1. 14
Dental Charting

2. Dental Charts Two areas Anatomical versus geometric Computerized
Dental charting
Record treatment
Anatomical versus geometric
Computerized
Charting is a part of the patient’s legal record and must be done correctly. The initial charting is normally done on the first exam.
Anatomical charts show the crown of the tooth, the crown and a portion of the tooth, or the crown and the complete root.
Geometric charts show the teeth as circles.
Computerized charting helps standardize. It’s more efficient, fewer mistakes are made, and it’s easier in many ways. Light pens are used to highlight and color.

3. Numbering Systems Universal/National
Fédération Dentaire Internationale (FDI)
Palmer
(The following slides illustrate each of these systems)
The Universal/National System was developed in 1968 and is most commonly used in the United States.
FDI was developed to provide an international system for coding teeth. Canada and European countries use this the most. In 1996, the ADA adopted this system and the universal system for tooth numbering.
The Palmer system is not too common, but still used in some offices.

4. Universal/National Numbering and Lettering System
Third molars 1 8 9 16 32 25 24 17
Maxillary right
Maxillary left
Mandibular right
Mandibular left
Permanent teeth
Each permanent tooth has its own number, starting at maxillary right third molar as #1 and moving clockwise mandibular right as #32. #1 and #32 occlude together as #16 and #17.
The primary teeth are given letters instead.

5. Universal/National Numbering and Lettering System
Second molars A E F J K T P O
Maxillary right
Maxillary left
Mandibular right
Mandibular left
Primary teeth
Each permanent tooth has its own number, starting at maxillary right third molar as #1 and moving clockwise mandibular right as #32. #1 and #32 occlude together as #16 and #17.
The primary teeth are given letters instead.

6. Fédération Dentaire Internationale System for Numbering
Maxillary right quadrant “1”
Maxillary left quadrant “2”
Mandibular right quadrant “4”
Mandibular left quadrant “3”
Permanent teeth 1 8
Third molars
With the FDI, each quadrant is assigned a number. The oral cavity is given two digits. Quadrant number is always recorded first, then the assigned tooth number.
Example: Maxillary right lateral incisor in the permanent dentition is numbered 12 and the maxillary right lateral incisor in the deciduous dentition is 52.

7. Fédération Dentaire Internationale System for Numbering1
Second molars 5
Maxillary right quadrant “5”
Maxillary left quadrant “6”
Mandibular right quadrant “8”
Mandibular left quadrant “7”
Primary teeth

8. Palmer System for Numbering1
Maxillary left quadrant
Mandibular left quadrant 8
Permanent teeth
Mandibular right quadrant
Maxillary right quadrant
With this system, the permanent teeth are numbered one through eight in each quadrant starting with centrals. Quadrant brackets are used to denote which one they are referring to.

9. Palmer System for Numbering
Primary teeth
Maxillary left quadrant
Mandibular left quadrant
Maxillary right quadrant
Mandibular right quadrant
With this system, the permanent teeth are numbered one through eight in each quadrant starting with centrals. Quadrant brackets are used to denote which one they are referring to.

10. Cavity Classifications
Six standard classes
Cavity is caries
The classifications of cavities were developed by G. V. Black. These are still the classifications being used today.

11. Cavity Classifications
Developed cavities in the pit and fissures
They are found in the occlusal surfaces of posterior teeth (premolars and molars), buccal or lingual pits on the molars, and lingual pit near the cingulum of the maxillary incisors.

12. Cavity Classifications
Class II
Proximal surfaces on posterior teeth
Class II caries are on the proximal (mesial or distal) surfaces on the posterior teeth (premolars and molars).
MO restoration
MOD restoration

13. Cavity Classifications
Class III
Interproximal surface of anterior teeth
Class III caries are on the interproximal surface (mesial or distal) of anterior teeth. They can be found on canines, lateral incisors, and central incisors.

14. Cavity Classifications
Class IV
Interproximal surface of anterior teeth and include the incisal edge
Class IV caries are on the interproximal surface (mesial or distal) of anterior teeth and include the incisal edge.

15. Cavity Classifications
Class V
Cervical third of the facial
Lingual surface of the tooth
Class V caries occur on the cervical third of the facial or lingual surface of the tooth.
Often this class of cavity occurs because the patient often sucks on sweets.
You may also find an entire quadrant with this type of cavity because a patient takes medications, chews gum, or drinks soft drinks over long periods of time.

