Dental Classifications Outline of Topics:

1
Dental Classifications Outline of Topics

• Military Dental Classifications
• Case presentations
• Discussion

2
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

3
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.

4
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.

5
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.

6
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.

7
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.

8
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.

9
??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.

10
The Human Fighting System
11
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
12
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
13
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
14
Case 4
This 30-year-old male complains of a loose upper
molar. Tooth 3 has significant mobility with gt6
mm probing depths and furcation involvement.
What should his dental classification be?
Class 3
15
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
16
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
17
Case 7
This 19-year-old female has impacted wisdom
teeth. She has never had any pain, and they dont
bother her.
Class 1
What is the dental classification with normal
perio probing? What is the dental classification
with 7mm perio probing ?
Class 3
18
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
19
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
20
Case 10
This 31-year-old female presents for biopsy of
this painless lesion.
What is the dental classification after the
biopsy?
Class 3
21
Case 11
This 38-year-old male has heavy subgingival
calculus on tooth 3 and adjacent teeth.
What is the dental classification?
Class 3
22
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
23
Case 13
A recent records review shows that this
33-year-old female has not been to the dental
clinic in 14 months.
What is her dental classification?
Class 4
24
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
25
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
26
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
27
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
28
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
29
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
30
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
31
Case 21
This 25-year old patient has a root canal filling
4 with a temporary restoration.
What is his dental classification?
Class 3
32
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
33
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
34
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
35
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
36
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).
37
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.
38
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.
39
Item 7-11 fill in completely by office starff.
40
Save Time Down Load the Form

• http//www.dtic.mil/whs/directives/infomgt/forms/e
  forms/dd2813.pdf
• Pre-Enter Practice Information
• Save As
• To Avoid HIPPA violations recommend
  pre-printing lines7-9 only

41
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

42
(No Transcript)
43
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

44
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

45
Any Questions