Dental notation

A committee of the American Dental Association (ADA) recommended the use of the Palmer notation method in 1947. Since this method required the use of symbols, its use was difficult on keyboards. As a result, the association officially supported the Universal system in 1968. The World Health Organization and the Fédération Dentaire Internationale officially uses the two-digit numbering system of the FDI system. However, in 1996, the ADA adopted the ISO System as an alternative to the Universal System.

FDI Notation, teeth's quadrants

The International Standards Organization Designation System (ISO System) by the World Health Organization notation system is widely used by dental professionals internationally to associate information with a specific tooth. Based on the Fédération Dentaire Internationale (FDI), it is also known as ISO 3950[1] notation. Thus the ISO System uses a two-digit numbering system in which the first digit represents a tooth's quadrant and the second digit represents the number of the tooth from the midline of the face. For permanent teeth, the upper right teeth begin with the number, "1". The upper left teeth begin with the number, "2". The lower left teeth begin with the number, "3". The lower right teeth begin with the number, "4". For primary teeth, the sequence of numbers goes 5, 6, 7, and 8 for the teeth in the upper right, upper left, lower left, and lower right respectively. When speaking about a certain tooth such as the permanent maxillary central incisor, the notation is pronounced “one, one”. Beware of mixing up the teeth in written form such as 11, 12, 13, 14, 15, 16, 17, 18 between the Universal and ISO systems.

For example: retention of a primary molar tooth in the otherwise regular intact lower right jaw, position 5, would be noted as: 41, 42, 43, 44, 85, 46, 47, 48.

• 
  ISO notation upper jaw
• 
  ISO notation lower jaw
• 
  ISO notation primary teeth

                    Permanent Dentition
        upper right - 1             upper left - 2
    18 17 16 15 14 13 12 11 | 21 22 23 24 25 26 27 28 
 R --------------------------------------------------- L
    48 47 46 45 44 43 42 41 | 31 32 33 34 35 36 37 38 
        lower right - 4             lower left - 3 

                    Primary Dentition
        upper right - 5             upper left - 6
             55 54 53 52 51 | 61 62 63 64 65 
          R --------------------------------- L
             85 84 83 82 81 | 71 72 73 74 75 
        lower right - 8             lower left - 7

 I - incisor
 C - canine
 P - premolar
 M - molar

The Palmer notation is a system used by dentists to associate information with a specific tooth. Although supposedly superseded by the FDI World Dental Federation notation, it overwhelmingly continues to be the preferred method used by dental students and practitioners in the United Kingdom.[2] It was originally termed the "Zsigmondy system" after the Hungarian dentist Adolf Zsigmondy who developed the idea in 1861, using a Zsigmondy cross to record quadrants of tooth positions.[3] Permanent teeth (adult) were numbered 1 to 8, and the child primary dentition (also called deciduous, milk or baby teeth) were depicted with a quadrant grid using Roman numerals I, II, III, IV, V to number the teeth from the midline distally. Palmer changed this to A, B, C, D, E.

The Palmer notation consists of a symbol (┘└ ┐┌) designating the quadrant of the tooth and a number indicating the position from the midline. Adult teeth are numbered 1 to 8, with primary teeth indicated by a letter A to E. Hence the left and right maxillary central incisor would have the same number, "1", but the right one would have the symbol, "┘", underneath it, while the left one would have, "└".

                    Permanent Dentition
        upper right - 1x            upper left - 2x
            8 7 6 5 4 3 2 1 | 1 2 3 4 5 6 7 8 
  R --------------------------------------------------- L
            8 7 6 5 4 3 2 1 | 1 2 3 4 5 6 7 8
        lower right - 4x            lower left - 3x

                     Primary Dentition
        upper right - 5x            upper left - 6x
                 E D C B A | A B C D E 
          R --------------------------------- L
                 E D C B A | A B C D E 
        lower right - 8x            lower left - 7x

I - Incisor
C - Canine
P - premolar
M - molar

Although it is termed "universal numbering system", it is most commonly used in the United States. It is also called the "American system".[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.

Paleoanthropologists use a system suitable to other primates as well. The upper teeth are denoted I¹, I², C⁻, Pm³, Pm⁴, M¹, M², and M⁴. Left or right has to be specified. The lower teeth are I₁, I₂, C₋, Pm₃, Pm₄, M₁, M₂, and M₃. The reason the premolars are labeled 3 and 4 is that in earlier primates there were two other premolars between them and the canines.[5]

In this system, also known as alpha-numeric notation, the four quadrants are designated as follows:

• UR - upper right
• UL - upper left
• LR - lower right
• LL - lower left

Within each quadrant, the teeth are numbered as in the Palmer notation: 1-8 for permanent and A-E for deciduous, both starting at the midline. For example, the permanent left maxillary first molar is designated UL6.

To prevent uncertainty or ambiguity, teeth may be indicated using more than one notation, particularly when referring for an extraction; this makes it less likely for the incorrect tooth to be needlessly extracted. For instance, a dentist may give an instruction to "extract the 24 (UL4) upper left first premolar tooth."