INTRODUCTION

The field of operative dentistry is usually held to cover all forms of

treatment aimed at the restoration of natural teeth. The operative procedures

performed on natural teeth occupy an increasing portion of the dental

surgeon’s time.

An appreciation of efficient patient and operator positions in

beneficial for the welfare of both persons. The patient who is in a

comfortable position is more relaxed, has less muscular tension and is more

capable of cooperating with the dentist.

By using proper operating positions and good posture, the operator

experiences less physical strain and fatigue and reduces the possibility of

developing musculoskeletal disorders.

Objectives of proper positioning of dental team :

1. Access to operative field

2. Visibility

3. Comfort

4. Patient safety

Chair and patient position :

Chair and patient positions are important considerations.

Chair :

Modern dental chair are designed to provide total body support in any

chair position. A contoured (or) lounge-type chair provides complete patient

support and comfort. An available chair accessory is an adjustable head rest

cushion or an articulating head rest attached to the chair back. Chair design

and adjustment permit maximal operator access to the work area. The

adjustment control switches should be conveniently located. To improve

infection control, chairs with a foot switch for patient positioning are

recommended.

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POSITIONING OF DENTAL TEAM AND THE PATIENT :

According to charbeneau to understand the operator’s position, it is

important to recognize that there are 4 major zones of activity around

operative field. They are

1. Operators zone

2. Assistant zone

3. Transfer zone

4. Static zone

Before talking about operators zone we should known about chair and

patient position.

CHAIR AND PATIENT POSITIONS :

The patient should have direct access to the chair. (no in between

blocking of area while patient coming to the chair). The chair height should

be low, the back rest up right and the arm rest adjusted to allow the patient

to get into the chair. After the patient is seated, the arm rest is returned to its

normal position.

The patient should sit well back on the seat and by suitable

adjustment of the chair, the lumbo dorsal and cervical spine should be

supported in a normal position between flexion and extension.

The headrest cushion is positioned to support the head and elevate the

chin slightly away from the chest. In this position neck muscle strain is

minimal and swallowing is facilitated. The chair is then adjusted to the place

the patient in a reclining position.

The most common positions for operative dentistry are almost supine

(or) reclined 450 degrees. In almost supine position, the patient, head, knees

and the foot are approximately the same level. The patient’s head should not

be lower than the feet, the head should be positioned lower than the feet

only in an emergency, as when the patient is in syncope.

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The choice of patient position varies with the operator, the type of

procedure, and the area of the mouth involved in the operation.

Using mirror vision for all the upper teeth the patient is preferably

seated in supine position. Using direct vision for all the upper teeth, the

chair back could be put at 1300- 1400 with the base. This position is usually

used for the right facial and left lingual operations.

For the lower right quadrant the chair back should make almost 900 -

1000 with the base for the lower left quadrant the chair back should make

1100 – 1300 with the base the chair should be positioned as low as possible

to facilitate direct vision in the lower arch and mirror vision in the upper

arch.

Normally by raising the chair the patient’s mouth should be brought

to the level of the operator’s elbow.

1) OPERATOR’S ZONE :

Operating stools :

A variety of operating stools are available for the dentist and dental

assistant. The design of the stool is important. The stool should be an casters

for mobility. It should be study and well balanced to prevent tipping or

gladding away from the dental chair. The seat should be padded with

smooth cushion edges and should be adjustable up and down. The back rest

should be adjustable forward and backward as well as up and down. The

operator should not be balanced on the stool, using it an a third leg. The

operator should site back on the cushion, using the entire seat and not just

the front edge.

The upper body should be positioned so that the spinal column is

straight or bent slightly forward and supported by the back rest of the stool.

Some stools may have back rests with curved extensions that after

additional body support. The thighs should be parallel to the floor, and the

lower legs should perpendicular to the floor. If the seat is too high its front

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edge will cut off circulation to the user’s legs. Feet should be flat on the

floor.

Operating positions :

When the operator is standing, it is important that his body be well

balanced with only moderate. Flexion and rotation of his spine, with his

weight evenly distributed on the feet.

Similarly, when sitting, his body must adopt a posture which is relatively

free from strain. In this case his legs, flat on the floor relieved of the main

weight bearing, assist in balance and mobility.

The operating stool must be chooser, from many different designs of

the chair, with the operator method, and with the plan of the working area.

