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Loss of Teeth F054

Last amended 
26 October 2015

In this section

Current RMA Instruments:
Reasonable Hypothesis SOP
124 of 2015
Balance of Probabilities SOP
125 of 2015
Changes from previous Instruments:


ICD Coding:
  • ICD-9-CM Codes: 525.1, 525.3
  • ICD-10-AM Codes: K08.1, K08.3
Confirming the diagnosis

Confirmation of tooth loss requires a dental/medical report or dental records that identifies the affected tooth/teeth.  The tooth or teeth affected should be specified in the diagnostic label used. 

Additional diagnoses covered by SOP
  • Surgical extraction of tooth
Conditions not covered by SOP
  • Dental caries, ICD code 525.0
  • Dental pulp disease, ICD codes 522.0, 522.1, 522.2, 522.5, 522.7, 522.9
  • Periodontitis, ICD codes 522.4, 522.6, 523.3-523.5
Clinical onset

Each loss of a tooth, or of a group of teeth at one time from one cause, represents a separate clinical onset.  Clinical onset will be when the tooth/teeth came out rather than when a disease or injury that led to subsequent tooth loss occurred.

Clinical worsening

The only SOP worsening factor is for inability to obtain appropriate clinical management.  Any later consequences following loss of a tooth or teeth would represent a new condition rather than a permanent worsening of loss of teeth.