DD 2813 — Dental Examination

Active Duty / Reserve / Guard / Civilian · Worldwide duty screen

Dental Examination

This form determines fitness for prolonged duty without ready access to dental care. It is not intended to document comprehensive dental needs. Suggested minimum: clinical exam with mirror and probe, plus bitewing radiographs.

Items 1–5 · Service member (prepopulated from the readiness record)

1 · Service member's name (Last, First, MI)

2 · DoD ID number

3 · Branch of service

4 · Unit of assignment

5 · Unit address

Item 6 · Examination results (dentist marks the single best-fit class)

Mark the block that best describes the condition of the member.

Class 1. Good oral health — not expected to require treatment or re-evaluation for 12 months. Class 2. Some oral conditions, but no dental emergency expected within 12 months if untreated (e.g., needs prophylaxis, asymptomatic caries with minimal dentin extension, edentulous areas not needing immediate prosthetics). Class 3. Oral conditions expected to result in a dental emergency within 12 months if untreated.

Class 1 or 2 members are considered dentally ready for worldwide duty. This will set the PHA DEN readiness element to READY.

Class 3 is not dentally ready. Identify the condition(s) below; this sets the PHA DEN element to NOT READY and routes to treatment scheduling.

Item 6(3) · Class 3 conditions (mark all that apply)

(a) Infections — acute oral infection, pulpal/periapical pathology, chronic infection, lesions requiring/awaiting biopsy (b) Caries/Restorations — caries/fractures with moderate-to-advanced dentin extension; defective/temporary restorations not maintainable 12 mo (c) Missing teeth — edentulous areas requiring immediate prosthodontics for mastication, communication, or esthetics (d) Periodontal — acute gingivitis/pericoronitis, active moderate-advanced periodontitis, abscess, heavy subgingival calculus (e) Oral surgery — unerupted/partially erupted/malposed teeth with signs of pathosis recommended for removal (f) Other — TMD or myofascial pain dysfunction requiring active treatment

Item 6(4) · Describe the identified condition(s):

Item 6(5) · Radiographs

6(5)Were X-rays consulted?

Required

Date X-ray was taken (YYYYMMDD):

Items 7–10 · Examining dentist

7 · Dentist's name (Last, First, MI)

8 · Telephone (incl. area code)

9 · License number

10 · Date of examination (YYYYMMDD)

9 · Dentist's signature

Signature captured at sign-off · CAC / PKI

Complete the required items to enable sign-off.