The Complete Guide to NHS DMF Indicators

A few weeks ago I briefly covered the changes that the NHS are making this April. Jonny has recently explained a bit about Compass. In this post. we'll be learning more about the new NHS decayed, missing and filled teeth indicators (DMF) that are being introduced to the FP17 forms.

What do I need to do differently?

From April 2016 you'll need to tell the NHS the number of decayed, missing and filled teeth that a patient has. You may need to record DMF values for both deciduous AND permanent teeth. That could be up to 6 new boxes to complete in total. It sounds simple enough but don't worry, the NHS have added their usual amount of confusion so you'll want to pay attention to the details. Here's the specifics:

Decayed Teeth

• A count of permanent and/or deciduous where established caries is charted on any surface
• Decayed means teeth with established caries
• Any tooth should only be counted once
• Permanent decayed teeth should be recorded for all patients aged 6 years and older
• Deciduous decayed should be recorded for all patients aged 0 up to and including 11 years of age

Missing Teeth

• A count of permanent and/or deciduous teeth charted as missing including those replaced by bridge pontics and dentures but excluding teeth charted as unerupted
• Missing means where a tooth has been extracted
• Any tooth should only be counted once
• ULA, ULB, URA, URB, LLA, LLB, LRA, LRB should not be counted
• Permanent missing teeth should be recorded for all patients aged 12 years and older
• Deciduous missing teeth should be recorded for all patients aged 0 up to and including 11 years of age

Filled Teeth

• A count of permanent and/or deciduous teeth charted as restored on any surface with direct restorations (fillings) or with indirect restorations of the following types: crowns, inlays, bridge retainers
• Any tooth should only be counted once.
• Where a tooth is restored but there is decay associated with the restoration or on any other unrestored surface, the tooth should be counted as decayed.
• Permanent missing teeth should be recorded for all patients aged 12 years and older
• Deciduous missing teeth should be recorded for all patients aged 0 up to and including 6 years of age

In addition, you should also note that:

• Each tooth should only be counted once in one of the decayed, missing or filled categories. Therefore, if a restored tooth has one of more surface which has established caries as well as one or more surface that is filled, the tooth should be counted as decayed and not counted as filled.
• All boxes should contain a value. Where no teeth fall into a category, zero must be entered.
• Decayed teeth: If a tooth has established caries on any of its surfaces it should be charted as decayed.
• Filled teeth: Where a tooth has previously been charted as filled it can subsequently be counted as decayed or missing, but not as sound.
• Missing teeth: Where a tooth has previously been charted as missing it cannot subsequently be counted as present.
• Sound teeth: No sound teeth should be included in the count for DMF
• Retained deciduous teeth in adulthood should be charted as permanent teeth.
• If both deciduous tooth and its permanent successor are present, only count permanent successor in completing the D or F scores.

There are three things we think you'll need to watch out for. Firstly, the change in age for deciduous teeth between the different DMF categories. Secondly the definition of filled teeth does not follow the definition of fillings as defined in the Clinical Data Set. Finally, remember not to count deciduous incisors. Clear as mud!

Why do we have to do this?

The official response of the NHS is:

Collecting this data will allow the NHS to understand whether the oral health of patients is improving for those patients that receive NHS dental services.

We're not entirely convinced here at Dentally, especially considering the majority of the information that they're collecting can already be inferred from the data submitted as part of the Clinical Data Set.

How does this affect my dental software?

If this sounds like a lot to take in then don't worry, we've got you covered. Dentally will automatically calculate the values based on the patients chart and display them to you before you submit the FP17. You should however check that the values are Dentally has calculated are correct before you submit your claim to the NHS.