Dental Classifications for Military Personnel

Report
Dental Classifications
Outline of Topics:
Military Dental
Classifications
Case presentations
& Discussion
Dental Classes
• Class 1 –
– Patients not requiring dental treatment or re-evaluation for 12
months.
• Class 2 –
– Patients who have oral conditions that, if not treated or
followed up, have the potential but are not expected to result in
dental emergencies within 12 months.
• Class 3 –
– Patient has oral conditions that if not treated are expected to
result in dental emergencies within 12 months. Patients should
be placed in Class 3 when there are questions in determining
classification between Class 2 and Class 3.
• Class 4 –
– Patient has not had a dental exam in the last 13 months
Class 1
• No active dental caries or defective restorations
• Arrested caries for which treatment is not indicated
• Healthy periodontium, no bleeding on probing; oral
prophylaxis not indicated.
• Replacement of missing teeth not indicated.
• Unerupted, partially erupted, or malposed teeth that
are without historical, clinical, or radiographic signs
or symptoms of pathosis and are not recommended
for prophylactic extractions.
Class 2
• Treatment or follow up indicated for dental caries
with minimal extension into dentin or minor
defective restorations easily maintained by the
patient where the condition does not cause
definitive symptoms
• Interim restorations or prostheses that can be
maintained by the patient for a 12-month period.
This includes teeth that have been restored with
permanent restorative material but for which
protective coverage is indicated.
• Edentulous teeth requiring prosthesis but not on an
immediate basis.
Class 2
• Periodontal disease or periodontium exhibiting:
– Requirement for oral prophylaxis.
– Requirement for maintenance therapy; this includes stable or nonprogressive mucogingival conditions requiring periodic evaluation.
– Non-specific gingivitis.
– Early or mild adult periodontitis.
• Unerupted, partially erupted, or malposed teeth that
are without historical, clinical, or radiographic signs
or symptoms of pathosis, but which are
recommended for prophylactic removal.
• Active orthodontic treatment.
• Temporomandibular disorder patients in
maintenance therapy.
Class 3
• Dental caries, tooth fractures, or defective
restorations where the condition extends beyond the
dentinoenamel junction and causes definitive
symptoms; dental caries with moderate or advanced
extension into dentin; and defective restorations not
maintained by the patient.
• Interim restorations or prostheses that cannot be
maintained for a 12-month period. This includes
teeth that have been restored with permanent
restorative materials but for which protective
coverage is indicated.
Class 3
• Dental caries, tooth fractures, or defective
restorations where the condition extends beyond the
dentinoenamel junction and causes definitive
symptoms; dental caries with moderate or advanced
extension into dentin; and defective restorations not
maintained by the patient.
• Interim restorations or prostheses that cannot be
maintained for a 12-month period. This includes
teeth that have been restored with permanent
restorative materials but for which protective
coverage is indicated.
Class 3
• Chronic oral infections or other pathologic lesions
including:
• Pulpal or periapical pathology requiring treatment.
• Lesions requiring biopsy or awaiting biopsy report.
• Emergency situations requiring therpy to relieve pain, treat
trauma, treat acute oral infections, or provide timely followup care (e.g., drain or suture removal) until resolved.
• Temporomandibular disorders requiring active treatment.
??Class 2 vs Class 3??
Both the Air Force and the Army agree that posterior teeth with
root canal therapy require full cuspal coverage. However, the
Army places the patient in class 2 after a permanent filling
and the Air Force does not place the patient in class 2 until
the tooth has full cuspal coverage.
Why? A contradiction or area of interpretation in “Policy for
Standardization of Dental Classifications.”
1- Air Force does not believe that as a rule a RCT tooth can last
12 months without cuspal coverage.
2- Army uses the “have been restored with permanent
restorative materials but for which protective coverage is
indicated.
The Human Fighting System
Case #1
This 35-year-old male
presents for a prophy. He
frequently smokes but
has no caries or defective
restorations.
What should his dental classification be after prophy?
Class 1
Case #2
This 40-year-old has a
history of periodontal
disease but is now in a
stable four-month
maintenance phase.
What is the correct dental classification? Class 2
Case #3
This 22-year-old female
presents to sick call with a
complaint of hot and cold
sensitivity in her lower
right molar.
What should his dental classification be until she
receives treatment?
Class 3
Case #4
This 30-year-old male
complains of a loose upper
molar. Tooth #3 has
significant mobility with >6
mm probing depths and
furcation involvement.
What should his dental classification be?
Class 3
Case #5
This 23-year-old female
presents for routine exam.
Teeth #13 & 14 have caries
visible on the radiograph.
What should her dental classification be?
Class 2
Case #6
This 19-year-old female
complains of cold
sensitivity in the area of
#19. The exam reveals
distal caries consistent
with the radiograph.
What is the dental classification until the patient is treated?
Class 3
Case #7
This 19-year-old female
has impacted wisdom
teeth. She has never had
any pain, and they don’t
bother her.
What is the dental classification with normal perio probing?
What is the dental classification with 7mm perio probing ?
Class 1
Class 3
Case #8
This same patient with
asymptomatic third molars
elects to have the teeth
extracted using IV
sedation.
What is the dental classification with normal probing until surgery?