Operating positions may be described by the location of the operator

or by the location of the operator’s arms in relation to the patient positions.

For a right handed operator :

There are essentially three positions.

i) Right front (70 clock)

ii) Right (90 clock)

iii) Right rear (110 clock)

For the left handed operator :

There are essentially three position.

i) Left front (50 clock)

ii) Left (30 clock)

iii) Left rare (10clock)

The dentist should be seated with his/her back straight, and with at

least 6 inches between his/her eyes and the filed of operation.

The operating stool must be chooser from many different designs of

the chair, with the operators method, and with the plan of the working area.

A fourth position, direct rear or 120 clock position, has application for

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certain areas of the mouth. All the position may be used from the standing

or seated operating position.

As a rule, the teeth being treated should be at the elbow level of the

operator.

Operating positions for the right handed operator :

1) Right front position : (70 clock)

The right front position facilitates examination and work on the

- Mandibular anterior teeth

- Mandibular posterior teeth and

- Maxillary anterior teeth. It is advantages to have the

patient’s head rotated slightly toward the operator.

2) Right position : (90 clock)

In the right position the operator is directly to the right of the patient

(90 clock). This position is convenient for operating on the

- Facial surfaces of the maxillary right posterior.

- Facial surface of the mandibular right posteriors.

- Occlusal surfaces of the mandibular right posteriors

teeth.

3) Right rear position : (110 clock)

The right rear position in the position of the choice for most

operations. Most areas of the mouth all accessible and can be viewed

directly or indirectly using a mouth mirror. The operator is behind and

slightly to the right of the patient. The lift arm is positioned around the

patients head. This position is convenient in operating the –

- Lingual and incisal (occlusal) surfaces of maxillary

teeth are viewed in the mouth mirror.

- Direct vision of the mandibular teeth particularly on

left side; but mirror is used for reflection.

4) Direct rear position :

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The direct rare position has some what limited application and is

primarily used for operating on – lingual surface of mandibular anterior

teeth.

The operator is located directly behind the patient and looks down

over the patient had.

2) ASSISTANT ZONE :

Assistant stool :

The seated work position for the assistant is essentially same as for

the operator except the stool is 4 to 6 riches higher for maximal visual

access. If it important there fore that the stool of assistant have an adequate

foot rest so that parallel thigh position can be maintained with good foot

support. The assistant stool should have a foot ring to permit proper leg

position.

Chain side assistance position :

Given adequate conditions of space and equipment the careful

organization of the work of a surgery assistant and its integration with the

operator’s procedure is based upon following considerations.

1) Assistant should be able to maintain a stress –free working position

an a mobile stool.

2) They must have leady access to instruments and materials currently in

use and to a working top within comfortable reach.

3) They must be able to assist in all intra-oral operations.

4) Their chief functions should be maintaining visibility of the filed of

operation.

5) They need three in one syringe, an aspirator, and operating light

within reach.

6) Assistant on the left side of and half faring the patient is a very

practical arrangement. In this position they can see operator and

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patient and can assist with one or both hands providing materials and

instruments.

7) She can retract and control tongue, checks, spray and dry the filed

prepared materials.

3) TRANSFER ZONE :

The transfer zone is located was the oral cavity where the instruments

and materials are transferred between operator and assistant.

They must have ready access to the instruments and materials used in

comfortable reach.

The patients chest should not be used as an instrument tray.

4) STATIC ZONE :

The static zone having no traffic flow, contains auxillay equipment

and supplies for the operating team.

The assistant zone allows the assistant access to both the transfer zone

and the static zone.

Equipment :

1) Equipment used by the dentist should be mounted on the patient’s

right and should be easily mobile that allows to use easily. This will

include rotary equipment air rotor, and air motor and three-in-one

syringe.

2) Equipment used by the surgery assistant will be on the left of the

patient.

3) The patient must be able to seat him self and get up again with ease,

so his access to the chain must be unobstructed.

4) Equipment should preferably not be mounted over the patient within

his line or sight.

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General considerations :

1) The operator should not hesitate to rotate the patients head back ward

or forward or from side to side to accommodate the demands of access

and visibility of the operating field.

2) When operating on maxillary arch, the maxillary occlusal surface

should be oriented approximately perpendicular to the floor.

3) When operating on the mandibular arch. The mandibular occlusal

surfaces should be oriented approximately 450 to the floor.

