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Loss of Teeth F054

Last amended 
29 October 2018

In this section

Current RMA Instruments

Reasonable Hypothesis SOP

124 of 2015 as amended

Balance of Probabilities SOP

125 of 2015 as amended

Changes from previous Instruments

  SOP Bulletin 204

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*
  • Dental pulp disease*
  • Periodontitis*
  • Tooth wear*

* another SOP applies

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.