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| The CDA is a scoring system used to
quantify an individual’s dental health at a certain
point in time. The scores range from 0-33. 33 is the highest
score, the epitome of dental health. It is the gold standard
upon which we base your dental health. We perform the CDA
every year. We want your CDA to improve as you remain under
our care. Like a fine wine, we want your dental health to
improve with age, so that you can avoid losing your teeth.
The CDA provides a quantitative result to the dental examination
and provides a reference point or benchmark upon which subsequent
CDA’s can be compared. It can be used as a gauge for
improvement or decline of one’s dental health over
the course of time. The CDA is also a very good tool for
doctor-patient communication. It has also proven to be an
effective motivation tool for optimizing one’s dental
health.
When you have your blood pressure measured, you are given
a number, and you want that number to be as close to 120/80
as possible. When you have your cholesterol level measured,
you want the number to be under 200. When you have your
CDA, we want your number to be as close to 33 as genetically
and environmentally possible. Achieving a 33 is very rare,
and frankly, only a very small percentage of the population
achieve a 33. However, it is the gold standard upon which
your dental health is based.
Over the past 20 years that I have been practicing, and
history reflects the same, dental health has been improving.
Evolution, environmental changes, technology, patient awareness
and intelligence and even the increasing desire to achieve
better dental results is driving expectations within the
profession to higher levels. We are seeing healthier mouths
and people want their teeth to be brighter, want there fillings
to be white, not silver, expect better looking crowns, want
straighter teeth, etc. Expectations are increasing and at
some point in time, anything less than a 33 may be unacceptable.
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| There are eleven categories that could
effect your dental health. The highest score you can achieve
in each category is a 3. If you receive 3’s in all
categories, your CDA would be a 33. The categories are;
Medical History, Oral
Cancer Screening, Caries, Existing
Restorations, Esthetics, Oral
Pathology & Anatomical Deviation, TMJ,
Occlusion, and three categories
on the Periodontia, or supporting structures of the teeth;
Bleeding Upon Probing
or Scaling, Plaque & Tartar Deposits
and Pocket Depths.
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The first category is your medical history.
Is there anything on your medical history that would predispose
you to dental disease? Predisposing factors could be systemic
or environmental. For example, diabetes. Diabetics are more
prone to infections and may be more likely to develop gum
disease, an infection of the gums. Another example would be
medications that cause xerostomia. Xerostomia is a dryness
of the mouth. Several of the most commonly prescribed medications
list xerostomia as a possible side effect. Dryness of the
mouth would make an individual more susceptible to tooth decay.
Other predisposing factors would be anemia, agranulocytosis,
radiation therapy to the head and neck, sjorgens syndrome,
inability to hold a toothbrush secondary to multiple sclerosis
or arthritis.
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Approximately 30,000 cases of Oral Cancer
are diagnosed each year. Predisposing factors include tobacco
use, excessive alcohol in conjunction with tobacco, previous
history of oral-pharyngeal cancer, family history of oral-pharyngeal
cancer, gender and age. For examples, African-American males
over the age of 40 who smoke a pack of cigarettes a day and
consume alcohol daily would be at a high risk of developing
oral cancer.
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| Caries is another word for tooth decay.
How many areas of active tooth decay do we see upon examination?
If there are no areas of tooth decay, your score would be
a 3. One area of tooth decay, your score would be a 2. Two
areas of tooth decay, your score would be a 1. More than two
areas of tooth decay would score a 0. Size or depth of the
carious lesion does not affect the score. |
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| This category assesses the condition of
your existing dental works; fillings, crowns, bridges, etc.
When dental restorations are initially placed, we consider
them in “Good” condition. As they initially age,
they undergo some wear and tear which we measure as “Early
Margination”. We don’t usually recommend treatment
at this stage. As the restorations age further, we often see
small gaps between the restorations and tooth structure. These
gaps make the tooth structure susceptible to decay and we
usually recommend replacing the restorations at this point.
We call this “Moderate Margination”. If Moderate
Margination is left untreated, the restorations can deteriorate,
break or present with obvious holes in them. We describe this
condition as “Significant Margination” and new
restorations are recommended, if the tooth can be saved. |
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| This category is an attempt to quantify
the beauty of your the smile. In order to achieve a 3 in this
category, your smile must meet several criteria that the College
of Cosmetic Dentistry has set in defining a beautiful smile.
The teeth have to be a shade A-1 or lighter on the Vita-Lumin
shade guide. The teeth should also be a certain size, shape
and proportion. They should lay against the lip in a certain
way when you smile. The amount of gum that shows when you
smile is also considered. |
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| When we look at a panoramic image of your
jaws, we do not want to see any pathology. Examples include
a polyp in the maxillary sinus, a cyst in the jawbone. Any
clinical or radiographic evidence of pathology would lower
your score in this category.
This category also includes any deviation from the normal
anatomy. As a silly example, on your panoramic image we
would normally see two orbits, or eye sockets. If you had
a third eyeball we would see a third orbit, and this would
be considered "a deviation from the normal anatomy”.
