The Collection and Recording of Clinical Data · 3 min read
Charting
Dental charting is the systematic documentation of the condition of teeth, restorations, and oral structures. Accurate charting serves as a legal record, facilitates communication among dental professionals, and tracks treatment progress over time.
Tooth Numbering Systems
Three primary numbering systems are used in dentistry:
Universal Numbering System: This is the most common system in the United States. Permanent teeth are numbered 1 through 32, starting with the maxillary right third molar (tooth 1) and proceeding around the arch to the maxillary left third molar (tooth 16), then dropping to the mandibular left third molar (tooth 17) and continuing to the mandibular right third molar (tooth 32). Primary teeth are designated by letters A through T, following the same pattern.
Palmer Notation System: This system uses a grid symbol to indicate the quadrant. Permanent teeth are numbered 1 through 8 in each quadrant, with the central incisor as 1 and the third molar as 8. Primary teeth are designated by letters A through E. The grid symbol indicates upper right, upper left, lower left, or lower right.
International Numbering System (ISO/FDI): This two-digit system uses the first digit to indicate the quadrant (1-4 for permanent teeth, 5-8 for primary teeth) and the second digit to indicate the tooth position (1-8 for permanent, 1-5 for primary). For example, tooth 11 is the maxillary right central incisor, and tooth 36 is the mandibular left first molar.
Tooth Surfaces
Each tooth has five surfaces for charting purposes:
Mesial: The surface toward the midline of the dental arch. Distal: The surface away from the midline. Facial: The surface toward the face (labial for anterior teeth, buccal for posterior teeth). Lingual: The surface toward the tongue. Occlusal: The chewing surface of posterior teeth. Incisal: The biting edge of anterior teeth.
Charting Symbols and Abbreviations
Dental charts use standardized symbols and color coding. Blue or black typically indicates existing conditions or completed work. Red indicates treatment needed. Common charting notations include:
Amalgam restorations: Outlined and filled in solid. Composite restorations: Outlined with diagonal lines or dots. Missing teeth: An X through the tooth or the tooth circled. Teeth to be extracted: Red X or diagonal lines. Crown: The entire crown portion outlined. Root canal: A line drawn through the root(s). Implant: Specific symbol resembling an implant fixture. Bridge: Crowns connected with an X for the pontic. Caries: Red outline of affected area. Fracture: Zigzag line. Impacted tooth: Parentheses or specific symbol.
Types of Dental Charts
Anatomic charts display realistic drawings of teeth with roots and crowns. These allow detailed notation of decay location, restorations, and root conditions.
Geometric charts use simplified circles, rectangles, or standardized shapes to represent teeth. These are faster to complete but provide less detail.
Computer-based charting systems are now standard in most practices. These allow real-time updates, digital imaging integration, voice-activated charting, and automatic insurance coding.
Charting Procedures
The dental assistant typically records findings as the dentist calls them out during examination. Key principles include:
Chart only what is observed or dictated by the dentist.
Use correct symbols consistently.
Update charts at each visit.
Maintain confidentiality of all records.
Documentation Standards
All entries must include the date, services rendered, materials used, teeth involved, and the signature or initials of the provider. Radiographs, photographs, and consent forms become part of the permanent record. Records must be retained according to state law, typically 7-10 years for adults and until age of majority plus the retention period for minors.
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