4) The face of the operator should not come in close approximately to

that of the patient. The ideal distance is similar to that for reading a book.

5) Minimize the body contact with the patient.

- Operator should not rest forearms on the patient shoulders.

- Operator should not place hands on the patients face fore head.

6) The patient’s chest should not be used as an instrument tray.

7) For must positions the left hand should be free to hold the mouth

mirror to reflect light or retract check or tongue.

8) In certain instance it is more appropriate to retract the check with one

or two forgers of left land.

9) When operating for an extended period, the operator will fund a

certain amount of rest and muscle relaxation can be obtained by

changing operating positions.

Chair side preventive measures :

Feet/legs/thighs

position

Body weight Aims and shoulder

position

1. Feet flat on the

floor

2. Thighs parallel

with the floor

1. Centered on the seat

of the clinicians stool

2. Supported by the legs

and thighs

1. Shoulders an relaxed

(parallel to floor)

2. Upper arms are relaxed

3. Elbows are in neutral

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position (close to body)

Back position Head position Eyes

1. Back is straight

2. Lumbar curve is

supported

1. Aligned with the

spine (sit fail in the

clinicians stool

2. Head is erect

1. Directed down wards

2. Distance from eyes to

client’s oral cavity is

approximately 14-16

inches

1. Maintain good operative posture : the clients mouth should be even

with the clinician’s elbow. The elbow should be held in neutral

position (900 angle)

2. Maintain proper position to support the clinicians body, thighs

parallel to the floor and feet flat on the floor.

3. Keep shoulders relaxed.

4. Avoid extremes in temperatures

5. Avoid or limit exposure to vibrating instruments.

6. Avoid forceful pinching and gripping of instrument handles.

7. Wear properly fitting gloves.

8. Alternate clinician position.

9. Perform tendon gliding exercises.

CLINICAL SIGNIFICANCE :

1) SHOULDER INJURIES :

a) Trapezius myalgia :

It is caused by static loading or stabilizing muscles over long period

of time.

Symptoms :

Pain and tenderness in trapezius muscle.

Risk factors :

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Long dental procedures which cause static loading on muscles of the

body, which are supporting the clinicians body weight.

Preventive measures :

- Manage appointment times : alternative long and short working.

- Take stretching breaks.

- Change body positions

- Maintain proper positions.

Assessing symptoms :

Consistent pain and tenderness in trapezius muscle.

Treatment :

Therapy consists of rest, physical therapy, massage, stretching

exercises and heat/ice regimens.

b) Rotator cuff injuries :

Include rotator cuff tendonitis and rotator cuff tears. Both affect the

connective tissue in the shoulder.

Symptoms :

- Pain when lifting arm

- Functional impairment

Risk factors :

- Static loading on shoulder muscles.

- Improper body support

Prevention :

- Avoid repetitive twisting and reaching for instruments.

- Maintain neutral shoulder and arm positions.

- Proper working positions.

Assessing symptoms :

Constant pain is shoulders and increased pain when raising arms.

Treatment :

- Therapy depends on degree of injury.

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- Corticosteroid injections.

- Anti-inflammatory medications.

- If conservative therapy fails surgery is performed.

2) NECK AND BACK INJURES :

a) Lumbar joint dysfunction :

Occurs from repetitive and continued twisting or rotating of the spine.

When improper support of clinicians spine is present during dental

procedures, the intervertebral dices are put under tremendous pressure,

possibly resulting in rupture or injury.

Symptoms :

Discomfort and pain in lumber region of the spine.

Risk factors :

In right handed clinicians at 80 clock position too much of rotation of

the midsection of the clinicians body while in this position will create strain

on the lumbar curve.

Prevention :

- Avoid twisting the back and the spine.

- Properly support body weight.

- Modify equipment placement to avoid twisting to reach instruments.

Assessing symptoms :

Constant lower back pain and limited movement of back.

Treatment :

- Rest

- Work place adjustments

- Physical therapy

- Occupation therapy

- Drug therapy

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b) Cervical spondylolysis and cervical disc disease :

This lead to degeneration of the cervical spine. This affect the neck,

scapula, shoulders and arms, causing osteoarthritis of the cervical spine and

disc degeneration and Herniation.

Symptoms :

- Stiffness and limited motion of the neck.