Class 1
Case #9
This 18-year-old male
presents for chronic pain
in the lower right wisdom
tooth area. He is examined
and scheduled for IV
sedation and extraction of
all wisdom teeth.
What is the dental classification until surgery?
Class 3
Case #10
This 31-year-old female
presents for biopsy of this
painless lesion.
What is the dental classification after the biopsy?
Class 3
Case #11
This 38-year-old male has
heavy subgingival calculus
on tooth #3 and adjacent
teeth.
What is the dental classification?
Class 3
Case #12
This 20-year-old female
presents for exam. She has
distal caries on teeth #3
and #30.
What is her dental classification? Class 2
Case #13
A recent records review
shows that this 33-yearold female has not been to
the dental clinic in 14
months.
What is her dental classification?
Class 4
Case #14
This 31-year-old male
presents with anterior
open bite. He has no caries
and a healthy periodontal
condition .
What is his dental classification?
Class 1
Case #15
This 40-year-old female
presents with a fractured
crown on endodontically
treated tooth #10. She has
no pain, no caries, and a
healthy periodontium.
What is her dental classification?
Class 3
Case #16
This 38-year-old male presents with missing
mandibular teeth. He has no other pathology,
functions well, and does not desire prosthetic
treatment.
What is his dental classification?
Class 1
Case #17
This same patient desires a partial denture to
replace his missing teeth. He is now waiting for a
framework for a try-in.
What is his dental classification?
Class 2
Case #18
This 22-year-old male just completed orthodontic
treatment and is now wearing a maxillary
retainer. He has no caries.
What is his dental classification?
Class 1
Case #19
This same patient develops acute TMD symptoms.
He is now being treated for his persistent TMD
pain.
What is his dental classification?
Class 3
Case #20
This 42-year-old male has
a defective distal margin
on tooth #19. He has no
symptoms.
What is his dental classification? Class 2
Case #21
This 25-year old patient
has a root canal filling # 4
with a temporary
restoration.
What is his dental classification?
Class 3
Case #22
This same 25-year old
patient has a root canal
filling # 4 now has a
permanent filling.
What is his dental classification?
Class 2 - Army
Class 3 - Air Force
Case #23
This same 25-year old
patient has a root canal
filling # 4 now has a
permanent restoration and
a temporary crown.
What is his dental classification?
Class 2 or 3
Case #24
This same 25-year old
patient has a root canal
filling # 4. Now with a
permanent crown.
What is his dental classification?
Class 1
Case #25
This same 25-year old
patient has a root canal
filling # 4 with a
permanent filling covering
the entire occlusal surface
of the crown.
What is his dental classification?
Class 1
Completing the DD Form 2813
Used to document
exams by private and
non-governmental
contract dentists.
Items 1-5 should be
completed by military
member
The minimum clinical
exam consists of the
use of a mirror, probe &
bitewing radiographs
(Use ADA guideline for
radiograph frequency).
Item 6 – Determine and
mark appropriate dental
Class (1, 2, or 3).
Only if Class 3 mark a-f
indicating treatment
needs.
If Class 3 must
complete this section! If
you will be treating this
patient estimated time
to get patient out of
class 3 is useful.
Item 6 (4) - Dental
radiographs should be
consulted unless:
patient is new to the
practice and has a
contraindication to new
radiographs, and you
are unable to obtain
recent radiographs from
previous dentist.
Item 7-11 fill in
completely by office
starff.
Save Time Down Load the Form
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•
•
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http://www.dtic.mil/whs/directives/infomgt/forms/eforms/dd2813.pdf
Pre-Enter Practice Information
Save As –
To Avoid HIPPA violations – recommend pre-printing lines7-9 only
National Guard Flyers
• Military Members who fly are special
• Due to pressurization issues may require DNIF
– Duties Not Including Flying
• They should tell you they fly
• They should give you a DD Form 1418
AFI 47-101 Recommendations
• Local Anesthesia (Numbing) 8 hours Verbal DNIF
• Root Canal Procedures 24 hours DNIF – Must Notify
Flight Surgeon via AF Form 1418
– If symptomatic may be longer at Flight Surgeon Direction
– If placed on medications may be longer at Flight Surgeon Direction
• Simple extractions 48-72 hours DNIF – Must Notify
Flight Surgeon via AF Form 1418 *
– If symptomatic may be longer at Flight Surgeon Direction
– If placed on medications may be longer at Flight Surgeon Direction
• Dentists may at their discretion recommend DNIF for
other issues via AF Form 1418
* No recommendations in AFI for Ext – Extrapolated
AFI 47-101 Recommendations
• Surgical Extractions 7-14 days DNIF – Must Notify
Flight Surgeon via AF Form 1418 *
– If symptomatic may be longer at Flight Surgeon Direction
– If placed on medications may be longer at Flight Surgeon Direction
• Dental Implants stage 1 and 2 10 days DNIF – Must
Notify Flight Surgeon via AF Form 1418
– Dentist may recommend longer based on bone quality/potential to
heal
• Guided Tissue Membranes 7-14 days DNIF – Must
Notify Flight Surgeon via AF Form 1418
* No recommendations in AFI for Ext – Extrapolated
Any Questions

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