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 surgeons 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 . !isibility ". #omfort $. %atient safety Chair and patient position : #hair and patient positions are important considerations. Chair : &odern 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 ad*ustable head rest cushion or an articulating head rest attached to the chair back. #hair design and ad*ustment permit maximal operator access to the work area. The ad*ustment control switches should be conveniently located. To improve infection control, chairs with a foot switch for patient positioning are recommended.

POSITIONIN

O! D"NT#$ T"#% #ND T&" P#TI"NT :

According to charbeneau to understand the operators position, it is important to recogni+e that there are $ ma*or +ones of activity around operative field. They are 1. ,perators +one . Assistant +one ". Transfer +one $. -tatic +one Before talking about operators +one we should known about chair and patient position. C&#IR #ND P#TI"NT 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 ad*usted 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 ad*ustment 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. .n this position neck muscle strain is minimal and swallowing is facilitated. The chair is then ad*usted to the place the patient in a reclining position. The most common positions for operative dentistry are almost supine 'or( reclined $/0 degrees. .n almost supine position, the patient, head, knees and the foot are approximately the same level. The patients 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.

The choice of patient position varies with the operator, the type of procedure, and the area of the mouth involved in the operation. 1sing mirror vision for all the upper teeth the patient is preferably seated in supine position. 1sing direct vision for all the upper teeth, the chair back could be put at 1"00) 1$00 with the base. This position is usually used for the right facial and left lingual operations. 2or the lower right 3uadrant the chair back should make almost 40 0 ) 1000 with the base for the lower left 3uadrant the chair back should make 1100 5 1"00 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. 6ormally by raising the chair the patients mouth should be brought to the level of the operators elbow. '( OP"R#TOR)S *ON" : 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. .t 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 ad*ustable up and down. The back rest should be ad*ustable 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 *ust 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. -ome 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. .f the seat is too high its front
"

edge will cut off circulation to the users legs. 2eet should be flat on the floor. Operating positions : 7hen the operator is standing, it is important that his body be well balanced with only moderate. 2lexion and rotation of his spine, with his weight evenly distributed on the feet. -imilarly, when sitting, his body must adopt a posture which is relatively free from strain. .n 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. ,perating positions may be described by the location of the operator or by the location of the operators arms in relation to the patient positions. i( ii( iii( i( ii( iii( 2or a right handed operator 8 9ight front ':0 clock( 9ight '40 clock( 9ight rear '110 clock( 2or the left handed operator 8 ;eft front '/0 clock( ;eft '"0 clock( ;eft rare '10clock( The dentist should be seated with his<her back straight, and with at least = 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 1
0

There are essentially three positions.

There are essentially three position.

clock position, has application for

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( ) ) ) ( 9ight front position 8 ':0 clock( &andibular anterior teeth &andibular posterior teeth and &axillary anterior teeth. .t is advantages to have the patients head rotated slightly toward the operator. 9ight position 8 '40 clock( .n the right position the operator is directly to the right of the patient '40 clock(. This position is convenient for operating on the ) ) ) teeth. "( 9ight rear position 8 '110 clock( The right rear position in the position of the choice for most operations. &ost 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 5 ) ) $( ;ingual and incisal 'occlusal( surfaces of maxillary teeth are viewed in the mouth mirror. >irect vision of the mandibular teeth particularly on left side? but mirror is used for reflection. >irect rear position 8
/

The right front position facilitates examination and work on the

2acial surfaces of the maxillary right posterior. 2acial surface of the mandibular right posteriors. ,cclusal surfaces of the mandibular right posteriors