- Crepitus during active or passive movements of the spine.

- Pain in upper/middle cervical region of the spine.

- Pain in the scapula of shoulder regions.

- Muscle spasms.

Risk factors :

Repeated stress and stain placed on neck and spine.

Prevention :

- Maintain proper clinician head and neck position.

- Properly seat clients for easy access to the mouth.

Assessing symptoms :

Occurrence of pain during neck motion and crepitus in spine.

Treatment :

Posture retraining exercises to restore the normal curvature of spine.

- Strengthening exercises for neck and back

- Rest

- Cervical colors

- Physical therapy

PHYSICAL EXERCISE :

1) Chair side stretching exercises :

It is recommended that the care provider stretch before work and

periodically through out the day that assist the diffusion of synovial fluid,

the lubricating fluid around the tendons in hard and fingers.

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- Hands and fingers are held straight, pointing upward.

- Fingers are bent into a 900 angle from the hand.

- Fingers are then closed into the hand.

- Fingers are then further arched in the same direction.

- Hold briefly and release.

2) Strengthening exercises :

This

- Improves strength and flexibility

- Improves lumbar spine, neck muscles and lower back

- Stretches and extends back muscles

- Strengthens abdominal muscles

- Strengthens finger, hand and arm muscles

Some of strengthening exercises are –

1. Pelvic tilt :

Strengthens the lumbar spine

- Lie on your

- Kness must be bent

- Flatten and press the back into the floor

- Hold briefly

- Repeat

2. Hyper extension :

- Safe guard the lumbar curve

- Lie on your stomach

- Arch the back back ward in an upward direction

- Hold briefly

- Repeat

3. Knee-to-chest :

Stretch the lumbar spine.

- Lie on your back

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- Bring both knees to your chest

- Hold briefly

- Return to normal without straightening legs.

- Repeat

5. Sit-ups :

Strengthens the abdominal muscles.

- Lie on your back

- Bend the knees

- Support the neck

- Gently raise the shoulders towards the knees

- Hold briefly and return

- Repeat

Suspend from a bar :

Relieves lower back pain

- Firmly grasp the bar

- Suspend your body from the bar, lift the feet slowly

- Hold for a short time

- Repeat

6. Doorway stretch :

Reverse poor posture.

- Stand infront of an open door way

- Place hands on either side of door frame

- Gently allow your body to lean forward

- Hold briefly

- Repeat

7. Neck isometric :

Stretches cervical spine and relieve neck muscle

- Grasp hands behind the head

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- Gently press your head back

- Do not allow any backward movement

- Hold briefly

- Repeat

8. Rubber ball squeeze :

Strengthens hand and finger muscles

- Grasp a rubber ball firmly in your hand

- Gently squeeze

- Hold briefly

- Repeat

9. Rubber band stretch :

Strengthens hand and finger muscles.

- Extend rubber band between the fingers of the hand

- Gently stretch the rubber band until you feel resistance

- Hold briefly

- Release the rubber band

- Repeat

TOOTH NUMBERING

The word dentition refers to all of the teeth in the upper jaw bones

and the lower jaw bones.

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Humans have two dentitions throughout life, one during childhood,

called the primary dentition deciduous dentition and of adult hood called the

permanent teeth.

Due to their location, the upper teeth are called maxillary teeth and

lower teeth are called mandibular teeth.

The dental formula is

Some of the dental formula in some animals are –

The making and storage of accurate dental records is an important

task in any dental practice. To do so expeditiously, it is necessary to adapt a

type of code or numbering system for teeth. Otherwise, one must write for

each tooth being charter something like, maxillary right second molar

mesio- occlusdistal amalgam restoration with buccal extension. By universal

numbering system this same information would be “2MODBA”. By palmer

notation system would be 71 or using the international system 17. The

MODRA describing the type of cavity and restorations is used with all three

systems.

System : 1

Universal numbering system :

This system is first suggested by Parriedt in 1882; was officially

adopted by ADA in 1975. It is accepted by third party providers and

endorsed by the American society of Forensic odontology.

Basically, it uses numbers 1 through 32 for the permanent dentition

starting with 1 for the maxillary right third molar, going around the arch to

the upper left third molar as 16, dropping drown on the same side, the left

mandibular third molar becomes 17, and then the numbers increase clock

wire around the lower arch to 32, which is the lower right third molar.

