MDS Alert

Published on Fri Dec 13, 2013 PDF

Do you know all your ‘abnormal mouth tissue’ definitions?

Although you can perform the assessment for L0200 — Dental fairly quickly with enough practice, you have a lot of different oral areas to inspect and quite a few potential problems to look out for. Here are some expert tips to help smooth your path.

Throughout the dental assessment, keep in mind that you’re essentially assessing the four major components of oral health: “the teeth, the gums, the soft tissue, and any appliances the resident may have, such as dentures or partials,” said Gregory Folse, DDS, a dental consultant with the Louisiana Department of Health, in a recent instructional session.

How to Spot Broken/Loose Dentures

Assessing for L0200A — Broken or loosely fitting full or partial denture (chipped, cracked, uncleanable, or loose) “begins by asking the person to remove the denture or partial,” stated Paul Glassman, DDS, MA, MBA with the University of the Pacific School of Dentistry in San Francisco, in a recent presentation. In some cases, you may need to help the resident remove his dentures.

How to do it: To remove an upper denture, reach to the top back part and pull downward to break the seal, Glassman instructed. To remove a partial denture with metal clasps, carefully lift up on the metal clasps.

After you’ve removed the denture or partial, look at the resident’s teeth, gums, tongue, cheeks, and palate, Folse said. “A flashlight, which works best, or a penlight can greatly improve your ability to accurately assess the resident’s oral condition.”

• And ask the resident questions such as:
• Are your dentures/partial loose? »
• Do they hurt you when you eat? If so, point to the place where they hurt you.
• Can you chew your food well with them?
• Are they broken?

Don’t forget: Or if the resident doesn’t wear the dentures or partials, ask the resident why he doesn’t wear them, Glassman instructed.

Don’t Overlook ‘Nearly Edentulous’ for L0200B

L0200B — No natural teeth or tooth fragment(s) (edentulous) refers to residents “who have an edentulous mouth, meaning they have no natural teeth, or you may see people with just a few tooth fragments or “root tips” that would not enable them to chew,” Glassman explained. This would leave the resident as nearly endentulous.

Know Your Mouth Tissue Definitions

For L0200C — Abnormal mouth tissue (ulcers, masses, oral lesions, including under denture or partial if one is worn), look for abnormal mouth tissue appearing in the mouth as red or white areas, “or a variety of different types of mouth sores that can be seen on the gums, lips, tongue, or lining inside the mouth,” Glassman stated.

Look for: “You might see red patches, open sores, cracked lips, or other changes that could be a sign of irritation or something as serious as mouth cancer,” Glassman noted. “Remember, you do not need to make a diagnosis about what the abnormal area represents,” but instead you are simply noting that it’s not normal and arranging for follow-up care.

So to correctly code this subsection, Glassman stated, you must understand the following terms that identify different types of mouth tissue abnormalities:

• Ulcer — Mouth sores, blister(s), sores caused by dentures or partials, or eroded areas of tissue on the lips, gums, tongue, palate, cheek lining, or throat. Ulcers often make eating and talking uncomfortable.
• Oral Mass — A swollen or raised lump, bump, or nodule on the lips, gums, tongue, palate, cheek lining, or throat. An oral mass may be hard or soft, painful or without pain, normally colored or discolored.
• Oral Lesions — A discolored area of tissue (red, white, yellow, or darkened) on the lips, gums, tongue, palate, cheek lining, or throat.

And for oral lesions, “also look for cracks or redness at the corners of the mouth … or along the gums where dentures are secured,” Glassman noted. Look for gums that are red or swollen, or that bleed easily. Additionally, check for dry mouth (very little saliva in the mouth), because this can cause sores and cracks in the mouth and tongue to occur.

Explore the Many Faces of L0200D

L0200D — Obvious or likely cavity or broken natural teeth may seem like it covers two very different issues, but you’re really looking for two different severity levels of the same problem.

First, you’re looking for a cavity, which is a tooth with a hole or darkly stained area, Glassman explained. “Often you will also see gums that have become loose and pulled away from the tooth instead of being tight against the tooth.”

And second, you’ll look for a “tooth fragment,” which would occur from a very large cavity, including teeth broken off or decayed to the gum line, Glassman explained. But a tooth fragment or broken teeth here can also be from a fall or trauma. “Tooth fragments may look like ‘root tips,’ which are often overlooked and not cleaned, leaving the mouth to gather harmful bacteria,” he added.

Beware of Gum Inflammation

For L0200E — Inflamed or bleeding gums or loose natural teeth, you are basically assessing the health of the resident’s gums, Glassman said. Look for “redness and bleeding in the gums around the teeth” and feel for loose natural teeth.

Beware: “The redness is a sign of inflammation,” Glassman explained. “Inflammation can lead to bone loss, and that is why teeth can become loose and painful.”

Ask 5 Questions to Assess Mouth Pain

To assess for L0200F — Mouth or facial pain, discomfort or difficulty with chewing, Glassman advises that you ask the resident these questions:

• Does your mouth hurt?
• Does your mouth hurt when you eat?
• Can you chew your food well?
• Does it hurt to eat or drink?
• Can you point to the place that hurts?

When to Check ‘G’ or ‘Z’

Checking item L0200G — Unable to examine means that you were not able to examine the resident’s mouth, Glassman stated. In many cases, you may employ a variety of methods that can increase residents’ cooperation for the oral assessment (see “Quick Tips: Don’t Let Oral Health Assessments Discourage You,” MDS Alert Vol. 11, No. 5).

But if you check item L0200Z — None of the above, this means you performed an examination and did not find any problems, Glassman said. “This is the best result as long as your examination was thorough and did not overlook any problems.”