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C&P Exam Prep: Teeth, Loss Due to Loss of Substance of Body of Maxilla or Mandible

DC 9913 dental-and-oral 38 CFR 4.150

DBQ Overview

Interview + Physical
Form Name
oral-and-dental
Form Code
oral-and-dental
Page Count
7
Examiner Type
Dentist or Oral Surgeon
Estimated Duration
20-30 minutes
Exam Format
Interview + Physical

What to Expect During Your Exam

Exam Overview

To document the extent of tooth loss caused by loss of substance of the body of the maxilla (upper jaw) or mandible (lower jaw) due to trauma or disease such as osteomyelitis - NOT periodontal disease - and to determine whether the lost masticatory surface can be restored by a suitable prosthesis, which directly determines the rating percentage under DC 9913.

What the examiner evaluates:

  • Confirmed diagnosis of bone loss (maxilla or mandible) due to trauma or disease such as osteomyelitis - not periodontal disease
  • Identification and count of all missing teeth by number and location (upper/lower, anterior/posterior, unilateral/bilateral)
  • Whether the lost masticatory (chewing) surface can be restored by a suitable prosthesis
  • Current prosthetic status - whether veteran has, uses, or can use a prosthesis
  • Cause and etiology of bone loss and tooth loss (service-connected trauma, osteomyelitis, osteoradionecrosis, or other bone disease)
  • Presence of any associated conditions: malunion or nonunion of maxilla or mandible, soft tissue injuries, lip injuries, TMD
  • Review of panographic or intraoral imaging to confirm tooth and bone loss
  • Functional impact on chewing, speaking, swallowing, and nutrition
  • Treatment history including surgery, radiation therapy, antineoplastic chemotherapy, or other therapeutic procedures
  • Residuals or complications from treatment or disease progression

Exam is conducted in a dental operatory or clinical examination room. The examiner will perform a clinical oral examination with direct visualization, palpation of jaw structures, and review of available dental and medical records including imaging. Bring all relevant dental records, X-rays, and a list of current medications to the appointment.

Typical duration: 20-30 minutes

Tooth Inventory and Missing Teeth Count

Identification by tooth number and location of all missing teeth, categorized as upper anterior, lower anterior, upper posterior, lower posterior, or all teeth, on one or both sides of the jaw

What to expect:

The examiner will visually inspect your mouth and may use a dental mirror and probe to identify present and missing teeth. They will record which teeth are missing using a standard tooth numbering system (Universal, Palmer, or FDI). Imaging such as a panographic X-ray may be reviewed.

Key thresholds:

  • All teeth missing - masticatory surface not restorable by prosthesis — 40% rating under DC 9913
  • All upper teeth missing OR all lower teeth missing - masticatory surface not restorable by prosthesis — 30% rating under DC 9913
  • All upper AND lower posterior teeth missing OR all upper AND lower anterior teeth missing - masticatory surface not restorable by prosthesis — 20% rating under DC 9913
  • All upper anterior teeth missing OR all lower anterior teeth missing OR all upper and lower teeth on one side missing - masticatory surface not restorable by prosthesis — 10% rating under DC 9913
  • Any qualifying tooth loss - masticatory surface CAN be restored by suitable prosthesis — 0% rating under DC 9913 regardless of number of teeth missing

Tips:

  • Know your tooth numbers before the exam - ask your private dentist or review your dental records so you can confirm the examiner has correctly identified all missing teeth
  • Be explicit about which teeth are missing and whether you currently wear a prosthesis (denture, partial denture, implant-supported prosthesis)
  • If you have a prosthesis but cannot wear it due to poor fit, pain, bone loss, or medical reasons, tell the examiner clearly - this is critical to whether the masticatory surface is 'restorable by suitable prosthesis'
  • Anterior teeth = front teeth (incisors and canines, typically teeth #6-11 upper and #22-27 lower); Posterior teeth = back teeth (premolars and molars)
  • If you have implants replacing missing teeth, clarify with the examiner whether these restore masticatory function adequately

Pain considerations: Although DC 9913 is not a musculoskeletal condition rated primarily on pain, note any pain or discomfort associated with bone loss that prevents prosthesis use or causes functional limitations in chewing.

