Chapter 11 - Dental and Oral Impairment

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Table of Contents PDF Version

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Introduction

This chapter provides criteria for assessing permanent impairment from entitled gingiva conditions, loss of teeth, temporomandibular joint dysfunction and loss of function of the mandible and/or maxilla.

Veterans Affairs Canada does not consider loss of teeth to be an assessable disability as the wearing of dentures or a prosthesis will restore an individual's ability to masticate. A nil assessment will be awarded for all entitled loss of teeth conditions regardless of the cause. Bruxism is also assessed at nil.

In complex cases where both a temporomandibular joint condition and a condition of the mandible and/or maxilla are entitled, a rating will be determined on individual merits.

No additional rating is taken from Chapter 14, Gastrointestinal Impairment, for entitled temporomandibular joint conditions or mandible and/or maxilla conditions.

No additional rating is taken from Chapter 22, Skin Impairment for disfigurement due to an entitled condition of the mandible and/or maxilla.

Impairment from malignant dental and oral conditions is rated within Chapter 18, Malignant Impairment. Follow the steps contained within the Malignant Impairment chapter.

Rating Tables

This chapter contains four "Loss of Function" tables and one "Other Impairment" table which may be used to rate entitled dental and oral conditions.

The tables within this chapter are:

Rating Tables

Table	Loss of Function	Other Impairment
Table 11.1	Loss of Function - Gingiva and Loss of Teeth	This table is used to establish a rating of nil for impairment from all gingiva conditions, bruxism and loss of teeth.
Table 11.2	Loss of Function - Temporomandibular Joint	This table is used to rate impairment from temporomandibular joint function.
Table 11.3	Other Impairment - Temporomandibular Resting Joint Pain	This table is used to rate impairment from resting pain in the temporomandibular joint.
Table 11.4	Loss of Function - Mandible and Maxilla	This table is used to rate impairment from mandible and/or maxilla function.
Table 11.5	Loss of Function - Disfigurement of the Mandible and Maxilla	This table is used to rate impairment from disfigurement of the mandible and/or maxilla.

Loss of Function - Gingiva and Loss of Teeth

Table 11.1 is used to rate impairment of gingiva conditions, bruxism and loss of teeth. These conditions are assessed at nil.

When entitled gingiva conditions, bruxism and loss of teeth result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).

Loss of Function - Temporomandibular Joint

Table 11.2 is used to rate impairment of temporomandibular joint conditions. Only one rating may be selected. If more than one rating is applicable, the ratings are compared and the highest selected.

When entitled temporomandibular joint conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).

If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.

Other Impairment - Temporomandibular Resting Joint Pain

Table 11.3 is used to rate impairment from joint pain that is persistent and unrelenting in the temporomandibular joint(s) when at rest. Only one rating may be selected. If more than one rating is applicable, the ratings are compared and the highest selected. Any applicable rating from this table must be added to the loss of function rating from Table 11.2.

Loss of Function - Mandible and Maxilla

Table 11.4 is used to rate impairment from entitled conditions of the mandible and/or maxilla. Two ratings may be initially selected from Table 11.4, one rating applicable to the loss of function of the mandible and one rating applicable to the loss of function of the maxilla. The ratings for the two individual areas are compared and the highest selected.

When entitled mandible and/or maxilla conditions result in permanent impairment of other organ systems, a consequential entitlement decision is required. If awarded, the resulting impairment of that organ system(s) will be rated using the applicable body system specific table(s).

If non-entitled conditions or conditions rated within another chapter/table of the Table of Disabilities are contributing to the overall impairment, then the Partially Contributing Table (PCT) must be applied to arrive at the rating which is due to the entitled condition(s) rated within this table.

Loss of Function - Disfigurement of the Mandible and Maxilla

Table 11.5 is used to rate impairment from disfigurement of the mandible and/or maxilla. Two ratings may be initially selected from Table 11.5, one rating applicable to the disfigurement of the mandible and one rating applicable to the disfigurement of the maxilla. The ratings for the two individual areas are compared and the highest selected.

