Oral Health Services

Dental and Medical History: To develop an appropriate treatment plan, the oral health care provider should obtain information about the patient’s health and medication status. At a minimum, the provider should obtain and review medical history and conduct a limited physical evaluation at the initial appointment and updated annually.

This information may include the following:

• HIV-related history, including information on the client’s HIV-treating provider
• Pregnancy and breastfeeding status
• Chief complaint
• Current medications, including medications affecting coagulation and any osteoporotic medications
• Allergies and drug sensitivities
• Alcohol and other drug use
• Tobacco use
• Physical and mental health diagnoses, including any chronic conditions
• Usual oral hygiene
• Date of last dental examination

1. Percentage of clients who had a dental and medical health history (initial or updated) at least once in the measurement year. (HRSA HAB measure)

Limited Physical Examination: The oral health provider is responsible for completing an initial limited physical examination in accordance with the Texas Board of Dental Examiners, which should include, at a minimum: 

• Blood pressure
• Heart rate

Dental practitioners must also record blood pressure and pulse heart rate for invasive procedures involving sedation and anesthesia. If the dental practitioner is unable to obtain a client’s vital signs, they must document in the client's chart the reason the attempt was unsuccessful.

2. Percentage of clients who had a limited physical examination, consisting of blood pressure and heart rate check at a minimum, performed at least once in the measurement year.

Oral Examination: Clients must have an initial comprehensive oral exam, a periodic recall oral evaluation, or a problem-focused oral exam once per year. This should consist of one of the following:

• Comprehensive oral evaluation, to include x-rays (full mouth and panoramic), new client 
• Periodic oral evaluation to include bitewing x-rays, established client
• Problem-focused oral evaluation for clients with an acute concern

3. Percentage of clients who had a documented oral examination completed within the measurement year.

Periodontal Screening or Examination: All clients should receive a periodontal screen or exam at least annually unless the client was only seen for evaluation or treatment of a dental emergency. This may consist of either a comprehensive initial screen or an annual re-evaluation.

The initial periodontal screen should include the assessment of medical and dental histories, the quantity and quality of attached gingiva, bleeding, tooth mobility, and a radiological review of the status of the periodontium and dental implants.  The comprehensive periodontal examination should include:

• Evaluation and recording of periodontal conditions
• Evaluation and recording of dental caries
• Evaluation and recording of missing, misaligned or unerupted teeth
• Evaluation and recording of restorations
• Evaluation and recording of occlusal relationships
• Evaluation and recording of dysplastic oral cancerous lesions

Annual re-evaluation should include follow-up on previously identified issues and evaluation for any new or emerging periodontal concerns.

Some forms of periodontal disease may be more severe in individuals affected with immune system disorders. Patients with HIV may have especially severe forms of periodontal disease, and the incidence of necrotizing periodontal diseases may increase with clients with AIDS.

4. Percentage of clients who had a periodontal screen or examination at least once in the measurement year, unless the client was only seen for a dental emergency. (HRSA HAB measure)

Dental Treatment Plan: The provider should develop a dental treatment plan that includes preventive care, maintenance, and elimination of oral pathology and should discuss this plan with the client. Oral health providers should select treatment options in collaboration with the client.
 
Treatment plans should be appropriate for the client’s health status, financial status, and individual preference, and must include, as clinically indicated: 

• Provision for the relief of pain
• Elimination of infection
• Preventive care
• Periodontal treatment
• Elimination of caries
• Replacement or maintenance of tooth space or function
• Consultation or referral for conditions where treatment is beyond the scope of services offered
• Determination of adequate recall interval
• Invasive procedure risk assessment (prior to oral surgery, extraction, or other invasive procedure)

 
The oral health care professional providing the services must sign the dental treatment plan (electronic signatures are acceptable).

5. Percentage of clients who had a dental treatment plan developed or updated at least once in the measurement year. (HRSA HAB measure)

Initial Treatment Plan: New clients should receive a treatment plan that includes prevention, maintenance, and elimination of oral pathology that results from dental caries or periodontal disease. This plan should be completed within the first year of services and should include:

• Restorative treatment
• Basic periodontal therapy (nonsurgical)
• Basic oral surgery that includes extractions and biopsy
• Non-surgical endodontic therapy if the tooth is restorable
• Space maintenance and tooth eruption guidance for transitional dentition.

The initial treatment plan, if the care was completed on schedule, should be completed within 12 months of initiating treatment.

6. Percentage of clients with an initial treatment plan that was completed within 12 months. (DSHS-revised HRSA HAB measure)

Oral Health Education: A licensed dentist, dental hygienist, dental assistant, or dental case manager must provide and document oral health education. Education should address the following topics: 

• Oral hygiene instruction
• Daily brushing and flossing (or other interproximal cleaning) or prosthetic care to remove plaque
• Daily use of over-the-counter fluorides to prevent or reduce cavities when appropriate and applicable to the client.
• Smoking or tobacco cessation counseling as indicated

Additional areas for instruction may include nutrition. For pediatric clients, oral health education should be provided to parents and caregivers and must be age appropriate.

7. Percentage of clients who received oral health education at least once in the measurement year. (HRSA HAB measure) This includes all of the following:

   a. Daily brushing and flossing (or other interproximal cleaning) or prosthetic care to remove plaque.

   b. Daily use of over-the-counter fluorides to prevent or reduce cavities when appropriate and applicable to the patient. 

   c. Smoking or tobacco cessation counseling as indicated.

Referrals: Providers should place referrals for other services when specialized care is indicated or other medical issues are identified during dental care.  Staff should document the referral and follow-up in the client’s chart, including the outcomes of the referral.

8. Percentage of clients who received referrals with documentation of the outcomes of the referral in the oral health care record. 

Expenditure Documentation: In the cases of emergency need or where extensive care is needed, the maximum cost may exceed the $3000 per client per calendar year expenditure cap. Dental providers are required to document the reason for exceeding the yearly maximum amount and must have documented approval from the local Administrative Agency (AA) for the purposes of funds only, but not the appropriateness of the clinical procedure.

9. If the cost of dental care exceeded the annual maximum amount for Ryan White and State Services funding, the reason is documented in the client's oral health care record.