Prosthesis Restorability Assessment

Whether the lost masticatory surface can be adequately restored by a suitable prosthesis - this is the single most critical determination for rating under DC 9913, as it distinguishes a 0% rating from a compensable rating

What to expect:

The examiner will assess the residual bone structure, soft tissue condition, and your current or potential ability to wear and functionally use a prosthesis. They will evaluate whether sufficient bone support exists for dentures or implants and whether any complications prevent prosthesis use.

Key thresholds:

  • Masticatory surface not restorable by suitable prosthesis — Compensable rating (10%-40%) based on teeth missing
  • Masticatory surface restorable by suitable prosthesis — 0% rating regardless of number of missing teeth

Tips:

  • If you have tried prostheses in the past and they failed due to insufficient bone, pain, poor retention, or inability to chew effectively, document this history thoroughly
  • Bring any prior dental records or prosthodontic notes documenting failed prosthesis attempts or contraindications to prosthesis use
  • If your bone loss is so severe that dentures cannot be stabilized or implants cannot be placed, tell the examiner and provide supporting documentation
  • If you currently have a prosthesis but it does not restore your ability to chew (masticatory function), describe specifically what you cannot eat and how your chewing is impaired
  • Radiation therapy or ongoing osteonecrosis may contraindicate implants or certain prostheses - document this if applicable

Pain considerations: Describe any pain when wearing a prosthesis that prevents consistent use, as inability to tolerate a prosthesis is relevant to whether the masticatory surface is truly restorable.

Bone Loss Documentation and Imaging Review

Confirmation and extent of loss of substance of the body of the maxilla or mandible through panographic or intraoral X-ray imaging, CT scan, or other diagnostic imaging, distinguishing traumatic or disease-based bone loss from alveolar bone loss due to periodontal disease

What to expect:

The examiner will review existing imaging or may order new panographic (panoramic) or intraoral X-rays. They will document whether bone loss is limited to alveolar (periodontal) bone or involves the body of the maxilla or mandible, since only the latter qualifies under DC 9913.

Key thresholds:

  • Bone loss involving the body of the maxilla or mandible due to trauma or disease (e.g., osteomyelitis, osteoradionecrosis) — Qualifies for rating under DC 9913
  • Bone loss limited to alveolar process from periodontal disease only — Does NOT qualify under DC 9913 - not considered disabling under this code

Tips:

  • Bring any CT scans, panoramic X-rays, or cone beam CT imaging from previous dental or medical visits that document your bone loss
  • If you have a history of jaw trauma, osteomyelitis, osteoradionecrosis, or cancer treatment affecting the jaw, ensure this is prominently documented in your history
  • Know the distinction: if your bone loss was caused by gum disease (periodontitis) alone, it does not qualify under DC 9913 - however, if trauma or osteomyelitis caused the bone loss leading to tooth loss, it does qualify
  • If you have both periodontal disease AND a qualifying bone disease or trauma, ensure the examiner documents the service-connected cause separately

Pain considerations: Document any jaw pain, sensitivity, or tenderness over areas of bone loss that affect function.

Estimate

Rating Criteria Breakdown

40% Loss of all teeth due to loss of substance of body of maxill ...

Loss of all teeth due to loss of substance of body of maxilla or mandible, where the lost masticatory surface CANNOT be restored by a suitable prosthesis. This represents the most severe outcome - complete edentulism (all teeth missing) with no feasible prosthetic restoration.