16. Cavity Classifications
Class VI
Worn away due to abrasion
Not part of the original five standard classification of cavities developed by G.V. Black. Later classified to better label those cavities that involve the incisal or occlusal surface that has been worn away due to abrasion.

17. Abbreviations of Tooth Surfaces
Simple involves one tooth surface
I: incisal
M: mesial
D: distal
B: buccal
O: occlusal
F: facial
When a dental assistant is documenting the chart to record the surfaces of the teeth that need restoration, abbreviations for single-surface restorations are used. Each surface is abbreviated using the first letter of the surface, capitalized.

18. Abbreviations of Tooth Surfaces
Compound involves two surfaces
DO: disto-occlusal
MO: mesio-occlusal
MI: mesio-incisal
DI: disto-lingual
If two or more surfaces are restored, then a combined word is used. For example, to identify the restoration on the distal and occlusal surfaces, the term is disto-occlusal restoration or DO restoration.

19. Abbreviations of Tooth Surfaces
Compound involves two surfaces
LI: linguo-incisal
DL: disto-lingual
OB: occlusobuccal
If two or more surfaces are restored, then a combined word is used. For example, to identify the restoration on the distal and occlusal surfaces, the term is disto-occlusal restoration or DO restoration.

20. Abbreviations of Tooth Surfaces
Complex involves more than two surfaces
MOD: mesio-occluso-distal
MODBL: mesio-occluso-disto-bucco-lingual
If three surfaces are combined, the same principle is applied to the second word as well. If the tooth has a mesial-occlusor-distal or MOD restoration. If a mesial surface of the tooth is restored with another surface, it is always used first. Occlusal and lingual normally fall in the last position.

21. Basic Charting Terms Abscess Bridge Abutments Pontic Cantilever bridge
Maryland bridge
An abscess is a localized area of infection.
A bridge is prosthetic device placed between teeth covering space created by a missing tooth. Abutments are the attaching sides and the pontic is the middle area.
A Cantilever bridge is attached only on one side.
The Maryland bridge has wings on the pontic that are attached to the lingual sides of the adjacent teeth.

22. Basic Charting Terms Crown (cap) Denture Permanent Temporary Complete
Partial
A crown can be made from gold, porcelain, steel, or plastic. Full crowns cover the complete tooth, while you can also have three-quarters covering three-fourths of the tooth. Although some are temporary, they are all ‘fixed’ into place.
Dentures are needed if all natural teeth in one arch are missing.
A partial denture is needed if only some natural teeth are missing.

23. Basic Charting Terms Diastema Drifting Gold foil Incipient
Diastema is the space between the maxillary central incisors. It could also refer to the space between two adjacent teeth in the same dental arch.
Drifting occurs when opposing teeth move or erupt into space after a tooth has been removed.
Gold foil is not commonly used today. It is when several layers of pure gold are placed in preparation for restoration.
Incipient is beginning decay that has not broken through the enamel yet. Some dentists will denote these areas in charts to keep close eye.

24. Basic Charting Terms Mobility Overhang Periodontal pocket Restoration
Root canal
Sealant
Mobility is when a tooth moves in the socket due to periodontal disease or trauma. Numbering system is used to record how many millimeters the tooth moves.
Overhang is excessive restorative material found interproximally near the gingiva.
Periodontal pocket is space in the gingival sulcus created by periodontal disease. A healthy depth is 1 to 3 mm; beyond that is considered a pocket.
Restoration is where replacing the tooth structure occurs. Often referred to as fillings. A root canal is where the pulp is removed and filled with other suitable materials. A sealant is a resin material used to seal pits and fissures to prevent decay.

25. Charting Colors and Systems
Red
Indicates work to be completed
Blue
Indicates completed work
Lines and fill-ins indicate restoration type
Computer programs
Colors and symbols are used in charting to indicate the condition of the patient’s teeth and surrounding tissues and the restorative services required. In some cases, it may be appropriate to use either color. An example would be that a patient has a fracture, but no discomfort or appearance issues; therefore, a notation is made on the chart that nothing is to be done at this time and charted in either color.
* Must look to tables and figures in book to explain charting colors and systems better. The book has great tables and examples of what to expect.
The computerized systems today work wonderfully. Although there are many dental software programs, they are easily learned. You can use voice activated systems, light pen systems, or use a covered keyboard (to keep sanitary). Dental assistants can become very proficient at computer charting. The software programs can handle periodontics, conditions of dentition, tissue, occlusion or any notations the dentist or auxiliary would like.