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 non-

progressive 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 follow-up 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 malepresents for a prophy. Hefrequently smokes buthas no caries or defectiverestorations.

What should his dental classification be after prophy? Class 1

Case #2

What is the correct dental classification?

This 40-year-old has a history of periodontal disease but is now in a stable four-month maintenance phase.

Class 2

Case #3

What should his dental classification be until she receives treatment?

This 22-year-old female presents to sick call with a complaint of hot and cold sensitivity in her lower right molar.

Class 3

Case #4

What should his dental classification be?

This 30-year-old male complains of a loose upper molar. Tooth #3 has significant mobility with >6 mm probing depths and furcation involvement.

Class 3

Case #5

What should her dental classification be?

This 23-year-old female presents for routine exam. Teeth #13 & 14 have caries visible on the radiograph.

Class 2

Case #6

What is the dental classification until the patient is treated?

This 19-year-old female complains of cold sensitivity in the area of #19. The exam reveals distal caries consistent with the radiograph.

Class 3

Case #7

What is the dental classification with normal perio probing?What is the dental classification with 7mm perio probing ?

This 19-year-old female has impacted wisdom teeth. She has never had any pain, and they don’t bother her.

Class 1Class 3

Case #8

What is the dental classification with normal probing until surgery?

This same patient with asymptomatic third molars elects to have the teeth extracted using IV sedation.

Class 1

Case #9

What is the dental classification until surgery?

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.

Class 3

Case #10

What is the dental classification after the biopsy?

This 31-year-old female presents for biopsy of this painless lesion.

Class 3

Case #11

What is the dental classification?

This 38-year-old male has heavy subgingival calculus on tooth #3 and adjacent teeth.

Class 3

Case #12

What is her dental classification?

This 20-year-old female presents for exam. She has distal caries on teeth #3 and #30.

Class 2

Case #13

What is her dental classification?

A recent records review shows that this 33-year-old female has not been to the dental clinic in 14 months.

Class 4

Case #14

What is his dental classification?

This 31-year-old male presents with anterior open bite. He has no caries and a healthy periodontal condition .

Class 1

Case #15

What is her dental classification?

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.

Class 3

Case #16

What is his dental classification?

This 38-year-old male presents with missing mandibular teeth. He has no other pathology, functions well, and does not desire prosthetic treatment.

Class 1

Case #17

What is his dental classification?

This same patient desires a partial denture to replace his missing teeth. He is now waiting for a framework for a try-in.

Class 2

Case #18

What is his dental classification?

This 22-year-old male just completed orthodontic treatment and is now wearing a maxillary retainer. He has no caries.

Class 1

Case #19

What is his dental classification?

This same patient develops acute TMD symptoms. He is now being treated for his persistent TMD pain.

Class 3

Case #20

What is his dental classification?

This 42-year-old male has a defective distal margin on tooth #19. He has no symptoms.

Class 2

Case #21

What is his dental classification?

This 25-year old patient has a root canal filling # 4 with a temporary restoration.

Class 3

Case #22

What is his dental classification?

This same 25-year old patient has a root canal filling # 4 now has a permanent filling.

Class 3 - Air Force

Class 2 - Army

Case #23

What is his dental classification?

This same 25-year old patient has a root canal filling # 4 now has a permanent restoration and a temporary crown.

Class 2 or 3

Case #24

What is his dental classification?

This same 25-year old patient has a root canal filling # 4. Now with a permanent crown.

Class 1

Case #25

What is his dental classification?

This same 25-year old patient has a root canal filling # 4 with a permanent filling covering the entire occlusal surface of the crown.

Class 1

Completing the DD Form 2813

Items 1-5 should be completed by military member

Used to document exams by private and non-governmental contract dentists.

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• 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