Any applicable rating from this table must be added to the loss of function rating from Table 11.4.

Table 11.1 - Loss of Function - Gingiva and Loss of Teeth

A nil assessment will be given from Table 11.1 for all gingiva conditions, bruxism and loss of teeth regardless of whether the teeth can be replaced by prosthetics or not.

Each bullet (•) represents one criterion. In order for a rating to be established for Table 11.1, only one criterion must be met at a level of impairment for that rating to be selected.

Table 11.1 - Loss of Function - Gingiva and Loss of Teeth

Rating	Criteria
Nil	Loss of teeth or dental surfaces which can or cannot be replaced by prosthetics; or Chronic periodontitis; or Trench mouth (Vincent's angina) or chronic gingivitis; or Bruxism.

Table 11.2 - Loss of Function - Temporomandibular Joint

Only one rating may be given from Table 11.2 for each entitled condition. If more than one rating is applicable for an entitled condition, the ratings are compared and the highest selected.

Each bullet (•) represents one criterion. In order for a rating to be established for Table 11.2, follow the "ands" and "ors".

Table 11.2 - Loss of Function - Temporomandibular Joint

Rating	Criteria
Nil	Occasional clicking in one or both temporomandibular joints with yawning, talking and chewing; and Inter-incisal range unrestricted.
Four	Frequent to constant pain and discomfort in one or both temporomandibular joints on jaw opening relieved with analgesia, heat and cold applications or other therapeutic measures; or Permanent avoidance of some solid foods such as apples or corn may be necessary due to symptoms.
Nine	Permanent soft diet may be required due to temporomandibular conditions; or Inter-incisal range is reduced to 27 mm or less.
Thirteen	Requires permanent purée or liquid diet; or Inter-incisal range is reduced to 20 mm or less.

Table 11.3 - Other Impairment - Temporomandibular Resting Joint Pain

Only one rating may be given from Table 11.3 regardless of whether the entitled condition involves one or both joints.

Each bullet (•) represents one criterion. In order for a rating to be established for Table 11.3, all criteria designated at that rating level must be met.

Table 11.3 - Other Impairment - Temporomandibular Resting Joint Pain

Rating	Criteria
Nil	Pain in the temporomandibular joint(s) that is not present at rest.
Two	Persistent, unrelenting resting pain in the temporomandibular joint(s) that is present during the night, every night but does not prevent sleep.
Four	Persistent, unrelenting resting pain in the temporomandibular joint(s) that is present during the night, every night, and disturbs sleep several times every night, but which improves with and responds to medication or other therapeutic measures.
Nine	Severe, persistent, unrelenting resting pain in the temporomandibular joint(s) that is present during the night, every night, and disturbs sleep several times during the night, does not respond adequately to medication or other therapeutic measures. May have sought advice from, or attended, a pain management clinic.
Thirteen	Severe, persistent, unrelenting resting pain in the temporomandibular joint(s) that is present during the night, every night, causes more wakeful periods than rest, and which does not respond adequately to medication or other therapeutic measures. Has attended a pain management clinic and is on extensive pain management regime. Pain, however, remains poorly controlled despite all interventions.

Table 11.4 - Loss of Function - Mandible and Maxilla

Two ratings may be initially given from Table 11.4, one rating applicable to the loss of function of the mandible and one rating applicable to the loss of function of the maxilla. The ratings for the two individual areas are compared and the highest selected.

Each bullet (•) represents one criterion. In order for a rating to be established for either the mandible or the maxilla area for Table 11.4, only one criterion must be met at a level of impairment for that rating to be selected.

