revised: 8/13/2025, 2/18/2026

Policy and/or Procedure:

To protect patient, faculty, staff and student/resident privacy; the UMSOD prohibits any form of photography, recording, and/or videotaping by patients and/or visitors in the clinic spaces or during dental treatment.

Prescriptions - Oral and Maxillofacial Surgery Residents

Subject: III. Clinical - H. Patient Administration

Department: Clinical Affairs

Effective Date: 05/01/2015

Reviewed and/or Revised: 09/01/2017, 8/13/2025

Policy and/or Procedure:

OMFS Residents may only write prescriptions under the DEA of the medical center for patients of the UMMC hospital.
OMFS residents may not use the DEA provided by the medical center to write prescriptions for patients seen at the UMSOD Dental clinics.
OMFS residents may only prescribe while in the UMSOD Dental clinics if they are a licensed Maryland Dentist with their own DEA, CDS, and NPI number.
While in the UMSOD Dental clinics, the OMFS residents must obtain all prescriptions for the patients they are treating in the Dental School from the faculty that are overseeing the clinic at that time. The OMFS resident will present the patients’ medical history and the procedure that has been performed on their patient as well as the medication, dose and regimen that they wish to prescribe to their patient. The Dental Faculty will then write and sign the prescription and document this in the Dental Axium chart.

Purging and Destruction of Patient’s Paper Medical/Dental Chart Records

Subject: III. Clinical - H. Patient Administration

Department: Clinical Affairs

Origination Date: 01/01/2014

Effective Date: 01/09/2014

Reviewed and/or Revised: 09/01/2017, 2/29/2024, 8/13/2025

Purpose: Guidelines for purging and destruction of patient’s paper medical/dental chart records.

Policy and/or Procedure:

All medical/dental chart records, laboratory, X-ray reports or photographs about and regarding patients may not be destroyed for 5 years after the last report has been made.

In the case of a Minor Patient, all medical/dental chart records, laboratory, X-ray reports or photographs about and regarding patients who are a minor may not be destroyed until the patient attains the age of majority (21 years old) plus 3 years or 5 years after the last record or report is made, whichever is later.

A letter sent by first class mail to the last known address of the patient’s parent or guardian shall be sent informing them of the intent to destroy the records unless advised in writing within 30 days of notification. If after 30 days from the mailing of the letter there is no response or if the letter is returned with no forwarding address, then the record will be destroyed.

Receiving Direct Payment for Services (Cash, Check, Charge or Debit Card)

Subject: III. Clinical - H. Patient Administration

Reviewed and/or Revised: 09/01/2017, 2/24/2024, 8/13/2025, 3/16/2026

Purpose

The purpose of this procedure is to manage direct payments for services rendered to patients.

Policy and/or Procedure

Patients make payments for services using a debit card, credit card, or check. Cash payments are only accepted at the Shady Grove clinics.
The Receptionist records the payment received in the system.
The Receptionist provides a receipt to the patient.

Referring a Patient to Secondary Provider Procedure

Subject: III. Clinical - H. Patient Administration

Department: Clinical Affairs

Effective Date: 08/19/2013

Reviewed and/or Revised: 09/01/2017, 8/18/2025

Purpose: Support Patient Administration Policy

Policy and/or Procedure

This procedure does not apply to residents. In an emergent situation outside scope of student provider capability:

Valuates status of patient and makes recommendation
Documents recommendation in patient progress note
Referral form completed by student provider and approved by faculty in EHR.
Advise student provider to escort the patient to the specialty clinic and/or place appropriate notes in EHR Medical health history to be approved by faculty.
Make arrangement for patient to be seen, may be performed by Patient Care Coordinator (PCC)

Assigning a student provider as a secondary provider.

Student provider consults General Practice Director (GP Director) or Assistant GP Director.
GP Director or Assistant GP Director documents decision for limited care by a "secondary student provider."
Student provider obtains Request for Patient Referral form and notes specific service being referred.
GP Director or Assistant GP Director approval needed.
PCC Notified by student provider after approval obtained.
PCC adds a provider assignment box of axiUm with a comment noting that the additional student provider is a secondary provider.

Refresh Button for Patient Records

Subject: Clinical III. – H. Patient Administration

Department: Clinical

Effective Date: 11/20/18

Reviewed and/or Revised: 12/12/18, 2/20/2024, 8/13/2025

In order to ensure patient records are up-to-date with the most recent patient information in Axium for a records release, please do the following going forward for EVERY patient after EVERY prescription is written:

Select Patient in AxiUm.
Click on the E.H.R.
Go to Medications tab.
Click the REFRESH button

Note: The Faculty member or Student must click the refresh button to ensure that all prescription and allergy data goes back into Axium. This action should be performed routinely by all Faculty and Students and is especially important when using a mobile app to prescribe medications. Please know that after a prescription is written and approved in iPrescribe, the iPrescribe mobile app doesn’t “sync” the information back into Axium. Hence, the need for the refresh button.

Please let the Sr. Business Manager of Business Operations know if you have any issues accessing this feature or send a help ticket to sodhelp@umaryland.edu.

Requesting Adjustment of Patient Account Procedures

Subject: III. Clinical - H. Patient Administration

Reviewed and/or Revised: 09/01/2017, 2/24/2024, 8/13/2025

Purpose

To adjust patient’s account that may include but not limited to: to be in compliance with financial contracts, to provide an act of good will toward patient.

Policy and/or Procedure

Obtain rationale for the adjustment to include but not limited to:

Redo- Depending on rationale, an outcome assessment form may need to be completed and signed by appropriate faculty member. Form is then given to accounting clerk to perform adjustment to patient’s account.
Contractual Agreement - If form is not needed, i.e., due to a contractual agreement, accounting clerk adjusts the patient’s account to be in accordance with the contractual agreement.
Overdue Account - If patient’s account has a balance that is overdue by 120+ days, the account is adjusted to zero balance. The account is forwarded to the State Central Collection Agency.
Patient Courtesy – Depending on circumstance, a patient courtesy may be extended as a good will gesture.

Requesting Duplication of Patient Records

Subject: III. Clinical – H. Patient Administration

Effective Date: 8/19/13

Reviewed and/or Revised: 09/01/2016, 09/01/2017, 2/28/2024, 8/13/2025

Upon receipt of a written request and signed authorization from a patient or parent/guardian and payment of a reasonable fee, the record and radiographs will be duplicated and provided by the Medical Records Supervisor (Room 5204).

If paper chart record is offsite, Medical Records Supervisor requests chart record from archive location. Note: This may take approximately 4 days to receive.
Once chart record is received, x-rays may be sent to be scanned.
Once x-rays are scanned, they are duplicated.
Requestor is notified to pick up record or it can be mailed.

Note: If patient brought x-rays into the Dental School and is requesting them back, the Chartroom Supervisor scans x-rays and places scanned copy in the patient’s chart record.

Patient records are the property of the UMSOD.
When a record request is made by an attorney or through a court ordered subpoena or by the Board of Dental Examiners, the subpoena is sent to the Director of Medical Credentialing and Quality Assurance to coordinate, and records are reviewed by Faculty prior to forwarding.

Requests for Discounted or Free CBCTs Policy

Subject: Clinical III. – H. Patient Administration

Department: Oncology and Diagnostic Sciences

Origination Date: 04/30/2024

Effective Date: 04/30/2024, 8/26/2025

Purpose: Define the write-off process for CBCT radiographs

Radiology cannot adjust or write off fees for other departments.
If programs determine that a CBCT should be offered at a reduced fee or no charge, the program will have to provide the funding source to cover the expense.

Terminating Dental Provider - Patient Relationship Policy and Procedure

Subject: III. Clinical – H. Patient Administration

Department: Clinical Affairs

Origination Date: 1/1/2009

Effective Date: 1/1/09

Reviewed and/or Revised: 07/01/2016, 05/08/2017, 09/01/2017, 04/17/2019, 2/28/2024, 8/13/2025

Purpose: Follow proper procedure to terminate the dental provider-patient relationship ensuring that abandonment of patients does not occur. Faculty and Clinic Administration will ensure that the decision to terminate a dental provider-patient relationship is appropriate and/or necessary, and that patients are properly advised of the decision.

Definitions: Abandonment – termination of a professional relationship between dentist and patient at an unreasonable time and without giving the patient sufficient opportunity to find an equally qualified replacement

Policy and/or Procedure:

Once a dental provider-patient relationship is established, a dentist is under an ethical and legal obligation to provide services as long as the patient needs them. There may be times, however, when you may no longer be able to reliably provide care. It may be that:

The patient is:

Not compliant with policies or procedures
Unreasonably demanding with treatment or clinic policies
Threatening and/or abusive to the dental provider and/or staff
Not paying bill(s) for dental services rendered
Taking legal action against the dental provider, contributing to the breakdown of the dental provider-patient relationship
Unwilling to accept treatment recommendations

Or the dental provider is:

Relocating
Retiring
Limiting practice
Or there is an unanticipated termination by a managed care plan and/or employer
Regardless of the situation, to avoid a claim of “patient abandonment”, a dental provider must follow appropriate steps to terminate the patient-dentist relationship.

Terminating the relationship should be the last resort and except in extreme cases should occur only after advising and warning the patient that continued behavior will result in termination. These advisories and warnings must be documented in the patient’s chart. The dental provider-patient relationship will only be terminated if the supervising faculty agrees with and approves of this action. Faculty approval must also be documented in the patient's record.

Hallmarks of proper procedure are reasonable notice of intent to terminate and adequate time for patient to find alternate care before termination takes effect. The following is the procedure when terminating dental provider-patient relationship:

Provide written notice of termination of relationship (see letter template below).
Mail letter certified mail return receipt requested or via Federal Express/overnight mail.
Specify effective date of termination (Note: patient may be treated in Urgent Care Clinic for emergency or urgent treatment until termination date).
Advise patient in letter of any unfinished treatment, the need for continued care, and the risk of not continuing current and future dental treatment.
Provide adequate time for patient to find another provider (30 days). Patient can obtain emergency or urgent care treatment if needed for 30 days.
Assist patient to transfer care to another provider.
Provide the Maryland State Dental Association 410-964-2880 as a resource for patient to identify another provider.
Provide a copy of dental record to new provider upon request (with patient signed authorization.
Document in patient’s chart record and scan copy of notification letter.
Place office code DNR on patient’s account.
Advise the clinic Director, Program Director, and the Associate Dean of Clinical Affairs.

Other References may be: UMB Police
Recourse for non-compliance: Academic Counseling; Suspension of Clinical Privileges

Sample Termination of Care Letter:

Date

name

address

Dear name:

The purpose of this letter is to inform you that the University of Maryland, School of Dentistry, has decided that we must terminate our dental provider-patient relationship with you due to (EXPLAIN REASON). Effective immediately, the School of Dentistry will not begin any new dental treatment.

As of the date of this letter, there are (DESCRIBE TREATMENTS THAT HAVE BEGUN AND EXPLAIN THAT THEY NEED TO BE COMPLETED). We will complete those treatments if you are willing to do so. You will be financially responsible for all treatment that is completed and will be charged accordingly.

For the next thirty days, the School of Dentistry will remain available to you to provide emergency treatment only through the Urgent Care Clinic. Please phone (410) 706-2716 to arrange an emergency appointment.

It is recommended that you identify a new dentist as soon as possible to continue your dental care. Failure to continue with care could result in a worsening of your oral condition, including possible pain, infection, swelling and/or tooth loss. If you need assistance in selecting another dental provider, you may wish to contact the Maryland State Dental Association at (410) 964-2880.

At your request, we will forward a copy of your dental record to your next provider. Attached please find a Records Request Form for your convenience and for you to complete if you would like a copy of your dental record forwarded.

Thank you for your past confidence and for allowing the University of Maryland, School of Dentistry to treat your dental needs.

Sincerely,

(Patient Care Coordinator, Director, Program Director, Director of Clinic Operations, Ombudsman, Associate Dean of Clinical Affairs)

Transferring Patients to Residents and Diamond Scholars in AEGD Clinic

Subject: III. Clinical – H. Patient Administration

Effective Date: 8/5/15

Reviewed and/or Revised: 09/01/2017, 2/29/2024, 8/13/2025

Purpose: To outline the process of transferring patients from one class of residents and diamond scholars to the next class. This system was developed to ease the transition of patient care and minimize lapses in care.

Policy and/or Procedure:

AEGD: Pathway for Patients Transferred to AEGD Resident or Diamond Scholar

All patients are assigned to their primary residents or diamond scholar provider
Any patient on recall and/or not in active treatment are assigned to our staff hygienist as their primary provider. This prevents losing track of patients who belong to the AEGD clinic.
All patients are transferred and assigned from one resident to another at the beginning of the postgraduate academic year.
In June, the incoming class receive their axium provider numbers (R-number)
During orientation, we hold a patient familiarity session during which new residents have a one-to-one meeting with the graduating provider. During the meeting providers are expected to discuss their schedules for the next month as well as review assigned patient needs and pending treatment.
An axium report outlining all “in-process” laboratory cases is printed and provided to the new providers upon matriculation in the program.
The Diamond scholars have an earlier graduation time compared to residents. They are unassigned from patients, and their patient cohort goes to the “needs list” and stored on axium,. Once the new Diamond Scholars are selected, the patients are re-assigned to the new Diamond Scholar providers.
As part of the program check out process, all providers are required to enter a transfer note on the patient axium record for any patient with completed care or pending needs. The note contains details pertaining to the progress of the patient treatment.
The business office initiates the chart checkout as early as Spring. Transfer notes are reviewed and approved by the business manager and Treatment coordinator. At that time, if a new provider is available for re-assignment, the patient becomes reassigned. If no new provider is available for the reassignment, then the patient is allocated on the “needs list” on axium and becomes re-assigned at the beginning of the academic year when new providers are available.
The transfer process cannot be initiated for providers with pending clinical administrative duties, such as in-process treatment or unapproved notes or forms.

Treatment Planning Policy – Predoctoral Clinic

Subject: III. Clinical – H. Patient Administration

Origination Date: 6/1/08

Reviewed and/or Revised: 09/01/2017, 8/15/2025, 2/04/2026

Purpose: Ensure accurate diagnostic data is compiled in order to develop an appropriate treatment plan.

Definitions: TPW- Treatment Plan Work up, TPU-Transfer Patient Update, TXP-Treatment Plan Presentation

Policy and/or Procedure:

Accurate diagnostic data gathered and recorded are essential for developing a patient’s treatment plan. During the treatment plan work up appointment (TPW) information the following information is collected and is entered into the Electronic Health Record (EHR):

Medical History and Exams form
- Medical History
- Dental History
- Extraoral Intraoral Exam (EOE/IOE)
- Occlusal Exam/TMD
- Periodontal Exam
Periodontal Chart
Periodontal Diagnosis and Treatment Plan
Caries Risk Assessment Form
Radiographic Exam
Additional discipline-based forms as applicable to the patient’s needs.

Diagnostic Models, appropriate radiographs, and intraoral images need to be obtained. Individual patients may require additional information including but not limited to medical consults, laboratory results, and in some cases legal authorization to treat. If you have questions, consult faculty to make sure all necessary data/information has been obtained. This information is the basis for decision-making and formulating a treatment plan for the patient.

Treatment plan presentations (TXP) include an in-depth faculty review of the student’s findings and radiographs from the treatment plan workup (TPW) appointment. The patient is evaluated clinically to confirm all findings. All treatment plan options are presented to determine the most appropriate course of treatment. Finances related to the proposed treatment are reviewed.

Treatment plan updates (TPU) are for patients of record that are transferred from a previous student provider. Appropriate updates are made in the Electronic Health Record (EHR) including updated periodontal charting, updated radiographic exam based on risk and clinical presentation. Once this is completed, the faculty reviews the findings and confirms existing planned treatment as well as any additional needed treatment.

Note: Treatment plans require the patient’s signature. Faculty verification is documented through the electronic approval in axiUm (“swiping” treatment from planned unapproved to planned approved) Additional signatures (witness/student and appropriate faculty is required for certain procedures “Day of Consent” and for certain third-party insurance coverage (Medicaid).

Failure to obtain signatures signifies a lack of fully informed consent. Since this is such an important issue, such failure will result in an N or a U grade in professionalism for that session. Repeated offenses may result in generation of a counseling report.

Recourse for non-compliance:

Student may receive an N or U grade for both Professionalism and/or the Clinical Procedure on their daily grading form in Axium. An N or U grade in Professionalism will negatively impact their grade in Comprehensive Care and Patient Management 538 and/or 548.
Academic Counseling Report will be generated that may lead to Dean’s counseling, suspension from clinic, or judicial board review.

Laws, Regulations, Standards, etc. that must be observed:

Treatment Planning Procedure

Subject: III. Clinical – H. Patient Administration

Effective Date: 8/19/13

Reviewed and/or Revised: 09/01/2017, 12/08/2025

Purpose: Accurate diagnostic data gathered and recorded are essential for developing a patient’s treatment plan. During the treatment plan work up appointment (TPW) information is entered into the Electronic Health Record (EHR), including the Caries Risk Assessment, Periodontal Charting, EOE/IOE, TP Primer, TMD/occlusion, Treatment History, Medical History, Dental History, and other discipline-based forms. Diagnostic Models, appropriate radiographs, and Intraoral Images need to be obtained on the patient. Individual patients may require additional information including but not limited to medical consults, laboratory results, and in some cases legal authorization to treat. If you have questions, consult faculty to make sure all necessary data/information has been attained. This information is the basis for decision making and writing a treatment plan for the patient.

Definitions:

TPW: Treatment Plan Work up
TXP: Treatment Plan Presentation
TPU: Treatment plan up-date

Pre-Requisite:

Students must be unconditionally advanced to the third year, including passing the TXPL 528 course to perform TPW and TXP independently. Generally, a screening appointment precedes the TPW appointment. If the patient’s case is straight forward and time allows, the initial appointment with the patient may include screening procedures, data collection, and a treatment plan presentation. The patient will be assigned to a primary student provider, as well as a secondary student provider for co-therapy at the initial appointment.

Part I – 1st appointment with patient

Treatment Plan Work Up (TPW):

Seat patient; Review medical history; Obtain BP and pulse
Get a start from faculty member. Inform the faculty member of any significant medical history and the procedure(s) you plan to perform today.
Complete hard tissue exam and periodontal exam, charting all findings to the odontogram.
Evaluate Radiographs and obtain assistance to take images of additional radiographs that may be needed. Chart all radiographic findings to the odontogram.
Obtain diagnostic impressions and bite registration as needed.
Take intraoral pictures when appropriate.
Write any necessary medical consultation if not already completed at screening appointment.

Part II

Preparation for Treatment Plan Presentation

Review and organize all data - systematically arrive at diagnoses, prognoses, contingencies, etc.

Complete the TxPlan module for complex treatment plans that include multiple Definitive Phase options.
Phase and sequence the plan of treatment using this feature in axiUm.
Confirm appointment with patient 24-48 hours in advance.
Cancellations, changes, etc. must be entered in the chart.
Be prepared to discuss alternative treatment plans.

Part III Treatment Plan Presentation

Have the electronic record, mounted models, radiographs, oral images, instruments and patient positioned.
Greet and seat patient.
Introduce instructor to patient.
Review medical history; obtain BP and pulse.
Get a “start” from a faculty member. Inform the Faculty member of any significant medical history and the procedure(s) you plan to perform today.
GP Director or Assistant GP Director are the only faculty that are calibrated to cover a TXP.
Present findings in EHR including caries risk assessment, periodontal charting, EOE/IOE, TP Primer, TMD/occlusion, treatment history, medical history, dental history, and other discipline-based forms. Faculty and the student will review radiographs, intraoral images, and mounted diagnostic casts.
Faculty member to examine the patient.
Consultation from specialties as needed.
Finalize the treatment plan and obtain an approval swipe of planned treatment from the supervising faculty.
Obtain informed treatment consent (TP-CON) from the patient, which includes having patient sign the treatment plan.
Inform the patient of all costs of treatment, and escort patient to the business manager for further discussion of payment options.

Note:

Treatment plans must include the patient, student and appropriate faculty consent signatures before treatment services are rendered. Failure to obtain signatures implies that there is no informed consent. Since this is such an important issue, such failure will result in an N or a U grade in professionalism for that session. Repeated offenses may result in generation of a counseling report.

Procedure is successful when all parties have signed the treatment plan, and the patient has been given a copy of the signed treatment plan that has been entered into Axium.

Recourse for non-compliance:

Student may receive an N or U grade for both Professionalism and/or the Clinical Procedure on their daily grading form in Axium. An N or U grade in Professionalism will negatively impact their grade in Comprehensive Care and Patient Management 538 and/or 548.
Academic Counseling Report will be generated that may lead to Dean’s counseling, suspension from clinic, or judicial board review

UMFDSP Food and Business Meals Expense Policy

Subject: III. Clinical – H. Patient Administration

Effective Date: February 1, 2014

Reviewed and/or Revised: 09/01/2017, 2/24/2024, 8/13/2025

Purpose: To describe and provide some examples of allowable and unallowable business meal reimbursements and food purchases using UMB funds in order to meet:

Maryland General Accounting Division requirements
Internal Revenue Code accountable plan requirements
Federal cost regulations under OMB Circular A-21

Policy and/or Procedure:

Section VIII - 99.00 (A) Food and Business Meals Expense

Functional Area of the VP-In-Charge:

Administration & Finance

Contact:

Disbursements Manager, Financial Services

410-706-2931

Required By:

State of Maryland General Accounting Division Guidelines

Policy is:

Revision of A&F Policy 3332

Policy Statement:

Expenditures for food must be in accordance with State requirements, reasonable, necessary, and part of a documented bona fide business function of the University of Maryland, Baltimore (UMB). Expenditures must not be for events considered to be routine meetings, gatherings that are primarily social in nature, or purchase of alcoholic beverages. Within these guidelines, the local hosting of an event and purchase of food/catering services or business meals in support of UMB business may be allowable use of UMB funds.

Department approvers have the right to reject all or part of the reimbursement requests at their discretion.

Allowable Expenses:

Using UMB funds to pay for business meals or food/catering services may be appropriate in the following circumstances:

Interviews of an applicant (and the applicant’s spouse, if invited) for employment by official UMB host(s) for positions of Faculty, Department Heads, Directors, Deans, Vice Presidents and President.
Meals with prospective students.
Meals for visiting scholars and faculty.
Meals for distinguished guest speakers/lecturers.
Meetings with business leaders outside UMB for the purpose of developing student interaction, future contributions to programs, or developing business relationships benefitting UMB.
Meetings with colleagues from other universities to discuss university research, instruction, administrative functions, etc.
Business meals where external consultants are participating in official UMB business.
Conferences, convocations, symposiums and other special events which are on behalf of or substantially involve personnel not employed by UMB.
Events where participant fees are collected to offset the food cost (e.g., a conference).
UMB-wide events coordinated through the Office of Communications and Public Affairs to promote or further UMB’s mission (e.g., commemoration of Dr. Martin Luther King Jr. during Black History Month).
Student events and student related functions (note- postdoctoral fellows, residents, and trainees are not students).
Food or meals for activities that are specified as allowable charges under a grant or contract.
Donor cultivation events.
Employee-only full or half-day workshops, seminars, conferences, retreats, etc., where the event overlaps routine meal times.
UMB-wide employee awards/appreciation events coordinated through the Department of Human Resource Services (within UMB University Operations).
Meals during unusual hours or at unusual places of work for employee groups performing required UMB services (e.g. weekend meetings or emergency-related activities).
Meetings with affiliates for three or more hours where the offices of the attendees are more than 5 miles apart.

Unallowable Expenses:

Business meals or food/catering services are not appropriate in the following circumstances:

Personal meals among UMB employees.
Routine (see definitions) meetings among UMB employees (e.g. faculty and/or staff meetings).
Meals during general discussion meetings among employees.
Costs associated with social functions or activities such as (but not limited to) birthday parties, holiday parties, retirement parties, Administrative Professional’s Day events, etc.
Expenses for food that are subsequently reimbursed by the UMB Foundation or any affiliated entity.
Purchase of alcoholic beverages (including related tax and tip).
Functions where one or more students are present but the primary purpose of the meeting is not student related.
Other expenses not listed under allowable expenses.

Dollar Limitation Guidelines:

The following guidelines are provided to assist faculty and staff in determining what food costs are reasonable within the broad array of events and situations that arise in the course of campus business.

