Medical Complexity Status – Medical History
Medical Complexity Status (MCS)
Explanation
Assigning a medical complexity status (MCS) category to a patient provides a systematic approach to potential adverse medical events and potential necessary modifications of dental treatment protocols. Although types of dental procedures, length of procedures, and level of trauma varies, the MCS system uses an uncomplicated single extraction as the norm.
Categories
MCS 0 – Patient with no medical problems.
MCS 1 – Patient with a stable and controlled medical disease or condition.
MCS 2 – Patient with an unstable or uncontrolled medical disease or condition, which may include multimorbidities.
MCS 3 – Patient needing continuous medical monitoring during any dental procedure.
Subcategories
A – No anticipated adverse medical events. No dental treatment protocol modifications are necessary.
B – Anticipated minor adverse medical events. Dental treatment protocol modifications may be necessary.
C – Anticipated major adverse medical events. Dental treatment protocol modifications are necessary.
Explanation:
Minor adverse medical events – adverse event that can be treated in the dental chair.
Major adverse medical events – adverse event that need to be treated in an emergency room/hospital.
Medical Complexity Matrix
This table depicts how a patient’s medical condition and anticipated adverse events can be classified into specific MCS categories.
Assess a patient’s MCS category frequently, as medical conditions may change between dental visits.
| MCS 0 | No medical problems |
| MCS 1A | Patient with a stable and controlled medical disease or condition. No anticipated adverse medical events. No dental treatment protocol modifications are necessary. |
| MCS 1B | Patient with a stable and controlled medical disease or condition. Anticipated minor adverse medical events. Dental treatment protocol modifications may be necessary. |
| MCS 1C | Patient with a stable and controlled medical disease or condition. Anticipated major adverse medical events. Dental treatment protocol modifications are necessary. |
| MCS 2A | Patient with an unstable or uncontrolled medical disease or condition. No anticipated adverse medical events. No dental treatment protocol modifications are necessary. |
| MCS 2B | Patient with an unstable or uncontrolled medical disease or condition. Anticipated minor adverse medical events. Dental treatment protocol modifications may be necessary. |
| MCS 2C | Patient with an unstable or uncontrolled medical disease or condition. Anticipated major adverse medical events. Dental treatment protocol modifications are necessary. |
| MCS 3 | Patient needing continuous medical monitoring during any dental procedure. |
Example
Medical Complexity Status – Diabetes
| Diabetes | MCS1B | MCS2C |
|---|---|---|
| Anticipated complication |
Controlled/ stable |
Uncontrolled/ unstable |
| Hemostasis | None | None |
| Microbial susceptibility | None | Minor |
| Drugs/drug interactions | Minor | Minor |
| Stress/trauma | None | Major |
Related Pages
References/Websites
- References
- Glick M, Greenberg MS, Lockhart PB, Challacombe SJ. Introduction to Oral Medicine and Oral Diagnosis: patient Evaluation. In: Glick M, Greenberg MS, Lockhart PB, Challacombe SJ, eds. Burket’s Oral Medicine. 13th ed. Wiley-Blackwell; 2021:1-18.
- Goodchild JH, Glick M. A Different Approach to Medical Risk Assessment. Endo Topics. 2003;4:1-8.
- Harrision C, et al. Comorbidity versus multimorbidity: Why it matters. J Comorb 2021;11:1-3.
- Patton LL, Glick M, eds. The ADA Practical Guide to Patients with Medical Conditions. 2nd ed. Wiley-Blackwell; 2016.