Chapter 3 – Health Care Operations

3.3.1 Dental Care Definitions

• Active Disease Site: Any site that bleeds or suppurates upon probing or has documented clinical attachment loss over successive periodontal chartings.

• Active Therapy: Procedures performed with the goal of eliminating periodontal inflammation and halting the disease process. Patients are considered to be in active therapy as long as any active disease site is present and the patient consents to periodontal treatment.

• Business Day: Monday through Friday, except for holidays.

• Caustic Materials: Substances that can destroy or eat away by chemical reaction.

• Certification: The process by which governmental, non-governmental or professional organizations or other statutory bodies:

  • Grant recognition to an individual who has met certain predetermined qualifications; OR

  • Confirm an individual’s proficiency in and grant authorization to carry out certain activities.

• Clinically Adequate Radiographs: Images that capture all areas required for satisfactory diagnosis and treatment.

• Clinical Performance Appraisal: For the purpose of Chapter 3, Article 3: Non-investigatory evaluation performed by a Program Support Team dentist to identify pertinent aspects of clinical care for Regional Dental Director, Headquarters Dental Peer Review Committee and/or Health Care Executive Committee review.

• Contact Amalgam: Dental alloy restorative material that has been in contact with the patient. (e.g., extracted teeth with amalgam restorations, carving scrap collected at chair side, amalgam captured by chair side traps, filters, or screens, as well as drain traps containing amalgam).

• Continuing Active Therapy: Procedures performed on a patient for whom periodontal disease has been previously diagnosed and treated at a California Department of Corrections and Rehabilitation institution during the sentence currently being served and active disease sites remain.

• Credentialing: The system of screening and evaluating qualifications and other credentials including, but not limited to, licensure, certification, required education, relevant training and experience, and current competence and health status.

• Custody Staff: California Department of Corrections and Rehabilitation correctional officers (CO), correctional administrators and supervisors (Sergeants and Lieutenants)

• Dental Clinic Operating Hours: At least eight hours per day, Monday through Friday, excluding holidays in which dental services are available to patients.

• Dental Emergency: A dental emergency, as determined by health care staff, includes any dental condition for which evaluation and treatment are immediately necessary to prevent death, severe or permanent disability, or to alleviate or lessen disabling pain.  Examples of dental emergencies include acute oral and maxillofacial conditions characterized by trauma, infection, pain, swelling, or bleeding that are likely to remain acute or worsen without immediate intervention. Additional conditions that always constitute dental emergencies include, but are not limited to:

  • Airway/breathing difficulties resulting from oral infection.

  • A rapidly spreading oral infection, such as Ludwig’s angina, cellulitis, (characterized by a firm swelling of the floor of the mouth, with elevation of the tongue), and acute abscess, (including an abscess at root end or a gingival abscess).

  • Facial injury and trauma to the jaws or dentition that threatens loss of airway.

  • Suspected shock due to oral infection or oral trauma.

  • Uncontrolled or spontaneous severe bleeding of the mouth.

  • Head injuries (including stabbing or gunshot wounds) that involve the jaws or dentition.

  • Moderate to severe dehydration associated with alteration in masticatory function due to obvious dental infection or dental trauma.

  • Clear signs of physical distress, (e.g., respiratory distress), related to infection or injury to the jaws or dentition.

  • Suspected or known fractures involving the nasal bones, mandible, zygomatic arch, maxilla and zygoma.

  • Acute Temporomandibular Joint (TMJ) pain, “closed-lock” TMJ, or dislocation of the TMJ.

  • Aspiration or swallowing of a tooth/teeth or foreign object that threatens loss of airway.

  • Acute, severe, debilitating pain due to obvious or suspected oral infection, oral trauma, or other dental-related conditions.

  • Infections, including infected third molars, (wisdom teeth), and acute infections with a fever of 101° F or above, infections not responsive to antibiotic therapy, and acute pulpitis.

  • Injuries from trauma, such as an avulsed tooth, or fractured tooth.

  • Postoperative complications including alveolar osteitis, bleeding or infection.

  • Facial swelling.