16

I

22 C 1

1 PM 22

M 33

For the deciduous dentition, the letters of the alphabet are from A

through T. ‘A’ is the maxillary right second molar, sequentially through the

alphabet to ‘J’ for the upper left second molar; there dropping down on the

same side to K for the mandibular left second molar, than clock wise around

the lower arch to ‘T’ for the lower right second molar.

System : 2

Two digit system (federation dentine international) :

In March of 1971 at the meeting of the general assembly, the

federation dentine interrationale adopted the two – digit system of

designated teeth.

The guide lines used in developing the two-digit system were that it

be

1) Simple to understood and to teach.

2) Easy to pronounce in conservation and dictation

3) Readily communicable in print and by wire.

4) Easy to translate into computer input

5) Early adaptable to standard charts used in general practice.

According to two –digit system, the first digit indicates the quadrant

and the second digit the specific tooth within quadrant. Quadrants are

allotted the digits 1 through 4 for permanent dentition and 5 through 8 for

primary in a clock wise sequence and starting at the patients upper right.

Permanent teeth within the same quadrant are allotted the digits 1 through 8

from the midline posteriorly and primary teeth 1 through 5 from the midline

posteriorly.

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A B C D E F G H I J

T S R Q P O N M L K

The digit should be pronounced separately, thus the permanent

cuspids are teeth one-three, two-the three-three, and four-three.

Again if should be noted that in all of the tooth designations, quadrant

designations are oriented to the patients right and for left.

System : 3

PALHER NATIONAL SYSTEM : (Angular or grid system)

Originally this was described in 1861 and was first noted in the dental

literature in the united states in 1970 and has remained a most widely used

method.

This system utilizes simple brackets to represent the four quadrants of

the dentition as if you all faring the patient ‘’ in upper right, ‘L’ upper left,

‘’ is the lower right, ‘L’ is lower left.

Each contraletral or opposing tooth pair of the permanent has a

specific number.

The primary teeth have letter designations.

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18 17 16 15 14 13 12 11

48 47 46 45 44 43 42 41

21 22 23 24 25 26 27 28

31 32 33 34 35 36 37 38

Maxillary

Patient left Patient right

Mandibular

Permanent teeth

55 54 53 52 51

85 84 83 82 81

61 62 63 64 65

71 72 73 74 75

Maxillary

Patient left Patient right

Mandibular

Primary teeth

E D C B A A B C D E

F D C B A A B C D E

Maxillary

Mandibular

Patient left Patient right

Numbering for permanent dentition from mid line posteriorly in both

maxillary and mandibular arches, each central incisor is designated 1 and

each third molar is 8.

Specific quadrants are designated as follows :

Identifying a specific tooth by this system combines the quadrant grid

with the tooth number in reference to the mid line, thus “ 6 |” represent the

maxillary right first molar and indicates the mandibular left first

cusped. A specific primary tooth designation represent mandibular

right primary cuspid.

The temporary teeth are indicated merely by altering the Arabic

numerals to Roman ones. Sometimes temporary teeth are designated with

the letters ‘a’ – ‘e’ or with capital letters ‘A’ – ‘E’ or letter ‘D’ (deciduous)

placed after the number of the tooth a small ‘d’ is placed before the number

of the tooth. The temporary teeth may also be indicated by addition of the

letter ‘m’ after the number of the tooth.

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8 7 6 5 4 3 2 1

8 7 6 5 4 3 2 1

1 2 3 4 5 6 7 8

1 2 3 4 5 6 7 8

Maxillary

Patient left Patient right

Mandibular

“ 4 ”

“ C ”

“ C ”

L R e d c b a

e d c b a

a b c d e a b c d e

L R E D C B A

E D C B A A B C D E A B C D E

L R 5D 4D 3D 2D 1D 1D 2D 3D 4D 5D

5D 4D 3D 2D 1D 1D 2D 3D 4D 5D

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R 5d 4d 3d 2d 1d 1d 2d 3d 4d 5d

5d 4d 3d 2d 1d 1d 2d 3d 4d 5d L

R 5m 4m 3m 2m 1m 1m 2m 3m 4m 5m

5m 4m 3m 2m 1m 1m 2m 3m 4m 5m L

System : 4

There is another system which employs both the angle signs and

numerals 1 to 8 for enumerating the permanent teeth and A to e for

enumerating the temporary teeth.