The direct rare position has some what limited application and is primarily used for operating on 5 lingual surface of mandibular anterior teeth. The operator is located directly behind the patient and looks down over the patient had. +( #SSIST#NT *ON" : #ssistant stool : The seated work position for the assistant is essentially same as for the operator except the stool is $ to = riches higher for maximal visual access. .f it important there fore that the stool of assistant have an ade3uate 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 : @iven ade3uate conditions of space and e3uipment the careful organi+ation of the work of a surgery assistant and its integration with the operators procedure is based upon following considerations. 1( Assistant should be able to maintain a stress 5free working position an a mobile stool. ( They must have leady access to instruments and materials currently in use and to a working top within comfortable reach. "( They must be able to assist in all intra)oral operations. $( Their chief functions should be maintaining visibility of the filed of operation. /( They need three in one syringe, an aspirator, and operating light within reach. =( Assistant on the left side of and half faring the patient is a very practical arrangement. .n this position they can see operator and

patient and can assist with one or both hands providing materials and instruments. :( -he can retract and control tongue, checks, spray and dry the filed prepared materials. ,( TR#NS!"R *ON" : The transfer +one 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. -( ST#TIC *ON" : The static +one having no traffic flow, contains auxillay e3uipment and supplies for the operating team. The assistant +one allows the assistant access to both the transfer +one and the static +one. "./ipment : 1( A3uipment used by the dentist should be mounted on the patients right and should be easily mobile that allows to use easily. This will include rotary e3uipment air rotor, and air motor and three)in)one syringe. ( A3uipment used by the surgery assistant will be on the left of the patient. "( The patient must be able to seat him self and get up again with ease, so his access to the chain must be unobstructed. $( A3uipment should preferably not be mounted over the patient within his line or sight.

eneral 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. ( "( $( /( ) ) =( :( B( 4( 7hen operating on maxillary arch, the maxillary occlusal surface should be oriented approximately perpendicular to the floor. 7hen operating on the mandibular arch. The mandibular occlusal surfaces should be oriented approximately $/0 to the floor. 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. &inimi+e the body contact with the patient. ,perator should not rest forearms on the patient shoulders. ,perator should not place hands on the patients face fore head. The patients chest should not be used as an instrument tray. 2or must positions the left hand should be free to hold the mouth mirror to reflect light or retract check or tongue. .n certain instance it is more appropriate to retract the check with one or two forgers of left land. 7hen 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 meas/res : !eet0legs0thighs 1od2 3eight #ims and sho/lder position position 1. 2eet flat on the 1. #entered on the seat 1. -houlders an relaxed floor . Thighs parallel with the floor of the clinicians stool . -upported by the legs and thighs 'parallel to floor( . 1pper arms are relaxed ". Albows are in neutral position 'close to body(
B

1ac4 position 1. Back is straight . ;umbar curve is supported

1.

&ead position "2es Aligned with the 1. >irected down wards spine 'sit fail in the clinicians stool . >istance from eyes to clients oral cavity is approximately inches 1$)1=

Cead is erect

1. &aintain good operative posture 8 the clients mouth should be even with the clinicians elbow. The elbow should be held in neutral position '400 angle( . &aintain proper position to support the clinicians body, thighs parallel to the floor and feet flat on the floor. ". Deep shoulders relaxed. $. Avoid extremes in temperatures /. Avoid or limit exposure to vibrating instruments. =. Avoid forceful pinching and gripping of instrument handles. :. 7ear properly fitting gloves. B. Alternate clinician position. 4. %erform tendon gliding exercises. C$INIC#$ SI NI!IC#NC" : '( S&OU$D"R IN5URI"S : a( Trape6i/s m2algia : .t is caused by static loading or stabili+ing muscles over long period of time. S2mptoms : %ain and tenderness in trape+ius muscle. Ris4 factors :

;ong dental procedures which cause static loading on muscles of the body, which are supporting the clinicians body weight. Preventive meas/res : ) &anage appointment times 8 alternative long and short working. ) Take stretching breaks. ) #hange body positions ) &aintain proper positions. #ssessing s2mptoms : #onsistent pain and tenderness in trape+ius muscle. Treatment : Therapy consists of rest, physical therapy, massage, stretching exercises and heat<ice regimens. b( Rotator c/ff inj/ries : .nclude rotator cuff tendonitis and rotator cuff tears. Both affect the connective tissue in the shoulder. S2mptoms : ) %ain when lifting arm ) 2unctional impairment Ris4 factors : ) -tatic loading on shoulder muscles. ) .mproper body support Prevention : ) Avoid repetitive twisting and reaching for instruments. ) &aintain neutral shoulder and arm positions. ) %roper working positions. #ssessing s2mptoms : #onstant pain is shoulders and increased pain when raising arms. Treatment : ) Therapy depends on degree of in*ury.
10

) #orticosteroid in*ections. ) Anti)inflammatory medications. ) .f conservative therapy fails surgery is performed.