• Dental Priority Classification: A numerical or alphanumerical code associated with a dental diagnosis and assigned by a dentist.  It is the objective expression of the degree of urgency of a patient’s dental needs, providing the timeframe within which treatment must be initiated subsequent to the date of diagnosis (Reference the Health Care Department Operations Manual [HCDOM], Section 3.3.5.3, Dental Priority Classification).

• Dental Staff: Includes dentists, dental hygienists, dental assistants and any other personnel in the dental clinic qualified to provide Basic Life Support (BLS)/Cardiopulmonary Resuscitation (CPR) (Reference the HCDOM, Section 3.3.5.7, Medical Emergencies in the Dental Clinic).

• Eligible Patients: Patients unable to communicate effectively in spoken English including those who:

  • Speak only languages other than English and who have no speaking ability in English.

  • Are able to speak their native language, and are able to speak some English, but are not fluent enough in English to understand basic facility activities and proceedings.

  • Are speech or hearing impaired and unable to communicate effectively in spoken English (Reference the HCDOM, Section 3.3.5.5, Interpreter Services).

• Emergency Dental Services: Procedures designed to prevent death, alleviate severe pain, prevent permanent disability and dysfunction, or prevent significant medical or dental complications. Emergency dental services include the diagnosis and treatment of dental conditions that are likely to remain acute or worsen without immediate intervention.  The following dental procedures shall not be considered or performed as emergency dental services:

  • Minor elective surgery.

  • Elective removal of dental wires, bands, or other fixed appliances.

  • Routine dental restorations.

  • Routine removable prosthodontic appliance adjustments or repairs.

  • Administration of general anesthesia.

  • Routine full-mouth scaling and root planing.

  • Periodontal treatments involving root planing unless required in order to abate the dental emergency condition.

  • Treatment of malignancies, cysts, neoplasms, or congenital malformations unless directly related to abatement of the dental emergency.

  • Biopsy of oral tissue unless there is an immediate need to perform this procedure as a result of the dental emergency condition.

  • Occlusal adjustment unless directly related to the abatement of the dental emergency condition.

  • Root canal therapy other than palliative in nature.

  • Any corrective dental treatment that can be postponed without jeopardizing the health of the patient.

• Empty Amalgam Capsules: Individually dosed containers leftover after mixing pre-capsulated dental alloy restorative material.

• First Responder: For the purpose of Chapter 3, Article 3: The first dental staff member, certified in BLS, on the scene of a medical emergency in the dental clinic whose priority is the preservation of life and to proceed with necessary basic first aid.

• Flammable Materials: Liquids with a flash point below 100° F.

• Hand Hygiene: General term that applies to hand washing, antiseptic hand wash, antiseptic hand rub, or surgical hand antisepsis.

• Health Care Services: California Correctional Health Care Services and Division of Health Care Services; medical, mental, and dental health services.

• Health Care Staff: For the purpose of Chapter 3, Article 3: Individuals licensed by the State of California to provide health care services and who are either employed by California Department of Corrections and Rehabilitation (CDCR), or are under contract with CDCR, to provide health care services to patients. This includes Physicians, Dentists, Registered Nurses, Physician Assistants, Nurse Practitioners, Licensed Vocational Nurses, Certified Nursing Assistants, Psychiatrists, Psychologists, Licensed Clinical Social Workers, Licensed Psychiatric Technicians, Registered Dental Assistants, Dental Assistants with appropriate certification and Registered Dental Hygienists.

• Initial Active Therapy: Procedures performed on a patient for whom periodontal disease has never before been diagnosed and treated at a CDCR institution during the sentence currently being served.

• Interpretation: The processes of assisting an eligible patient to communicate in the English language for facility-based proceedings, and to interpret into the patient’s primary language of communication, written documents or responses spoken in English to the patient (Reference the HCDOM, Section 3.3.5.5, Interpreter Services).

• Licensure: The legal authority or formal permission from authorities to perform certain activities which by law or regulation require such permission.

• Mainline Facility: A California Department of Corrections and Rehabilitation facility where a patient is housed and assigned after completing the reception center initial intake process.