Individuals must apply a prudent and reasonable approach to business meals. The reasonableness of an expense depends upon many relevant factors, including the business purpose of the event and the location. The maximum amount of expense allowable for business and catered meals for one person in one day (including tax and tip) is one and one half (1 ½) times the maximum per diem rate set by the federal government (US General Services Administration). Refreshment or snack expenses are set at the breakfast rate. Click the following link for the current Business Meal Rates.
Departments have the authority to limit or prohibit reimbursement or payments based on availability of funds, availability of lower cost alternatives, specific requirements of funding sources, or reasonableness. Established meal rates are maximums and should not be considered entitlements.
Amounts in excess of these guidelines may be permitted based upon circumstances including location. Expenditures that exceed these guidelines must be justified by the department and approved in writing by the President or his/her designee.

Applies to:

All UMB Personnel and Affiliates

Definitions and Terms:

Affiliated Entity - An entity that has a relationship with UMB authorized by the Board of Regents or by law, e.g., faculty practice plan organizations, UMB Foundation and other affiliated foundations, recognized incorporated alumni associations, affiliated business entities, the University of Maryland Medical System/University of Maryland Medical Center, and other University System of Maryland institutions.

Business Meal- A meal, generally occurring off campus, involving one or more non-UMB employees where the business purpose for the expense is clearly identified.

Employees- Includes all UMB employees (staff, faculty, residents, and postdoctoral fellows; regular, contingent I and contingent II), trainees, and employees of Affiliated Entities.

Food/Catering Services- The purchase of meals or refreshments served on UMB property or at an off-campus location for a group of people.

IRS Accountable Plan- An accountable plan is a method for reimbursing employees for business expenses that complies with IRS regulations. If the IRS rules for an accountable plan are maintained, reimbursement paid to employees is not required to be treated as taxable income.

Routine - In the context of frequency or types of meetings- a meeting is routine when it is regularly scheduled or recurring on a periodic basis (i.e. weekly, bi-weekly, monthly, quarterly, annually, etc.) for the same group of people.

UMB funds – All funds administered by UMB, regardless of fund source. UMB funds include State Appropriations, Auxiliary funds, Revolving/Discretionary funds, Designated Research Initiative Funds, Contracts or Grants, and Other Restricted funds.

Scope:

This policy applies to all food and business meal purchases with UMB funds. The requirements stated in this policy apply when reimbursement or payment is being requested directly from UMB. The policy also applies when reimbursement or payment is being requested from an affiliated entity and subsequently reimbursed by UMB.

Limitations:

This policy does not apply to food/meal purchases during travel that are covered under UMB Policy VIII-11.00 (A) – UMB Policy on Travel.
This policy does not apply to personal meal purchases related to employee relocations.
This policy does not apply to food that is purchased for resale by UMB (e.g. Donaldson Brown Center).

Responsibilities:

The UMB employee responsible for an event or meal involving food cost reimbursement must:

Submit all appropriate supporting documentation for food purchase or meal reimbursement.

Ensure that all food purchases and meal reimbursements are appropriate and in compliance with campus policy and Financial Services procedures.

Obtain appropriate approvals for food or meal reimbursements.

The Department of Financial Services under the direction of the Chief Administrative and Finance Officer (CAFO) is responsible for establishing procedures to promote compliance with this policy and adhere to IRS accountable plan requirements.

Employees who improperly submit and approvers who improperly authorize the use of UMB funds may be subject to disciplinary action. Purchases for food using UMB funds that are not in accordance with this policy must be reimbursed to UMB from external funds (e.g., Foundation funds or personal funds).

Exceptions:

Exceptions to this policy must be approved in writing by the CAFO. All requests should be in the form of a memo to the CAFO signed by the Dean/Vice President or the Dean/Vice President’s designee (e.g., an appropriate Associate Dean or Associate Vice President).

Attachments:

See UMB A&F Financial Services Standard Operating Procedure No. 3332 - Food and Business Meals Expense

Policy Effective: February 1, 2014

Verifying Medicaid Eligibility Procedure (Paying for Services: Medicaid (Title 19))

Subject: III. Clinical – H. Patient Administration

Reviewed and/or Revised: 09/01/2017, 2/26/2024, 8/13/2025

Purpose: The purpose of this procedure is to assure proper payment for care rendered to individuals who claim Medicaid eligibility

Policy and/or Procedure

Present a valid M.A. card performed by patient
Verify and record verification (point to website and telephone number) performed by first contact personnel
Check for coverage of planned procedure performed by first contact personnel

Verifying Patient Account Status Procedure

Subject: III. Clinical – H. Patient Administration

Reviewed and/or Revised: 09/01/2017, 8/15/2025, 1/09/2026

Purpose

The purpose of this procedure is to provide high-quality care to patients in alignment with the School of Dentistry business standards.

Policy and/or Procedure

Student reviews AxiUm "Transaction Screen", and "Patient Care" to assure account status: performed by student, and occasionally under the supervision of their business manager.

Steps

Account no more than 60 days overdue
Patient owes no more than $150
Patient has paid the cost of care not covered by insurance
Grant has not expired (check date)
Grant does not exceed cost of care delivered

Writing a Prescription Procedure

Subject: III. Clinical – H. Patient Administration

Effective Date: 9/20/15

Reviewed and/or Revised: 06/04/2016, 05/25/2017, 09/01/2017, 1/28/2024, 8/13/2025

Purpose: Support Policy Prescription Control System

Policy and/or Procedure:

Student/resident discusses with faculty need for prescription medication for patient
Credentialed/licensed faculty assesses need for medication
Student/resident informs faculty of what prescription they want to prescribe with name of medication, dose, instructions for taking medication, the # to dispense, the number of refills, and any other notes needed.
Faculty gives verbal authorization to student to create prescription
After reviewing the patient's medication history and medication allergies, the student/resident fills out prescription in Axium under the medications tab by launching eRx using the plus sign (+).
Credentialed Faculty review the medications, allergies, and prescription(s) set up by the student or resident. Then, faculty enter their Signature Password and click the send button in eRx. For EPCS medications, faculty must enter their Signature Password and EPCS Signing Passphrase to approve the prescription.
Student /resident makes an entry on the progress notes in patient record regarding the prescription written
Credentialed faculty swipes approval for progress note entry in patient record

Writing a Progress Note Procedure

Subject: III. Clinical – H. Patient Administration

Department: Clinical Affairs - General Dentistry

Effective Date: 8/19/13

Reviewed and/or Revised: 06/04/2016, 05/25/2017, 09/01/2017, 2/04/2026

Purpose: Assure content and format of progress note entries in the patient record are consistent across all provider groups

Policy and/or Procedure:

Definitions:

Axium: School of Dentistry’s electronic patient record system.

Approval: Approval is needed for the tasks mentioned. Click the Approve button to complete Approval. If the user has forgotten to approve an item, follow the directions below.

Policy and/or Procedure: To follow the procedures below, the user must log into Axium with their specific username and password.

Progress Note:

Health history review/update
Chief concern (CC) of the patient at that visit (if any)
History of present illness (HPI)
Appointment specific diagnosis(es)
Details of treatment provided
- Region/teeth/soft tissue treated
- Medications administered
- Medications prescribed
- Materials used
- Imaging (radiographic, digital, photographic)
- Findings during the procedure/appointment
- Prognosis
- Expected outcome
Patient behavior during the appointment
Plans for the next visit

Faculty and resident providers have the option of using a General Progress Note or SOAP template note in the TxHistory tab OR the Visit Form template in the Forms tab of the EHR.

Current instructions on how to add a General Note or a Visit Form are in the LINKS menu of axiUm.

I. Patient Care

Antibiotic Prophylaxis Prior to Dental Procedures

Subject: III. Clinical – I. Patient Care

Department: Clinical

Origination Date: 5/2007

Effective Date: 04/01/2025

Reviewed and/or Revised: 08/2007, 09/01/2017, 2/08/2024, 07/09/2025, 11/25/2025, 2/13/2026

Purpose

To prevent infective endocarditis (IE) or prosthetic joint infections (PJIs) in select high-risk individuals undergoing dental procedures known to cause bacteremia.

Policy & Procedure

I. Purpose
To prevent infective endocarditis (IE) or prosthetic joint infections (PJIs) in select high-risk individuals undergoing dental procedures known to cause bacteremia.

II. General Guidelines as per the AHA 2021 and ADA 2023 guidelines

Antibiotic prophylaxis is not recommended for most patients undergoing dental procedures.

It is only indicated for patients at highest risk of adverse outcomes from infective endocarditis or immunocompromised.

The use of an antiseptic mouth rinse before invasive dental procedures is not necessary or beneficial.

III. Indications for Prophylaxis
Antibiotic prophylaxis is recommended only for patients with the following cardiac conditions before invasive dental procedures (i.e., involving manipulation of gingival tissue, periapical region of teeth, or perforation of oral mucosa, refer to table below)

Prosthetic cardiac valve or prosthetic material used for valve repair
History of infective endocarditis
Congenital heart disease (CHD) as follows:
- Unrepaired cyanotic CHD (including palliative shunts/conduits)
- Completely repaired CHD with prosthetic material during the first 6 months
- Repaired CHD with residual defects at/adjacent to prosthetic site.
- Cardiac transplant recipients who develop valvulopathy

IV. Dental Procedures Requiring vs. Not Requiring Antibiotic Prophylaxis (Cardiac Risk Patients)

Procedures Requiring Prophylaxis	Procedures NOT Requiring Prophylaxis
Tooth extractions	Routine anesthetic injections (non-intraligamentary)
Periodontal procedures (e.g., surgery, scaling/root planing)	Dental radiographs
Dental implant placement	Placement/removal of prosthodontic/orthodontic appliances
Intraligamentary local anesthesia injections	Adjustment of orthodontic appliances
	Shedding of deciduous teeth
	Bleeding from trauma to lips/oral mucosa

V. Prosthetic Joints

Routine antibiotic prophylaxis is not recommended for patients with prosthetic joints (including hip/knee replacements), regardless of risk factors. It does not reduce their risk of developing prosthetic joint infections (PJIs) but may result in adverse drug reactions (e.g., Clostridioides difficile infection) and promote the development of antibiotic resistance.
Temporomandibular Joint replacements (TMJR)- Antibiotic prophylaxis for procedures involving the dentition post- TMJR is unnecessary, providing sufficient time for healing has occurred, with exceptions made only when clinically appropriate (e.g. infected third molars in close proximity to the ramus component with possibility of direct contamination during surgical removal, severely immunocompromised patient and history of previous joint infections)

PDF Appropriate Use Criteria for Management of Patients with Orthopedic Implants Undergoing Dental Procedures. 2016

Adapted from: Appropriate Use Criteria for Management of Patients with Orthopedic Implants Undergoing Dental Procedures. 2016.

VI. Recommended Regimens

Administer 30–60 minutes before the procedure.

Patient Type	Agent	Dose	Route	Notes
Adults (no allergy)	Amoxicillin	2 g	Oral
Children (no allergy)	Amoxicillin	50 mg/kg	Oral
Penicillin-allergic (adults)	Clindamycin	600 mg	Oral
	Azithromycin/Clarithromycin	500 mg	Oral
Penicillin-allergic (children)	Clindamycin	20 mg/kg	Oral
	Azithromycin/Clarithromycin	15 mg/kg	Oral
If oral meds can't be taken	Ampicillin, Cefazolin, or Ceftriaxone	Refer to guidelines	IV/IM	Avoid in penicillin-allergic patients due to cross- reactivity

If oral meds can't be taken, IV/IM options include ampicillin, cefazolin, or ceftriaxone (except in penicillin-allergic patients due to cross-reactivity risk).

VII. Documentation

Clearly document the medical indication for prophylaxis in the patient chart.
Confirm the dose, timing, and route used.
If in doubt, consult the patient’s cardiologist or medical provider.

VIII. References

American Heart Association (AHA), 2021 Scientific Statement
American Dental Association (ADA) Clinical Practice Guidelines, 2023
Wilson W. et al. "Prevention of Infective Endocarditis." Circulation. 2021
ADA Council on Scientific Affairs. "Antibiotic Prophylaxis for Dental Patients with Prosthetic Joints." JADA. 2023
M. Gadd, R.O. Elledge, Dental prophylaxis and alloplastic temporomandibular joint replacement (TMJR): time for a consensus? British Journal of Oral & Maxillofacial Surgery (2025), doi: https:// doi.org/10.1016/j.bjoms.2025.04.001
Paumier, T. M., Lockhart, P. B., Springer, B., & Thornhill, M. H. (2026). What dentists need to know about new guidelines for the treatment of patients with prosthetic joints. Journal of the American Dental Association, 157(2), 118–120.

Anticoagulant Therapy Guidelines for Dental Procedures

Subject: III. Clinical – I. Patient Care

Department: Clinical

Origination Date: 5/2007

Effective Date: 04/01/2025

Reviewed and/or Revised: 08/2007, 09/01/2017, 07/09/2025, 1/05/2026, 2/02/2026

Policy & Procedure

Purpose

To provide standardized guidelines for managing patients on anticoagulant or antiplatelet therapy undergoing dental procedures, minimizing the risk of bleeding while preventing thromboembolic events.

To assess and reduce the risk of severe/excess bleeding during dental procedures.
To assess the risk of serious medical complications
To provide guidance for dental faculty, residents, and students

II. General Guidelines from the AAOMS & ADA 2025

The decision to hold Oral Antiplatelets/Anticoagulants is based on overall bleeding risk, whereas the decision by the patient’s cardiologist to bridge with parenteral agents is based on thromboembolic risk. Procedures with MINIMAL RISK of major bleeding DO NOT warrant discontinuation, whereas those with greater bleeding risk do.

Minimal Bleeding Risk (No adjustment necessary): - Scaling/polishing- Simple fillings- Supragingival cleaning

Moderate-to-High Bleeding Risk: - Extractions- Periodontal surgery- Implant placement- Biopsies, advanced surgical procedures may require consultation)

Most patients taking anticoagulant (e.g., warfarin, DOACs) or antiplatelet therapy (e.g., aspirin, clopidogrel) can safely undergo dental procedures without interruption of therapy.
Unnecessary discontinuation increases the risk of thromboembolic complications (e.g., stroke, myocardial infarction).
Bleeding is usually minor and manageable with local measures.

Drug Class	Drug Names
Anticoagulant*	warfarin (Coumadin®) – Pt should have a recent INR
Antiplatelet agents*	clopidogrel (Plavix®) ticlopidine (Ticlid®) prasugrel (Effient®) ticagrelor (Brilinta®) Aspirin
Direct-acting oral anticoagulants**	dabigatran (Pradaxa®) rivaroxaban (Xarelto®) apixaban (Eliquis®)

III. Indications for Medical Consultation

Medical consultation is advised prior to invasive dental procedures if:
- INR is unknown or outdated (>7 days old) in warfarin patients
- The patient has:
  - A history of major bleeding complications
  - Liver or kidney failure
  - Combined use of multiple anticoagulants/antiplatelets
  - High thromboembolic risk (e.g., recent stroke (within the past 90 days), mechanical heart valves)

IV. Indications for Discontinuations of Anticoagulants

For most dental procedures performed in an office-based environment, Oral Antiplatelets/Anticoagulants discontinuation is not recommended as per ADA/AAOM guidelines. However, in instances where more invasive or extensive dental or oral and maxillofacial surgery is planned that ideally requires Oral Antiplatelets/Anticoagulants stoppage, the proposed timelines for when Oral Antiplatelets/Anticoagulants should be used as a guideline in conjunction with the patient’s cardiologist for stopping and restarting the anticoagulants. The ranges presented allow for some discretion based on the degree of functional coagulation needed to minimize major bleeding.

V. Anticoagulant Agents and Considerations

Agent Type	Examples	Management Strategy
Warfarin	Coumadin	Proceed if INR ≤3.5 within 48–72 hrs of appt.
DOACs	dabigatran (Pradaxa®), apixaban (Eliquis®), rivaroxaban (Xarelto®)	Delay dose on day of procedure (if AM appt). Continue therapy without interruption for minimal to moderate bleeding risk patients.
Antiplatelets	Aspirin or Clopidogrel	Continue therapy without interruption
Dual Therapy	Aspirin + Clopidogrel	Assess bleeding risk; consult physician

*The patient’s cardiologist is the ultimate decision maker in stopping OAPs, and the duration of medication is to be held. A cardiac clearance or medical consultation should be obtained if there are any questions/concerns.*

VI. Dental Procedures Requiring vs. Not Requiring Clearance for Anticoagulant Therapies

DO NOT require Cardiac Clearance	Require Cardiac Clearance and Medical Consult*
General Exams & Cleanings	Major Surgery/ Flaps/ Perio Surgery
Simple Extractions	Multi-Tooth Extractions
Deep Scaling and root planning	Implant Placement
Placement/Removal of rubber dam	Biopsies
Placement/Removal of restorations (fillings) that do not extend subgingivally	Crown Lengthening
Crown or Bridge cementation	Incision and Drainage of abscess

*Providers must obtain a Medical Consult for all procedures requiring cardiac clearance.

Management: for the above-listed procedures:

Proceed without altering anticoagulants
Use local hemostatic measures (e.g., sutures, Gel foam, tranexamic acid rinse)

VII. Local Hemostatic Measures

Focus on controlling bleeding using local techniques:
- Pressure: Apply pressure with gauze for 30-60 minutes and instruct the patient to bite down on it. For broad surgical flaps use moist (saline) gauze with direct manual pressure to establish the clot and not traumatize the flaps.
- Hemostatic Agents: Consider using local hemostatic agents like collagen or gelatin sponges. (Judicious, limited use of local anesthetic with vasoconstrictor.)
- Cauterization: If necessary, use cauterization to control bleeding, where appropriate and not at the base of a flap.
- Sutures: Sutures can be used to close the wound, but this is a point of variation in protocols.
- Antifibrinolytics: In some cases, antifibrinolytics like tranexamic acid or epsilon aminocaproic acid may be used topically to help clot formation.
- Additional recommendations: During surgical procedures, obtain primary closure wherever possible and ensure flap stability prior to patient dismissal. Avoid prescribing post-operative analgesics that my bind to platelets (i.e. ibuprofen) which may enhance post-operative bleeding.

VIII. Documentation

Record
- Anticoagulant/antiplatelet regimen
- INR value and date (if warfarin)
- Nature of dental procedure
- Hemostatic strategies used
- Communication with prescribing physician (if applicable)
- Follow- up with patients in person or at least via telephone communication and documentation in chart will be necessary after the procedure.

IX. References

ADA Clinical Practice Guidelines on Managing Patients on Anticoagulants, 2023
ACC/AHA Guidelines for Antithrombotic Therapy in Dental Procedures, 2022
Nakasone et al. “Bleeding Risk and Management in Dental Patients on Anticoagulants.” JADA, 2023

Assessing Patient Symptoms of Respiratory or Airborne Diseases Procedure

Subject: III. Clinical – I. Patient Care

Reviewed and/or Revised: 09/01/2017, 1/18/2024, 4/19/2024, 8/15/2025, 9/02/2025, 1/7/2026

Purpose

To detect respiratory or airborne disease and minimize the possibility of spreading such diseases

Policy and/or Procedure

Institute Respiratory Hygiene and Cough Etiquette: performed by caregiver
Don PPE: performed by caregiver
Take vital signs: performed by caregiver
Assess condition of individuals who exhibit symptoms of
Tuberculosis: (cough lasting longer than 3 weeks, hemoptysis, weakness, weight loss, chills, fever, night sweats)

SARS-COVID: (temperature greater than 100.4°F (>38.0°C); headache, an overall feeling of discomfort, and body aches; diarrhea; dry cough)

Influenza: (fever: usually high; headache; tiredness (can be extreme); cough; sore throat; runny or stuffy nose; body aches; diarrhea and vomiting (more common among children than adults)

RSV: (cough, headache, sore throat, shortness of breath, cyanosis, wheezing)

Pertussis: (Violent & rapid cough with difficulty inhaling, fever, cyanosis, sore watery eyes, sneezing and nasal discharge)
Question individuals about current respiratory symptoms and, if patient, record thorough medical history in progress notes: performed by caregiver
If history or symptoms suggest undiagnosed active TB refer to Baltimore City Health Department or private physician for medical evaluation: performed by performed by caregiver
If febrile
For Elective Dental Treatment: Defer treatment until physician confirms that the patient does not have infectious respiratory disease, OR another diagnosis is made that explains the signs and symptoms, OR patient recovers: performed by caregiver

For Urgent Dental Care: Refer to HOSPITAL that provides airborne infection isolation and fit-tested, disposable N-95 respirators
If having tested positive for or experiencing signs and symptoms of a respiratory illness, follow the current CDC and MD health department’s recommendations and guidelines.

NOTE: The individual should not remain in the Dental School any longer than necessary. Dismiss them immediately after evaluating their condition and arranging a referral. The individual should not return to the Dental School or Dental School Clinic until a diagnosis of TB has been excluded OR the individual is on therapy and a physician has determined that the individual is noninfectious.

Audit of Patient Records: Pre-Prosthetic Audit Policy and Procedure

Subject: III. Clinical – I. Patient Care

Origination Date: 6/1/08

Effective Date: 8/19/13

Reviewed and/or Revised: 09/01/2017, 8/15/2025

Purpose: To ensure sequence of treatment is appropriate, financial issues are addressed, periodontal status is adequate and all disease control procedures have been completed prior to commencing prosthetic/definitive treatment.

Policy and/or Procedure:

Student ensures that patient’s record up to date and contains a treatment plan with all appropriate signed informed consent.
Student reviews AxiUm to ensure that finances are addressed which is subsequently reviewed by a business manager.
A Prosthodontic Pre-Doc EPR Form is completed electronically by the student (including a scanned in RPD Design, if applicable) and is reviewed and approved by a supervising faculty.
Student reviews the patient record to ensure that there are current radiographs, that the periodontal status is stable and that all disease control procedures are completed.
PCC updates patient status code to in-process for General Practice Director (GPD) /Assistant General Practice Director (AGPD) to review (code D0170.5).
GP Director/Assistant GP Director examines the above steps performed by the student, then evaluates the patient clinically, and swipes Code D0170.5 as complete if all conditions are met.
Student continues with prosthetic/definitive procedures when authorized.

Axium Access Policy

Subject: III. Clinical – I. Patient Care

Department: Office of Information Technology

Origination Date: July 23, 2013

Effective Date: August 5, 2013

Reviewed and/or Revised: 09/01/2017, 8/14/2025

Purpose: The purpose of this policy is to safeguard data and access controls within our Electronic Patient Record system, Axium.

Policy and/or Procedure:

Faculty, resident, and staff Axium users may access Axium from 1am to 11pm daily. Student Axium users may access Axium from 6 m to 12pm daily. During the periods when access is denied, Axium backup procedures are occurring.

Specific user levels are defined within Axium to identify and manage the access that each user level has. There are various types of user levels (about 40) in Axium, both providers and non-providers. User levels and access is defined by each employee’s job duties and responsibilities.

Blood Pressure Equipment (Manual and digital handheld); Use and Management

Subject: III. Clinical – I. Patient Care

Department: Clinical

Origination Date: 11/5/13

Reviewed and/or Revised: 09/01/2017, 4/20/2018, 1/08/2024, 8/13/2025, 11/18/2025, 12/09/25

Purpose: To promote the proper use and management of School of Dentistry manual and digital electronic handheld equipment to be used for patient blood pressure assessment, per the Testing for Hypertension Policy, to ensure safe patient treatment, including the need for medical consultation or referral as needed. All blood pressure readings will be evaluated based on the 2017 ACC/AHA Hypertension Guidelines published September 13, 2017.