Key Symptoms

  • All teeth absent (both upper and lower arches completely edentulous)
  • Bone loss of maxilla or mandible body due to trauma or disease such as osteomyelitis sufficient to cause total tooth loss
  • Inability to fit, retain, or functionally use any form of prosthesis due to extent of bone loss
  • Severely impaired or absent masticatory (chewing) function
  • Significant difficulty eating, requiring dietary modifications to soft or liquid foods
  • Possible speech impairment due to complete tooth loss and jaw bone loss

CFR: Loss of all teeth where the lost masticatory surface cannot be restored by suitable prosthesis - 40% (38 CFR - 4.150, DC 9913)

30% Loss of all upper teeth OR all lower teeth due to loss of su ...

Loss of all upper teeth OR all lower teeth due to loss of substance of body of maxilla or mandible, where the lost masticatory surface CANNOT be restored by a suitable prosthesis. Either complete upper arch or complete lower arch edentulism without viable prosthetic option.

Key Symptoms

  • All upper teeth absent (complete maxillary edentulism) OR all lower teeth absent (complete mandibular edentulism)
  • Bone loss of maxilla or mandible body sufficient to cause full arch tooth loss
  • Prosthesis cannot be fitted, retained, or used functionally due to bone deficiency
  • Significantly impaired chewing on the affected arch
  • Dietary restrictions due to inability to chew solid foods
  • Possible changes in facial structure or occlusion due to bone and tooth loss

CFR: Loss of all upper teeth OR loss of all lower teeth where the lost masticatory surface cannot be restored by suitable prosthesis - 30% each (38 CFR - 4.150, DC 9913)

20% All upper AND lower posterior teeth missing, OR all upper AN ...

All upper AND lower posterior teeth missing, OR all upper AND lower anterior teeth missing, due to loss of substance of body of maxilla or mandible, where the lost masticatory surface CANNOT be restored by a suitable prosthesis. Both arches affected in the same functional zone (all posterior or all anterior).

Key Symptoms

  • All posterior teeth (premolars and molars) missing on both upper and lower arches, OR all anterior teeth (incisors and canines) missing on both upper and lower arches
  • Bone loss of maxilla or mandible body causing loss of these specific tooth groups
  • No viable prosthetic restoration for the missing tooth groups
  • Impaired chewing of hard or fibrous foods (posterior loss) or difficulty biting/incisal function and speech issues (anterior loss)
  • Nutritional impact from inability to process certain food textures

CFR: All upper and lower posterior teeth missing OR all upper and lower anterior teeth missing where the lost masticatory surface cannot be restored by suitable prosthesis - 20% (38 CFR - 4.150, DC 9913)

10% All upper anterior teeth missing, OR all lower anterior teet ...

All upper anterior teeth missing, OR all lower anterior teeth missing, OR all upper and lower teeth on one side missing, due to loss of substance of body of maxilla or mandible, where the lost masticatory surface CANNOT be restored by a suitable prosthesis.

Key Symptoms

  • All upper anterior teeth (incisors and canines, upper arch) missing, OR all lower anterior teeth missing, OR all upper and lower teeth on one side (left or right) missing
  • Bone loss of maxilla or mandible body as the underlying cause of tooth loss
  • Prosthesis is not a viable restorative option
  • Functional impairment in biting or incisal function (anterior loss) or unilateral chewing impairment (one-sided loss)
  • Possible speech articulation difficulties with anterior tooth loss
  • Aesthetic and psychosocial impact of anterior tooth loss

CFR: All upper anterior teeth missing OR all lower anterior teeth missing OR all upper and lower teeth on one side missing where the lost masticatory surface cannot be restored by suitable prosthesis - 10% (38 CFR - 4.150, DC 9913)

0% Any qualifying tooth loss due to loss of substance of body o ...

Any qualifying tooth loss due to loss of substance of body of maxilla or mandible WHERE the lost masticatory surface CAN be restored by a suitable prosthesis. The veteran either currently wears a functional prosthesis or is a viable candidate for one that would restore chewing function.

