EZCodes, a Dental Diagnostic 

Terminology for the Electronic 

Health Record 

Elsbeth Kalenderian, DDS, MPH 

Chair, Oral Health Policy and Epidemiology 

Chief of Quality 

Harvard School of Dental Medicine 
Which diagnoses led to the choice of 

three different restorations? 
EZCodes in EHR
Development Process 

Kalenderian, E. et al, The Development of a Dental Diagnostic Terminology, JDE 2011 (1);75:68-76
Distribution of EZCodes Sources 
Method: Controlled Terminology (CT) 

Term: Mulberry Molar 

Definition: Shape alteration of tooth 

Identifier: EZ840069 

Synonym: Moon’s molar teeth 

Term: Xerostomia 

Definition: Dry mouth 

Identifier: EZ494038 

Synonym: Hyposalivation, Asialorrhea, Asialia 

 
Improve Usability: 

• Assertional medical (dental) knowledge 

• Synonyms 

• Balance between pre-and post 

coordination 

• Mapping to ICD and SNOMED 

Design: Interface Terminology 
Reference Terminology: SNOMED-CT:

EZCodes submitted to complete oral health terms 

• 15 terms accepted 

• 40 terms forwarded to the IHTSDO 

• 63 terms require clarification: in process 

• 12 terms rejected: 

– 4 terms already exist in SNOMED 

– 8 terms have quantitative modifiers e.g., 

“Arthrogenous TMD pain (“Arthralgia”) ≤ 12 weeks 
R01 Research 

Entering diagnostic terms in the EHR should be easy! By 

learning from the dentist in the clinic we can craft best 

practices, which will: 

 Increase dentist satisfaction with the Dx term entry process 

 Increase utilization of diagnostic terms 

 Reduce error rates in the entry of diagnostic terms 

Results YTD: 

• Validation has been completed 

– Evaluating a Dental Diagnostic Terminology in an Electronic Health Record. 

White JM, et al. JDE; 75(5):605-615, 2011

• Utilization of EZCodes can be improved 

– Assessing the Use of a Standardized Dental Diagnostic Terminology in an 

EHR. Tokede O, et al. JDE, in press 

• Mapping has been completed: ICD, SNOMED, CDT 

• Annual Revision Process 
Content experts: Oral 

diagnosis/ 

Periodontics/ Caries/ 

Endodontics

Direct feedback from 

users of the EZCodes 

dental terminology

Analysis of ‘use’/’validity 

of use’ of the EZCodes at 

3 centers

Diagnostic terms re-organized based on drawn up sorting 

principles

Clinicians’ satisfaction 

survey at 4 centers 

that use the EZCodes

EZCodes review workgroup meets to discuss and accept, 

reject, or modify feedback received

Removal of redundant and antiquated concepts 

Inclusion of ICD/SNOMED terms that have finer granularity

EZCodes 2013

The EZCodes Revision Process 
Pre-coordination and assertional knowledge
Clinical Decision Support – Mapping to CDT
Insurance Billing – Mapping to ICD
EZCodes Implementation

• ACTA 

• Creighton 

• HSDM 

• Indiana University 

• OHSU 

• Temple 

• UCSF 

• U. of Illinois, Chicago 

• University of Michigan 

• U. of Minnesota 

• U. of Oklahoma 

• U. of Tennessee 

• UT Houston 

• Midwestern U. 

• U. Florida 

• Willamette Dental Grp. 

• Children’s Hosp. Boston 

1,909,557 Patient visits 

3,707 Providers 
Benefits of EZCodes Terminology 

• Provider 

– Influence quality of care – become diagnostic centered 

– Improve communication: w/patients; between providers 

– Usability of an interface terminology 

• Patients/Population 

– Identification and tracking of high need groups 

– Disease surveillance 

– Assess trends in nation’s health

• Research 

– Synthesize literature; compare across cultures/countries 

– Identification and tracking of best practices 

– Tracking of clinical outcomes 

Leake, J.L., et al, A system of diagnostic codes for dental health care. J Public Health Dent, 1999. 59(3): p. 162-70.

Verdonschot EH, et al. Developments in caries diagnosis and their relationship to treatment decisions and quality of care. 1997. Caries research. 1999;33(1):32-40. 

Pitts NB. Clinical diagnosis of dental caries: a European perspective. J Dent Educ. 2001; 65(10):972-8. Rosenbloom ST Interface Terminologies JAMIA 2006; 13(3):277-88

Ettelbrick KL, et al. Hospital charges for dental caries related emergency admissions. Pediatric dentistry. 2000; 22(1):21-5.
Interface with ADA158 

• The EZCodes terminology can be 

included into ADA158 

• The EZCodes terminology can be mapped 

to ADA158 

• Certain EZCodes terms can supplement 

ADA158 
© All rights reserved 

Questions and Comments? 

Funded by: 1R01DE021051-01 A Cognitive Approach To 

Refine And Enhance Use Of A Dental Diagnostic 

Terminology