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Routine: DVBCWDO3

DVBCWDO3.m

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DVBCWDO3 ;ALB/CMM DENTAL AND ORAL WKS TEXT - 1 ; 5 MARCH 1997

 ;;2.7;AMIE;**183**;Apr 10, 1995;Build 8

 ;

 ;

TXT ;

 ;;Narrative:  Regional Office action is required for all dental treatment

 ;;based on combat wounds, service trauma, prisoner of war or extracted 

 ;;teeth under 38 CFR 17.123.

 ;;

 ;;A.  Review of Medical Records:

 ;;

 ;;

 ;;B.  Medical History (Subjective Complaints):

 ;;

 ;;    1.  Describe the circumstances and initial manifestations of the disease or

 ;;        injury.

 ;;    2.  Describe the course since onset.

 ;;    3.  Describe current treatment and any side effects of treatment.

 ;;    4.  Report history of dental-related hospitalization or surgery, including

 ;;        location, date, and type of surgery.

 ;;    5.  Report history of trauma to the teeth, with location and date.

 ;;    6.  If there is a history of neoplasm, provide:

 ;;

 ;;        a. Date of diagnosis, exact diagnosis, location.

 ;;        b. Benign or malignant.

 ;;        c. Types of treatment and dates.

 ;;        d. Last date of treatment.

 ;;        e. State whether treatment has been completed.

 ;;

 ;;    7.  Report symptoms:

 ;;

 ;;        a. Difficulty chewing (frequency and extent).

 ;;        b. Difficulty in opening mouth.

 ;;        c. Difficulty talking.

 ;;        d. Swelling (location and duration).

 ;;        e. Pain (location, frequency, and severity).

 ;;        f. Drainage (frequency).

 ;;

 ;;    8.  Report other significant history.

 ;;

 ;;C.  Physical Examination (Objective Findings):

 ;;

 ;;    Address each of the following, as applicable, and fully describe:

 ;;

 ;;    1.  Tooth loss due to loss of substance of body of maxilla or mandible

 ;;        (other than loss due to periodontal disease).  Describe the extent and

 ;;        location of missing teeth and whether the masticatory surface can be

 ;;        restored by a prosthesis.

 ;;    2.  Loss of bone of the maxilla.  State extent (less than 25%, 25 to 50%,

 ;;        more than 50%) and whether loss is replaceable by a prosthesis.

 ;;    3.  Malunion or nonunion of the maxilla and extent of displacement (none,

 ;;        mild, moderate, severe).

 ;;    4.  Loss of bone of the mandible.  State side or sides affected and extent:

 ;;        a. Complete loss, between angles.

 ;;        b. Loss of half of mandible involving temporomandibular articulation.

 ;;        c. Loss of half of mandible not involving temporomandibular

 ;;           articulation.

 ;;        d. Loss of part or all of ramus involving loss of temporomandibular

 ;;           articulation.

 ;;        e. Loss of part or all of ramus not involving loss of temporomandibular

 ;;           articulation.

 ;;        f. Loss of less than one-half of ramus with loss of continuity.

 ;;        g. Loss of less than one-half of ramus without loss of continuity.

 ;;        h. Loss of condyloid process.

 ;;        i. Loss of coronoid process.

 ;;

 ;;        State if loss is replaceable by prosthesis.

 ;;    5.  Nonunion of the mandible, extent of abnormal motion (none, mild,

 ;;        moderate, severe), and extent of interference with masticatory function

 ;;        (none, mild, moderate, severe).

 ;;    6.  Malunion of the mandible, extent of displacement (none, mild, moderate,

 ;;        severe), extent of abnormal motion (none, mild, moderate, severe), and

 ;;        extent of interference with masticatory function (none, mild, moderate,

 ;;        severe).

 ;;    7.  Loss of bone of hard palate.  State side(s), extent of loss of the

 ;;        entire palate (less than half, half, more than half), and state whether

 ;;        loss is replaceable by prosthesis.

 ;;    8.  Evidence of osteoradionecrosis of maxilla, mandible, or both.

 ;;    9.  Evidence of osteomyelitis of maxilla, mandible, or both.

 ;;   10.  Speech difficulty and extent.

 ;;   11.  Limitation of motion at the temporomandibular articulation.

 ;;        a. Report inter-incisal range of motion (O to X mm.) and range of

 ;;           lateral excursion (O to X mm.) on the left and right sides.

 ;;        b. Describe objective evidence of pain in the affected joint/joints at

 ;;           rest and during active range of motion.

 ;;        c. Have the veteran move the affected joint/joints through repetitive

 ;;           active range of motion as tolerated (at least 3 repetitions).

 ;;        d. After repetitions, re-measure the range of motion of the affected

 ;;           joint/joints.

 ;;        e. If there is additional loss of the range of motion after the

 ;;           repetitions, report the range of motion and state whether pain,

 ;;           fatigue, weakness, lack of endurance, or incoordination is the most

 ;;           important factor in the additional loss of motion.

 ;;        f. If repetitive active range of motion of a joint cannot be done,

 ;;            state so and give the reason.

 ;;   12.  If there is or was a related neoplasm, report residuals of the neoplasm

 ;;        and its treatment.

 ;;

 ;;D.  Diagnostic and Clinical Tests:

 ;;

 ;;    Provide:

 ;;

 ;;      1.  X-ray to determine extent of bone tissue loss.

 ;;      2.  Include results of all diagnostic and clinical tests conducted

 ;;          in the examination report.

 ;;

 ;;E.  Diagnosis:

 ;;

 ;;    1.  Where there is loss of teeth due to loss of substance of body  of 

 ;;        maxilla or mandible, state etiology.

 ;;    2.  If there is speech difficulty, state etiology.

 ;;    3.  State effects of the condition on occupational functioning and daily

 ;;        activities.

 ;;

 ;;

 ;;Signature:                             Date:

 ;;END