Tooth Numbering System Universal

[Lenora Rademacher]

Thereare several tooth numbering systems used around the world. In the United States, the Universal System is the most commonly employed.1 The primary dentition is identified by the letters of the alphabet, A-T, while the permanent dentition is identified by the numbers 1-32. Table 3 outlines the Universal Tooth Numbering System.

Tooth numbering is a notation used by dentists to denote and specify information linked with a particular tooth. Using a tooth numbering system allows for easy identification, communication, and dental record maintenance in an easy and a precise manner.

Tooth numbering serves various purposes like helping to identify and classify the condition associated with the concerned tooth both clinically and radiographically. This allows easy communication among the dental professionals to assess and treat dental disease. Globally, there are several different tooth numbering systems.

Some commonly used systems are the Zsigmondy-Palmer system, Universal Numbering System, and the FDI system numbering system. Among these systems, Zsigmondy-Palmer system is the oldest and by far the most widely used. Zsigmondy-Palmer system was introduced in 1861 and is popularly called Palmer's notation among dental professionals. Some other systems are the Victor Haderup system, Woelfel system, and MICAP system.

Even though most tooth numbering systems focus on classifying permanent teeth, notations for deciduous (milk) teeth are also available under each system, particularly to understand the deciduous dentition more accurately.

Understanding dental quadrants is important for understanding tooth numbering systems. Dentists divide the whole dentition into four quadrants or sections. The upper arch has two sections, upper right and upper left sections, which are named first and second quadrants, respectively. Similarly, the lower jaw has the third and fourth quadrants. Dental charts are prepared from the perspective of the dentist, wherein the right side is shown on the left side of the chart and vice-versa.

Dental quadrants also allow a quick and easy understanding of the concerned tooth. All naming systems require an understanding of quadrants so that a specific tooth located in a particular quadrant acquires the designated name.

A universal tooth numbering system was first proposed in the year 1882 by German dentist Julius Parreidt. Under this naming system, primary and permanent teeth are named differently. This naming system is accepted and approved by the American Dental Association (ADA) and is the most commonly naming system used by dental professionals in America. One drawback of this naming system is that it fails to classify supernumerary (extra) teeth. However, the main advantage of this system is that it follows a sequential pattern of naming teeth and can be easily understood in locating the concerned tooth. Owing to its easy understanding ADA accepted this nomenclature in 1968.

While numbering the primary teeth under this system, the naming begins from the upper arch (both the quadrants), starting with the letter A and proceeding sequentially through J. Naming of primary teeth begins with the posterior part of the upper right quadrant where the right second molar tooth is assigned the name A, and follows around until letter J, the left second molar on the left posterior side of the dental arch.

This naming follows a similar pattern on the lower arch, where the right second molar is denoted by the letter T. Naming is in reverse alphabetical order around to K, which is designated to the lower second left molar. It is important to note that while numbering the primary teeth the tooth naming is assigned only in upper case following from A till T.

Permanent teeth are also assigned numbers sequentially. The naming starts from the posterior most region of the upper first quadrant and each tooth is numbered from 1 to 32 in a sequential pattern. The numbering starts from the third molar tooth where the upper right third molar is assigned the number 1. This naming system follows a sequential pattern and continues until the left third molar tooth, which is numbered as 16. The similar pattern follows in the lower dentition wherein the lower left third molar in the third quadrant is assigned number 17, and a sequential pattern ends with number 32 with lower right molar tooth.

Akshima is a registered dentist and seasoned medical writer from Dharamshala, India. Akshima is actively involved in educating people about the importance of good dental health. She examines patients and lends free counseling sessions. Taking her passion for medical writing ahead, her aim is to educate the masses about the value of good oral health.

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Most of the rest of the world uses the FDI World Dental Federation notation, accepted as an international standard by the International Standards Organization as ISO 3950.[3] However, dentists in the United Kingdom commonly still use the older Palmer notation despite the difficulty in representing its graphical components in computerized (non-handwritten) records.

Dental charts are normally arranged from the viewpoint of a dental practitioner facing a patient. The patient's right side appears on the left side of the chart, and the patient's left side appears on the right side of the chart.

Although it is named the "universal numbering system", it is also called the "American system" as it is only used in the United States.[4] The uppercase letters A through T are used for primary teeth and the numbers 1 - 32 are used for permanent teeth. The tooth designated "1" is the maxillary right third molar ("wisdom tooth") and the count continues along the upper teeth to the left side. Then the count begins at the mandibular left third molar, designated number 17, and continues along the bottom teeth to the right side. Each tooth has a unique number or letter, allowing for easier use on keyboards.

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Tooth numbering provides dentists with an essential shortcut in clinical record-keeping. Today, three systems are favored worldwide: the Zsigmondy/Palmer system, the universal system, and the FDI two-digit system. Histories of these tooth numbering methods are traced, and the strengths and deficiencies of each are discussed. The FDI two-digit system-used throughout the world, but not in the USA-is the only method that makes visual sense, cognitive sense, and computer sense. It deserves consideration by American dentists as our official tooth numbering system.

This is by far the most used dental numbering system by general dentists. The teeth will be numbered between 1 and 32, beginning with the farthest tooth to the back on the upper right side of the jaw. From the right side of the jaw, you continue counting across the top until you reach the back left tooth (#16). Then you drop down to the back left tooth on the bottom left and starting at #17. Continue counting until you reach the back right bottom. Any missing teeth will still be counted as a number, instead of simply being left out.

The FDI system is a globally-used system that assigns each quadrant of the mouth a number 1 through 4. The top right is #1, top left #2, bottom left #3, and bottom right is #4. Then each of the eight teeth and each molar are number 1 through 8. Unlike the Universal Numbering System, the 1 start at the front middle tooth and the numbers rise the farther back we go. So for example, the back tooth on the lower left side would be #48.

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The Universal Numbering System has been adopted by the American Dental Association and is in use by most general dentists today, and the Palmer Notation Method is used by some orthodontists, pedodontists (child dental specialist), and oral surgeons (originally called the Zsigmondy system after an Austrian dentist of that name who developed the idea in 1861). Internationally the two-digit FDI* World Dental Federation ISO-3950 notation is widely used.

In this system, the teeth that should be there are numbered. If you are missing your wisdom teeth, your first number will be 2 instead of 1, acknowledging the missing tooth. If you've had teeth removed or teeth are missing, the missing teeth will be numbered as well.

In the original system, children's 20 primary teeth are numbered in the same order, except that a small letter "d" follows each number to indicate deciduous (primary) teeth. So, a child's first tooth on the upper right would be 1d and the last tooth on the lower right would be 20d.

However, most dentists and insurance companies now use a modified version of the Universal Numbering System for children. This version uses the letters A through T instead of the number 1 through 20. So, a child's first tooth on the upper right would be A and the last tooth on the lower right would be T.

In this system, the mouth is divided into four sections called quadrants. The numbers 1 through 8 and a unique symbol are used to identify the teeth in each quadrant. The numbering runs from the center of the mouth to the back.

In the upper right section of the mouth, for example, tooth number 1 is the incisor (flat, front tooth) just to the right of the center of the mouth. The numbers continue to the right and back to tooth number 8, which is the wisdom tooth (third molar.)

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