Key Symptoms

  • Missing teeth from jaw bone loss but veteran successfully wears functional dentures, partial dentures, or implant-supported prosthesis
  • Prosthesis restores adequate masticatory function
  • Sufficient bone support exists for prosthesis retention and function
  • No medical contraindication to prosthesis use

CFR: Where the loss of masticatory surface can be restored by suitable prosthesis - 0% (38 CFR - 4.150, DC 9913). Note: These ratings apply only to bone loss through trauma or disease such as osteomyelitis, NOT to loss of the alveolar process as a result of periodontal disease.

How to Describe Your Symptoms

Cause of Bone Loss and Tooth Loss

How to describe:

Clearly state the specific event, injury, or disease that caused the loss of jaw bone substance leading to your tooth loss. Distinguish between traumatic injury (combat wound, blast injury, MVA, fall) and bone disease (osteomyelitis, osteoradionecrosis, osteonecrosis). Provide dates, locations, and any treatment received in service.

Worst-day example:

“During my deployment in [year/location], I sustained a blast injury to my jaw that fractured and destroyed bone in my mandible. After multiple surgeries for osteomyelitis, which developed from a service-connected wound, I lost bone in my lower jaw that could not be reconstructed, resulting in loss of all my lower teeth. The bone destruction was so extensive that there is no adequate ridge remaining to support a denture.”

What the examiner listens for:

Specific causative event or disease process; timeline linking service to bone loss; distinction from periodontal disease as the cause; medical and surgical history related to jaw bone loss; current functional status.

Understatements to avoid:

Do not simply say 'I lost my teeth' without explaining the jaw bone loss caused by trauma or disease - the examiner must document that this is NOT periodontal disease but rather structural bone loss from a qualifying cause.

Prosthesis Use and Restorability

How to describe:

Accurately describe your experience with prostheses - whether you have one, whether you can use it, whether it functions adequately, and if not, exactly why not. If your prosthesis does not restore your ability to chew, describe specific foods you cannot eat and how your daily nutrition is affected.

Worst-day example:

“I have tried dentures twice. Because so much of my jaw bone was destroyed by osteomyelitis, the dentures cannot stay in place - they shift and fall out even with adhesive. On my worst days, I cannot eat anything firmer than mashed potatoes or yogurt. I have lost 15 pounds over the past year because I cannot chew meat, raw vegetables, or most solid foods. I gave up on wearing the dentures because they cause pain on the raw bone and create sores that take weeks to heal.”

What the examiner listens for:

Whether prosthesis has been tried and failed; specific mechanical or anatomical reasons prosthesis does not work; functional limitation in chewing; dietary modifications forced by inability to chew; pain or complications from prosthesis attempts; prosthodontist or oral surgeon notes documenting poor candidacy for prosthesis.

Understatements to avoid:

Do not say 'I have dentures' if they do not actually restore your chewing function - describe exactly what masticatory function remains impaired even with the prosthesis.

Functional Impact on Eating and Nutrition

How to describe:

Describe in specific, concrete terms how tooth and bone loss affects your ability to eat, what foods you must avoid, how long meals take, whether you have experienced weight loss or nutritional deficiencies, and how this affects your daily life and social functioning.

Worst-day example:

“On my worst days, I am limited to liquids and very soft foods. I cannot bite into any solid food, cannot chew meat or raw vegetables, and have difficulty with even cooked vegetables if they are not pureed. Eating in social settings - restaurants, family gatherings - is deeply embarrassing. I spend significantly more time preparing food and often skip meals because eating is so difficult and painful. My doctor noted I am underweight and referred me to a dietitian.”

What the examiner listens for:

Specific dietary restrictions; weight loss or malnutrition; time burden of meals; social and occupational impact; secondary health effects from nutritional impairment; need for liquid dietary supplements.

Understatements to avoid:

Do not minimize eating difficulties by saying 'I manage okay' - describe specifically what you cannot eat and the real impact on your nutrition and quality of life.