+( N"C7 #ND 1#C7 IN5UR"S : a( $/mbar joint d2sf/nction : ,ccurs from repetitive and continued twisting or rotating of the spine. 7hen improper support of clinicians spine is present during dental procedures, the intervertebral dices are put under tremendous pressure, possibly resulting in rupture or in*ury. S2mptoms : >iscomfort and pain in lumber region of the spine. Ris4 factors : .n right handed clinicians at B0 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. ) %roperly support body weight. ) &odify e3uipment placement to avoid twisting to reach instruments. #ssessing s2mptoms : #onstant lower back pain and limited movement of back. Treatment : ) 9est ) 7ork place ad*ustments ) %hysical therapy ) ,ccupation therapy ) >rug therapy
11

b( Cervical spond2lol2sis 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 Cerniation. S2mptoms : ) -tiffness and limited motion of the neck. ) #repitus during active or passive movements of the spine. ) %ain in upper<middle cervical region of the spine. ) %ain in the scapula of shoulder regions. ) &uscle spasms. Ris4 factors : 9epeated stress and stain placed on neck and spine. Prevention : ) &aintain proper clinician head and neck position. ) %roperly seat clients for easy access to the mouth. #ssessing s2mptoms : ,ccurrence of pain during neck motion and crepitus in spine. Treatment : %osture retraining exercises to restore the normal curvature of spine. ) -trengthening exercises for neck and back ) 9est ) #ervical colors ) %hysical therapy P&8SIC#$ "9"RCIS" : '( Chair side stretching e:ercises : .t 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.
1

) Cands and fingers are held straight, pointing upward. ) 2ingers are bent into a 400 angle from the hand. ) 2ingers are then closed into the hand. ) 2ingers are then further arched in the same direction. ) Cold briefly and release. +( Strengthening e:ercises : This ) .mproves strength and flexibility ) .mproves lumbar spine, neck muscles and lower back ) -tretches and extends back muscles ) -trengthens abdominal muscles ) -trengthens finger, hand and arm muscles -ome of strengthening exercises are 5 1. %elvic tilt 8 -trengthens the lumbar spine ) ;ie on your ) Dness must be bent ) 2latten and press the back into the floor ) Cold briefly ) 9epeat . Cyper extension 8 ) -afe guard the lumbar curve ) ;ie on your stomach ) Arch the back back ward in an upward direction ) Cold briefly ) 9epeat ". Dnee)to)chest 8 -tretch the lumbar spine.
1"

) ;ie on your back ) Bring both knees to your chest ) Cold briefly ) 9eturn to normal without straightening legs. ) 9epeat /. -it)ups 8 -trengthens the abdominal muscles. ) ;ie on your back ) Bend the knees ) -upport the neck ) @ently raise the shoulders towards the knees ) Cold briefly and return ) 9epeat -uspend from a bar 8 9elieves lower back pain ) 2irmly grasp the bar ) -uspend your body from the bar, lift the feet slowly ) Cold for a short time ) 9epeat =. >oorway stretch 8 9everse poor posture. ) -tand infront of an open door way ) %lace hands on either side of door frame ) @ently allow your body to lean forward ) Cold briefly ) 9epeat :. 6eck isometric 8 -tretches cervical spine and relieve neck muscle
1$

) @rasp hands behind the head ) @ently press your head back ) >o not allow any backward movement ) Cold briefly ) 9epeat B. 9ubber ball s3uee+e 8 -trengthens hand and finger muscles ) @rasp a rubber ball firmly in your hand ) @ently s3uee+e ) Cold briefly ) 9epeat 4. 9ubber band stretch 8 -trengthens hand and finger muscles. ) Axtend rubber band between the fingers of the hand ) @ently stretch the rubber band until you feel resistance ) Cold briefly ) 9elease the rubber band ) 9epeat