Table 11.4 - Loss of Function - Mandible and Maxilla

Rating	Criteria
Nil	Maxillaire
	No difficulty with chewing and inter-incisal range unrestricted.
	Mandibule
	No difficulty with chewing and inter-incisal range unrestricted.
Four	Maxillaire
	Frequent to constant pain relieved by analgesics or other therapeutic measures; or Permanent avoidance of some solid foods such as apples or corn due to symptoms may be necessary.
	Mandibule
	Frequent to constant pain relieved by analgesics or other therapeutic measures; or Permanent avoidance of some solid foods such as apples or corn due to symptoms may be necessary.
Nine	Maxillaire
	Permanent soft diet required; or Inter-incisal range reduced to 27 mm or less.
	Mandibule
	Permanent soft diet required; or Inter-incisal range reduced to 27 mm or less.
Thirteen	Maxillaire
	Permanent purée or liquid diet; or Inter-incisal range reduced to 20 mm or less.
	Mandibule
	Permanent purée or liquid diet; or Inter-incisal range reduced to 20 mm or less.

Table 11.5 - Loss of Function - Disfigurement of the Mandible and Maxilla

Two ratings may be initially given from Table 11.5, one rating applicable to the loss of function of the mandible and one rating applicable to disfigurement of the mandible and one rating applicable to disfigurement of the maxilla. The ratings for the two individual areas are compared and the highest selected.

Each bullet (•) represents one criterion. In order for a rating to be established for either the mandible or the maxilla area for Table 11.5, all criteria designated at that rating level must be met.

Table 11.5 - Loss of Function - Disfigurement of the Mandible and Maxilla

Rating	Criteria
Nil	Maxilla
	No disfigurement.
	Mandible
	No disfigurement.
Four	Maxilla
	Mild disfigurement.
	Mandible
	Mild disfigurement.
Nine	Maxilla
	Severe disfigurement.
	Mandible
	Severe disfigurement.

Steps to Determine the Dental and Oral Impairment Assessment

• Step 1: Determine the rating from Table 11.1 (Loss of Function - Gingiva Conditions, Bruxism and Loss of Teeth).

  The Medical impairment rating for entitled gingiva conditions, bruxism and loss of teeth is always NIL.

This is the Disability Assessment for for gingiva conditions, bruxism and loss of teeth.

• Step 2: Determine the rating from Table 11.2 (Loss of Function - Temporomandibular Joint). Only one rating is applicable from Table 11.2 regardless if the condition is unilateral or bilateral.
• Step 3: Does the Partially Contributing Table apply? If yes, apply to rating at Step 2.
• Step 4: Determine the rating from Table 11.3 (Other Impairment - Temporomandibular Joint - Resting Joint Pain). Only one rating is applicable from Table 11.3 regardless if the condition is unilateral or bilateral.
• Step 5: Add the ratings at Step 3 and Step 4.
• Step 6: Determine the Quality of Life rating.
• Step 7: Add the ratings at Step 5 and Step 6.
• Step 8: If partial entitlement exists, then apply to the rating at Step 7.

This is the Disability Assessment for temporomandibular joint conditions.

• Step 9: Determine the rating from Table 11.4 (Loss of Function - Mandible and Maxilla). Only one rating is applicable from Table 11.4 regardless if the condition is unilateral or bilateral. If more than one rating is applicable, the ratings are compared and the highest selected.
• Step 10: Determine the rating from Table 11.5 (Loss of Function - Disfigurement of Mandible and Maxilla). Only one rating is applicable from Table 11.4 regardless if the condition is unilateral or bilateral. If more than one rating is applicable, the ratings are compared and the highest selected.
• Step 11: Add the ratings at Step 9 and Step 10 if applicable.
• Step 12: Does the Partially Contributing Table apply? If yes, then apply to rating at Step 11.
• Step 13: Determine the Quality of Life rating.
• Step 14: Add the ratings at Step 12 and Step 13.
• Step 15: If partial entitlement exists, apply to rating at Step 14.

This is the Disability Assessment for mandible and maxilla conditions.