• Major Dental Equipment: A piece of equipment costing more than $5,000 that is used in the delivery of dental services (Reference the HCDOM, Section 3.3.4.7, Clinic Space, Equipment and Supplies).

• Medical Emergency: For the purpose of Chapter 3, Article 3: A medical emergency exists when there is a sudden, marked change in a patient’s condition so that action is immediately necessary for the preservation of life or the prevention of serious bodily harm to the patient or others, and it is not practical to first obtain consent.

  • Examples may include visible injuries, high blood pressure, rapid heart rate, sweating, pallor, involuntary muscle spasms, nausea and vomiting, high fever, and facial swelling.

  • An emergency, as determined by dental staff, also includes necessary crisis intervention for patients suffering from situational crises or acute episodes of mental illness.

• Medically Necessary: Health care services that are determined by the attending or primary medical, mental health, or dental care provider(s) to be needed to protect life, prevent significant illness or disability, or alleviate severe pain, and are supported by health outcome data or clinical evidence as being an effective health care service for the purpose intended or in the absence of available health outcome data is judged to be necessary and is supported by diagnostic information or specialty consultation.

• Mentoring: The process by which a clinician offers helpful guidance and the opportunity for remediation to a colleague who has failed to demonstrate acceptable skills.

• Minor Dental Equipment: A piece of equipment costing less than $5,000 that is used in the delivery of dental services (Reference the HCDOM, Section 3.3.4.7, Clinic Space, Equipment and Supplies).

• Non-Contact Amalgam: Excess mix leftover at the end of a procedure.

• Nourishments: Approved food items, in addition to the standard meal, ordered for patients with certain dental or medical conditions.

• Outcome Data or Clinical Evidence: Professionally accepted results of studies and analyses, using evidence-based methodologies and expert clinical judgment, regarding the effectiveness of various health care services, how those services relate to patient morbidity and mortality, and overall efficiency and effectiveness of care.

• Palliative endodontic therapy: The procedure in which pulpal debridement is performed to relieve acute pain.

• Pattern of Practice (POP): For the purpose of Chapter 3, Article 3: An in-depth peer review investigation performed by a Program Support Team dentist when a clinician’s actions or level of care may result in imminent danger to the health of any patient, prospective patient, or other person.

• Peer Review: The process whereby licensed practitioners, such as dentists and physicians, evaluate the professional activities of their colleagues.

• Periodontal Maintenance: Procedures performed after the successful completion of active therapy which are intended to prevent or minimize the recurrence of periodontal disease.

• Proctoring: For the purpose of Chapter 3, Article 3: The process by which a dentist’s skills are monitored and reviewed during the initial probationary period to ensure that he or she can adequately perform the minimum expected clinical skills.

• Qualified Bilingual Health Care Staff Interpreter: Any CDCR health care employee who has been determined to have a satisfactory level of competency in both English and the patient’s primary language of communication, and is thereby eligible to perform interpretation services (Reference the HCDOM, Section 3.3.5.5, Interpreter Services).

• Radiographs of Diagnostic Quality: Images that manifest a degree or grade of technical excellence that facilitate and do not impede diagnosis and/or treatment.

• Root canal therapy: The procedure in which the pulpal chamber and canals undergo cleaning, shaping and obturation.

• Root planing: A treatment procedure designed to remove cementum or surface dentin that is rough, impregnated with calculus, or contaminated with toxins or microorganisms.

• Routine Peer Review: A process performed at the institution level on an ongoing basis to identify professional practice trends that impact quality of care and patient safety.

• Scaling: Instrumentation of the crown and root surfaces of the teeth to remove plaque, calculus, and stains from these surfaces.

• Severe Pain: A degree of discomfort that significantly disables the patient from reasonable independent function.

• Significant Illness and Disability: Any medical, mental health, or dental condition that causes or may cause, if left untreated, a severe limitation of function or ability to perform the daily activities of life or that may cause premature death.

• Supplements: Medically necessary high caloric drinks ordered by a Primary Care Provider or Dentist.

• Toxic Materials: Substances that through chemical reaction or mixture can produce possible injury or harm to the body by entering through the skin, digestive tract or respiratory tract.