Loss of teeth due to inflammation or destruction of bone without the possibility of restoration by prosthesis may be considered disabling because the teeth are a part of the masticatory mechanism.

Loss of teeth from the common causes of caries, periodontal disease and simple trauma (teeth simply avulsed or knocked out) are not considered disabling because it is usually possible to replace such loss with routine dental prostheses. Teeth may be lost with destructive processes such as major trauma, where there is loss of bone or soft tissue or both, and diseases including osteomyelitis, osteoradionecrosis, cysts, and tumors, including cancer.

There is evidence of multiple missing teeth from the same area of the mouth, interfering with the ability to chew food, e.g., all teeth, all upper or lower teeth, all upper and lower back teeth, or all upper and lower front teeth. Accompanying the loss of teeth is the lack of supporting bone to allow construction of artificial replacement teeth.

Evaluation may include clinical examination, plain x-rays, and possibly computed tomography (CT) scan, and laboratory testing such as white blood cell (WBC) count and erythrocyte sedimentation rate (ESR). Evaluation should determine whether there is persistent disease and whether or not reconstruction for dental prostheses is possible.

Treatment should be directed toward elimination of any active or persistent disease, and reconstruction, if possible. Treatment may include additional surgery to remove diseased tissue, antibiotic use, or hyperbaric oxygen therapy (HBO). Once healthy tissues have been restored, reconstructive surgery may be possible to prepare for dental implants or other prosthetic restoration. When this is not possible, disability may result from the missing teeth.

In cases of acute osteomyelitis where treatment is only partially successful, low-grade chronic osteomyelitis results with sporadic (months to many years) bone pain, tenderness and drainage. Body image disturbances, which may require counseling, are possible after facial changes or surgery. Nutritional problems may occur due to the inability to chew (masticate) because of groups of missing teeth.

• None.

• These ratings apply only to bone loss through trauma or disease such as osteomyelitis, and not to the loss of the alveolar process as a result of periodontal disease, since such loss is not considered disabling

• For VA compensation purposes, diagnostic imaging studies include, but are not limited to, conventional radiography (X-ray), computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), radionuclide bone scanning, or ultrasonography

• Separately evaluate loss of vocal articulation, loss of smell, loss of taste, neurological impairment, respiratory dysfunction, and other impairments under the appropriate diagnostic code and combine under 38 CFR 4.25 for each separately rated condition.