Definitions:

Aneroid Sphygmomanometer: An instrument for measuring blood pressure in the arteries, consisting of a pressure gauge and a rubber cuff that wraps around the upper arm and inflates to constrict the arteries; they are mercury free.
Auscultation: listening for sounds within the body
Calibration/recalibration: the act of adjustment to match a standard
Diastolic: pertaining to the relaxation and dilation (diastole) of the heart when the chambers fill with blood
Hypertension: A blood pressure with a systolic pressure reading of 140 or greater and a diastolic pressure reading of 90 or greater (pressure level readings for the stages of hypertension, and pressure readings denoting prehypertension can be found in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and treatment of High Blood Pressure (JNC 7) published in 2003)
Korotkoff sounds: arterial sounds heard through a stethoscope applied to the brachial artery distal to the cuff of a sphygmomanometer that change with varying cuff pressure and that are used to determine systolic and diastolic blood pressure
mmHg: A unit of pressure equal to 0.001316 atmosphere. Used in the assessment of blood pressure.
Stethoscope: instrument for listening to the sounds made within the body, typically consisting of a hollow disc (diaphragm) that transmits the sound through hollow tubes to earpieces
Systolic: pertaining to the contraction of the heart when blood is driven through the aortal and pulmonary arteries after each dilation or diastole

Procedure:

I. Blood pressure must be assessed and recorded in the electronic record on each patient, at each visit, at the time the medical history is reviewed and updated as needed. Ask an SOD nurse if assistance is needed.

Two types of handheld equipment are available within the SOD for use:
1. Digital/electronic cuff with automatic inflation for use on the arm or wrist as indicated
  *****(automatic wrist cuffs are not as reliable as arm cuffs/ automatic cuffs are not as reliable as manual cuffs)
2. Aneroid Sphygmomanometer (definition above)
CHECK THE EQUIPMENT. Do not use if any problems are found
1. Look to see that the aneroid sphygmomanometer gauge needle is at zero (needle on dial is centered at pressure gauge bottom, or at least within the box or circle).
  
  *Blood pressure cuffs that are no longer calibrated to zero are to be thrown in the trash, and replaced with a new cuff; they are not recalibrated.
2. Check the cuff for any breaks in stitching or tears in the fabric.
3. Check the rubber tubing for cracks or leaks, especially at connections.
4. Be sure three sizes of cuffs are accessible (small, regular, and adult large).
5. Use 12-15 inch stethoscope tubing and bell/diaphragm stethoscope head when using aneroid sphygmomanometer.
6. When using an electronic blood pressure assessment device, make sure the batteries are fresh

II. Procedure for Determining Blood Pressure with a Manual Device

Prepare the Patient
1. Tell the patient briefly what is to be done.
2. Seat the patient comfortably, with the arm slightly flexed, palm up and the whole forearm supported on a level even with the heart. (figure 1 below)
3. Use either arm unless otherwise indicated, for example do not use the arm with an A/V fistula, shunt, PICC line or physical disability. Repeat blood pressure readings should be completed on the same arm as differences in each arm can be as much as 10 mm Hg.
4. Take pressure on bare arm, not over clothing.
Apply the Cuff
1. Use proper cuff size. The size of the patient determines the size of the cuff selected. There are several cuff sizes. The cuff width should be approximately 20% greater than the diameter and take up 2/3 of the upper arm. When a cuff is too narrow, the blood pressure reading is too high; when the cuff is too wide, the reading is too low. (figure 1)
  figure 1
2. The patient's skin at cuff placement area should be bare and unrestricted by clothing
3. Apply the completely deflated cuff to the patient’s arm, supported at the level of the heart (either on a table or with your arm) figure 2
  figure 2
  - Place the portion of the cuff that contains the inflatable bladder directly over the brachial artery (located medial to midline moving toward the patient’s body). figure 3
    figure 3
  - The cuff may have an arrow to show the point that should be placed over the artery. Attach cuff so it fits snugly enough not to slide down the arm, but not so tight as to not be able fit 2 fingers underneath cuff edge. The cuff should be placed 2 finger widths or about an inch (2cm) above the crease of the arm (antecubital fossa/inside crease of the elbow). Fasten the cuff evenly and snugly. figure 4
    figure 4
  - Adjust the position of the gauge for convenient reading (the gauge does not have to be attached to the cuff, remove it if it is difficult to visualize clearly while attached). figure 5
    figure 5
Proceed with blood pressure measurement
1. Blood pressure measure should be done in a quiet environment; instruct patient not to talk and make sure patients sure legs are not crossed which may elevate blood pressure.
2. For the first reading only, OBTAIN ESTIMATED SYSTOLIC PRESSURE
  - Palpate the radial artery at the wrist; thumb side. figure 6a
    figure 6a
  - Inflate the cuff to the point where the pulse can no longer be felt. figure 6b
    figure 6b
  - Slowly deflate the cuff, noting on the gauge the point where the pulse can no longer be felt (this is the estimated systolic pressure), then rapidly deflate the cuff and wait at least 15 to 30 seconds before re-inflating the cuff to begin the first measurement
  - Calculate the maximum inflation level (MIL) by adding 30 mm Hg to the estimated systolic pressure
For the second reading, and subsequent readings:
- Palpate the area between the antecubital fossa and cuff to locate the brachial artery pulse found on the medial side of the forearm between midline and the patient’s body (figure 3 above). The stethoscope end piece is placed over the spot where the brachial pulse is felt. (figures 3, 4, and 5 above)
- Position the stethoscope earpieces in the ears, with the tips directed forward toward the nose. figure 7
  figure 7
Inflate the Cuff
- Close the needle valve (air lock) attached to the hand control bulb firmly, but so it may be released readily. Pump to inflate the cuff until the radial pulse stops. Note the mercury level at which the pulse disappears.
- Look at the dial, and pump to 20 or 30 mm Hg beyond where the radial pulse was no longer felt. This is the maximum inflation level (MIL). It means that the pressure of the cuff collapses the brachial artery and no blood is flowing through the artery.
Deflate the Cuff Gradually
- Release the air lock slowly (2 to 3 mm per second) so that the dial drops very gradually and steadily.
- Listen for the first sound: systole (“tap, tap”). Note the number on the dial, which is the systolic pressure. This is the beginning of the flow of blood past the cuff.
- Continue to release the pressure slowly. The sound will continue, first becoming louder, then diminishing and becoming muffled, until finally disappearing. Note the number on the dial where the last distinct tap was heard (not the muffled sound). This number is the diastolic pressure.
- Let the remaining of the air out rapidly.
Repeat for confirmation when there is a question about a reading
- Wait 1 minute before inflating the cuff region again. More than one reading is needed within a few minutes to determine an average and ensure a correct reading.
Record blood pressure:
- Write the date and arm used.
- Record blood pressure as a fraction. Example: R Arm, Nov. 3, 20XX, 120/80.
- Record the reading to the nearest 2mm (round off upward); for non-electronic equipment only.
If blood pressure reading is exceptionally high:
***(Systolic >160/ Diastolic >100) or low ***(Systolic <100/ Diastolic <65) , consult a dental school nurse for assistance.
- Also, ask patient if they smoked, drank caffeine or alcohol and engaged in any physical exercise within the past 30 minutes. If the patient is prescribed hypertension medications ask if they compliant with taking them on a regular basis.
- Digital electronic cuffs may not be as accurate as manual cuffs. The School of Dentistry is not responsible for electronic cuff recalibration. If an electronic cuff is providing consistent readings that are off from non-electric aneroid sphygmomanometer readings by more than 5mmHg, it must be replaced.
- A minimum of two reading should be taken at least 1 minute apart, and the average should be used; if there is 5 mm Hg difference or more between the first and second readings, one or two additional reading should be obtained using the average of those readings.

NORMAL BP: BP is <120/80 mmHg
ELEVATED: systolic BP 120-129 and diastolic BP <80 mmHg
Stage 1 Hypertension: systolic BP 130-139 mmHg or diastolic BP 80-89 mmHg
Stage 2 Hypertension: systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg

Caring for a Patient with an Aspirated or Ingested Foreign Body Policy and Procedure

Subject: III. Clinical – I. Patient Care

Origination date: 12/8/2014

Effective date: 1/1/2015

Reviewed and/or Revised: 08/04/2016, 09/01/2017, 01/18/2024, 8/13/2025

Purpose: The purpose of this procedure is to manage and coordinate responses for incidents involving patients ingesting or aspirating a foreign object associated with dental treatment.

Procedure:

If a patient aspirates or swallows (or may have aspirated or swallowed) a foreign object during treatment, the provider should immediately notify attending faculty and page the SOD Emergency Response Team @ 410-706-8128.

Faculty will take command of the situation while the Emergency Response Team is en route or if the Emergency Response Team is unavailable after the second page.
If the patient has shortness of breath, uncontrollable coughing, or any other signs of respiratory involvement, retrieve the nearest red emergency cart. Then start oxygen with a nasal cannula at 2-4 L/min for oxygen support or if patient is in moderate respiratory distress, use a non-rebreather oxygen mask at 10 L/min (make sure the bag inflates).
If the patient is in acute respiratory distress or otherwise unstable, attending faculty and/or the Emergency Response Team member will direct that an ambulance be called via the Campus Police at 911.
If the patient is medically stable and not having any respiratory symptoms as a result of having swallowed something, the student or resident treating the patient will retrieve a Radiology Request Packet available on the nurses’ office doors (rooms 1326, 2318, 3322, or 4317). Inside the packet is a Radiology Request Form, Patient Foreign Object Ingestion/Aspiration Information Sheet and Incident Form. This incident form is to be filled out by the provider and signed by the Faculty. Instructions on how to proceed with getting the patient x-rayed, to verify the object’s location, are located on the outside of the packet envelope and attached.
- The patient MUST sign the Patient Foreign Object Ingestion/Aspiration Information Sheet, it must also be signed by attending faculty or the nurse. The patient will then be given a copy of the information sheet.
- If the patient insists they feel fine and doesn’t want an x-ray, have the patient initial the Patient Foreign Object Ingestion/Aspiration Information Sheet on the line for “Refused x-ray”).
- If a nurse was not assisting with the incident, submit the completed Incident form to a nurse at the next available opportunity, along with the original signed Patient Foreign Object Ingestion/Aspiration Information Sheet (not patient’s copy).
Write a note in the chart, documenting the event and responsive action taken, and have note approved by faculty.
The provider should contact the patient periodically to monitor the status of the patient’s condition and document the outcome/conclusion of this incident in the dental record.

Patient Foreign Object Ingestion/Aspiration Information Sheet

Caring for Patients with Latex Sensitivity or Allergy Procedure

Subject: III. Clinical – I. Patient Care

Department: Oncology and Diagnostic Sciences

Reviewed and/or Revised: 09/01/2017, 1/28/2024, 8/13/2025

Purpose: Prevention of allergic reaction and the provision of safe dental care for patients who are latex sensitive

Policy and/or Procedure:

The prevention of an allergic reaction and the provision of safe dental care for patients who are latex sensitive is a major concern in the dental school. Latex allergy should be determined and documented in the patient’s electronic health record during the medical health history screening questionnaire. Distinction between a true Type I (immediate hypersensitivity reaction) reaction and a Type IV delayed hypersensitivity reaction where an allergic contact dermatitis occurs should be determined if possible. Effort should be made to avoid any latex-containing products while treating the patient. Latex-containing blood pressure cuffs can be used with a barrier such as a patient bib between the cuff and the patient’s arm.

Powder-free, non-latex gloves must be worn by the dental provider as well as the supervising clinical faculty member (and dental assistant if appropriate) when treating a dental patient with a latex sensitivity or latex allergy. In addition, powder-free, nonlatex gloves must be worn by dental students, clinical faculty and dental assistants with a latex sensitivity or latex allergy even if the patient is not latex sensitive as a best practice strategy for prudent patient treatment management.

Should it occur, management of severe Type I hypersensitivity reactions in the dental operatory require immediate medical attention. Emergency medical services (EMS) should be activated immediately as per dental school protocol. In addition, the patient must be monitored and maintained for an open airway.

Comprehensive Care Policy

Subject: III. Clinical – I. Patient Care

Reviewed and/or Revised: 09/01/2017, 02/15/2024, 3/13/2024, 7/31/2025

Purpose

Patients receiving comprehensive care and in an appropriate manner and timeframe

Definitions

Patients whose recall appointments are past due for > 24 months are no longer considered recall patients and must be assigned as new comprehensive care patients.

Policy Statement:

UMSOD will operate clinics that are patient centered, and which focus on the delivery of quality oral healthcare in an efficient manner. Appropriate attention must always be given to each patient’s unique personal circumstances (emotional, physical, social, economic, cognitive, and others) as treatment options are considered and proposed and as treatment is delivered to patients.

The objective of our comprehensive care program is to establish optimal health for all patients seeking care, with a focus on oral health. Optimal health is achieved for a patient when disease processes are eliminated or controlled, and the effects of past diseases are stabilized. Comprehensive dental care, in an educational environment, requires the student provider to integrate basic and behavioral science concepts with clinical science knowledge. Effective delivery of comprehensive care requires a coordinated, multidisciplinary and individualized approach leading to optimal oral health for the patient.

UMSOD will observe the following guidelines:

Patients may be assigned to a student dentist who arranges appointments, provides general dentistry services, and arranges for specialty consultations and treatment. All care is closely supervised by faculty.
A written treatment plan will include a phased description of the proposed care to be provided for the patient. The treatment plan will be written in the proper, individualized sequence.
Treatment planning will be based upon a diagnostic summary and reflect attention to all relevant medical and dental conditions.
The patient will be advised of appropriate alternate treatment approaches.
The detailed criteria for treatment planning, as listed in the Clinic Manual, shall apply.
Informed consent must be obtained from the patient or parent/guardian prior to initiating any treatment. The patient, primary student and faculty member approving the treatment plan will sign the treatment plan form. Translation services are available as needed.
Patient consent on the treatment plan will not imply patient financial obligation until specific treatments are initiated.
Patients classified as Adult prophies may be transferred to Continuing Care Hygiene or to Team Recall once the patient’s treatment is complete. Students are to provide at least one recall exam / scaling after initial adult prophy.
Patients classified as Perio Class 2 (or higher) should be maintained by their dental student until the spring semester of their senior year.
Graduating seniors in the DDS program must bring all records of patients assigned to them to the PCCs before they are cleared for graduation.
Students are responsible for performing scheduled recall and maintenance appointments on all active assigned patients.
Patients whose treatment has been completed by their assigned student may be assigned to the Continuing Care Program or Team Hygiene.
Patients in need of supportive periodontal therapy are seen in “Sophomore Block” preclinical exercise.
Senior dental hygiene and junior dental hygiene students (spring semester only) treat team patients. These are patients who, upon completion of their treatment, are assigned to dental hygiene students. The hygiene students are assigned as primary care providers and are responsible for maintaining the patients’ hygiene care.
When dietary counseling is needed for a co-therapy or other patient, this service will be included in the dental hygiene care plan and implemented during the course of dental hygiene treatment.
Year III and IV dental students will be responsible for providing the recall services for their assigned patients.
The continuing care program provides recall services for patients who have completed comprehensive treatment with a dental student who has graduated.
Individual departments and programs may institute quality assurance programs that include chart audits
The assigned student is responsible for appointing the patient and performing the recall. Recall information is automatically entered into AxiUm via procedure code.

Dental Management of Patients at Risk for Medication-Related Osteonecrosis of the Jaw (MRONJ)

Subject: III. Clinical – I. Patient Care

Department: Clinical

Origination Date: 1/2026

Effective Date:

Reviewed and/or Revised:

Policy & Procedure

I. Purpose
This policy establishes standardized clinical guidelines for the identification, prevention, counselling, and management of patients at risk for or diagnosed with Medication-Related Osteonecrosis of the Jaw (MRONJ).

The policy promotes patient safety, consistent evidence-based decision-making, optimized oral health outcomes, and preservation of the therapeutic benefits of antiresorptive therapy for oncologic disease control and fracture prevention.

2. Scope

This policy applies to all providers and clinical personnel involved in the dental and surgical management of patients with current or previous exposure to antiresorptive therapy and

other therapies associated with MRONJ risk.

3. Definition

MRONJ Case Definition (AAOMS): A diagnosis of MRONJ requires all of the following:

Current or previous treatment with antiresorptive therapy alone or in combination with immune modulators or antiangiogenic medications.
Exposed bone, or bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region, persisting for more than eight weeks.
No history of radiation therapy to the jaws or metastatic disease to the jaws.

4. Medications Associated with MRONJ

MRONJ is associated with medications used for management of osteoporosis and malignancy-related bone disease in cancer patients. Antiresorptive agents (bisphosphonates, RANK-L inhibitors and dual anabolic/antiresorptive sclerostin inhibitors) as well as antiangiogenic agents have been associated with the occurrence of MRONJ.

It is the responsibility of the dental clinician to review the patient’s medical history and understand the patient’s medical management and have knowledge of the medications of their osteoporotic and cancer patients. Consultation with the patient’s primary care physician will be necessary prior to beginning dental treatment to learn the pharmacologic method of delivery and duration of the patient’s medications which impact the patient risk for MRONJ. Documentation of such information in patient’s HER is MANDATORY prior to initiating any type of treatment.

Below is a partial listing of medications associated with MRONJ by medication class, indication with examples of the medication class.

Medication Class	Indications	Examples
Bisphosphonates (BPs)	Malignancy-related skeletal events; osteoporosis/fragility fracture prevention	Alendronate; Risedronate, Zoledronic acid, Ibandronate
RANK-L inhibitor (Denosumab)	Osteoporosis (Prolia, q6 months); malignancy-related bone disease (Xgeva, monthly)	Denosumab*
Sclerostin inhibitor	Postmenopausal osteoporosis with high fracture risk	Romosozumab
Antiangiogenic	Cancer therapy/ Inhibit VEGF and suppress the neovascular angiogenesis	bevacizumab, sunitinib, aflibercept, and cabozantinib
MTOR inhibitors	Cancer therapy/ Antiangiogenic and immunosuppressive	everolimus, temsirolimus

* Refer to section 7.1 for special consideration for Denosumab

5. Risk Stratification

Risk is dependent on drug type, dose, duration, and indication. The reported risk for MRONJ is low, especially in patients taking antiresorptives for osteoporosis, rather than cancer. However, this may reflect an underestimation due to a lack of clinical recognition and possible under-reporting of these adverse events. Therapeutic indication (malignancy vs. osteoporosis/osteopenia), duration of therapy, and local/systemic risk modifiers will alter risk.

Risk increases with:

High-dose IV therapy for cancer
Treatment duration > 2 years
Periodontitis or ill-fitting dentures
Smoking, diabetes, and steroids
Invasive bone procedures (e.g., extractions)

Risk by Medication & Indication

Osteoporosis dose (low risk):
- Oral bisphosphonates (BPs) (alendronate, risedronate, ibandronate)
- IV zoledronic acid (Reclast)
- Denosumab (Prolia) (low-moderate; higher than BPs)
Cancer dose (higher risk):
- IV bisphosphonates (Zometa, Pamidronate)
- Denosumab (Xgeva)

6. Patient Management

6.1. Prevention of MRONJ

Prevention is the primary goal. Preventive measures include dental optimization, patient education, and coordinated interdisciplinary care.

6.1A. Pre-therapy dental optimization

Before starting antiresorptive therapy, patients should have a comprehensive dental evaluation, including clinical examination and radiographic assessment as indicated. All active infections should be eliminated, and sites of potential dental complications addressed. Teeth with questionable prognoses may need to be removed to prevent future loss once on the resorptive therapy. All restorations should be stable and have a proper margin contour with adequate embrasure spaces.

Before starting antiresorptive therapy

Comprehensive dental exam
Identify and eliminate active infection (caries, periodontal disease, periapical pathology)
Complete caries control, restorative dentistry and endodontic therapy, as needed
Extract non-restorable teeth and those with poor prognosis, especially for oncology patients
Stabilize periodontal disease and complete dental prophylaxis
Complete all necessary and planned dentoalveolar surgery
Optimize oral hygiene (encourage smoking cessation)
Educate the patient on MRONJ risk, risk factors, oral hygiene, and the importance of regular preventive dental care/ maintenance to reduce risk. American Association of Oral and Maxillofacial Surgeons

6.1.B. In-therapy maintenance and surveillance

For patients already on antiresorptive therapy

Update medical history (drug, dose, duration)
Assess for symptoms or signs of early MRONJ
Review radiographs for irregular patterns of radiodensity (sclerosis) and radiolucency or delayed healing
Reinforce excellent oral hygiene and regular preventive dental care
Avoid elective procedures involving osseous injury when possible (especially in oncology patients on parenteral therapy).
Promptly manage dental infections/inflammation to reduce the need for extraction.
Evaluate denture fit and eliminate mucosal trauma, particularly along the posterior lingual flange region in denture wearers.

6.2. Dental Treatment Recommendations

Most routine dental care is generally considered safe. Non-invasive procedures are not considered an increased risk for MRONJ.

It is strongly recommended to stratify and document the patient risk, appropriate risk-based specialty consultations prior to proceeding with invasive procedures to ensure appropriate management and mitigation of complications.

Routine care that would not require treatment modification:

Routine cleanings
Restorations (fillings, crowns)
Endodontic therapy
Nonsurgical periodontal therapy
Denture adjustments
Orthodontic treatment

Invasive Procedures (Higher Caution)

Tooth Extractions

Avoid when possible; consider root canal therapy or coronectomy as alternatives.
If extraction is necessary:
- Use minimally traumatic technique
- Achieve primary closure when possible
- Consider post-op antimicrobial mouth rinses (e.g., chlorhexidine)
- Close follow-up until full mucosal healing
- Discuss MRONJ risk with the patient beforehand

Implants

Evidence is mixed; implants may be considered in low-risk osteoporosis patients with appropriate consent but are not recommended for cancer dose antiresorptive therapy patients.

Periodontal Surgery or Oral surgery

Conservative approaches preferred; selection of nonsurgical therapy should be balanced with the potential impact of persistent deep pocketing in cancer patients.
If surgery is required, minimize trauma to the area.

6.3 Perioperative risk-reduction measures (when surgery is necessary)

For unavoidable dentoalveolar procedures in at-risk patients, clinicians should implement risk-reduction strategies such as:

Pre- and postoperative antibiotics when clinically indicated.
Antimicrobial mouth rinses (e.g., chlorhexidine). Continue through the healing phase.
Atraumatic technique, smoothing sharp bony edges, and primary mucosal closure when feasible.
Staged approach (single tooth/sextant) rather than extensive multi-quadrant surgery in a single visit, when clinically appropriate.
Optimization of systemic factors: smoking cessation, diabetes control, and review of concurrent immunosuppressants/antiangiogenics in collaboration with the treating physician.
Post-operative care- Monitor for delayed healing, exposed bone, pain, or swelling. Continue chlorhexidine rinse until healing is complete. Ensure the patient is on a soft diet during the healing phase.

7. Biomarkers and Drug Holiday

Bone turnover markers are not recommended, nor validated, for routine clinical decision-making for MRONJ risk prediction. Drug holidays are not routinely recommended for osteoporosis patients and not recommended for cancer-dose therapy.
Evidence supporting or refuting routine drug holidays remains inconclusive; decisions must be individualized and coordinated with the prescribing physician based on indication (cancer vs. osteoporosis), dosing frequency, duration of therapy, comorbidities, and extent of surgery. Care should be coordinated with oncology for medication timing and systemic considerations.

7.1 Special consideration undergoing dentoalveolar surgery: Denosumab (RANK-L inhibitor) timing guidance

If denosumab interruption is considered necessary, balance MRONJ mitigation with the known rebound increase in bone resorption and vertebral fracture risk following discontinuation.

When clinically appropriate and coordinated with the prescribing provider:

Schedule dentoalveolar surgery approximately 3–4 months after the last dose (when osteoclast inhibition is waning).
Reinstitute therapy approximately 6–8 weeks post-surgery, once soft tissue healing is adequate, to minimize fracture risk while supporting healing.

8. Interdisciplinary Coordination of Care

Management requires coordinated care between dental and medical teams to balance MRONJ risk against the benefits of antiresorptive therapy. Referral to oral maxillofacial surgery when MRONJ is suspected, non-healing extraction sites observed or when cancer-dose antiresorptive patients require extractions. Oral maxillofacial surgery will coordinate with appropriate medical teams to coordinate care as well as communicating with dental providers.

IT IS STRONGLY RECOMMENDED THAT THE MANAGEMENT OF ESTABLISHED MRONJ IS ONLY CARRIED OUT IN SURGICAL SPECIALTY CLINICS (PERIODONTICS & ORAL SURGERY)

9. Management of Established MRONJ

9.1 Nonsurgical management (First step for all stages of MRONJ)

Conservative strategies can be used in all stages, particularly when significant comorbidities preclude surgery or when disease is stable. The rationale is to improve comfort, reduce infection, and to stabilize and resolve early lesions.