TOOT& NU%1"RIN

1/

The word dentition refers to all of the teeth in the upper *aw bones and the lower *aw bones. Cumans have two dentitions throughout life, one during childhood, called the primary dentition deciduous dentition and of adult hood called the permanent teeth. >ue to their location, the upper teeth are called maxillary teeth and lower teeth are called mandibular teeth. The dental formula is %& 0 & "0

-ome of the dental formula in some animals are 5 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. ,therwise, 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 E &,>BAF. By palmer notation system would be :1 or using the international system 1:. The &,>9A describing the type of cavity and restorations is used with all three systems. S2stem : ' Universal n/mbering s2stem : This system is first suggested by %arriedt in 1BB ? was officially adopted by A>A in 14:/. .t is accepted by third party providers and endorsed by the American society of 2orensic odontology. Basically, it uses numbers 1 through " for the permanent dentition starting with 1 for the maxillary right third molar, going around the arch to the upper left third molar as 1=, dropping drown on the same side, the left
1=

mandibular third molar becomes 1:, and then the numbers increase clock wire around the lower arch to " , which is the lower right third molar. 2or the deciduous dentition, the letters of the alphabet are from A through T. GA is the maxillary right second molar, se3uentially through the alphabet to GH for the upper left second molar? there dropping down on the same side to D for the mandibular left second molar, than clock wise around the lower arch to GT for the lower right second molar.
AB#>A T-9I% 2@C.H ,6&;D

S2stem : + T3o digit s2stem ;federation dentine international( : .n &arch of 14:1 at the meeting of the general assembly, the federation dentine interrationale adopted the two 5 digit system of designated teeth. The guide lines used in developing the two)digit system were that it be 1( -imple to understood and to teach. ( Aasy to pronounce in conservation and dictation "( 9eadily communicable in print and by wire. $( Aasy to translate into computer input /( Aarly adaptable to standard charts used in general practice. According to two 5digit system, the first digit indicates the 3uadrant and the second digit the specific tooth within 3uadrant. Iuadrants are allotted the digits 1 through $ for permanent dentition and / through B for primary in a clock wise se3uence and starting at the patients upper right. %ermanent teeth within the same 3uadrant are allotted the digits 1 through B

1:

from the midline posteriorly and primary teeth 1 through / from the midline posteriorly. 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, 3uadrant designations are oriented to the patients right and for left. Permanent teeth &axillary
" $ / = : B

%atient right

1B 1: 1= 1/ 1$ 1" 1 11 1

$B $: $= $/ $$ $" $ $1 "1 " "" "$ "/ "= ": "B

%atient left

Primar2 teeth

&andibular &axillary

%atient right

// /$ /" / /1 =1 = =" =$ =/ B/ B$ B" B B1 :1 : :" :$ :/

%atient left

&andibular S2stem : , P#$&"R N#TION#$ S8ST"% : ;#ng/lar or grid s2stem( ,riginally this was described in 1B=1 and was first noted in the dental literature in the united states in 14:0 and has remained a most widely used method. This system utili+es simple brackets to represent the four 3uadrants of the dentition as if you all faring the patient G in upper right, G; upper left, G is the lower right, G; is lower left. Aach contraletral or opposing tooth pair of the permanent has a specific number.

1B

The primary teeth have letter designations. &axillary %atient right

A>#BA 2>#BA AB#>A AB#>A

%atient left

&andibular 6umbering for permanent dentition from mid line posteriorly in both maxillary and mandibular arches, each central incisor is designated 1 and each third molar is B. -pecific 3uadrants are designated as follows 8 &axillary %atient right
B:=/$" B:=/$" 1 1 1 1 "$/=:B "$/=:B

