Oral Health Services

Service Standard

Oral Health Services Service Standard print version

Subcategories	Service Units
Oral Health Care - Routine Treatment	Per visit
Oral Health Care - Prophylaxis	Per visit
Oral Health Care - Specialty	Per visit

Health Resources & Services Administration (HRSA) Description:

Oral Health Care (OH) activities include outpatient diagnostics, prevention, and therapy provided by dental health care professionals, including general dental practitioners, dental specialists, dental hygienists, and licensed dental assistants.

Program Guidance:

Language assistance must be provided to individuals who have limited English proficiency and/or other communication needs at no cost to them in order to facilitate timely access to all health care and services.

Subrecipients must provide easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area to inform all individuals of the availability of language assistance services.

All AAs and subrecipients must establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organizations’ planning and operations.

Limitations:

Cosmetic dentistry for cosmetic purposes only is prohibited.

Services:

Services will include routine dental examinations, prophylaxes, radiographs, restorative therapies, basic oral surgery (e.g., extractions and biopsy), endodontics, and prosthodontics. Referral for specialized care should be completed if clinically indicated.

Emergency procedures will be treated on a walk-in basis as availability and funding allows. Funded Oral Health Care providers are permitted to provide necessary emergency care regardless of a client’s annual benefit balance.

Oral health services are an allowable core service with an expenditure cap of $3,000/client per calendar year. Local service regions may set additional limitations on the type or number of procedures covered and/or may set a lower expenditure cap, so long as such criteria are applied equitably across the region and the limitations do not restrict eligible individuals from receiving needed oral health services outlined in their individualized dental treatment plan.

In the cases of emergency need and/or where extensive care is needed, the maximum amount may exceed the above 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.

Teledentistry services are allowable in Texas as of September 1, 2021 and are defined in Title 3, Subtitle A, Chapter 11, §111.001(4) of the Texas Occupations Code (TOC) as health care services delivered by a dentist or not more than five health professionals who are not dentists acting under the delegation and supervision of a dentist acting within the scope of the dentist's or health professional's license or certification to a patient at a different physical location than the dentist or health professional using telecommunications or information technology.

Service Standard and Measure

The following Standards and Measures are guides to improving health outcomes for people living with HIV throughout the State of Texas within the Ryan White Part B and State Services Program.

Standard	Measure
Dental and Medical History: To develop an appropriate treatment plan, the oral health care provider shall obtain complete information about the patient’s health and medication status. As per the Texas Board of Dental Examiners, at minimum, a medical history and limited physical evaluation should be obtained and reviewed at the initial appointment and updated annually. This information may include, but not be limited to, the following: The client’s HIV-prescribing primary medical care provider name and phone number; Pregnancy status as applicable; Coagulants; Patient’s chief complaint; Current Medications, including any osteoporotic medications; Allergies and drug sensitivities; Alcohol and other drug use; Tobacco use; Neurological diseases; Usual oral hygiene; and Date of last dental examination.	Percentage of oral health 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 that shall include, but not be limited to: Blood Pressure; Pulse/Heart Rate; and Basic vital signs. Dental practitioner shall also record blood pressure and pulse heart rate as indicated for invasive procedures involving sedation and anesthesia. If the dental practitioner is unable to obtain a client's vital signs, the dental practitioner must document in the client's oral health care record why the attempt to obtain vital signs was unsuccessful.	Percentage of oral health clients with a documented limited physical examination completed in the primary client oral health record.
Oral Examination: Clinical oral evaluations include evaluation, diagnosis and treatment planning. Client must have either an initial comprehensive oral exam or a periodic recall oral evaluation once per year such as: Comprehensive oral evaluation, to include bitewing x-rays, new or established client; Periodic Oral Evaluation to include bitewing x-rays, established client; Detailed and Extensive Oral Evaluation, problem focused by report; Re-evaluation, limited, problem focused (established client; not post-operative visit); or Comprehensive Periodontal Evaluation, new or established client. Source: ada.org ADA Oral Health Topic: HIV.	Percentage of oral health clients with a documented oral examination completed within the measurement year in the client’s primary oral health record.
Periodontal Screening or Examination: A periodontal screen shall include the assessment of medical and dental histories, the quantity and quality of attached gingival, bleeding, tooth mobility, and radiological review of the status of the periodontium and dental implants. A comprehensive periodontal examination includes: Evaluation of periodontal conditions; Evaluation and recording of dental caries; Evaluation and recording of missing or unerupted teeth; Evaluation and recording of restorations; Evaluation and recording of occlusal relationships; Evaluation of oral cancer; Probing and charting; Evaluation and recording of the client’s medical history; and General health assessment. 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. The incidence of necrotizing periodontal diseases may increase with clients with acquired immune deficiency syndrome.	Percentage of oral health clients who had a periodontal screen or examination as least once in the measurement year. (HRSA HAB Measure)
Dental Treatment Plan: A dental treatment plan that includes preventive care, maintenance, and elimination of oral pathology shall be developed and discussed with the client. Various treatment options shall be discussed and developed in collaboration with the client. A treatment plan appropriate for the client’s health status, financial status, and individual preference must include as clinically indicated: Provision for the relief of pain; Elimination of infection; Preventive plan component; Periodontal treatment plan if necessary; 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) [1]; Dental treatment plan will be signed by the oral care health professional providing the services. (Electronic signatures are acceptable)	Percentage of oral health clients who had a dental treatment plan developed and/or updated at least once in the measurement year. (HRSA HAB Measure)
Phase 1 Treatment Plan: Phase 1 treatment includes prevention, maintenance, and/or elimination of oral pathology that results from dental caries or periodontal disease. This includes: Restorative treatment; Basic periodontal therapy (nonsurgical); Basic oral surgery that includes extractions and biopsy; Non-surgical endodontic therapy; and Space maintenance and tooth eruption guidance for transitional dentition. A Phase 1 treatment plan will be established and updated annually to include diagnostic, preventative, and therapeutic services that will be provided. The Phase 1 treatment plan, if the care was completed on schedule, is completed within 12 months of initiating treatment.	Percentage of oral health clients with a Phase 1 treatment plan that is completed within 12 months. (HRSA HAB Measure)
Oral Health Education: Oral health education must be provided and can be documented by either a licensed dentist, dental hygienist, dental assistant, or dental case manager and shall include: Oral hygiene instruction; Daily brushing and flossing (or other interproximal cleaning) and/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. If deemed appropriate, the reason is stated in the client’s oral health record; and Smoking/tobacco cessation counseling as indicated. Additional areas for instruction may include Nutrition. For pediatric clients, oral health education shall be provided to parents and caregivers and be age-appropriate for pediatric clients. Source: ada.org or the ADA’s website for patient education information.	Percentage of oral health clients who received oral health education at least once in the measurement year. (HRSA HAB Measure)
Referrals: Referrals for other services must be documented in the client’s oral health care chart. Any referrals provided by the oral health provider must have documented evidence of outcomes of the referral and/or follow-up documentation regarding the referral.	Percentage of oral health clients with documented referrals provided have outcomes and/or follow-up documentation in the primary oral health care record.