Nonsurgical management of MRONJ includes:

Patient education and reassurance.
Antimicrobial mouth rinses and local wound care to reduce biofilm burden.
Analgesics for pain control.
Systemic antibiotics when there is evidence of secondary infection.
Active clinical and radiographic surveillance for progression.
Removal of loose sequestrum or superficial bone spicules.

9.2 Surgical management

Surgical therapy is supported as a viable option with high success rates for many patients and can be considered for all stages based on surgical judgment and patient factors. Indications include progression despite conservative management, refractory symptoms, inability to maintain adequate hygiene, recurrent infection, or advanced disease at presentation.

Surgical procedures may include:

debridement of soft-tissue lesion,
sequestrectomy,
mucosal flap closure or/ and
block resection.

Block resection is reserved for advanced Stages of MRONJ. When resection is performed, margins should extend to vital, bleeding bone.

10. Documentation and Patient Counseling

Providers should document medication history (agent, dose, route, duration), indication (cancer vs. osteoporosis), concomitant therapies (e.g., steroids, antiangiogenics), local risk factors (infection, extraction/trauma), counseling discussion points, and shared decision-making.

Informed consent discussions should include: the overall rarity of MRONJ (especially in osteoporosis dosing), potential benefits of antiresorptive therapy, procedure-specific MRONJ risk, preventive measures, and follow-up expectations.

11. References (APA 7th Edition)

American Association of Oral and Maxillofacial Surgeons. (2022). AAOMS position paper on medication-related osteonecrosis of the jaw—2022 update.

Ruggiero, S. L., Dodson, T. B., Aghaloo, T., Carlson, E. R., Ward, B. B., & Kademani, D. (2022). Medication-related osteonecrosis of the jaw—2022 update. Journal of Oral and Maxillofacial Surgery, 80(5), 920–943. https://doi.org/10.1016/j.joms.2022.02.008

Khan, A. A., Morrison, A., Hanley, D. A., Felsenberg, D., McCauley, L. K., O’Ryan, F., Reid, I. R., Ruggiero, S. L., Taguchi, A., Tetradis, S., Watts, N. B., Brandi, M. L., Peters, E., Guise, T., Eastell, R., Cheung, A. M., Morin, S. N., Masri, B., Cooper, C., … Compston, J. E. (2015). Diagnosis and management of osteonecrosis of the jaw: A systematic review and international consensus. Journal of Bone and Mineral Research, 30(1), 3–23. https://doi.org/10.1002/jbmr.2405

Saad, F., Brown, J. E., Van Poznak, C., Ibrahim, T., Stemmer, S. M., Stopeck, A. T., Diel, I. J., Takahashi, S., Fizazi, K., Henry, D. H., & Jun, S. (2012). Incidence, risk factors, and outcomes of osteonecrosis of the jaw: Integrated analysis from three blinded phase III trials. Annals of Oncology, 23(5), 1341–1347. https://doi.org/10.1093/annonc/mdr435

Dodson, T. B. (2015). The frequency of medication-related osteonecrosis of the jaw and its associated risk factors. Oral and Maxillofacial Surgery Clinics of North America, 27(4), 509–516. https://doi.org/10.1016/j.coms.2015.06.003

Khosla, S., Burr, D., Cauley, J., Dempster, D. W., Ebeling, P. R., Felsenberg, D., Gagel, R. F., Gilsanz, V., Guise, T., Koka, S., McCauley, L. K., McGowan, J., McKee, M. D., Mohla, S., Pendrys, D. G., Raisz, L. G., Ruggiero, S. L., Shafer, D. M., Shum, L., & Watts, N. B. (2007). Bisphosphonate-associated osteonecrosis of the jaw: Report of a task force of the American Society for Bone and Mineral Research. Journal of Bone and Mineral Research, 22(10), 1479–1491. https://doi.org/10.1359/jbmr.0707onj

Pimolbutr K, Porter S, Fedele S. Osteonecrosis of the Jaw Associated with Antiangiogenics in Antiresorptive-Naïve Patient: A Comprehensive Review of the Literature. Biomed Res Int. 2018 Apr 23;2018:8071579. https://doi.org/10.1155/2018/8071579. PMID: 29850569; PMCID: PMC5937620.

R. Sacco, J. Woolley, G. Patel, M.D. Calasans-Maia, J. Yates, Systematic review of medication related osteonecrosis of the jaw (MRONJ) in patients undergoing only antiangiogenic drug therapy: surgery or conservative therapy?, British Journal of Oral and Maxillofacial Surgery,60, Issue 2, 2022,e216-e230 ISSN 0266-4356, https://doi.org/10.1016/j.bjoms.2021.03.006

Osteoporosis Medications and Medication-Related Osteonecrosis of the Jaw, ADA resource. https://www.ada.org/resources/ada-library/oral-health-topics/osteoporosis-medications

HbA1C Policy

Subject: III. Clinical – I. Patient Care

Reviewed and/or Revised: 07/03/2018, 1/28/2024, 8/13/2025

Policy Statement:

Incoming patients will be screened for risk factors regarding diabetes. Patients with significant risk factors for diabetes will be offered HbA1C testing. If the patient has high risk factors and refuses the HbA1C test the faculty member will be required to write a medical consult. The faculty member will explain to the patient the risk factors, and the need for evaluation and treatment.

The HbA1C test will place patients in to one of three categories: diabetic, pre-diabetic, or not diabetic. Post-test results of pre-diabetic or diabetic require:
Informing and educating patient about results Writing of a medical consult for further evaluation and treatment by a medical doctor
Providing the patient with a copy of aforementioned medical consult
Should the patient not have a medical home, providing patient with a current list of locally available medical clinics throughout the community
Documenting the HbA1C test results in the chart

Purpose

There is an association between periodontal disease, general oral health, and diabetic control. The majority of the population sees their dental healthcare provider more frequently than their physician. This policy ensures dental providers at the dental school will analyze risk factors of incoming patients for diabetes that have not been previously screened, diagnosed, or that are being actively treated. If these risk factors are sufficiently elevated, the patient will be offered HbA1C testing, on-site, by finger stick. This ensures dental providers will be aware of a patients diabetic status, and refer patients to a physician for further evaluation and treatment.

There is an established correlation between oral and systemic health. Monitoring of patients’ for diabetic control in the dental setting will provide information regarding this link, so that further dialogue on oral and systemic health can be achieved. Patients will benefit from earlier diagnosis and management of disease.

Procedure

Click the following link to access the entire HbA1C Policy & Procedure (PDF) which includes the patient risk assessment chart.

Implant Screening Policy

Subject: III. Clinical – I. Patient Care

Department: Pre-Doctoral Clinic

Effective Date: 5/31/16

Reviewed and/or Revised: 09/01/2017, 2/07/2024, 07/29/2025

Policy and/or Procedure:

Implants may be considered as part of a comprehensive treatment plan for patients with missing teeth or who are about to lose a tooth (teeth) in the near future.

To facilitate the integration of implants into the treatment planning, an initial consultation with the prosthodontist attending is required. This consultation takes place on the floor during the treatment planning process for those patients who are interested in implants and for which implants are a viable option. The primary objective of the consultation is two-fold. First, it aims to assess whether implants are the most suitable option for the patient. Secondly, it determines the appropriateness of the undergraduate clinic as the venue for the implant restoration process.

For detailed guidance on the procedural aspects, step-by-step guides are available on Blackboard. These guides cover the entire process, from using digital scanners to merging CBCT scans with digital casts and attaching guide sleeves to the surgical guide. These instructions are accessible in the courses REST538B Clinical Fixed Prosthodontics for D3 students and REST 548B Clinical Fixed Prosthodontics for D4 students. The guides ensure that both D3 and D4 students can confidently navigate implant treatment planning and restoration process, contributing to a seamless and effective clinical experience.

Implant Treatment Planning and Referral for Implant Surgery

Subject: III. Clinical – I. Patient Care

Policy/Procedure: Implant Treatment Planning and Surgery - Referral in the Predoctoral Clinic

Effective Date: July 2016

Reviewed and/or Revised: 09/01/2017, 02/07/2024, 07/29/2025

Implant planning and referral to radiology and surgeons must occur under the supervision of a Prosthodontics attending.

Case selection: single tooth implants in the non-esthetic zone, two consecutive implants in the posterior and mandibular implant overdentures are considered mainstream treatments in most treatments. Other treatment types such as single implants in the esthetic zone, implant supported FPDs in the posterior area, partial edentulous implant overdentures, maxillary overdentures, etc. are considered advanced treatment and may need to be referred to the implant clerkship, advanced prosthodontics clerkship or Advanced Dental Education Programs (ADE) for treatment.
Fixed Case Presentation Appointment: once the patient has completed Phase I (disease control and periodontal clearance). The patient should be scheduled in an IMP/TP chair in the undergraduate clinic for clinical evaluation. Appropriate treatment plan codes must be entered, and treatment consent must be obtained. If the patient is a patient of record periodontal maintenance should be up to date and/or an approval from the GP director must be obtained to move on with the implant planning.
Required codes: the following codes must be present in all implant plannings: D9450.9 (Pre-Implant Prosth Review), D9450.3 (Fixed Case Presentation), and D6190 (Radiographic Template/surgical guide). Additionally, all fixed implants treatments must have D6085 (Implant Provisionals) code. All these codes should be approved by Prosthodontic attending signifying case acceptance for restoration in the undergraduate clinic. At this time treatment consent should be obtained. Additional fees for radiographs and other surgical fees will be planned by the requesting provider and additional consent obtained at the time of the surgical consultation.
Financial Arrangements: During this appointment the patient makes the financial arrangements with the business office and makes a payment for the fabrication of the surgical guide.
Referral to the Specialty Clinic: Patient should be referred to ADE Periodontics, OMS department or ADE Prosthodontics for implant placement based on input from supervising prosthodontic faculty. A consultation with ADE program/OMS will be requested to determine if any site preparation is required (e.g., sinus elevation, GBR procedures, etc.). After this consultation, a referral for CBCT scan will be submitted in Axium using the RADCON form, specifying a full volume to capture both arches. CBCT codes are planned by the Radiology Division, not by the student. Additionally, a referral to specialty clinic Axium form is submitted to the appropriate specialty.
Digital planning and surgical guide fabrication: all implant treatments will be planned using a digital workflow and a surgical guide is fabricated. Once the plan is completed and approved by the prosthodontic attending, the students will contact the surgeon to stop by the clinic floor and in presence of a prosthodontic attending to approve the digital plan. After approval, the student will proceed to finalize the surgical guide design.
Surgical guide: The student must prepare and submit a laboratory prescription using PR DIGITAL laboratory in Axium and obtain prosthodontic attending approval. This prescription is then printed and dropped off at the in-house lab for printing of the guide. Students must allow 7 business days for the guide to be completed. Finally, the student must pick up the guide and verify seating on the diagnostic cast and attach the metal sleeves to the surgical guide under the supervision of a prosthodontic faculty.

Note: In certain cases, a CBCT may not be required (e.g. immediate implant in a posterior site), and a vacuum form guide can be requested by the surgeon with the prosthodontic attending agreement.

Changes to the treatment plan (placement of additional implants e.g.) should not be made without consulting the referring student and their attending faculty. In some cases, the new treatment plan may exceed the capability of the undergraduate students and therefore the case may need to be reassigned to a more advanced student with commensurately higher fees. In any case the new treatment must also be consented to by the patient.

Predoctoral clinic Directors will ensure that the restorative treatment plan has been discussed with the patient by confirming that there is a restorative treatment plan for the implants that is signed by the patient in the Axium record prior to sending the patient for an implant consult. Documentation that is signed by the patient and a related treatment note are the only record that this discussion was had with the patient. The student should additionally advise the patient of the restorative procedures and fees and the need for a surgical phase of treatment, including the surgical procedures (implant placement, grafts, etc.) and the associated fees for those treatments.

Although Directors and restorative faculty have the primary responsibility for ensuring the completeness and accuracy of the restorative treatment plan (for implants), ADE residents are encouraged to monitor the presence of a restorative treatment plan in Axium when formulating the surgical treatment plan (as a means of check and balance). This effort will help ensure that a restorative plan has been formulated and documented and that the patient is aware of that phase of treatment, including the fees associated with restoring the implants.

Predoctoral prosthodontic faculty have been asked to identify instances when treatment is modified by residents in the ADE programs without appropriate consultation with the pre-doctoral student, and faculty, and to report these cases to the Assistant Dean for Clinical Affairs. Treatment that is planned and approved by faculty in the predoctoral clinic should never be changed by residents of any specialty clinic without consultation and approval by the predoctoral student and faculty who referred the patient to them.

Instructions for Dental Care in the Operating Room

Subject: III. Clinical – I. Patient Care

Effective Date: July 2016

Reviewed and/or Revised: 09/01/2017, 3/01/2024, 07/29/2025

Scheduling Instructions:

Within six weeks of your child’s screening visit, you should receive a letter confirming your child’s place on the OR list. If you do not receive a letter in that time, please call Ms. Nelson (410) 706-3300 to confirm that your child is on the OR list.
You should receive a second letter with a reserved appointment date and pre-operative instructions approximately 4 weeks prior to the date of your child’s treatment. After you receive this letter, please call (410) 706-3300 to confirm your treatment date. If we do not hear from you within 2 weeks of receipt of the letter, you will not be scheduled.
You may be asked to bring your child for an evaluation appointment once the OR date is finalized.
Your child may be assigned to get treatment done at one of two following facilities:
- University of Maryland Medical Center:
  The University of Maryland has pediatric operating rooms staffed by pediatric anesthesiologists. Children with complex medical history as well as healthy children are seen at this facility.
- University of Maryland Rehabilitation & Orthopedic Institute (Kernan):
  If your child is healthy, he or she may have dental treatment under anesthesia at this facility.
  
  The dentist who screened your child will determine if he or she can be seen at this facility.
While we will try our best to schedule your child for treatment as soon as possible, it is understandable that you may be uncomfortable with the wait times. Please feel free to discuss this with the dentist screening your child. You may choose to explore other Offices/Hospitals that have shorter wait time. Should you choose to go elsewhere for care, please remember to inform the screening dentist and/or the OR coordinator so that another child needing treatment can be scheduled in that time slot.
The hospital anesthesia department requires that your child’s history and physical be completed by your child’s physician/pediatrician within 2 weeks of the OR date. Please schedule an appointment for this history and physical 2 weeks prior to the surgery date because the history and physicals are only good for a short time.
Please let the screening dentist know if you are willing to have your child on the 'Standby List’. Sometimes we have cancellations, and we will contact patients from the standby list. As a standby patient, you are consenting to get the paperwork and clearance from pediatrician (with History and Physical) done on short notice and are willing to be seen earlier.
Some of the common reasons that have led to cancelled/rescheduled patient appointments in the past are:
1. Patient was not cleared for the procedure by the pediatrician/specialty doctor/anesthesiologist. For example, if your child is ill (fever, vomiting, cough, runny nose) within 30 days of the OR appointment, the procedure may be rescheduled for safety.
2. Parents failed to get the tests recommended by the child’s physician done in a timely manner.
3. Parents failed to confirm their child’s appointment.
4. Inability to contact parents due to inactive phone number or old contact information. Please make sure to provide multiple working phone numbers to the screening dentist.
5. The child’s medical/dental insurance was not active, or the procedure could not be pre-authorized.
If your child experiences increased symptoms or signs of infection during the waiting period, please bring your child as a “walk-in” emergency to the Pediatric Dental Department. After hours bring your child to the Pediatric Medical Emergency Department, University of Maryland Medical Center.
Please contact the OR Coordinator or speak with your screening dentist if you have any questions.

Contact Individual:

Ms. Dorothy Nelson	Phone: (410) 706-3300
OR Coordinator	Fax: (410) 706-4031

Medical Consultation Follow Up Procedure

Subject: III. Clinical – I. Patient Care

Effective Date: 8/19/2013

Reviewed and/or Revised: 6/4/16, 5/25/17, 09/01/2017, 1/28/2024, 8/13/2025

Purpose: To obtain an accurate medical history and instructions from the patient’s Physician/s pertaining to items that may cause complications during dental treatment.

Definitions:

EPR: Electronic patient record

E-form: Electronic form

Med: Medical

Physician: Medical doctor

PCC: Patient Care Coordinator

Request for Medical Consult

When student, faculty, or resident identifies items in a patient’s med history that may cause complications during dental treatment a medical consultation will be indicated.

When a Medical Consult Request form is indicated:

Medical consult request form must be added to the patient’s EPR
Student/Residents/Faculty assigned to patient will complete page 1 of the medical consult request e-form.
Student reviews consult with faculty member and makes appropriate changes if indicated by faculty.
Faculty approves the medical consult form.
Patient signs the Med consult form electronically.
A copy is printed from the patient’s EPR to be faxed or given to the patient to take to their physician. Physician will complete page 2 of the medical consult.

When the medical consult reply is returned:

By fax or mail:

The med consult is scanned into the patient’s EPR in the medical consult results tab by a dental school Nurse.
Dental school nurse notifies the patients dental school provider and approving faculty via email.
The consult reply is interpreted and discussed with faculty who approved the medical consult.
Dental school provider is required to update the patient’s medical history and medication list with any information returned from the medical consult

By patient:

The dental school provider will have the medical consults reply reviewed by faculty and discuss under what conditions the patient may receive treatment.
The student will place the medical documents in the secured box located outside nurse’s office and/or the 3rd floor PCC’s office.
The med consult is scanned into the patient’s EPR in the medical consult results tab by a dental school Nurse.
Dental school nurse notifies the patients dental school provider and approving faculty via email.
Dental school provider is required to update the patient’s medical history and medication list with any information returned from the medical consult

Mental Health and Safety Policy

Subject: III. Clinical – I. Patient Care

Department: SOD Clinics

Origination Date: June 2015

Effective Date: 8/25/15

Reviewed and/or Revised: 09/01/2017, 3/15/2025, 8/15/2025

Purpose: To assure the safety of patients and visitors by appropriately managing individuals who are expressing and/or exhibiting homicidal and/or suicidal thoughts or ideations.

Policy and/or Procedure: If an individual should make statements that implies, suggests, or states their intention to harm anyone, including themselves, campus police (911) are to be called immediately as well as our Emergency Response Team.

Every effort should be made to safely detain the individual until campus police arrive.

Once campus police arrive, we will explain the situation and ask them to complete an Emergency Petition based on the comments made by the individual.

Once the Emergency Petition is completed, campus police will call the Baltimore City Police Dept. to transport the individual to the nearest Emergency Dept. for further evaluation.

If a nurse was not present for the incident, notify a nurse as soon as possible so that an incident report can be documented.

Nitrous Oxide Protocol

Subject: III. Clinical – I. Patient Care

Department: AGD, ASE, Oral Surgery, Special Patient and UMOMSA Clinics

Policy Number: CL008

Origination Date: 03/14/2008

Effective Date: April 3, 2008

Reviewed and/or Revised: 09/01/2017, 6/4/16, 5/25/17, 9/24/19, 05/16/2022, 03/13/2024, 07/31/2025, 9/26/2025, 11/19/2025

Policy Statement: The Department of Environment Health and Safety (EHS) will conduct exposure monitoring of clinical operations that utilize nitrous oxide in the Dental School. Periodic training will be conducted in each department where Nitrous oxide is administered, including staff, residents, and students. Equipment maintenance will be performed on a periodic basis and recorded by EHS. Reports will be provided by EHS to the Director of Clinical Operations, with a copy to the Director of Medical Credentialing and Quality Assurance. Training for new staff will be coordinated, conducted, and logged by the Supervisor of Dental Assistants.

Purpose: The purpose of the EHS & UMSOD’s monitoring will be to:

ensure that employee exposures are below National Institute for Occupational Safety and Health (NIOSH) and American Conference of Government Industrial Hygienists (ACGIH) limits;
to detect leaks in the nitrous oxide delivery systems and
to assess the effectiveness of work practices.

Compliance:

Nitrous Oxide Exposure Limits:

Permissible Exposure Limit (PEL) is not currently regulated by OSHA.
American Conference of Government Industrial Hygienists (ACGIH) Threshold Limit Value (TLV): 50 ppm 8-hr time weighted average (TWA).
National Institute for Occupational Safety and Health (NIOSH) Recommended Exposure Limit (REL): 25 ppm-8 hr TWA.

Procedure:

The sampling will be conducted using a combination of a MIRAN SapphIRE Infrared Analyzer and Vapor-Trak Nitrous Oxide Badges.
The infrared analyzer will be used to obtain real time data on the effectiveness of work practices and to detect leaks in the delivery systems.
The nitrous oxide badges will be used to determine full day person exposure levels.
Testing areas may include:
1. 1st Floor: UMOMSA Practice
2. 2nd Floor: AEGD and Oral Surgery Clinic
3. 3rd Floor: ASE Pediatric Dentistry Clinic
4. 4th floor: SCG, ASE Periodontics, Prosthodontics & Endodontics clinics
The sampling will be conducted under the direction of a Certified Industrial Hygienist (CIH) from the University of Maryland, Baltimore Environmental Health Safety Office.
After initial testing, if results are within compliance standards, testing to be performed bi-annually.

Training:

Training will be conducted on a periodic basis to refresh current staff, residents and students and to train newly arrived staff, residents or students.
ASE Departments – coordinate new training with arrival of new class of residents.
Oral Surgery – coordinate training as new residents come through the program.
Training sessions will be logged by each Department.
Training will include:

Equipment set-up
Selection of properly fitted mask
Use of monitoring badges
Maintenance of equipment

Maintenance:

Periodic maintenance is essential.
Hoses and masks will be inspected by each Department’s designated person for wear, holes and loss of elasticity.
Equipment will be inspected by each Department’s designated person to be certain that connections are secure; gaskets are functional.

On Call Policy and Procedure

Subject: III. Clinical – I. Patient Care

Reviewed and/or Revised: 09/01/2017, 03/13/2024, 07/31/2025

Purpose

This on-call service is provided for active patients of record only. Patients are considered active patients of record if they are in current treatment with an Undergraduate Dental Student or Post Graduate Resident. Patients who are inactivated or not assigned to a Dental Student are not considered active patients. Patients who have been treated through the Dental School’s Urgent Care Clinic are not considered active patients unless they have an emergency associated with the recent area of treatment at the Dental School.

Definitions

Active patient of record– a patient that is in current treatment with an Undergraduate Dental Student or Post-Graduate Resident.

Patients who are inactivated or not assigned to a Dental Student are not considered active patients.
Patients who have been treated through the Urgent Care Clinic are not considered active patients unless they have an emergency associated with a recent (within one week) area of treatment that was performed at the Dental School.

Policy and/or Procedure

This person will be a Dentist, Resident, Patient Care Coordinator, or a Dental Assistant with a minimum of 10 years of experience. The Dean of Clinical Affairs must approve the dental personnel providing this service.

On call schedule:

The on-call schedule will be prepared and maintained by the Director of Urgent Care.
The schedule will be prepared in July to cover the entire year and will indicate the name of the dental personnel on call to triage incoming phone calls for each week during this year.
Any changes to the schedule must be made through the Director of Urgent Care as soon as possible. In case of the need for last-minute substitutions, the personnel currently on call must make arrangements for other approved dental personnel to cover for them and inform the Director of Urgent Care.

On call responsibilities:

Be accessible by pager 24 hours per day on the weekends, holidays, and weekdays when the dental school's clinics are closed as well as from 5pm through 8AM on weekdays when the dental school clinics are open.
Consult with and triage “emergency “calls for the University of Maryland Dental School’s active patients of record.
Affirm that the patient calling is an active patient of record by accessing the Axium Database on a laptop computer that is provided by the Dental School. Axium may also be used to verify any recent treatment or prescriptions given to the patient.
Access the situation and manage /initiate treatment of after-hours “emergency” patients during non-clinic hours.
Contact the on-call Oral Surgery Resident for assistance with emergency conditions that may require the patient to be seen in the hospital during non-clinic hours.
Contact the dentist faculty member assigned that week to provide assistance when needed.
Contact the appropriate Resident on call for the Periodontics, Oral Surgery, AEGD Prosthodontics, Pedodontics, Orthodontics, and Endodontics Department, as needed, if patients from these departments require assistance.
Call in prescription for the dentist on call if verbal order for any medication(s) is given.
Maintain a log of all of all phone inquiries, which will include the following information:
1. Patient name and telephone number.
2. Patient chart Number (if known).
3. Date and time of call.
4. Dental Clinic in which comprehensive treatment is usually provided (name of dental student or resident the patient is assigned to).
5. Chief complaint and history of present condition.
  Note: Esthetics is not considered an Emergency situation.
6. Name of the on-call Resident that the patient was referred to, if the patient is a post-graduate patient.
7. Treatment advised (referral, medications, immediate clinic evaluation, follow-up appointments).
8. Contact student or resident that patient is assigned to.
Patients that are referred to a hospital are advised to come to the University of Maryland Hospital Emergency Room rather than another hospital, if possible, if they are experiencing:
1. Trauma to teeth or the peri-oral area.
2. Fever, swelling, toothache interfering with eating or sleeping
3. Difficulty swallowing, difficulty breathing, or trismus.
When a patient is being referred to a hospital they shall be notified that any costs associated with their visit to the hospital will be the patient’s responsibility.