%atient left

&andibular .dentifying a specific tooth by this system combines the 3uadrant grid with the tooth number in reference to the mid line, thus E = JF represent the maxillary right first molar and E $ F right primary cuspid. The temporary teeth are indicated merely by altering the Arabic numerals to 9oman ones. -ometimes temporary teeth are designated with the letters Ga 5 Ge or with capital letters GA 5 GA or letter G> 'deciduous( placed after the number of the tooth a small Gd is placed before the number of the tooth. The temporary teeth may also be indicated by addition of the letter Gm after the number of the tooth.
e d c b a 9 e d c b a A>#BA 9 A>#BA E # F

indicates the mandibular left first

F represent mandibular

cusped. A specific primary tooth designation E #

a b c d e a b c d e AB#>A AB#>A 14

/> $> "> > 1> /> $> "> > 1> /d $d "d /d $d "d d 1d d 1d

1> 1> 1d 1d 1m

> "> $> /> > "> $> /> d "d $d /d d "d $d /d m "m $m /m m "m $m /m

/m $m "m m 1m

/m $m "m m 1m 1m

S2stem : There is another system which employs both the angle signs and numerals 1 to B for enumerating the permanent teeth and A to e for enumerating the temporary teeth. .t is exactly opposite to the Asignomdys system. .n this system nations begins with the number 1 for the third molar and with the letter GA for the second temporary molar. .t ends with GB and GA for the permanent and deciduous central incisors respectively.
1 1 "$/=:B 1 "$/=:B 1 "$/=:B "$/=:B

AB#>A AB#>A

AB#>A AB#>A

S2stem :< ,ther angle systems do not make use of numerals, but designate the teeth 'starting from the central incisor( as 8 . 1, . , #, %1, % , &1, & , &" i.e. initial letters of their respective ;atin names. Permanent teeth :
9 & " & & 1 % % 1 # . .1 & " & & 1 % % 1 # . .1 .1 . # %1% &1 & &" .1 . # %1% &1 & &" ;

Temporar2 teeth :
9 dm dm1 dc di di1 dm dm1 dc di di1 di1 di dc dm1 dm di1 di dc dm1 dm ;

This system is employed mainly in Colland.

S2stem : = &#D"RUP)S S8ST"% : This is another older system which was invested by >ane, Cader up '1BB:, 1B41(. 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 B in a distal direction. The tooth number in the upper *aw are combined with the plus sign, those in the lower *aw 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 *aw and the left of the number if the tooth is situated on the left side of the *aw.
9 BK :K =K /K $K "K K 1K B) :) =) /) $) ") ) 1) K1 K K" K$ K/ K= K: KB )1 ) )" ) $ ) )/) )= ): )B ;

Temporary teeth were originally shown by the addition of the letter G; placed before. The numeral. After a few years this was altered to another form, where by G, also placed before the numeral? substituted the letter G;. .n the central Aurope, the temporary teeth are indicated by 9oman numerals without additions of the figure G, in con*unction with GK and G) signs.
0/K 0$K 0"K 0 K 01K 0/) 0$) 0") 0 ) 01) K01 K0 K0" K0$ K0/ )01 )0 )0" )0$ )0/

!K !.K ...K ..K .K !) !i) ...) ..) .)

K. K.. K... K.! K! ). ).. )... 5.! )!

This is practically the only one used on -urden, >enmark, 6orway, 2inland and .ce land.

Along with other systems it is also used in @ermany, .taly, -wit+erland, Lugoslavia, %oland and #Me #hoslvakia. S2stem : > There are some systems in which one does not use the angle signs. .n one such system, the incisors '.(, canines '#(, premolar '%(, and molars '&( are indicated in the following way 8 .1, . , #, %1, % , &1, & , and &". The upper *aw is indicated by letter Gs 'superior( and the lower *aw by the letter Gi 'inferior( placed immediately after the index numeral and followed by the Gd 'dexter( for the right side and Gs '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 m . Permanent teeth :
9 &"sd & sd &1sd % sd %1sd #sd . sd .1sd .1ss . ss #ss %1ss % ss &1ss & ss &1ss &"id & id &1id % id %1id #id . id .1id . is . is #is % is % is & is & is & is 1 1 1 1

Temporar2 teeth :
m sd m1sd # d i sd i1sd m id m1id # id i id i1id i1ss i ss #ss m1ss m ss i1is i is #is m1is m ss

This system is employed in Colland S2stem : ? This system is very similar to system : 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. 2or the upper right segment, the index placed higher than and the left of the alphabetical symbol of the tooth. 2or the upper left segment, higher and to the right of it. 2or the lower right segment, the index is placed lower and to the left of the alphabetical symbol of the tooth. 2or the left lower segment, lower and to the right of if.
"

"

& & 1& % 1% 1# . 1.