Speech and Communication Impact

How to describe:

If anterior teeth are missing, describe any speech difficulties such as problems with certain sounds (especially sibilants like 's' sounds, or 't', 'd', 'th'), difficulty being understood in conversation, and any social or occupational consequences of speech impairment.

Worst-day example:

“Since losing my upper front teeth, I have difficulty pronouncing words with 's' and 'th' sounds clearly. People frequently ask me to repeat myself. In my work environment, I have avoided phone calls and presentations because I am self-conscious and sometimes cannot be understood. This has affected my professional performance evaluations.”

What the examiner listens for:

Specific sounds or words affected; impact on professional communication; social withdrawal due to speech impairment; whether speech therapy has been pursued.

Understatements to avoid:

Do not fail to mention speech difficulties if present - anterior tooth loss directly impacts articulation and this functional limitation supports your claim.

Pain and Associated Symptoms

How to describe:

Describe any pain in the jaw, gum tissue, or surrounding structures related to the bone loss or missing teeth, including pain from exposed bone, sore spots from prosthesis contact, jaw pain with movement, or pain that prevents prosthesis use.

Worst-day example:

“On my worst days, there is constant throbbing pain along my lower jaw where the bone was destroyed. The exposed bone areas become sore and inflamed, especially when I try to wear my partial denture. The pain radiates up to my ear and temple. I take [medication] daily to manage the pain, and even then I often cannot wear any prosthesis for days at a time.”

What the examiner listens for:

Location, character, and severity of pain; relationship of pain to prosthesis use; medications taken for pain management; impact of pain on eating and daily function.

Understatements to avoid:

Do not say 'it's fine most of the time' - report your worst days and the full range of pain you experience, particularly pain that prevents prosthesis use.

Common Mistakes to Avoid

Prep Checklist

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Before Your Exam

Day Of

During the Exam

After the Exam

Your Rights During a C&P Exam

  • You have the right to an accurate and adequate C&P examination - if the examiner does not perform a clinical oral examination, does not review relevant records, or does not address the key diagnostic question of prosthesis restorability, the exam may be considered inadequate and you can request a new one.
  • You have the right to submit private dental opinions or independent medical opinions (IMOs) from your own oral surgeon or dentist to support or rebut C&P exam findings.
  • You have the right to request a copy of your completed C&P examination report through VA.gov Blue Button or by contacting your regional VA office.
  • In many states, you have the right to record your C&P examination - check your state's consent laws before the appointment and notify the examiner at the start if you choose to record.
  • You have the right to have a representative (VSO, accredited claims agent, or VA-accredited attorney) assist you with your claim, though the representative typically cannot be present in the exam room during the clinical examination.
  • You have the right to submit buddy statements, lay statements, and personal statements documenting your functional limitations for inclusion in your claims file.
  • You have the right to appeal any rating decision you believe is incorrect, including requesting a supplemental claim with new evidence, a Higher-Level Review, or a Board of Veterans' Appeals hearing.
  • Under 38 CFR - 4.3 (benefit of the doubt), when the evidence for and against your claim is in approximate balance, the benefit of the doubt must be given to you as the veteran.
  • The DC 9913 rating criteria explicitly exclude periodontal disease as a qualifying cause - if you believe your tooth loss was due to qualifying bone disease or trauma and the examiner incorrectly attributes it to periodontal disease, you have the right to challenge that finding with additional medical evidence.
  • You have the right to request that VA provide you with the full claims file (C-file) so you can review all evidence being used to decide your claim.

Related Conditions

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This C&P exam preparation guide is for educational purposes only and does not constitute legal, medical, or claims advice. Always consult with a qualified Veterans Service Organization (VSO) representative or VA-accredited attorney for guidance specific to your claim. Never exaggerate, minimize, or fabricate symptoms during a C&P examination.