Patient Access to Care Policy

Subject: III. Clinical – I. Patient Care

Origination Date: 6/30/09

Effective Date: 6/30/09

Reviewed and/or Revised: 09/01/2017, 03/15/2024, 07/31/2025

Purpose: The purpose of this policy is to ensure that patients are accepted, assigned, treated, and referred elsewhere as needed.

Policy Statement

UMSOD will accept patients based upon their dental needs, the ability of the school to meet their needs, the needs of the educational programs to provide clinical experiences to the students, and the patient’s ability to meet their responsibilities. Patients will be assigned to students will take place as soon as possible after the first contact with the school.

The frequency of treatment for each patient will be determined on an individual basis.

Patients may be referred elsewhere when it is determined that the school is unable to meet the patient's needs and/or the patient is unwilling or unable to meet his/her responsibilities.

Consistent with University of Maryland, Baltimore policies, UMSOD does not discriminate on the basis of race, color, religion, national origin or ancestry, sex, sexual orientation, gender identity or expression, physical or mental disability, marital status, protected veteran's status, or age in its programs and activities. Specifically, Title IX prohibits discrimination on the basis of sex in UMB's programs and activities. UMB will take steps to eliminate prohibited conduct, prevent its recurrence, and remedy its effects. Please refer to the “UMB Policy On Discrimination and Sex-Based Discrimination” elsewhere in the Clinic Manual for additional information.

Patient Rights Policy

Subject: III. Clinical – I. Patient Care

Origination Date: 6/1/09

Effective Date: 6/1/09

Reviewed and/or Revised: 09/01/2017, 02/01/2019, 03/15/2024, 07/31/2025, 3/15/2024, 7/31/2025, 1/23/2026

Purpose: To guide University of Maryland School of Dentistry personnel in their interactions with patients.

Policy Statement

Each patient is entitled to:

Considerate, respectful and confidential treatment;
Continuity and completion of treatment;
Access to complete and current information about his/her condition;
Advance knowledge of the cost of treatment;
Informed consent;
Explanation of recommended treatment, treatment alternatives, the option to refuse treatment and risk of no treatment and expected outcomes of various treatments;
Emergency, incremental and total patient care;
Treatment that meets the standard of care in the profession;
Access to a patient advocate who will appropriately communicate your experience. To communicate your experience, please contact one of the following Patient Care Coordinators at one of the appropriate numbers below:
- 1st Floor Faculty Practice Clinic: 410-706-7961
- 2nd Floor AEGD Clinic: 410-706-4428 or 410-706-4156
- 2nd Floor Undergraduate & Screening Clinics: 410-706-8127
- 2nd Floor Urgent Care & Oral Surgery Clinics: 410-706-8127
- 3rd Floor Undergraduate Clinic: 410-706-8127
- 3rd Floor Orthodontics/Pediatric Dentistry Clinic: 410-706-0768
- 4th Floor Endodontics, Prosthodontics & Periodontics Clinic: 410-706-8111
- 4th Floor PLUS & Special Care & Geriatrics Clinics: 410-706-8127
- Universities At Shady Grove, Rockville, MD UMSOD Dental Clinic: 240-665-6700

Patients Accompanied by Non-Patient and/or Minors While in Dental Operatories or Surgical Areas Policy

Subject: III. Clinical – I. Patient Care

Department: Oral Surgery

Effective Date: 9/13/13

Reviewed and/or Revised: 09/01/2017, 1/28/2024, 8/13/2025, 3/25/2026

Purpose: Accompanied and/or Unaccompanied Children in Clinical Areas

Policy and/or Procedure:

Policy for the Management of Pregnant Patients

Subject: III. Clinical – I. Patient Care

Origination Date: 6/16/2025

Effective Date: 6/17/2025

Reviewed and/or Revised: 06/17/2025, 2/13/2026, 3/26/2026

Purpose

To guide providers on the management and dental procedures that are considered safe through all stages of pregnancy.

Scope

Applies to all pregnant patients treated in SOD clinics.

Policy and/or Procedure

Personal health considerations in pregnant patients imply specific approaches regarding obtaining consent, collecting information relevant to pregnancy, and proceeding with additional consultations with the physician, obstetrician, and other dental specialties, all of which are relevant to treatment planning.

Routine oral and dental care should establish a dental home during the first trimester of pregnancy. Education and counselling in early oral health promotion in the pregnant individual affects a child’s oral health and enables the establishment of an early dental home for the newborn child.

Recommendations regarding preventive, diagnostic, and therapeutic interventions should follow standard best practice protocols for pregnant patients. A patient-centered oral health preventive and treatment plan should be implemented for each pregnant individual.

Treating a pregnant patient in the dental school clinic settings requires a consultation with an attending faculty (instructor) for further guidance.

Consent:

Maryland Law and HIPAA should be followed regarding statutes that govern confidentiality and consent for care of patients under 18 years old. Dental providers should be aware of the State’s regulations on consent and caring for a pregnant dental patient. Overall, attention is required in adolescent pregnant individuals under 18 years of age, as in some states a parental consent may be required prior to proceeding with non-emergency dental treatment.

Routine dental and oral care during pregnancy:

Positioning considerations:

Proper positioning in the second and third trimesters advised avoiding postural hypotension.
Dental exam requires positioning the pregnant patient to keep patient comfortable in left lateral decubitus position by elevating the patient’s right hip by 15 degrees, to relieve abdominal pressure and prevent supine hypotensive syndrome due to inferior vena cava compression.

The initial/first visit should occur in the first trimester of pregnancy.

During this visit, the providers must:

Obtain, and update at each visit, a thorough medical history includes specific information related to the mother’s overall health condition and/or any systemic, chronic, or underlying conditions, medications, allergies. If warranted, further consultation with the obstetrician and/or physician should be conducted prior to planning dental treatment.
Collect all information relevant to pregnancy,
Provide anticipatory guidance for both the mother and unborn child (i.e. diet and oral hygiene counselling, caries and periodontal risk assessment, consultations regarding fluoride intake and radiographic exposure)
Discuss safety of prescription-based and over-the-counter medications, and
Discuss risks of exposure to smoke, tobacco and illicit substances (including potential harm to the fetus)
Perform a thorough dental examination (including chief complains or any emergencies)
Address any acute issues at the initial visit.
Blood pressure screening should be performed during the initial exam and at all subsequent visits to rule out hypertensive disorders during the first trimester of pregnancy. If warranted, an obstetrician and/or primary physician should be consulted for further treatment of hypertension.

Caution should be exercised regarding an increased risk for aspiration due to delayed gastric emptying in pregnant individuals.

Subsequent visits:

Dental emergencies should be treated immediately and should not be postponed for pregnant patients.
Non-urgent and elective dental procedures, such as restorative, surgical, and periodontal interventions, are recommended during the second trimester.
Dental bleaching is recommended to be postponed until after delivery.
- Anticipatory guidance relevant to both the mother and unborn child, caries risk assessment, dietary counseling and oral hygiene instructions should be emphasized at each periodic examination.
Oral health counselling should address topics relevant to relationship of maternal oral health and fetal health (such as prevention of vertical transmission of bacteria) but also should include topics related to association with pre-eclampsia, preterm births, and developmental defects in the primary dentition.
Healthy diet is critical to the health of the mother and the fetus, particularly considering intake of some nutrients, such as folic acid, iron, calcium, vitamin D, choline, omega-3 fatty acids, B vitamins, and vitamin C, but also in prevention of caries lesions, and dental erosions due to vomiting. Pregnant patients should be advised to avoid highly cariogenic foods and drinks, and to consume noncariogenic and nutrient rich food.
Oral hygiene, pregnant patients should be instructed on the frequency and technique of toothbrushing. It is advised to brush twice daily with fluoridated toothpaste and additionally implement daily flossing. If experiencing nausea and vomiting, it is recommended to use a sodium bicarbonate or fluoridated oral rinse afterward.
Preventive measures regarding fluoride intake should be emphasized in all pregnant patients, which includes dosage and frequency of fluoride intake, but also frequency of topical fluoride application. Special consideration is required in pregnant patients who are at increased risk of developing caries lesions.
Avoid prescribing highly concentrated fluoride products, as this affects both the pregnant individual and the fetus, including potential effects on the developing dentition in the newborn. Information on dosage-related potential toxicity is mandatory.
Anticipatory guidance and consultation should be provided regarding using tobacco, alcohol, marijuana, and other illicit substances. The pregnant individual may require referral for appropriate counselling if substance misuse is observed.

Periodontal diseases during pregnancy

Pregnant patients may be at increased risk for gingivitis and periodontal diseases. Therefore, additional advising regarding oral hygiene and diet should be provided. Pregnancy associated hormonal disbalance causes dryness of the mouth, so increasing frequency of drinking water and chewing sugarless gum, to stimulate saliva production, is highly recommended in the pregnant individual.

Pyogenic granuloma, a common periodontal lesion resulting from hormonal changes, requires immediate treatment.

Periodontal diseases and negative sequalae related the mother’s oral health status, but also potential complications during, pre- and post-delivery (low-birth weight, preterm birth, pre-eclampsia and gestational diabetes) can be prevented by encouraging pregnant individuals to have routine dental examinations, to be evaluated for commonly associated oral lesions and advised on preventive protocols.

Radiographic diagnostics during pregnancy

Follow the most current radiographic imaging guidelines and safety protocols, including for pregnant patients.
Minimize radiation exposure by tailoring radiographs to individual patient needs.
Apply ALARA principles and weigh maternal–fetal risks against diagnostic benefits.
Use clinical judgment to determine the type, number, and technique of radiographs.
Base radiographic indications on medical and dental history, clinical examination, and treatment necessity.
Do not delay justified standard dental radiographs needed for emergency or diagnostic purposes.
When proper safety precautions are used, standard dental radiographs pose negligible risk to the fetus.
Although lead aprons are no longer generally recommended, their use is required at UMSOD per Maryland State law.
Stay current with updated radiographic safety recommendations and state regulatory requirements.
Radiographic techniques beyond standard dental imaging are not addressed; consult the patient’s OB/GYN if needed.
Final decisions on radiographic procedures should consider all clinical circumstances and individual patient needs.

Dental emergencies during pregnancy

Chief complaints due to odontogenic or periodontal infection should be addressed and resolved promptly.

The pregnant patient experiencing odontogenic related infection, and its potential complications in oral facial region, is considered an emergency and requires immediate treatment, regardless of the stage of pregnancy.

Dental pain in pregnant patients should be categorized as odontogenic (pulpal or periapical), periodontal, pericoronal, or non-odontogenic. Conditions such as irreversible pulpitis, acute apical abscess, cellulitis, and pericoronitis are considered urgent dental infections requiring immediate treatment regardless of trimester.

Certain precaution measures are necessary when deciding on the treatment options (restorative, endodontic, periodontal, surgical) and therapeutic agents for pain control and infection (local anesthesia, analgesics, antimicrobials, and sedation), given the potential benefits of the dental therapy versus the risks to the pregnant patient and fetus.

Decisions regarding the timing and selection of dental or surgical (e.g extractions) treatment for pregnant patients should be based on an individualized assessment of risks and benefits. Such decisions remain within the professional judgment of the treating dentist or oral and maxillofacial surgeon, following appropriate evaluation of the patient’s medical status and consultation with the patient’s obstetric provider when indicated. If pregnancy is deemed high risk such as risk of preterm labor, supine hypotensive syndrome, preeclampsia, placenta previa, gestational diabetes (poorly controlled), anticoagulation therapy, severe cardiovascular disease, multiple gestation or any other significant obstetric complications then such patients should be referred to ASC or hospital setting for treatment.

Medical history; Medications; Specialty consultations:

Certain medications present an increased risk for both the pregnant individual and fetus (due to crossing the placenta) and must be avoided.
Limited duration and minimal dosages, avoidance of certain prescription-based and over the counter medications, but also consultation with the OB/GYN physician, is warranted during pregnancy and lactation period to obtain a full list of indicated and contra-indicated medications.

Indicated Medications

Penicillin
Amoxicillin
Cephalosporins
Clindamycin
Metronidazole
Analgesic and antipyretic of choice during pregnancy and lactation period is acetaminophen (acetyl-para-aminophenol).

Contra-indicated Medications

It has been suggested to avoid the following prescription-based medications during pregnancy and postpartum lactation period:

Antibiotics (doxycycline, tetracycline)
Anxiolytics (alprazolam and diazepam)
Anticonvulsants (topiramate, valproic acid), due to potential risk for cleft lip and palate in fetuses.
Erythromycin in the first trimester of pregnancy may require additional consultation with the physician.
Fluoroquinolones should be avoided during pregnancy; alternatives are recommended during lactation period.
Aspirin (acetylsalicylic acid) should be avoided during pregnancy and lactation period.
NSAID (nonsteroid anti-inflammatory drugs) are contraindicated in first and third trimester, such as naproxen, ibuprofen, diclofenac, and celecoxib, should be avoided in pregnancy. In rare cases in the second trimester if considered, they should be used under the guidance of a healthcare provider and in minimal dosages with restricted duration, considering the stage of pregnancy.
OTC (over the counter) medications that should be avoided by pregnant patients include medications for gastrointestinal upset and diarrhea (drugs containing bismuth subsalicylate; decongestants such as phenylephrine, pseudoephedrine), antipyretics (containing guaifenesin). Special precaution is required with pain medications (ibuprofen, naproxen, and aspirin).
Opioids (codeine, morphine, meperidine) in pregnancy, due to certain potential risks of harm to the pregnant mother and fetus. If any consideration is given for prescription of opioids for acute pain, it should be under the physician’s guidance for any potential risk, and the lowest dose and duration appropriate to indications.

Local anesthetics during pregnancy:

Local anesthesia is safe to use in pregnant patients.
Patients with hypertensive disorders should avoid vasoconstrictors due to potential exacerbation of cardiovascular risks.
For pregnant patients with underlying conditions, obstetricians and/or physicians should be consulted. Standard protocols and precaution measures regarding dosages, techniques, and needle aspirations should be applied.
Preference is given to an amide-type of local anesthetics. Lidocaine with 1:100,000 epi (class B) remains the safest choice.

Advanced pharmacologic behavior and pain management during pregnancy:

Nitrous oxide should be avoided in pregnant patients and is contraindicated during the first trimester.
If the treatment requires sedation or general anesthesia, anesthesiology and the patient’s medical provider should be further consulted prior to planning the treatment.

References:

American Academy of Pediatric Dentistry: Oral Health Policies & Recommendations (The Reference Manual of Pediatric Dentistry): https://cicero.umaryland.edu/Cicero/sd/Rooms/DisplayPages/LayoutInitial?Container=com.webridge.entity.Entity[OID[875E0245CF1AE3438767F9707A13BE7F]
The Reference Manual of Pediatric Dentistry 2024-2025: Definitions, Oral Health Policies, Recommendations, Endorsement, Resources. Chicago III: American Academy of Pediatric Dentistry; 2024.
Nowak AJ, Casamassimo PS. The Handbook of Pediatric Dentistry. 5h ed. Chicago. American Academy of Pediatric Dentistry; 2018.
American Dental Association: https://www.ada.org/resources/practice/dental-standards
CDC guidelines https://www.cdc.gov/opioid-use-during-pregnancy/index.html
American College of Radiology: ACR-SPR Practice Parameter for managing Pregnant or Potentially Pregnant Patients with Ionizing Radiation https://gravitas.acr.org/PPTS/GetDocumentView?docId=23
American College of Obstetricians and Gynecologists: Guidelines for Diagnostic
Imaging During Pregnancy and Lactation https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/10/guidelines-for-diagnostic-imaging-during-pregnancy-and-lactation
The National Institute for Occupational Safety and Health’s (NIOSH): Reproductive
Health and the Workplace: Radiation – Ionizing https://www.cdc.gov/niosh/reproductive-health/prevention/ionizing-radiation.html
Parameters of Care: Clinical Practice Guidelines for Oral and Maxillofacial Surgery (ParCare), 7th ed. Rosemont, IL: AAOMS; 2023
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Drug Safety Communication – Avoid Use of NSAIDs in Pregnancy at 20 Weeks or Later. Silver Spring, MD: FDA; 2020
American College of Obstetricians and Gynecologists. (2013). Oral health care during pregnancy and through the lifespan. Committee Opinion No. 569. Obstetrics & Gynecology, 122(2), 417–422.

Protocol Workflow for Pretreatment Review of EPR

Subject: III. Clinical – I. Patient Care

Origination Date: 07/28/21

Effective Date: 07/28/21

Reviewed and/or Revised: 03/13/2024, 07/31/2025

Protocol/Workflow for Pretreatment Review of EPR:

Blood pressure
Medical history review
- Including eRx review for allergies and changes in medications
Patient card review for phone, email, special needs
Check for consents
Check for outstanding medical consults

Provisional Crowns/Bridges - Post Graduate Clinics

Subject: III. Clinical – I. Patient Care

Department: Post-Graduate Prosthodontics, Periodontics and AEGD

Effective Date: June 19, 2008

Reviewed and/or Revised: 5/31/16, 09/01/2017, 1/12/2024, 8/13/2025

Purpose: The purpose of this policy is to follow guidelines for when provisional (temporary) crowns/bridges may be used during treatment.

Definition: Provisional – Formed or preformed for temporary purposes or used over a limited period; a temporary or interim solution; usually refers to a prosthesis or individual tooth restoration or dental implant. This is according to the American Dental Association (ADA) 2024 CDT Code Book.

Policy and/or Procedure:

The purpose of this policy is to follow guidelines when provisional (temporary) crowns/bridges may be used during treatment.

This policy applies to Post-Graduate Clinics - Prosthodontics, Periodontics and AGD, Faculty, Residents, Business/Office Managers and Patient Care Coordinators.

Provisional crowns and/or bridges are to be noted on the treatment plan, which the patient signs. The fee being charged should also be noted.
Patients who need provisionals should be charged for this treatment when the care will be long and extensive. In most instances, this policy does not refer to a single crown or short span bridge.
Only Post-Graduate level Clinics will oversee these patients if at all possible.
The treatment plan and consent form must contain information regarding all services rendered and their fees including:
1. Tooth or implant numbers involved,
2. Fee for each tooth
3. Total fee
4. Patient understands that he/she is responsible for payment of provisional crown/bridges.
5. Patient understands that he/she is responsible for payment of the permanent crowns/bridge(s).
6. Signed by Patient, Program Director or Attending Faculty, and Resident.
7. Patient must know that these are temporary restorations and that they must complete the treatment with the final restorations in a timely manner or risk having their teeth become carious.

Referral of Patients Assigned for Pre-doctoral Implant Treatment Planning and Referral

Subject: III. Clinical – I. Patient Care

Department: Pre-Doctoral Clinic

Effective Date: 5/31/16

Reviewed and/or Revised: 09/01/2017, 02/07/2024, 07/29/2025

Policy and/or Procedure:

The primary source of implant treatments is from the pool of patients available to students. If students require additional treatment experience, they should contact their GP directors for assistance.

Referral from Specialty Clinics: cases referred from specialty clinics (OS, ADE-Perio, ADE-Prosth, AEGD) for restorations in the predoctoral clinics should ideally be referred before implant placement. This allows for accurate planning and discussion of treatment plans with the patient, following the undergraduate implant protocol.

Evaluation of Existing Implants: if implants have already been placed, a consultation appointment should be made in the Prosthodontics Clinic for evaluation of the suitability for implant restoration in the undergraduate clinic.

Acceptance Criteria: only Nobel Biocare implants are restored in the undergraduate clinic. Cases involving other implant systems should be referred to the Implant or Advanced Prosthodontics Clerkship or ADE-Prosthodontics.

Assessment and Clearing Phase I: once deemed acceptable for undergraduate clinics, the patient's general oral condition should be assessed by General Dentistry faculty in the undergraduate clinic. After clearing Phase I, the student should schedule the patient for a case presentation in the Prosthodontics Clinic.

Case Assignment from Outside referral to undergraduate clinics: the resident will contact PCC (Mrs. Martha Kreiner) or the Predoctoral Prosthodontics Director via Axium message to assign the case to an undergraduate student, who will initiate the process for restoring the case.

The resident will contact PCC or Predoctoral Prosthodontics Director via Axium message for the case to be assigned to an undergraduate student that will start the process for restoring the case.

Referral of Patients to Special Care and Geriatrics Program

Subject: III. Clinical – I. Patient Care

Department: Oral and Maxillo Facial Surgery

Effective Date: 9/7/16

Reviewed and/or Revised: 09/01/2017, 02/08.2024, 07/29/2025

Purpose: Protocol for Referral of Patients to Special Care and Geriatrics

Policy and/or Procedure:

Patients treated in Special Care and Geriatrics Clinic include individuals with: intellectual, developmental and/or physical disabilities; Cognitive disorders including but not limited to: Alzheimer’s disease, dementia, frontal temporal disorder; Medically complex individuals including those undergoing dialysis, chemotherapy, preparing for or awaiting organ transplant; including frail older adults, those 70 years of age and older and those with Health or Physical limitations. This group includes those 18 years and older with complex medical histories, awaiting organ transplant, receiving cancer therapy or who require consideration beyond routine approaches to receive oral health care.

Patients may contact SC+G directly at 410-706-7039.

Patients presenting to Admissions/Screening and deemed appropriate for SC+G clinic by the supervising faculty may be referred to SC+G. When appropriate, medical consults should be written in Admissions/Screening and forwarded to the patient’s primary health care provider. Returned, completed medical consults should be available in the patient’s electronic health record for review prior to an appointment being confirmed in SC+G.

Patients currently being treated in the predoctoral, postgraduate or faculty practice can be transferred to S C + G if they fit the criteria listed above. Referrals should be filled out in Axium including reasons for referral to specialty clinic and swiped by attending faculty. The Director of SCG will review all referrals for approval to schedule in SCG.

Patient assignment to SC+G is based on 1) the patient’s physical or cognitive capacity, 2) the need for advanced behavioral management in order to effectively provide oral health care, 3) the need for the patient’s oral health care to be supervised by faculty experienced in advanced oral medicine, 4) for the patient’s safety as a result of physical or cognitive limitations, and/or 5) the need for nitrous oxide to receive care.

Patients assigned to SC+G includes, but is not limited to the following:

Patients

on hemodialysis
on an organ transplant list
with Down Syndrome, Cerebral Palsy, and/or with severe and profoundly challenging behaviors
with hemophilia where injection of factor is required immediately preceding the dental procedure
with uncontrolled Epilepsy
with cognitive impairments such as dementia, frontal temporal dementia or Alzheimer’s disease;
with spinal cord injuries and/or amputees who cannot ambulate with prosthetic limbs or be transferred from their wheelchair or stretcher (Gurney) to the operatory chair
with cancer receiving chemotherapy or radiation therapy
with physical disabilities which interfere with ability to function. include but not limited to:
- multiple sclerosis
- blindness – if cannot function without assistance
- confined to a wheelchair AND cannot transfer to dental chair
- transferred by stretcher AND cannot transfer to dental chair
- unable to ambulate or be transferred to the operatory chair
require nitrous oxide to receive oral health care.

All patients are required to obtain copies of a recent, complete physical examination. Supportive laboratory studies may be requested, as needed

Referral of Surgical Treatment of Patients for Implants to PG

Subject: III. Clinical – I. Patient Care

Department: Pre-Doctoral Clinic

Origination Date: 5/31/16

Reviewed and/or Revised: 09/01/2017, 01/12/2024, 03/13/2024, 07/31/2025

Policy and/or Procedure:

There is no longer a formal implant screening process in the undergraduate clinic. Implants may be considered as part of a comprehensive treatment plan for patients with missing teeth or who are about to lose a tooth (teeth) in the near future.

