Idaho Admin. Code r. tit. IDAPA 16, r. 16.03.10, SUB AREA: BREAST AND CERVICAL CANCER PROGRAM, app A

Current through September 2, 2024

Appendix A - IDAHO MEDICAID HANDICAPPING MALOCCLUSION INDEX

OVERBITE:	MEASUREMENT/POINTS:	SCORE:
Lower incisors: striking lingual of uppers at incisal	1/3 = 0
Striking lingual of uppers at middle	1/3 = 1
Striking lingual of uppers at gingival	1/3 = 2
OPENBITE: (millimeters) *a,b
Less than...........................	2 mm = 0
	2-4 mm = 1
	4+ mm = 2
OVERJET: (millimeters) *a
Upper...............................	2-4 mm = 0
Measure horizontally parallel to occlusal plane.	5-9 mm = 1
	9+ mm = 2
Lower..............................	0-1 mm = 0
	2 mm = 1
	3+ mm = 2
POSTERIOR X-BITE: (teeth) *b
Number of teeth in x-bite:	0-2 = 0
	3 = 1
	4 = 2
TOOTH DISPLACEMENT: (teeth) *c, d, e
Number of teeth rotated 45 degrees or displaced 2mm from normal position in arch.	0-2 = 0 3-6 = 1 7+ = 2
BUCCAL SEGMENT RELATIONSHIP:
One side distal or mesial 1/2 cusp	= 0
Both sides distal or mesial or one side full cusp	= 1
Both sides full cusp distal or mesial	= 2
TOTAL SCORE:______ Scoring Definitions: Impacted or blocked cuspids are scored 1 open bite and 1 over jet for two teeth. Score 2 for open bite and 2 for over jet for 4 blocked cuspids. a) Cross bites are scored for the teeth in cross bite, not the teeth in the opposing arch. b) Missing teeth count as 1, if the space is still present. c) Do not score teeth that are not fully erupted. d) Displaced teeth are based on where they are in their respective arch line, not their relationship with the opposing arch.