It is exactly opposite to the Esignomdy’s system. In this system

nations begins with the number 1 for the third molar and with the letter ‘A’

for the second temporary molar. It ends with ‘8’ and ‘E’ for the permanent

and deciduous central incisors respectively.

System :5

Other angle systems do not make use of numerals, but designate the

teeth (starting from the central incisor) as : I1, I2, C, P1, P2, M1, M2, M3 i.e.

initial letters of their respective Latin names.

Permanent teeth :

Temporary teeth :

This system is employed mainly in Holland.

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A B C D E

A B C D E

A B C D E

A B C D E R L

1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8

1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8 R L

M3 M2 M1 P2P1 C I2 I1 R L

I1 I2 C P1P2 M1 M2 M3

M3 M2 M1 P2P1 C I2 I1 I1 I2 C P1P2 M1 M2 M3

dm2 dm1 dc di2 di1 R L

dm2 dm1 dc di2 di1

di1 di2 dc dm1 dm2

di1 di2 dc dm1 dm2

System : 6

HADERUP’S SYSTEM :

This is another older system which was invested by Dane, Hader up

(1887, 1891).

According to this system the teeth are numbered in each segment

starting with number 1 for the central incisor. The teeth are then numbered

from 1 to 8 in a distal direction. The tooth number in the upper jaw are

combined with the plus sign, those in the lower jaw with a minus sign.

These signs are placed to the right of the number of if the tooth is situated

on the right side of the jaw and the left of the number if the tooth is situated

on the left side of the jaw.

Temporary teeth were originally shown by the addition of the letter ‘L’

placed before.

The numeral. After a few years this was altered to another form,

where by ‘O’ also placed before the numeral; substituted the letter ‘L’. In

the central Europe, the temporary teeth are indicated by Roman numerals

without additions of the figure ‘O’ in conjunction with ‘+’ and ‘-’ signs.

This is practically the only one used on Surden, Denmark, Norway,

Finland and Ice land.

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8+ 7+ 6+ 5+ 4+ 3+ 2+ 1+ R L

8- 7- 6- 5- 4- 3- 2- 1- -1 -2 -3 - 4 - -5- -6 -7 -8

+1 +2 +3 +4 +5 +6 +7 +8

05+ 04+ 03+ 02+ 01+ R L

05- 04- 03- 02- 01-

+01 +02 +03 +04 +05

-01 -02 -03 -04 -05

V+ VI+ III+ II+ I+ R L

V- Vi- III- II- I-

+I +II +III +IV +V

-I -II -III –IV -V

Along with other systems it is also used in Germany, Italy,

Switzerland, Yugoslavia, Poland and CZe Choslvakia.

System : 7

There are some systems in which one does not use the angle signs. In

one such system, the incisors (I), canines (C), premolar (P), and molars (M)

are indicated in the following way : I1, I2, C, P1, P2, M1, M2, and M3.

The upper jaw is indicated by letter ‘s’ (superior) and the lower jaw

by the letter ‘i’ (inferior) placed immediately after the index numeral and

followed by the ‘d’ (dexter) for the right side and ‘s’ (sinister) for the left

side. The method is the same for the temporary teeth, the difference being

that small letters are used to represent the teeth i e i, e, m1 and m2.

Permanent teeth :

Temporary teeth :

This system is employed in Holland

System : 8

This system is very similar to system 7 having the same letter and

index numeration for the teeth but here the segment is identified by the

position of the index in relation to the alphabetical letter of the tooth. For the

upper right segment, the index placed higher than and the left of the

alphabetical symbol of the tooth. For the upper left segment, higher and to

the right of it. For the lower right segment, the index is placed lower and to

the left of the alphabetical symbol of the tooth. For the left lower segment,

lower and to the right of if.

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L M3sd M2sd M1sd P2sd P1sd Csd I2sd I1sd

R I1ss I2ss Css P1ss P2ss M1ss M2ss M1ss

M3id M2id M1id P2id P1id Cid I2id I1id I1is I2is Cis P1is P2is M1is M2is M1is

L m2sd m1sd C2d i2sd i1sd R m2id m1id C2id i2id i1id

i1ss i2ss Css m1ss m2ss

i1is i2is Cis m1is m2ss

System : 9

This system manages without the use of angle signs. In this, the teeth

are numbered ‘1-8’ from the central incisor to the last molar. The teeth of

the right side of upper jaw are indicated by capital D (droite) and lower

right teeth with small ‘d’ (droite). The upper left teeth are indicated by

capital ‘G’ (gacha) and the lower left teeth are indicated by small ‘g’

(gacha).