A consultation is obtained with the attending prosthodontist on the floor during the treatment planning process for those patients who are interested in implants and for which implants are a viable option. The purpose of the consultation is to determine if implants are the appropriate option and if so, is the undergraduate clinic an appropriate venue for the restoration of the implants? Single tooth implants in the non-esthetic zone and mandibular implant overdentures are considered mainstream treatments in most cases. Other treatment types such as single implants in the esthetic zone, Implant supported FPDs, maxillary implant overdentures, etc., etc. are considered advanced treatment and may need to be referred to the implant clerkship or ADE for treatment. The D9450.9 code is planned and approved signifying case acceptance for restoration in the undergraduate clinic.

A referral to specialty clinic request is planned for consultation with one of the surgical residents. Before this referral can be made the appropriate fees for the implant and associated restorative phase must be planned and the treatment plan consented to by the patient. Additional fees for radiographs and other surgical fees will be planned by the requesting provider and additional consent obtained at the time of the surgical consultation.

Changes to the treatment plan (placement of additional implants e.g.) should not be made without consulting the referring student and their attending faculty. In some cases, the new treatment plan may exceed the capability of the undergraduate students and therefore the case may need to be reassigned to a more advanced student with commensurately higher fees. In any case, the new treatment must also be consented to by the patient.

Referring a Patient for a Medical Evaluation Consult

Subject: III. Clinical – I. Patient Care

Origination Date: 11/1/2008

Effective Date: 11/1/2008

Reviewed and/or Revised: 09/01/2017, 03/13/2024, 07/31/2025

Purpose: To insure a proper process for gaining knowledge about a patient’s medical history to allow for safe dental treatment

Definitions:

EPR: electronic patient record
E-form: electronic form
Med: medical
Physician: medical doctor
PCC: Patient Care Coordinator

Policy and/or Procedure:

Request for Medical Consult:

When a student, faculty, or resident identifies items in a patient’s med history that may cause complications during dental treatment a medical consultation will be indicated.
When a Medical Consult Request form is indicated:
Medical consult request form must be add to the patient’s EPR
Student/Residents/Faculty assigned to the patient will complete page 1 of the medical consult request e-form.
Student reviews consult with the faculty member and makes appropriate changes if indicated by faculty.
Faculty approves the e-form.
Patient signs the Med consult form electronically.
A copy is printed from the patient’s EPR to be faxed or given to the patient to take to their physician. Physician will complete page 2 of the medical consult.
When the medical consult reply is returned:
- By fax or mail: The med consult will be scanned into patient’s EPR by the General Practice Nurse. Provider will be notified via email. The consult reply must be interpreted and discussed with assigned faculty. Faculty will approve the completed medical consult optional note. Provider will be required to update patient’s medical history and medication list.
- By patient: The student should have the med consults reply reviewed by assigned faculty and discuss under what conditions the patient may receive treatment. *The student will place the medical documents in the secured nurse’s box located outside nurse’s office and/or the 3rd floor PCC’s office to be scanned into the patient’s EPR. Faculty will approve the completed medical consult optional note. Providers are required to update patient’s medical history and medication list.

Release From Responsibility

Subject: III. Clinical – I. Patient Care

Policy Number: CL007

Origination Date: February 22, 2008

Effective Date: May 1, 2008

Reviewed and/or Revised: 09/01/2016, 09/01/2017, 3/13/2024, 7/31/2025, 3/27/2026

Purpose: The purpose of this policy is to follow guidelines when a patient refuses appropriate dental/medical care.

Policy and/or Procedure:

Patient is to be educated and informed of treatment options as well as the possible outcomes of not obtaining the recommended treatment
If patient refuses appropriate recommended dental/medical treatment, patient is to complete, sign and date the Refusal of First Recommended Treatment Option Form. One witness will also need to sign and date the form.
- Refusal of First Recommended Treatment Option Adult
- Refusal of First Recommended Treatment Option Minor or Person with Guardian
Refusal for appropriate recommended dental/medical treatment and completion and signature of Refusal of First Recommended Treatment Option Form (attached copy) noting patient is aware of the risks for refusing the highly recommended treatment is also to be placed in the chart and noted in the chart notes.
Chart note information needs to be signed.
Program GP Director
Student

Risk Management Policy

Subject: III. Clinical – I. Patient Care

Effective Date: 6/1/08

Reviewed and/or Revised: 09/01/2016, 09/01/2017, 03/13/2024, 07/31/2025

The objective of the Risk Management Plan is to minimize the adverse effects of loss through identification and assessment of loss potential and loss prevention and to maintain an environment for its faculty, staff, students and visitors that does not adversely affect their health and safety. The plan is integral to the quality management of the UMSOD.

Identify, classify, and evaluate risks of loss to patients, employees, students, faculty and visitors;
Document the frequency and severity of risks;
Initiate action to eliminate or minimize these risks; and,
Integrate risk activities into the Quality Assurance Program.

Scheduling a Patient for Dental Implants Procedure

Subject: III. Clinical – I. Patient Care

Effective Date: 5/31/16

Reviewed and/or Revised: 09/01/2017, 02/07/2025, 07/29/2025

All scheduling for appointments in the undergraduate prosthodontics clinic must be done through the Axium Scheduler tab. IMP/TP chairs are designated for treatment planning and digital planning, while IMP or FIX chairs are allocated for implant restorations.

Note: Prosthodontics attendings do not have access to scheduled appointments and should not be contacted for scheduling issues.

Surgical appointments are scheduled by the surgical providers in their respective assigned specialty clinics.

CBCT scan appointments are scheduled through the Radiology Division. Students are encouraged to assist patients in scheduling these appointments.

Screening for Hypertension Policy and Procedure

Subject: III. Clinical – I. Patient Care

Department: Clinical

Origination Date: July 1, 2009

Effective Date: July 1, 2009

Reviewed and/or Revised: 6/4/16, 5/25/17, 09/01/2017, 4/20/2017, 1/28/2024, 3/06/2025, 10/29/2025, 11/18/2025

Purpose: To provide blood pressure guidelines when providing dental treatment to patients to allow for safe treatment in the following areas, AEGD, ASE, Emergency, Faculty Practice, Oral Surgery, Predoctoral Clinics, Radiology, Screening, SPC, and PLUS. This parameter is important to ensure safe patient treatment, including the need for medical consultation or referral as needed.

Policy Statement

Patients treated in the SOD clinics will have their blood pressure monitored consistent with guidelines published in the Eighth Report of the Joint National Committee on the Prevention, Detection, Evaluation of High Blood Pressure (JNC) published December 18, 2013; and evaluated based on the 2017 ACC/AHA Hypertension Guidelines published September 13, 2017.

These blood pressure guidelines are intended to assist the provider treating the dental patient and not intended to be a substitute for consultation with the patient’s physician or the clinical judgment of the dental provider.

Definitions: See the Blood Pressure Equipment (Manual and digital handheld); Use and Management Policy/Procedure

Policy and/or Procedure

I. Adult Procedure Step List:

Measure blood pressure and record in progress notes
1. Elevated (systolic 120-129 mmHg) and Stage I (systolic 130-139 mmHg/diastolic 80-90 mmHg
  - May receive planned dental treatment.
  - Use of local anesthetic with vasoconstrictor should be limited to no more than 2-3 carpules with epinephrine 1:100,000
  - The patient should be referred to see their doctor regarding their blood pressure.
2. Stage II (Systolic >140/ Diastolic >90)
  - No elective dental treatment should be provided.
  - Systolic <160-170/diastolic <100-109
    - Emergency dental treatment may be provided at the discretion of the covering faculty.
3. Systolic >170/diastolic >110
  - No elective or Emergency dental treatment to be provided.
  - Patient should be referred to a hospital for immediate treatment

II. Children and Adolescents Procedure Step List:

For a child or adolescent 10-17 years of age, the blood pressure must be taken at the initial visit
1. Systolic = or <140mm Hg and/or a diastolic 90mm Hg or higher
  - Elective dental procedures can be preformed
2. Systolic >140 or higher and/or diastolic > 90mm Hg
  - No elective dental treatment should be performed
  - The patient’s parent or guardian must be advised to obtain a consultation with the patient’s physician
  - Written documentation of the patient’s consultation with the physician must be entered into the patient record

III. Emergent Dental Procedure

Systolic = or <160/ Diastolic = or <100
- May receive emergency dental treatment
- Systolic > 160mm Hg and/or a diastolic blood pressure >100mm Hg or higher, a medical consult must be generated in the patient's electronic record for the patient to present to their physician to be addressed.

Silver Diamine Fluoride Directions Policy

Subject: III. Clinical – I. Patient Care

Origination Date: 10/2019

Effective Date: 11/01/2019

Reviewed and/or Revised: 01/28/2024, 07/29/2025

Purpose: Arrest of Caries

Indications: To slow or arrest caries in vital teeth.

Contraindications: Allergy to silver (very rare)

Alert: Inform patient: Carious lesions will turn black when treated with SDF. Sound tooth structure will not discolor. The stain can be removed when/if restoration is placed.

Application:

Isolate carious lesions with cotton rolls and remove food/debris from lesion, when possible.
Gently dry lesion with air syringe. For interproximal lesions – use a small wedge to open contact.
Place one drop of SDF solution into a disposable dappen dish and use microbrush to place SDF into the lesion. Rub/leave on lesion for ONE MINUTE.
If needed, to mask metallic taste - rinse and suction out water.
Remove cotton rolls.
Dispose of cotton roll, applicator brush, dappen dish in rolled-up glove to eliminate the risk of staining skin, counter tops, and clothing.
Use D1354 to code each tooth treated with SDF.
Re-evaluate lesion for caries arrest and/or recurrent decay. Re-apply up to TWICE a year.

Standards of Care Policy

Subject: III. Clinical – I. Patient Care

Date: 11/4/10

Reviewed and/or Revised: 09/01/2017, 02/18/2024, 07/31/2025, 3/18/2026

These Standards of Patient Care are guidelines established to ensure the quality, consistency and timeliness of patient care delivered at the School of Dentistry. Patient treatment will comply with these Standards and according to the UMSOD Departmental Patient Care and Treatment Guidelines document established and maintained by the Clinic Administration.

The Standards of Patient Care are shown below:

All people receiving dental treatment at the UMSOD dental clinics must be registered patients of the UMSOD before they are admitted for treatment. Coincident with the registration of patients is the establishment of a patient record. The record shall comply with COMAR 10.44.2 in the State of Maryland Dental Practice Act and include (but is not limited to) demographic data, medical history, radiographs, diagnostic and therapeutic actions, consultations, dental charting, treatment and progress notes, patient consents, correspondence related to care, laboratory reports, prescription data for medications, and prescription data for dental laboratory services.
All patients will be advised of the general and financial policies of the UMSOD prior to the initiation of treatment.
All patients will be informed of the Privacy Practices of the clinics of the UMSOD, including the Patient Bill of Rights. This will occur via review and acknowledgement by patients of the UMSOD Notice of Privacy Practices which contains the Patient Bill of Rights. The Patient Bill of Rights is also posted in every clinic reception area on the video monitor.
All prospective patients shall be offered a Screening appointment within 30 days of contacting the school when the Screening clinic is open.
All comprehensive care patients shall be assigned to the appropriate provider within 60 days of their Screening appointment when school is in session (the most notable exception occurs when new providers are entering the clinic).
All patients assigned to the pre-doctoral clinic will receive a comprehensive examination, including examination of hard and soft tissues, the findings of which will be documented in the patient record and approved by attending faculty’s signature.
Patients with active oral disease shall have the opportunity to be seen at least once every 30 days when school is in session.
All patients seeking comprehensive care who receive a comprehensive or periodic examination (including all appropriate specialty consultations and faculty approval) shall be informed of their condition and presented with a recommended treatment plan within 30 days following the examination.
Informed consent will be obtained from all patients prior to the initiation of treatment. This informed consent shall include procedure specific informed consent, problem identification, treatment alternatives, benefits of treatment, risks of treatment including the risk of no treatment, prognosis for successful outcomes and cost estimates and verified by patient and faculty signature. Translation services are available when required.
All patient treatment will be documented in the dental record via treatment / progress note that shall be reviewed for accuracy and approved by supervising faculty signature.
All radiographic images will be ordered by faculty and reviewed by faculty and will be approved in Infinitt and the procedure will be completed in Axium.
All patients will receive fixed or removable prosthodontic dental treatment only after oral disease control treatments have been provided to the patient and ensuring that proposed treatment is being delivered in an optimal sequence for patient care. Review of patient readiness and treatment status will be via record audit.
All faculty, clinical staff, and students must be CPR certified and must receive training on the management of medical emergencies in the UMSOD clinics, prior to working in the clinic and at least annually.
The School of Dentistry will maintain an ongoing Quality Assurance program using quality of care indicators to ensure compliance with these and/or other standards.

Submitting Oral Pathology Specimens Procedure

Subject: III. Clinical – I. Patient Care

Department: Oncology and Diagnostic Sciences

Origination Date: 5/23/16

Reviewed and/or Revised: 09/01/2017, 2/28/2024, 8/13/2025, 3/10/2026, 3/18/2026

Purpose:

The purpose of this procedure is to facilitate the billing, transport, and processing of pathology specimens.

Scope:

Applies to all providers performing biopsies or requesting processing of pathology specimens.

Policy and/or Procedure

Providers must educate patients on biopsy billings; there are two charges:
1. for performing biopsy
2. for assessing and providing a report of the biopsy
All patients will be asked for both their Dental and Medical Insurance cards to be on file since some of the procedures can be billed medically.
Upon tissue removal from a patient, the specimen is promptly placed in a fixative provided in a specimen bottle by the user
Complete identifying information on the specimen bottle by user
Fill out a biopsy requisition form by user
Obtain requisite Faculty signature on the biopsy requisition form by user
Deliver the specimen bottle and one copy of the biopsy requisition form to UMDS 7th Floor North Prep Room (RM 7355) by user
Await results, which will be in reported in Axium
Advise patient on diagnosis by student or resident providers

Tuberculosis (TB) Screening and Infection Management Policy and Procedure

Subject: III. Clinical – I. Patient Care

Department: Clinical

Origination Date: 2/24/14

Effective Date: 5/23/14

Reviewed and/or Revised: 09/01/2017, 3/13/2026

Purpose: The purpose of the Tuberculosis Screening and Infection procedure is to ensure that TB screening of students, faculty and staff takes place according to JCAHO policy, and that diagnosis of Tuberculosis in a student, faculty, staff member or patient is managed in an appropriate manner.

Policy: Because of over a 15 year history of negligible risk in dentistry for TB, faculty, staff and students at the School of Dentistry will not need TB testing unless they are required to be tested according to JCAHO policy because of an upcoming internship or clinical rotation to a JCAHO accredited institution.

Any student, faculty, staff, or patient with a medical diagnosis of TB will be managed in an appropriate manner as outlined in the Tuberculosis Screening and Infection Control Procedure.

Definitions:

JCAHO: Joint commission on accreditation of health care organizations.
TST: A tuberculin skin test (screening) is done to see if you have ever had tuberculosis (TB). The test is done by putting a small amount of TB protein (antigens) under the top layer of skin on your inner forearm. If you have ever been exposed to the TB bacteria (Mycobacterium tuberculosis), your skin will react to the antigens by developing a firm red bump at the site within 2-3 days.
PPD: PPD: The TB antigens used in a tuberculin skin (TST) test are called purified protein derivatives (PPD). A measured amount of PPD is injected into the top layer of skin on your forearm.
QFT Gold: QuantiFERON®-TB Gold is an FDA approved blood test for the detection of tuberculosis (TB) infection. As a modern alternative to the 100-year-old tuberculin skin test (TST); QFT-G is a more accurate, reliable, and convenient TB diagnostic tool. QFT-G is highly specific, and a positive test result is strongly predictive of true infection with Mycobacterium tuberculosis (M. tb). The test is approved as an aid for diagnosing both active TB disease and latent TB infection (LTBI); however, it does not differentiate between the two.
BCG: BCG, or bacille Calmette-Guerin, is a vaccine for tuberculosis (TB) disease. Many foreign-born persons have been BCG-vaccinated. BCG is used in many countries with a high prevalence of TB to prevent childhood tuberculosis meningitis (infection of membranes covering brain and spinal cord) and military disease. However, BCG is not generally recommended for use in the United States because of the low risk of infection with Mycobacterium tuberculosis, the variable effectiveness of the vaccine against adult pulmonary TB, and the vaccine’s potential interference with tuberculin skin test reactivity (CDC).
Military is a form of tuberculosis characterized by a wide dissemination into the human body and by the tiny size of the lesions (1–5 mm). Its name comes from a distinctive pattern seen on a chest X-ray of many tiny spots distributed throughout the lung fields with the appearance similar to millet seeds—thus the term "miliary" tuberculosis. Miliary TB may infect any number of organs, including the lungs, liver, and spleen.

Procedure:

SOD TB Screening Requirements:

In general, all TB, faculty, staff and students at the Dental School will not need to be screened for TB via TST
All UMDS faculty, staff and students who have clinical activity in the UMMS hospital, affiliated clinics other medical facility that requires Tuberculosis (TB) testing according to JCAHO regulations, will be screened for TB in accordance with the policy of the affiliated institution
1. Students that have TB screening done elsewhere, should have results also submitted to University of Maryland Student and Employee Health; 667-214-1899)
2. Additionally, faculty, staff and students who take part in clinical rotations/internships where exposure to TB may occur will also be screened
3. The level of TB risk will determine the need for routine follow-up TSTs.

SOD Students, Faculty or Staff with a Positive TB Screening Result:

If a TST is positive, a negative chest x-ray report is required (the test may be repeated once to rule out false positive).
1. Before going on a TB medication treatment regiment, a QFT laboratory test can be performed to definitively verify the TB diagnosis (TSTs can react to other mycobacterium present in soil and water and to the BCG vaccine; the QFT Gold will react only to Mycobacterium tuberculosis
Once an individual has had two positive TST reactions, they will not be required to have any more repeat TSTs.
Diagnostics and/or treatment for TB detected prior to the start of employment will be at the “employee’s” cost.

SOD Faculty Staff or Students with TB symptoms and/ or TB diagnosis:

Any student, faculty member, or employee with a persistent cough (i.e., lasting greater than 3 weeks), especially in the presence of other signs or symptoms compatible with active TB (e.g., weight loss, night sweats, fatigue, bloody sputum, anorexia, or fever), should be evaluated promptly.
The Student or Employee should not return to the Dental School or Dental School Clinic until a diagnosis of TB has been excluded or the Student or Employee is on therapy, and a physician has determined that the Student or Employee is noninfectious.
1. Physician documentation indicating that it is safe for the student, staff or employee to return to clinical duties will need to be sent to University of Maryland Immediate Care (UMIC/ Student and Employee Health; 410-328-1362/410-328-6791) and be evaluated by the Physician Director; once confirmation has been made, and the ‘all clear’ communicated to the UMSOD Infection Control RN, and, Associate Dean of Clinical affairs, the individual can return to the clinic (sensitive health information will be closely guarded by those with a need to know, and not placed in the SOD academic record).

Patients with TB Symptoms or Diagnosis:

While taking patients' initial medical histories and at periodic updates, Dental Students, Residents, and/or Faculty should routinely ask all patients whether they have a history of TB disease or symptoms indicative of TB.
1. While in the dental clinic, a patient with TB symptoms or a recent diagnosis without documentation of a completed treatment regimen and medical documentation of being non-infectious, should be isolated from other patients, , and be provided with a surgical mask to wear when not being evaluated, or be instructed to cover their mouth and nose when coughing or sneezing.
Patients with a medical history of TB or symptoms should not remain in the dental clinic any longer than required to evaluate their dental condition and arrange a referral for medical evaluation to determine possible infectiousness.
1. Referrals need to be made to the Baltimore City Health Dept., Clinical Services, EASTERN CHEST CLINIC, 620 North Caroline Street, Baltimore, Maryland 21205, (410) 396-9413 or their private physician for medical evaluation for possible infectiousness.
Elective dental treatment should be deferred until a physician confirms that a patient does not have infectious TB, or if the patient is diagnosed with active TB disease, until confirmed the patient is no longer infectious.
If urgent dental care is provided for a patient who has, or is suspected of having active TB disease, the care should be provided in a facility (e.g., hospital) that provides airborne infection isolation (i.e., using such engineering controls as TB isolation rooms, negatively pressured relative to the corridors, with air either exhausted to the outside or HEPA-filtered if recirculation is necessary). Standard surgical face masks do not protect against TB transmission; Dental Students, Residents, Faculty and Clinic Staff should use respiratory protection (e.g., fit-tested, disposable N-95 respirators).
1. The Infection Control RN (room 4317; phone: 6-6344) and the General Practice Nurse (room 2318; phone: 6-7496) are both trained by University of Maryland, Baltimore, Environmental Health and Safety to perform N95 Mask fit testing, but initial fit testing cannot take place unless the individual to be fitted has passed the federally mandated physical exam specifically for individuals who are going to be fit tested for N-95 Respirator mask use. The dental school has faculty/staff members that are certified once every 2 years to wear N-95 Respirator masks.
2. Dental treatment should not be performed by individuals who are not certified to use the N95 respirator mask.

UMB UMSOD Policy For Known or Suspected Monkeypox Cases

Subject: III. Clinical – I. Patient Care

Effective Date: 08/20/2022

Reviewed and/or Revised: 08/20/2022, 03/15/2024, 07/31/2025

UMB/UMSOD Policy For Known or Suspected Monkeypox Cases

Policy and/or Procedure:

First priority is to prevent exposure of employees or patients!

Immediately Isolate patient to dental chair
Keep patient seated
Patient should wear a mask and cover all skin lesions, as much as possible
Anyone with contact should don gown, gloves, face shield, and N95 or equivalent respirator
Provide medical consultation including stressing the importance of prompt follow-up with a physician, and dismiss patient ASAP
Immediately contact the Baltimore City Health Department (BCHD) or Maryland State Department of Health (MDH) to report the case, including providing patient contact information
BCHD: (410) 396-4436, or after hours: (410) 396-3100
MDH: (410) 767-6700, or after hours: (410) 795-7365
CDC: (770) 488-7100, if additional clinical guidance is needed CDC: (770) 488-7100, if additional clinical guidance is needed
Do not take samples of lesions or make direct skin contact as part of the physical exam
Contact 410-328-2637 or UMBOccupationalHealth@som.umaryland.edu for additional assistance, including to discuss any potential exposure concerns
Once patient leaves the operatory/clinic, consult EHS for proper decontamination protocols (410-706-7055 from 8-4 M-F, otherwise 410-706-6665). Per EHS instructions, perform surface disinfection to all operatory surfaces and dispose of all PPE, including gowns, in the special medical waste containers surfaces
More information on waste management can be found here: Infection Prevention and Control of Monkeypox in Healthcare Settings
For those working in UMMS sites, please follow UMMS guidance

Urgent Care Clinic Patients with Periodontal Issues who need Debridement

Subject: III. Clinical – I. Patient Care

Department: University of Maryland Dental School, Clinical Affairs Urgent Care Program

Policy Number: CL001

Origination Date: January 2, 2008

Effective Date: February 1, 2008

Reviewed and/or Revised: 09/01/2017, 1/28/2024, 2/03/2025, 8/13/2025

Purpose: Procedure for Dental Hygiene Students who see Urgent Care Clinic Patients with Periodontal issues that need debridement when Dental Students are not available.

Policy:

When patient presents to the Urgent Care Clinic with Periodontal issues and needs gross debridement, Director of Urgent Care Clinic will refer patient to a Dental Student for care.
If the patient needs to be placed on antibiotics (determined by Urgent Care Clinic Faculty and/ Dental Student) being seen for follow up treatment, this needs to be noted in the patient’s chart.
If a Dental Student is not available, the Director of the Urgent Care clinic will refer patients to the Dental Hygiene Department for gross debridement. This is to be noted in the patient’s chart.
Dental Hygiene Students are not performing gross scaling on the entire mouth in one visit. This is to be done on multiple visits.
Since Dental Hygiene Students need more than one visit to complete the gross scaling for the patient, the Dental Hygiene Student must have a GP Director covering the floor examine the patient before dismissing them. A note must be placed in the chart as to who the GP Director was and any findings that they made.
At all appointments for gross debridement by a hygiene student a note in the chart needs to be made regarding:
1. What treatment was received.
2. Which GP Director examined the patient and what findings they made.
3. If another follow up appointment is needed (give date if known).
4. If treatment is completed, note patient was referred for comprehensive care after completion of gross debridement.
If another follow-up visit should be needed for further debridement by a hygiene student, this should be reported to the hygiene faculty member covering the clinic at the time in order to get them rescheduled.
Upon completion of the gross debridement the patient will be encouraged to obtain a screening for comprehensive care appointment so that all their needs may be attended to including a maintenance schedule.