We take the number of teeth into consideration in this category.
The CDA is based upon someone with 28 teeth, not 32. We
consider 28 teeth an ideal situation and the presence of
the third molars is a deviation from ideal. Other anatomical
deviations would include impacted teeth, delayed exfoliation,
missing teeth, supernumerary teeth. Radiographic lesions
such as periapical radiolucencies /opacities, intraradicular
resorption, sialoliths. Soft tissue deviations noticed clinically
such as fibromas, mucoceles lichen planus, etc.
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| The temporomandibular joints are screened
for degeneration. Three areas are assessed; range of motion,
palpation & ausciculation of the joint and anatomy of
the joint, as reproduced on the panoramic image. Range of
motion values are measured in maximum opening, protrusion
and lateral movements of the mandible. Restrictions in any
of these movements are considered a deviation from normal.
Palpation and ausciculation may reveal joint noises such as
popping or crackling upon opening. This is considered a deviation
from normal. The joint anatomy is also assessed. Deviations
from normal would include flattened condylar heads, bifid
condylar heads, compressed temporomandibular joint space,
asymmetrical temporomandibular joints, etc. The total number
of deviations would result be used in determining your score.
Severity of the condition is not reflected in the score. |
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Your occlusion is the way the teeth come
together when you close your mouth. A perfect occlusion where
the molars and cuspids are in a Class I relationship, with
a 1mm overbite and 1 mm overjet with no rotations or spacing
would receive the highest score of a 3. If there is a minor
deviation form this “perfect occlusion” of the
teeth, but the vertical dimension is healthy, we consider
this a “Stable” condition and score it a 2. If
there are multiple deviations form the “perfect occlusion”,
such as missing teeth, loss of vertical dimension, overbite
or overjet greater than 3mm, etc, the occlusion is considered
to have “Significant Discrepancy” and would score
a 1. If the multiple deviations result in an unstable bite,
a score of 0 would apply.
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| The last three categories evaluate the
periadontia, or the supporting structures of the teeth. These
include the gums, the bone and the ligaments. These literally
hold the teeth in our heads. These categories were placed
at the bottom of the CDA to represent the foundation of or
teeth. |
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| Bleeding is a sign of inflammation and
periodontitis. Periodontitis is a main cause of tooth loss
and has been linked to other systemic problems such as coronary
artery disease, diabetes, bacterial pneumonia and low birth
weight.
If there is site specific, light bleeding upon probing
or scaling and the bleeding is isolated to one sextant or
is not enough to be evacuated by a low-volume evacuator,
and is likely to be the result of the light trauma inherent
in scaling below the gum line, we categorize this as “Little
to No Bleeding” and score it a 3.
If the bleeding upon scaling or probing is generalized,
as opposed to site specific, but is not plentiful enough
to require low-volume evacuation, we categorize this as
“Light” and score it a 2.
If the bleeding upon scaling or probing is generalized
as opposed to site specific, and is associated with edematous
tissue, and is plentiful enough to require low-volume evacuation,
we categorize this as “Moderate” and score it
a 1.
If the bleeding upon probing or scaling is plentiful enough
to consider aborting the procedure, it is categorized as
“Heavy” and scored a 0.
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| If the amount of plaque and/or tartar deposits
are minimal and confined to the lingual of the mandibular
anterior teeth and/or the buccal surfaces of the maxillary
first molars, and is most likely not preventable despite proper
home care, we categorize this as “Little to None”
and score it a 3. If the amount of plaque and/or tartar
deposits are more than minimal, but confined to the lingual
of the mandibular anterior teeth and/or the buccal surfaces
of the maxillary first molars, and can most likely be prevented
with better home care, we categorize this as “Light
to Moderate” and score it a 2.
If the plaque and tartar deposits are generalized throughout
the dentition, and in addition to the aforementioned areas,
there are deposits elsewhere, such as the invagination of
the the mesial root of the maxillary first bicuspids and
interproximal spicules are evident radiographically, we
categorize this as “Moderate” and score it a
1.
If the plaque and tartar deposits are generalized and located
throughout the dentition and characteristics include ledges
occupying 30% of the lingual surface of the mandibular anterior
teeth, sub and supragingival interproximal deposits and
perhaps accumulations on the occlusal surfaces of one or
more teeth we categorize this as “Heavy” and
score it a 0.
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If the measured pocket depths are all within
1-3mm, the score is a 3. If the pocket measurements are 1-3mm
in 90 % of the sites, and there are a couple of 4-5mm sites
the score is a 2. If there are more than 2 sites that measure
4-5mm, and 4-5mm is the deepest measurement, the score is
a 1. If there is one or more sites that measure 6mm or greater,
the score for this category of the CDA would be a 0. Bleeding
does not affect the score in this category.
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If we add up the scores in each of the
eleven categories, we arrive at your CDA, or Comprehensive
Dental Assessment. This is where you stand at this point in
time. We can use this assessment to aid in developing a treatment
plan that can improve your overall dental health. We like
to perform a CDA every year so that we can monitor your progress
and optimized your dental health as you age.
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