Temporary teeth are indicated by substituting Roman numerals for

the Arabic ones. This system is used to a limited extent in France, while a

variant occurs in Romania.

System : 10

Army system :

System : 11

Navy system :

System : 12

Boswarth system :

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D8 D7 D6 D5 D4 D3 D2 D1

d8 d7 d6 d5 d4 d3 d2 d1

G1 G2 G3 G4 G5 G56 G7 G8

g1 g2 g3 g4 g5 g56 g7 g8

8 7 6 5 4 3 2 1

16 15 14 13 12 11 10 9

1 2 3 4 5 6 7 8

9 10 11 12 13 14 15 16 R L

1 2 3 4 5 6 7 8

17 18 19 20 21 22 23 24

9 10 11 12 13 14 15 16 R L

25 26 27 28 29 30 31 32

8 7 6 5 4 3 2 1

H G F E D C B A

1 2 3 4 5 6 7 8R L

A B C D E F G H

3M 2M 1M 2P 1P 1C 2I 1IR L

3M 0M 1M 2P 1P 1C 2I 1I

I1 I2 C 1P1 P2 M1 M2 M3

I1 I2 C 1P1 P2 M 1M2 M3

In the above three-systems the designation for the temporary teeth can

be made for each system on two different principles.

1) Retain the designation of the first five teeth in each segment and

indicate that they are temporary teeth by making some addition to the

symbol of the tooth (like ring around number).

2) Retain the method of designating the teeth, but substitute for the

numbers of the permanent teeth. (adding ½ to the number) Eg: 1 ½

substitutions can be in the form of alphabetical letters or different

numericals.

3) We can add ‘D’ before the numerical number. For example in

Bosworth system.

Some times letter is placed after the numerals.

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D5 D4 D3 D2 D1

DE DD DC DB DA

D1 D2 D3 D4 D5

DA DB DC DD DE

317:30-5-703. TOOTH NUMBERING SYSTEM :

a) For adult teeth, the universal tooth numbering system (1 through 32) is

used. for primary teeth, tooth letters A through T are used.

b) No other tooth letter or number system will be accepted. Failure to use

this system will result in the claim being rejected and could cause

faulty history which could prevent future claims from being paid.

(example : using tooth number 25d instead of number P for an

extraction. The computer would not allow a service for permanent

tooth number 25 as history would indicate that tooth has already been

extracted and is ineligible for other services). All procedures performed

on a specific toothy require the appropriate tooth number.

c) Listed below are the identifying numbers for supernumerary teeth.

1. # 46 Mesiodens (Between # 8 and # 9)

2. # 47 Second Mesiodens (Between # 8 and # 9)

3. # 48 Supernumerary tooth between or alongside # 28

4. # 49 Supernumerary tooth between or Alongside # 29

5. # 50 Supernumerary tooth between or alongside # 20

6. # 51 Supernumerary tooth between or Alongside # 21

7. # 52 Supernumerary tooth between # 7 and # 8

8. # 53 Supernumerary tooth between # 9 and # 10

9. # 54 Upper right 4th molar (permanent)

10. # 55 Upper right 4th molar (permanent)

11. # 56 Lower right 4th molar (permanent)

12. # 57 Upper right 4th molar (permanent)

13. # 58 Supernumerary between or alongside # 4 and # 5

14. # 59 Supernumerary between or alongside # 12 and # 13

15. # 60 Supernumerary not otherwise identified (identify location on

claim)

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CONTENTS

CHAIR SIDE POSITIONS AND TOOTH NUMBERING

1) INTRODUCTION

2) TOOTH NUMBERING

3) CHAIR AND PATIENTS POSITION

4) OPERATORS ZONE

5) ASSISTANT ZONE

6) TRANSFER ZONE

7) STATIC ZONE

8) GENERAL CONSIDERATIONS

9) CHAIR SIDE PREVENTIVE

MEASURES

10) CLINICAL CONSIDERATIONS

11) REFERENCES

12) CONCLUSION

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