Use of Restraint Devices During Dental Procedures - Procedure

Subject: III. Clinical – I. Patient Care

Reviewed and/or Revised: 09/01/2017, 2/07/2024, 8/13/2025

Purpose

Establish safe and consistent guidelines for the use of restraint devices for dental patients who exhibit behaviors that put them at risk for unintentionally interrupting their dental procedure and posing a threat to the physical safety of self and others.

Definitions

Restraint Device – used to restrict freedom of movement.

Policy and/or Procedure

Applying Restraints:

after assessment of the patient’s specific need for restraints by a nurse or physician
after attempting less restrictive interventions
after ruling out medical, psychological, and physical conditions that contraindicate the use of restraints

Procedure for Restraint Use:

Obtain informed consent from parent or legal guardian
The passive restraint device will be applied by staff educated in the safe application of such device.
Nursing staff will provide continuous monitoring of the patient assessing patient’s behavior, circulation, skin and muscle condition and adjusting the restraint device as necessary.
Appropriate documentation (indication, type and duration of stabilization, behavior evaluating during stabilization, untoward outcomes, and management implications for future appointments) will be made in the patient’s chart. Written consent is required in the treatment notes.

J. Radiology

General Radiography Policies

Subject: III. Clinical – J. Radiology

Department: Oncology & Diagnostic Sciences

Origination Date: July 17, 2013

Effective Date: August 19, 2013

Reviewed and/or Revised: 09/01/2017, 02/26/2024, 1/07/2025

Purpose: To comply with Federal and State regulations as well as other practice guidelines as recommended by the ADA and NCRP.

Definitions:

Justification Principle—radiographic examinations should be ordered only after a clinical evaluation of the patient; and only when there is a reasonable expectation that the information obtained from the radiograph will affect the patient’s diagnosis.
Limitation Principle—the primary radiographic beams should be optimized to limit exposure to the patient; i.e. fast receptors should be used when possible; and x-ray beams should be collimated to match the region of interest when possible.
ALARA Principle—As Low As Reasonably Achievable, which means that radiographic examinations are obtained with the lowest radiation dose possible, within reason.

Related links and documents:

The Regulatory Guideline for Use of Dental X-Ray Machines in the State of Maryland was updated in May 2013:
In 2012 the ADA and FDA released an updated statement, Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure.

Policy and/or Procedures: The following are the UMSOD Radiography General Policies:

Only individuals holding a valid Maryland License (DDS, DH or dental radiation technologist) are permitted to make exposures, with the exception of supervised students, in the clinic setting at the UMSOD. A properly licensed UMSOD faculty dentist must personally determine the indication for and prescribe the appropriate radiographic procedures prior to exposure of radiographs.
Students (both Dental and Dental Hygiene) must demonstrate pre-clinical radiographic competency before exposing patients. Pre-doctoral Dental Students must have completed Radiology 512 and 528; and Dental Hygiene Students must have completed Radiology 316.
Existing radiographs of the patient are reviewed before new exposures are made. Only additional views required for diagnosis and treatment are ordered and exposed.
The school attempts to obtain any recent radiographs, taken outside the Dental School, provided patient consent is obtained and documented in the Axium electronic health record.
Radiographs are made only after medical and dental histories have been reviewed; a clinical examination has been completed; and, only when a patient is able to cooperate.
The type and number of radiographs must be consistent with the patient’s clinical requirements as determined by clinical examination.
Per the 2012 FDA/ADA selection criteria guideline summary, ‘Radiographs should be taken only when there is an expectation that the diagnostic yield will affect patient care.’
The FDA/ADA selection criteria guidelines should be followed for radiographic examination selection for pregnant patients. The NCRP Report #177 only refers to the management of the pregnant dental office worker and does not refer specifically to radiographic exposures for pregnant patients with the expectation that the FDA/ADA patient selection criteria will be applied equally to pregnant patients and non-pregnant patients alike. In a 2006 JADA article, the ADA Council on Scientific Affairs stated that dental radiographs may be prescribed for pregnant patients with careful adherence to the FDA selection criteria guidelines. Finally, in an article published in the American Journal of Obstetrics & Gynecology in 2009, Dr. R.L. Brent stated that ‘It can be definitively stated that dental radiography is not a risk for any fetal effects, including fetal growth retardation.’
The requirement for radiographs, before, during and following treatment, is based on the patient's needs and the dentist's professional judgment.
No administrative radiographs (e.g. radiographs made for third parties, insurance claims, or legal proceedings), with no health benefit shall be made, per NCRP Report #177, Section 4.4.1.3, page 39, Recommendation 15: Administrative use of radiation to provide information that is not necessary for the treatment or diagnosis of the patient shall not be permitted.
Radiographs are not made solely for the purpose of student training or demonstration. Patients who require radiographs for diagnostic purposes may participate in educational activities.
Extraoral radiographs shall be made with the beam collimated to the region of diagnostic interest.
Following the ALARA principle, all radiographic examinations made within the dental school will use digital or PSP receptors only. Film radiography is prohibited.
Approval for radiographic examinations within Axium expires within one week.
Quarterly quality assurance reports will be reviewed by the Director of Oral Radiology.

Radiation Safety Policy

Subject: III. Clinical – J. Radiology

Department: Oncology & Diagnostic Sciences

Origination Date: July 17, 2013

Effective Date: August 19, 2013

Reviewed and/or Revised: 09/01/2017, 02/26/2024, 1/07/2025

Purpose: To minimize exposure to ionizing radiation

Definitions:

Justification Principle—radiographic examinations should be ordered only after a clinical evaluation of the patient; and, only when there is a reasonable expectation that the information obtained from the radiograph will affect the patient’s diagnosis.
Limitation Principle—the primary radiographic beams should be optimized to limit exposure to the patient; i.e. fast receptors should be used when possible; and x-ray beams should be collimated to match the region of interest when possible.
ALARA Principle—As Low As Reasonably Achievable, which means that radiographic examinations are obtained with the lowest radiation dose possible, within reason.

Related links and documents:

The Regulatory Guideline for Use of Dental X-Ray Machines in the State of Maryland was updated in May 2013.
In 2012 the ADA and FDA released an updated statement, Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure.
The following is a link to the UMB Campus website for Radiation Safety

Policy and/or Procedure: It is the policy of the UMSOD that ionizing radiation be used only when necessary for diagnostic or treatment procedures.

The benefit of the diagnostic information obtained from the radiographic examination must clearly outweigh the potential risks of the radiation that the patient receives. Standard radiation hygiene techniques such as lead aprons, thyroid collars, and fast digital receptors are used at the school to minimize the risk to dental school patients.
FDA/ADA patient selection guidelines noted above are used routinely in the school to assist students and practitioners with selection of radiographic examinations.
The Director of Oral Radiology has the authority and responsibility to establish, implement, and monitor guidelines, policies, and procedures for radiographic practices within the school.
The Director of Oral Radiology will incorporate established UMB campus radiation standards and programs in coordinating, monitoring and controlling the School's use of diagnostic x-ray imaging equipment.
If the Director of Oral Radiology determines that any student lacks the required skills to make satisfactory patient exposures, the student is required to satisfactorily complete additional radiology competency training.
Approval of the Director of Oral Radiology (and the University Office of Radiation Safety) must be obtained prior to installing or remodeling radiographic facilities or purchasing new radiographic equipment.
Students who require three or more retake radiographs during a complete radiographic survey are assisted, and receive direct supervision by a radiology faculty or radiology staff member.
All radiographs exposed in the undergraduate clinic or pre-doctoral clinics and patient admissions area are evaluated for clinical acceptability. The need for retakes is determined by a faculty member, based on diagnostic acceptability. All images should be approved for technical quality within INFINITT at the time the radiographs are made (aka, at the time of service).
The following clinic protocol for image approvals MUST be followed for diagnostic radiographs:
1. Retakes are justified using the ‘Comments’ section of INFINITT.
2. Radiology clinic staff or radiology-approved staff or faculty swipe approval is required for retakes.
3. When a complete radiographic series (CRS or FMX) is complete, a technical analysis is required; analysis comments are placed in the ‘Comments’ section of INFINITT.
4. The series is then approved for technical quality by radiology clinic staff or radiology-approved staff or faculty via swipe approval.
5. If the patient is an Urgent Care patient, the radiographic findings are then completed in the problem-based spreadsheet section of the patient VISIT form.
6. If the patient is a Comprehensive Care patient, the radiographic findings are charted in the Odontogram with a note in the ‘site section’ of the problem-based spreadsheet area to ‘see odontogram’.
No occupational worker; i.e., clinic staff personnel, is permitted to hold a receptor for a patient during any exposure.
Dosimetry reports for faculty, students and staff that are monitored with badges are kept permanently by the Environmental Health and Safety Office and are available for review by the individual. Records are kept on file at the UMSOD in the office of the Administrative Assistant or Executive Assistant to the Chairman of Clinic Operations Office. The dose limit (MPD) specified by the NRC, is observed. Presently, the dose limit is 50 mSv (5 rem) per calendar year.
Any dosimetry reading which is in excess of 10% of the monthly dose limit, (40 mrem), is investigated by the Dosimetry Coordinator of the Environmental Health and Safety Office of UMB. A written inquiry is sent to the occupational worker to determine the probable reason for the exposure.
Pregnant faculty, students or staff, who have declared their pregnancy, must not be exposed to more than 5 mSv (500 mrem) during the entire term of pregnancy. Declared pregnant faculty, students or staff may request radiation badges from the Administrative Assistant to the Associate Dean for Clinical Affairs. Please see the Radiation Badges Policy.

Radiation Safety Policy for Use of Handheld X-Ray Units

Subject: III. Clinical – J. Radiology

Department: Oncology & Diagnostic Sciences

Subject: Radiation Safety Policy for Use of Handheld X-Ray Units

Origination Date: July 1, 2014

Effective Date: August 1, 2014

Reviewed and/or Revised: 09/01/2017, 05/21/2024, 1/07/2025

Purpose: To minimize exposure to ionizing radiation by adhering to the State of Maryland Guidelines for use of handheld x-ray units

Definitions:

Handheld x-ray unit—a battery operated x-ray unit for use when fixed or wall-mounted units are difficult to use or not practical to use, particularly helpful with the special patient population such as debilitated geriatric patients or other special needs patient who have difficulty obeying routine instructions to enable proper patient cooperation during intraoral radiographic procedures; the leading example of a dental handheld x-ray device is the NOMAD.
ALARA Principle—As Low As Reasonably Achievable, which means that radiographic examinations are obtained with the lowest radiation dose possible, within reason.

Related links and documents:

The Regulatory Guideline for Use of Dental X-Ray Machines in the State of Maryland was updated in May 2013.
The State of Maryland also has specific guidelines on the use of handheld x-ray units; located in this document: Maryland Department of the Environment Radiological Health Program Application for Use of Hand-Held Dental Radiation Machine.
In 2012 the ADA and FDA released an updated statement, Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure.
This is the link to the UMB Campus website for Radiation Safety.

Policy and/or Procedure:

It is the policy of the UMSOD that ionizing radiation be used only when necessary for diagnostic or treatment procedures. The following policy incorporates the State of Maryland requirements for use of handheld x-ray units. The UMSOD Radiation Safety Policy should also be followed during use of these handheld units and follows these specific guidelines as a reference.

The following is a list of conditions placed on the UMSOD by the State of Maryland’s Guidelines for use of Handheld X-ray units for the request to own and operate the hand-held dental radiation machine as part of the facility’s registration:

Only a United States Food and Drug Administration (FDA) approved hand-held radiation machine can be utilized.
The hand-held radiation machine is allowed in dental offices as a replacement for, or in addition to, the use of a wall-mounted or free-standing portable dental radiation machine, when it is determined by the dentist that it is not possible or not safe to utilize a wall mounted or portable stand mounted radiation machine.
A log of hand-held usage must be maintained on a form provided by the Radiation Machines Division (RMD).
Hand-held radiation machines require dental film speeds E or faster or with digital imaging.
Each individual operating the device must complete the manufacturer’s training and submit the training certificates to the Department. The records will be maintained by the RMD as part of the facility registration.
When registering the device, the facility must indicate to the RMD that the intended manner of use is for handheld operation.
The device shall be locked up after use, and a description of where and how the device will be stored must be provided to the Department.
The device must be locked down (Safety) mode when it is not active so that exposures cannot be taken.
The device used shall have a permanently mounted non-removable shield in order to protect the operator from backscatter.
Only those persons licensed to operate radiographic equipment in the State of Maryland are permitted to make exposures using this device.
The operator must wear a whole body dosimeter when taking an exposure at all times.
As low as reasonably achievable (ALARA) practices will be in place during use.
The RMD reserves the right to perform an unannounced audit to ensure that the hand held dental device is utilized properly.
If the device is missing or stolen, the facility must report this to the RMD.

The following is a list of specific actions that MUST be monitored by the Director of the Clinic in which the NOMAD or other handheld x-ray unit is in use:

The handheld x-ray unit log MUST be accurately maintained at the time of the radiographic examination
Only digital receptors such as a direct digital sensor or an indirect PSP imaging plate can be used with the handheld device.
Each individual operating the handheld device must have approved training; the Clinic Director will maintain the appropriate records and make these available to the Radiation Machine Division (RMD) of the State as well as the University’s Radiation Safety Officer and UMSOD’s Director of Oral Radiology as requested.
The Clinic Director MUST indicate to the RMD that the intended manner of use is for handheld operation.
The Clinic Director MUST have a plan of operation for securing the handheld unit that specifically addresses the manner in which the unit will be locked after use as well as the storage location and how the unit will be obtained for clinical use on a patient by patient basis, including who controls the key and/or lock for the storage cabinet.
As required by the state, operators of the handheld device MUST wear a whole-body dosimeter when using the device. (See the Radiation Badge Policy for details about obtaining a radiation badge.)
The Clinic Director MUST ensure that all other State Guidelines for use and operation of the handheld device are being followed.

Radiation Badges Policy

Subject: III. Clinical – J. Radiology

Department: Oncology & Diagnostic Sciences

Origination Date: July 17, 2013

Effective Date: August 19, 2013

Reviewed and/or Revised: 09/01/2017, 02/12/2018, 02/26/2024, 1/07/2025

Purpose: The use of radiation badges is not routinely required at the UMSOD due to our status as a ‘safe facility’. Individuals for whom radiation badging is recommended and those individuals who request to be monitored with a radiation badge may do so in accordance with this policy. The purpose of this policy is to have a process in place for radiology badge distribution, collection, reporting of results, and communication of results by EHS of Clinic Personnel who are monitored with radiation badges as well as the results of the area badges placed in areas of radiation exposures as determined by EHS. The results of radiation monitoring will be reported to the UMSOD QA Committee. This policy has been formulated with the approval of the UMB Department of Environmental Health and Safety (EHS).

Policy and/or Procedure: Procedural steps for radiology badge use:

Radiation Badges must be worn in the UMSOD Clinics and removed when leaving the Clinic area. Badges are NOT to be worn outside of the building.
Clinic Business Managers are to advise new employees who regularly expose radiographs and who wish to wear a radiation badge to complete the Radiation Worker Registration Form which is sent to the Contractor Mirion by EHS.
The Contractor, Mirion, will send a list of names from the website of those names they have received who are to be badged and the badges to EHS for distribution and collection each month.
EHS is to send the radiation badges with the names and badge numbers from Mirion of those who are to wear the badges to UMSOD’s Director of Medical Credentialing and Quality Assurance.
The Director of Medical Credentialing and Quality Assurance will give the list of names and the badges to the Administrative Assistant for Clinical Affairs. The Administrative Assistant for Clinical Affairs will make a copy of the list of names for the UMSOD files and then take the list of names and badges to the Business Managers in each clinic as appropriate.
The Business Manager of each clinic will distribute the current month’s badges and give the Administrative Assistant for Clinical Affairs the list of names and badges from the previous month. A radiation badge should only be exchanged by the person wearing the badge. The Business Manager is to check the names of those who returned their badges that were given to them previously. If someone does not return their badge, the Business Manager reports this to EHS and makes a note on the list of names.
The Administrative Assistant for Clinical Affairs will make a copy of the list given to her by the Business Manager for UMSOD files. Then she will send the original list of names back to EHS with the badges.
EHS will send the Director of Medical Credentialing and Quality Assurance and the Director of Oral Radiology a monthly report on the badges and any exposures. The Director of Medical Credentialing and Quality Assurance will then report the results of this report to the QA Committee. EXHIBIT 5-7.3, STANDARD 5 76, Patient Care Services.
Appropriate Clinic Personnel will be notified only if their badge shows there was an exposure. Clinic Personnel may request a copy of their record at any time through Clinical Affairs or EHS. Requests need to be made in writing.
According to state guidelines, whenever a radiation badge is processed and a radiation level greater than 10% of the established safe radiation limit is detected (>5 milliSv per month), an immediate report is sent to the UMB Radiation Safety Officer for investigation. If radiation levels are detected, but they are less than this 10% level, the exposure will be reported routinely, usually after a period of 3 months after the badges have been collected. If an employee does not have an exposure, the Radiation Safety Office does NOT routinely inform employees of zero radiation exposures, although summary reports are provided to the UMSOD.
The Director of Radiology (Dr. Price) will receive the complete dosimetry report for review. The report will include doses greater than 10% of the established safe limit as outlined above, as well as all other recorded radiation doses below the 10% established safe limit.
Anyone who regularly exposes radiographs and wishes to be badged can be monitored. Email Dr. Price for assistance if you have problems submitting the Radiation Worker Registration Form.
If you become pregnant, and expose radiographs, please be aware that the recommendation is to declare your pregnancy in writing so that your radiation exposure can be monitored. If you choose to declare your pregnancy status, please obtain the Pregnant Worker Declaration Form (PDF) and print, complete, sign and send the form to:
- Dr. Price JBPrice@umaryland.edu,
- Dr. Noonan knoonan@umaryland.edu and
- Ms. Markwitz emarkwitz@umaryland.edu
You will receive a collar radiation badge as well as a fetal radiation badge. Wear the fetal radiation badge at your waist. You may wear it under your clothing. Additionally, you will continue to wear the regular radiation badge given to you each month. A new badge for each will be sent to your Business Manager monthly. You will turn in your used radiation and fetal radiation badge to the Business Manager who will exchange it for the new badges each month. Once you are no longer pregnant, please return the badges to your Business Manager and inform them you no longer with to be monitored.
Directions to obtain a regular radiation badge. If you would like to receive a regular radiation badge, go online and complete the Radiation Worker Registration Form.

Pre Clinical Radiation Policy

Subject: III. Clinical – J. Radiology

Department: Oncology & Diagnostic Sciences

Origination Date: July 17, 2013

Effective Date: August 19, 2013

Reviewed and/or Revised: 09/01/2017, 02/26/2024, 1/07/2025

Purpose: Prevent human exposure to ionizing radiation during pre-clinical exercises Scope (applies to): Dental students, faculty and staff

Definitions:

Justification Principle—radiographic examinations should be ordered only after a clinical evaluation of the patient; and, only when there is a reasonable expectation that the information obtained from the radiograph will affect the patient’s diagnosis.
Limitation Principle—the primary radiographic beams should be optimized to limit exposure to the patient; i.e. fast receptors should be used when possible; and x-ray beams should be collimated to match the region of interest when possible.
ALARA Principle—As Low As Reasonably Achievable, which means that radiographic examinations are obtained with the lowest radiation dose possible, within reason.

Policy and/or Procedure: Maintain simulation OF radiographic equipment, including DXTTRs, to prevent human exposures to ionizing radiation. When appropriate, pre-clinical radiographic exposures must be accomplished inside shielded cabinets in accordance with State and UMB guidelines.

Related links and documents:

The Regulatory Guideline for Use of Dental X-Ray Machines in the State of Maryland was updated in May 2013.
In 2012 the ADA and FDA released an updated statement, Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure.

Procedural Steps for Pre-Clinical Radiography:

Wherever possible, simulations in the pre-clinical laboratory should emulate clinical practice so that students will learn to apply appropriate radiation safety practices to the clinical setting.
Simulation radiographs are ordered using the ADA/FDA Selection Criteria Guidelines following the principles of justification, limitation and ALARA. A licensed professional must supervise the treatment planning and approval of all pre-clinical radiographs within Axium. In addition, student exposures of intraoral and extraoral images must be supervised by a licensed professional; and the radiographic quality of these images and diagnostic findings for these images must be reviewed by a licensed professional.
To practice good radiation hygiene, only students and instructors should be in the SimLabs during exposures for pre-clinical, laboratory exercises. The cabinet containing the radiographic equipment shall require shielding and interlocks so that no radiation is emitted to occupants of the simulation laboratory. Planmeca ProSensors integrated with ‘development’ versions of INFINITT and Axium are used within a shielded box for exposures.
For pre-clinical exposures utilizing DXTTR radiology mannequins, all normal, routine clinical techniques and proper radiation hygiene procedures are practiced.

Asepsis in Radiology and Imaging Policy and Procedure

Subject: III. Clinical – J. Radiology

Department: Oncology & Diagnostic Sciences

Origination Date: July 17, 2013

Effective Date: August 19, 2013

Reviewed and/or Revised: 09/01/2017, 02/26/2024, 1/07/2025

Purpose: To prevent the spread of communicable disease

Definitions: None

Policy and/or Procedure: All patients should be considered potentially infectious. Each patient's medical history will be evaluated for indications of infectious disease before treatment. Digital sensors are assigned to a specific radiographic operatory and are physically in place ready for service each day after appropriate Axium and INFINITT approvals. All radiographic equipment, including sensors, should be inspected for damage on a daily basis. If damage is noted, it should be reported to Radiology Staff and/or the Clinic Coordinator and the Director of Oral Radiology. X-ray cubicles and equipment will be inspected for cleanliness prior to disinfection and cleanliness problems are to be reported to the Clinic Coordinator and/or Housekeeping and Facilities/Maintenance personnel. Cubicles that are not clean must be cleaned prior to disinfection. The operatory will then be disinfected by the student before the patient is seated; and, cubicles are to be disinfected after the patient is dismissed. Sensors must be covered by a barrier at all times; sensor holding instruments (XCP’s) will be sterilized and provided, along with other necessary supplies, through Central Materials Services (CMS).

Procedural Steps:

Obtain all required supplies; cover the bracket table with an impervious barrier (either patient napkin or head rest cover) and cover the headrest with a plastic bag.
Cover the x-ray control panel, tubehead, position indicating device (x-ray cone), exposure control switch, digital sensors, light handle, keyboard and mouse with disposable plastic film barriers.
Log into Axium and select patient; next, treatment plan the appropriate radiographic examination and obtain faculty approval; then, send the order to INFINITT per clinic protocol. INFINITT will open automatically; so, wait a few seconds; when INFINITT opens, ensure the planned examination template is showing in Xelis 2D, the INFINITT Acquisition Software module. For all exposures, ensure that a green rectangle highlights the desired location (frame or slot) in the template where you want the initial exposure to go. Next, in the top menu bar, look at the far right and ensure that a green solid circle is visible, which is the ‘ready’ button, you are ready to make exposures! At this point, begin placement of the sensor in the patient’s mouth with the x-ray generator set at the correct technique settings for your initial exposure; remember to evaluate your image after each exposure and look at the red/green/yellow indicator which will indicate whether you have too much/enough/too little radiation and adjust your time settings as needed; as a general rule of thumb, only adjust the time and keep kVp and mA the same for ease of calculation. The blue line indicating the next exposure will automatically move to the next available slot in the template.
Keep any paper forms away from your work area.
Wear gloves, mask, protective eyewear, with side shields and face shield during sensor placement, tube head alignment, and image exposures.
Place digital sensors that are contaminated with the patient’s saliva only on the bracket table (not on the x-ray machine).
When using PSP plates, place a protective plastic barrier on the countertop; next, obtain a plastic cup; and, place the exposed PSP plates into the cup as each exposure is completed; then, when all exposures are completed, remain over the barrier to prevent contamination of the counter top by the saliva-contaminated PSP barriers and transfer the PSP sensor plates into a clean, black, light-proof PSP storage box with an aseptic technique by opening the black plastic storage bag and dropping the PSP plates into the black box. Remember: The black box should remain clean; and, the PSP plates are clean; therefore, DO NOT touch the PSP plates OR the black box with your gloved hands! Next, take the black box with the PSP plates to the processing room for processing! When all exposures are complete, remove remaining barriers and disinfect any object or surface that was touched or disinfect the PSP’s with EtOH if barrier is noted to have been violated.
Remove used barrier. Wipe the sensor with disinfectant wipes. Place sensor in sensor caddy. Wipe sensor holders with disinfectant wipes and place into autoclave bag, return them to CMS, and REPORT any instrument breakage!
If there is any episode of barrier breakage during the procedure, student will notify clinic personnel immediately for assistance.
At the end of the clinical procedure and after de-gloving, wash hands, or use alcohol wash!
Complete image mounting and technical analysis within INFINITT, immediately followed by sending the radiographic series in INFINITT; next, complete your radiographic interpretation within Axium per clinic protocol.