.1 . # 1%1 % &1 & &" .1 . # 1%1 % & 1& &"

& 0& 1& % 1% 1# . 1. "

S2stem : @ This system manages without the use of angle signs. .n this, the teeth are numbered G1)B from the central incisor to the last molar. The teeth of the right side of upper *aw are indicated by capital > 'droite( and lower right teeth with small Gd 'droite(. The upper left teeth are indicated by capital G@ 'gacha( and the lower left teeth are indicated by small Gg 'gacha(.
>B >: >= >/ >$ >" > >1 @1 @ @" @$ @/ @/= @: @B dB d: d= d/ d$ d" d d1 g1 g g" g$ g/ g/= g: gB

Temporary teeth are indicated by substituting 9oman numerals for the Arabic ones. This system is used to a limited extent in 2rance, while a variant occurs in 9omania. S2stem : 'A #rm2 s2stem :
B : = / $ " 1 1 " $ / = : B ;

1= 1/ 1$ 1" 1 11 10 4

4 10 11 1 1" 1$ 1/ 1=

S2stem : '' Nav2 s2stem :

1 " $ / = : B " $ 4 10 11 1 1" 1$ 1/ 1= / = : B 4 "0 "1 "

1: 1B 14 0 1

S2stem : '+ 1os3arth s2stem :

9 B : = / $ " 1 1 " $ / = : B ;

C @ 2 A > # B A

$ # > A2 @ C A B

.n the above three)systems the designation for the temporary teeth can be made for each system on two different principles. 1( 9etain 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(. ( 9etain the method of designating the teeth, but substitute for the numbers of the permanent teeth. 'adding N to the number( Ag8 1 N substitutions can be in the form of alphabetical letters or different numericals. "( 7e can add G> before the numerical number. 2or example in Bosworth system.
>/ >$ >" > >1 >1 > >" >$ >/

>A >> ># >B >A >A >B ># >> >A

-ome times letter is placed after the numerals.

,'>:,AB<B>A,C TOOT& NU%1"RIN

S8ST"% :

a( 2or adult teeth, the universal tooth numbering system '1 through " ( is used. for primary teeth, tooth letters A through T are used. b( 6o other tooth letter or number system will be accepted. 2ailure to use this system will result in the claim being re*ected and could cause faulty history which could prevent future claims from being paid. 'example 8 using tooth number /d instead of number % for an extraction. The computer would not allow a service for permanent tooth number / as history would indicate that tooth has already been extracted and is ineligible for other services(. All procedures performed on a specific toothy re3uire the appropriate tooth number. c( ;isted below are the identifying numbers for supernumerary teeth. 1. O $= &esiodens 'Between O B and O 4( . O $: -econd &esiodens 'Between O B and O 4( ". O $B -upernumerary tooth between or alongside O B $. O $4 -upernumerary tooth between or Alongside O 4 /. O /0 -upernumerary tooth between or alongside O 0 =. O /1 -upernumerary tooth between or Alongside O 1 :. O / -upernumerary tooth between O : and O B B. O /" -upernumerary tooth between O 4 and O 10 4. O /$ 1pper right $th molar 'permanent( 10. O // 1pper right $th molar 'permanent( 11. O /= ;ower right $th molar 'permanent( 1 . O /: 1pper right $th molar 'permanent( 1". O /B -upernumerary between or alongside O $ and O / 1$. O /4 -upernumerary between or alongside O 1 and O 1" 1/. O =0 -upernumerary not otherwise identified 'identify location on claim(

CONT"NTS C&#IR SID" POSITIONS #ND TOOT& NU%1"RIN

'( +( ,( -( <( =( >( ?( @( %"#SUR"S 'A( ''( 1 ( C$INIC#$ CONSID"R#TIONS R"!"R"NC"S CONC$USION INTRODUCTION TOOT& NU%1"RIN C&#IR #ND P#TI"NTS POSITION OP"R#TORS *ON" #SSIST#NT *ON" TR#NS!"R *ON" ST#TIC *ON" "N"R#$ CONSID"R#TIONS C&#IR SID" PR"D"NTID"