Radiographic Examinations for the Pregnant Patient Policy

Subject: III. Clinical – J. Radiology

Department: Oncology & Diagnostic Sciences

Origination Date: August 19, 2013

Effective Date: August 19, 2013

Reviewed and/or Revised: 09/01/2017, 02/26/2024, 1/07/2025

Purpose: To review the school’s policy regarding radiographic examinations for pregnant patients; and to provide rationale for the policy as well as offer references for further reading.

Definitions:

Policy and/or Procedure: The school’s radiation policies are described in full in other clinic manual policies. The following is found in the General Radiography Policy: The FDA/ADA selection criteria guidelines should be followed for radiographic examination selection for pregnant patients. The following documents support this policy: NCRP Report #177 only refers to the management of the pregnant dental office worker and does not refer specifically to radiographic exposures for pregnant patients with the expectation that the FDA/ADA patient selection criteria will be applied equally to pregnant patients and non-pregnant patients alike. In a 2006 JADA article, the ADA Council on Scientific Affairs stated that dental radiographs may be prescribed for pregnant patients with careful adherence to the FDA selection criteria guidelines. Finally, in an article published in the American Journal of Obstetrics & Gynecology in 2009, Dr. R.L. Brent stated that ‘It can be definitively stated that dental radiography is not a risk for any fetal effects, including fetal growth retardation.’

The NCRP is the National Council for Radiation Protection & Measurements. They mention taking ‘special care’ to minimize radiation. The single most effective way to minimize radiation is to use patient selection guidelines, which provide the latest recommendations on the use of dental radiographs, particularly on whether to order a radiograph and how often radiographs may be indicated. Other significant ways to reduce radiation doses for pregnant patients are to use optimized techniques such as fast direct digital sensors or indirect PSP plates like we use in the clinic; collimate the beam with rectangular collimation; practice excellent projection geometry technique to minimize retakes; and, finally use proper shielding for the patient, such as lead aprons and thyroid collars when appropriate. In clinical practice here at the school, there are standard radiation hygiene techniques that are used for all patients, not just our pregnant patients.

The most current FDA/ADA guidelines for patient selection for dental radiographs were published in late 2012. This document is the third version and, unlike the previous version, provides a lengthy review of many aspects of dental radiography. One area that does not receive any specific, in-depth mention in this document is the topic of pregnant patients. This is not an oversight by the committee; rather it is an indication that pregnant patients are to be treated just like all other patients when it comes to deciding whether radiographs are indicated. The only vague reference to pregnancy comes in the article’s concluding statements when the authors refer to environmental factors: "Dentists should conduct a clinical examination, consider the patient’s oral and medical histories, as well as consider the patient’s vulnerability to environmental factors that may affect oral health before conducting a radiographic examination. This information should guide the dentist in the determination of the type of imaging to be used, the frequency of its use, and the number of images to obtain. Radiographs should be taken only when there is an expectation that the diagnostic yield will affect patient care." The final sentence is the key to ordering radiographs on an individual basis. There must first be a specific diagnostic question that the clinician needs to answer; the clinician then decides that a radiographic examination will provide information that will assist with answering that diagnostic question; the clinician selects the proper type of examination; i.e., periapical, bitewing, etc. and orders the examination. This is the protocol that should be followed for all patients; and, particularly for pregnant patients. An example of the ‘special care’ mentioned earlier may be applied when the clinician and the pregnant patient together decide to postpone elective procedures such as dental implant planning since a cone beam CT will be ordered in most implant cases. However, if the pregnant patient has dental caries and radiographs are deemed necessary for their proper diagnosis and management, then not taking the indicated radiographs so that a proper treatment plan can be generated and treatment rendered may have a significantly worse outcome for the patient (irreversible pulpitis or development of odontogenic infections, for instance) than taking the radiographs. Again, ordering radiographs for the pregnant patient is on an individual basis, just as with all our patients.

What amounts of radiation are involved? First of all, the risk of dental radiographic examinations is exceedingly low. The average person receives ~8 microSieverts of radiation per day just by being alive. The typical panoramic dose here at the school is ~24 MicroSieverts per panoramic examination. We can determine the background dose equivalency by dividing the radiation dose of the examination by the amount of radiation dose per day; for a panoramic that is 24 MicroSieverts divided by 8 MicroSieverts per day, which equals 3 days of background equivalency for a typical panoramic radiograph here at the school. One bitewing or one periapical is ~6 MicroSieverts per image; a typical maxillofacial field of view cone beam CT may be in the 150 MicroSieverts range and limited field of view cone beam CT may be 25 to 30 MicroSieverts. A full mouth series (FMX) using digital receptors and rectangular collimation is ~36 MicroSieverts while a FMX taken with digital receptors and round collimation is ~180 MicroSieverts; and, finally, one taken with D-speed film and round collimation is ~388 MicroSieverts. Our country’s fatal cancer rate is 200,000 cancer deaths per 1 million people. If 1.25 million people had a panoramic radiograph, it is estimated that one additional fatal cancer would occur due to the radiation received from the panoramic. When viewed against the 20% of our population that dies due to cancer, the risk of taking a panoramic radiograph is, again, exceedingly low.

In summary, our pregnant patients are managed the way all of our patients should be managed: only take the indicated radiographs when there is a reasonable expectation that the diagnostic information obtained from the radiographs will affect patient care or treatment outcomes.

References

Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure
NCRP Report #177, Radiation Protection in Dentistry and Oral & Maxillofacial Imaging, 2019.
Oral Radiology: Principles and Interpretation by White & Pharoah, Ed. 8, 2018.
The use of dental radiographs: update and recommendations; ADA’s Council on Scientific Affairs, 2006.
Saving lives and changing family histories: appropriate counseling of pregnant women and men and women of reproductive age, concerning the risk of diagnostic radiation exposures during and before pregnancy; Brent, RL, American Journal of Obstetrics & Gynecology, 2009.

Selection Criteria of Patients for Radiographic Examinations Policy

Subject: III. Clinical – J. Radiology

Department: Oncology & Diagnostic Sciences

Origination Date: July 17, 2013

Effective Date: August 19, 2013

Reviewed and/or Revised: 09/01/2017, 05/21/2024, 1/07/2025

Purpose: The purpose of this policy is to comply with FDA/ADA guidelines on patient selection criteria for radiographic examination. It is consistent with the principles of justification, limitation, and ALARA which when used together act to minimize radiation doses for the dental patient.

Definitions: Justification Principle—radiographic examinations should be ordered only after a clinical evaluation of the patient; and, only when there is a reasonable expectation that the information obtained from the radiograph will affect the patient’s diagnosis. Limitation Principle—the primary radiographic beams should be optimized to limit exposure to the patient; i.e., fast receptors should be used when possible; and x-ray beams should be collimated to match the region of interest when possible. ALARA Principle—As Low As Reasonably Achievable, which means that radiographic examinations are obtained with the lowest radiation dose possible, within reason.

Policy and/or Procedure: Attending faculty at the UM School of Dentistry should order radiographic examinations based on the medical and dental history of the patient, the findings of the clinical examination and the unique needs of the individual patient. In 2012 the ADA and FDA released the following updated statement which provides detailed guidance: Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure

The following table is a summary of the Selection Criteria for Dental Radiographic Examinations:

Type of Encounter	Patient Age & Dental Developmental Stage
Type of Encounter	Child with Primary Dentition (prior to eruption of first permanent tooth)	Child with Transitional Dentition (after eruption of first permanent tooth)	Adolescent with Permanent Dentition (prior to eruption of third molars)	Adult, Dentate and Partially Edentulous	Adult Edentulous
New patient being evaluated for oral diseases	Individualized radiographic exam consisting of selected periapical/occlusal views and/or posterior bitewings if proximal surfaces cannot be visualized or probed. Patients without evidence of disease and with open proximal contacts may not require a radiographic exam at this time.	Individualized radiographic exam consisting of posterior bitewings with panoramic exam or posterior bitewings and selected periapical images.	Individualized radiographic exam consisting of posterior bitewings with panoramic exam or posterior bitewings and selected periapical images. A full mouth intraoral radiographic exam is preferred when the patient has clinical evidence of generalized oral disease or a history of extensive dental treatment.		Individualized radiographic exam, based on clinical signs and symptoms
Recall patient* with clinical caries or at increased risk for caries**	Posterior bitewing exam at 6–12-month intervals if proximal surfaces cannot be examined visually or with a probe			Posterior BW exam at 6–18-month intervals	Not Applicable
Recall patient* with no clinical caries and not at increased risk for caries**	Posterior bitewing exam at 12–14-month intervals if proximal surfaces cannot be examined visually or with a probe		Posterior bitewing exam at 18–36-month intervals	Posterior bitewing exam at 24–36-month intervals	Not Applicable
Recall patient* with periodontal disease	Clinical judgment as to the need for and type of radiographic images for the evaluation of periodontal disease. Imaging may consist of, but is not limited to, selected bitewing and/or periapical images of areas where periodontal disease (other than nonspecific gingivitis) can be demonstrated clinically.				Not Applicable
Patient (New and Recall) for monitoring of dentofacial growth and development, and/or assessment of dental/skeletal relationships	Clinical judgement as to need for and type of radiographic images for evaluation and/or monitoring of dentofacial growth and development or assessment of dental and skeletal relationships		Clinical judgment as to need for and type of radiographic images for evaluation and/or monitoring of dentofacial growth and development, or assessment of dental and skeletal relationships. Panoramic or periapical exam to assess developing third molars	Usually not indicated for monitoring of growth and development. Clinical judgment as to the need for and type of radiographic image for evaluation of dental and skeletal relationships.	Usually not indicated for monitoring of growth and development. Clinical judgment as to the need for and type of radiographic image for evaluation of dental and skeletal relationships.
Patient with other circumstances including, but not limited to, proposed or existing implants, other dental and craniofacial pathoses, restorative/endodontic needs, treated periodontal disease and caries remineralization		Clinical judgment as to need for and type of radiographic images for evaluation and/or monitoring of these conditions

Clinical Situations:

Example 1 Screening Clinic—a screening periodontal examination is encouraged to determine the patient’s periodontal status. A patient with gingivitis or 4 mm probings only would most likely have a panoramic, BWs, and perhaps selected PA’s ordered as needed. When a patient has isolated 5 mm periodontal probings in only one quadrant, a panoramic, BWs, and PAs in that quadrant is indicated; however, when 5 mm probings are present in two or more quadrants, this patient is considered to have a more generalized periodontal condition and as noted in the selection guidelines, a FMX is indicated.

Example 2 Recall Patients—using a standard time interval for routine, recall BWs is no longer considered acceptable. Instead, determination of when to order radiographs should be determined by individual patient factors such as frequency of dental visits, plaque score, caries risk, existing restorations, diet and periodontal status. The guidelines have a 6-to-18- month time period range for exposing recall BW’s, based on these individual factors

Example 3 Periodontal Patients—patients with periodontal disease will generally require radiographs at more frequent intervals than healthy adults. Since periodontitis is an episodic disease, radiographic intervals are usually correlated with clinical findings; therefore, when a clinical examination indicates changes in probing depths and attachment levels, selected PA’s and/or entire FMX’s may be exposed based on the individual patient’s findings.

Obtaining Intraoral and Extraoral Radiographs Procedure

Subject: III. Clinical – J. Radiology

Department: Oncology & Diagnostic Sciences

Origination Date: July 17, 2013

Effective Date: August 19, 2013

Reviewed and/or Revised: 09/01/2017, 02/26/2024, 1/07/2025

Purpose: Assist students with knowledge and practical application of the use and operation of intraoral and extraoral dental x-ray equipment; and, to provide practical, clinical experience in the diagnosis of diseases and abnormalities.

Policy and/or Procedure: Before any radiograph is ordered and exposed, a clinical assessment must be accomplished; and the attending faculty member must approve the ordered radiographic examination within the patient’s Axium electronic health record.

Related links and documents:

The Regulatory Guidelines for Dental Radiation Machines was updated in May 2013. (Click on the "here" link to download a copy of the Guidelines.)
In 2012 the ADA and FDA released an updated statement, Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure.
Intraoral Technique Chart (PDF)

Procedural Steps for Intraoral Radiography:

All intraoral radiographs are exposed using digital receptors in accordance with NCRP Report #177 guidelines and the latest recommendations from the ADA and the FDA as noted above.
Intraoral radiographs are taken using a collimated beam, in accordance with NCRP Report #177 and Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure. Only position-indicating devices with a beam size of less than 2.75” (7 cm) in diameter are used. In addition, it is standard operating procedure to use a rectangular collimation system for all intraoral radiographs.
The x-ray source to skin distance for intraoral radiography shall be 12” (30 cm) or greater.
The paralleling technique is used for periapical radiography, whenever feasible.
Total filtration of the intraoral x-ray machines is at least 1.5 mm of aluminum equivalent for units operating at or below 70 kVp and at least 2.5 mm of aluminum equivalent for units operating above 70 kVp.

Procedural Steps for Extraoral Radiography:

All extraoral radiographs are exposed using digital receptors in accordance with NCRP Report #177 guidelines and the latest recommendations from the ADA and FDA, Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure.
All extraoral radiographic machines that have beam-limiting, or collimation, capability; i.e.; such as cone beam computed tomography (CBCT) units like the Carestream 9600 and the Morita VeraView X800, should be collimated to the region of interest before making the exposure. Exposing large fields of view simply for operator convenience is a violation of the ALARA Principle (As Low As Reasonably Achievable) and is not an acceptable radiation hygiene practice.

Xray Logon Policy

Subject: III. Clinical – J. Radiology

Department: Radiology

Origination Date: 10/9/15

Effective Date: 10/9/15

Reviewed and/or Revised: 09/01/2017, 02/26/2024, 1/07/2025

Purpose: To help minimize the number of dropped images by allowing us to free up disk space on these hard drives.

Policy and/or Procedure:

To improve the efficiency of the x-ray acquisition computers; and, to attempt to decrease the number of dropped images, these acquisition computer workstations will ONLY BE AVAILABLE FOR X-RAY ACQUISITION. This means that the acquisition computers will automatically boot up to ‘x-ray log on’ and ‘No other network log on is allowed’. The following is the list of computers affected:

DSC-1318-PAN, DSC-1323-PAN, DSC-1323-PANNEW, DSC-1320-9601, DSC-1320-9602, DSC- 2304-PAN, DSC-2305, DSC-2306, DSC-2321, DSC-2322, , DSC-2329-SPSP, DSC-3308-PAN, DSC-3317-SPSP, DSC-3321, DSC-3317-SPSP, DSC-3308-SPSP, DSC-3328, DSC-4304-Morita, DSC-4304-SPSP, USG-2110-CS, USG-2114-CS

Please report any issues to the help desk at sodhelp@umaryland.edu

Policy for Requesting the Import of Outside Radiographs into INFINITT

Subject: III. Clinical – J. Radiology

Department: Radiology

Origination Date: September 9, 2016

Effective Date: September 9, 2016

Reviewed and/or Revised: 09/01/2017, 02/26/2024, 1/07/2025

Purpose: To allow for a standardized protocol for the importing of Outside radiographs into the current image management system of the school (INFINITT)

Policy and/or Procedures: The following is the UM School of Dentistry Radiographic Import policy for Outside images:

As part of the initial contact with patients, they should be encouraged to obtain digital copies of their radiographs and either send them to the school or take them to their initial appointment at the School of Dentistry.
If the patient does not have their radiographs, the patient must provide a release form to the office or clinic in possession of the radiographs, if the office does not already have a release form on file. This form is located in Axium under Forms; in addition, hard copies are located in the Radiology Clinic on the First Floor.
The primary provider (in the pre-doc clinic, this is the student provider) should contact the outside clinic or private office to inform them that the patient has requested that their radiographs and other records be sent to the School of Dentistry. The release form should be faxed to the outside provider.
The outside dental clinic/practice should send the digital images to OralRad@umaryland.edu
Radiology clinic personnel will review the images for quality and import the images into the patient’s INIFINITT chart.
Upon image import into INFINITT, the imported full mouth series images will be mounted into a full mouth series template, images rotated, and the series will be saved with a name that includes the exposure date. A treatment note will be placed in Axium documenting the date of exposure and type of radiographs imported.
Please note: priority for image importing is given to patients who are physically present in the school; the turnaround time for image import may be as long as five (5) days for patients who have sent images to the school before appointments.

Policy for Requesting the Import of Romexis Radiographs into INFINITT

Subject: III. Clinical – J. Radiology

Department: Radiology

Origination Date: September 9, 2016

Effective Date: September 9, 2016

Reviewed and/or Revised: 09/01/2017, 02/28/2024, 1/07/2025

Purpose: To allow for a standardized protocol for the importing of Romexis radiographs into the current image management system of the school (INFINITT)

Policy and/or Procedures: The following is the UM School of Dentistry Radiographic Import policy for Romexis images:

Currently, Romexis images are viewable using the Romexis Images Report found in the Patient Care module of Axium. It is expected that this resource will continue to be used for viewing radiographs.
After reviewing the patient’s record and determining the need for access to previous Romexis images in order to view CRS/FMX series and or sequential radiographs within INFINITT, the treating provider should send an import request to oralrad@umaryland.edu. This request should contain the patients Axium #, specific image type requested (for example, panoramic, cephalometric, CRS, BW, CBCT) as well as the exact date of the exposure. For periodontal patients, a suggested protocol is to request the original CRS/FMX in Romexis as well as the most recent CRS/FMX. For other situations of sequential treatment such as monitoring an implant site or endodontically treated tooth, please give the initial date, image type, and other dates that are required.
Upon image import into INFINITT, the imported full mouth series images will be mounted into a full mouth series template, images rotated, and the series will be saved with a name that includes the exposure date.
A treatment note will be placed in Axium documenting the date of exposure and the type of radiographs imported.
Please note: the turnaround time for image retrieval and import is up to five (5) days.

Intraoral (IO) Camera Policy

Subject: III. Clinical – J. Radiology

Effective Date: January 1, 2017

Reviewed and/or Revised: 09/01/2017, 02/26/2024, 1/07/2025

Purpose: To describe the clinical use of the intraoral cameras

Definitions: Intraoral (IO) camera—this is the Panasonic camera to be plugged directly into a clinical computer workstation and used to capture intraoral images.

Related links and documents:

Users are required to follow proper protocols for checking out equipment from Prep Dispense as well as general INFINITT usage policies found in the AxiUm clinical guides.
The IO camera training video in Blackboard Clinic Essentials.

Policy and/or Procedure:

Upon determining the need for intraoral imaging, the user should check out an IO camera from Prep Dispense. Please note that if damage occurs to the camera, the user may be liable for a $1,200 breakage fee per normal clinic protocol.
The following items should be within the rubber lined camera case:
1. The Panasonic IO camera, with a cloth lens cover to prevent scratches to the lens, within a bubble wrap protective bag
2. Plastic sheaths for infection control
3. Alcohol wipes for cleaning the lens, as needed
In the patient’s AxiUm chart, plan a D0350.1 code; please note the “.1”. INFINITT will not recognize the acquired images taken with the intraoral camera using the D0350 code and consequently you will NOT be able to acquire intraoral images.
Send the D0350.1 code to INFINITT per normal clinic routine.
In INFINITT, select the ‘Microsoft’ image source in the box along the top left of the imaging template, then select the ‘IO Camera’ which activates the IO camera properly.
A live feed of the camera and a temporary workspace will open; as you ‘capture’ intraoral images, they will appear in the workspace.
Per the training video, capture images.
In the temporary workspace, you will then select the images you wish to save in the patient’s INFINITT chart. When you close the temporary workspace, the selected images will automatically be transferred to the INFINITT template. Please refer to the training video for additional details.
Adjust images as needed (brightness/contrast, orientation, order, etc.) BEFORE sending the images to the INFINITT Cloud.
Finally, have your faculty complete the procedure in AxiUm.

Radiography Record Policy

Subject: III. Clinical – J. Radiology

Department: Oncology & Diagnostic Sciences

Origination Date: July 17, 2013

Effective Date: August 19, 2013

Reviewed and/or Revised: 09/01/2017, 05/21/2024, 1/07/2025

Purpose: Ensure complete and accurate radiographic exposures, including documentation in the Axium electronic health record.

Related links and documents:

The Regulatory Guideline for Use of Dental X-Ray Machines in the State of Maryland was updated in May 2013:
In 2012 the ADA and FDA released an updated statement, Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure.

Policy and/or Procedure: In all clinics, radiographic examinations are ordered according to current FDA/ADA selection criteria guidelines.

Procedural Steps for Documentation of Radiographs:

All ordered radiographic examinations are documented in the Axium EHR and in INFINITT; records of exposed radiographs are recorded and tracked in INFINITT.
In the pre-doctoral and dental hygiene clinics, all radiographs must be appropriately documented, approved and authorized, in Axium, our electronic health record, by a licensed faculty dentist prior to exposing radiographs.
In the pre-doctoral and dental hygiene clinics, INFINITT is the PACS software used by the UMSOD for acquiring, viewing, processing and storing images. Radiographic images cannot be deleted from the INFINITT database.
In the undergraduate clinic, all radiographs must be properly oriented and teeth numbered in MiPACS on the day the exposure was made. A template corresponding to an ADA code must be used for each radiographic exposure.
The following clinic protocol for image approvals MUST be followed for diagnostic radiographs:
1. Retakes are justified using the ‘Comments’ section of INFINITT; and radiology clinic staff or radiology-approved staff or faculty swipe approval is required for retakes.
2. When a complete radiographic series (CRS or FMX) is complete, a technical analysis is required; analysis comments are placed in the ‘Comments’ section of INFIITT.
3. The series is then approved for technical quality by radiology clinic staff or radiology-approved staff or faculty via swipe approval.
4. If the patient is an Urgent Care patient, the radiographic findings are then completed in the spreadsheet section of the patient's VISIT form.
5. If the patient is a Comprehensive Care patient, the radiographic findings are then charted in the Odontogram with a note in the spreadsheet area to ‘see odontogram’.
Interpretation of radiographs are the responsibility of the individual who exposed the radiographs.
Completion of the technical quality analysis and documentation of radiographic findings are expected at the time of service.

Radiation Safety Procedures

Subject: III. Clinical – J. Radiology

Department: Oncology & Diagnostic Sciences

Origination Date: July 17, 2013

Effective Date: August 19, 2013

Reviewed and/or Revised: 09/01/2017, 02/28/2024, 1/07/2025

Purpose: This procedure provides instructions for creating, reviewing, routing, storing, and maintaining reports that are necessary for proper documentation of UMB radiation safety activities; and this procedure addresses many of the regulatory requirements found in COMAR Sections 26.12.01.01.

Scope (applies to): This procedure addresses radiation safety reports that are required by COMAR and UMB’s radioactive material licenses.

Policy and/or Procedure: The Radiation Safety Committee of the University has generated a Radiation Safety Procedure to which the School of Dentistry must adhere. Click the following link to access the The University of Maryland's Radiation Safety Procedure document.