“A thorough and timely dental charting can be the difference between a dismissal and a large fine.” (thedentaladvocate.com, 2021)

Even the best dentists can make the occasional charting mistake. As dental professionals, it is our duty to keep contemporaneous, complete and accurate patient records, as part of the General Dental Council (GDC)’s standards to practice. That includes the ability to clearly and reliably identify each tooth with the right symbols. This is because illegible and incomplete charting can bring about medico-legal issues. What's more when a fellow colleague misinterprets the notation and mistakenly carries out the wrong treatment/treatment on the incorrect tooth? The patient would be brought unintended harm and the dental professional a potential complaint and fitness to practice hearing.

So what are dental charting symbols?

Dental charting is the graphical method of organising information about the oral cavity and dental health, usually done during routine dental checkups either on paper or digitally on a dental software program. It is an essential part of the comprehensive dental exam during the patient’s initial visit as a basis to form a coherent treatment plan and a baseline for monitoring. It normally includes abbreviations, acronyms and symbols that have been maintained by several national dental associations to give uniformity across the profession. Hence, to ensure good charting, we must first get the basic foundation of getting the charting symbols right.

As part of our efforts at Kiroku to make note-taking in dental practice a shorter and easier process, we have compiled all the dental charting symbols you need to know to ensure you’ve got everything you need for a thorough and accurate chart.

Dental charting symbols and how to chart with them:

• Missing teeth – As a rule of thumb, it is recommended that we start off on a fresh chart by scoring out all the missing teeth, wisdom teeth being a common one, on the written or digital dental chart with a single line across each tooth horizontally. This can ensure that we don’t mistakenly chart symbols on the wrong tooth.
• Notation systems - Every country uses a different notation system and it is crucial to have a baseline knowledge of all the different tooth numbering systems available. You can head onto to our article on Dental Charting: All you need to know to get the low down on the four most common types of notation, i.e. FDI World Dental Federation, Palmer, Alphanumeric and Universal.
• Types of teeth present – Depending on the notation system, the numberings used for both permanent teeth and deciduous teeth differs. For example, with the FDI World Dental Federation notation, the prefixed number to each quadrant for adult teeth would be 1,2,3,4 whereas for baby teeth it would be 5,6,7,8.
• Status of teeth - whether it be extracted teeth (a cross over tooth), rotated/drifted teeth (direction indicated by an arrow), fractured teeth (hashtag on surface affected), retained roots (++) etc., we need to record the state of the patient's teeth during their initial visit.
• Restorations – It is also important for us to note what existing restorations patients teeth have when we first see them as they form the baseline for diagnoses and treatment planning. Some common restorations are direct fillings, indirect restorations like veneers/crowns and bridges, dentures, implants, root canal treatments, splints and so on. Charting digitally also means we can use colours to highlight the status of treatment, in this case it is blue for treatment completed and red for caries/ treatment to be completed.
• Caries – Any decay needs to be reflected as dental treatment required in the dental charts and notes. The tooth surface affected, either mesial, distal, palatal/lingual, buccal/labial or occlusal/incisal, can be circled to mirror this. If an existing restoration is present, the circle goes around the coloured restorations.
• Basic Periodontal Exam (BPE) – The BPE is done in sextants around the dentition and the highest scoring code is given for each sextant based of the amount of gingival inflammation as evidenced by bleeding and epithelial attachment loss as evidenced by probing depths. Any furcation involvement is noted down as an asterisk *.

| BPE score | Indication | | :-------: | ----------------------------------------------------------------: | | 0 | No calculus or overhangs, no bleeding, probing depth < 3.5mm | | 1 | No calculus or overhangs, bleeding present, probing depth < 3.5mm | | 2 | Calculus or overhangs present, probing depth < 3.5mm | | 3 | Probing depth 3.5 - 5.5mm | | 4 | Probing depth > 5.5mm |

Abbreviations Used in Dental Charts

The tooth surfaces are abbreviated with the starting letter in capital form (e.g, O as in 26O - Occlusal, L - labial/lingual, B - buccal, M - mesial, D - distal, I - incisal, P - palatal)

Examples of combinations of the above could also be OL as in 36OL - occluso-lingual, MO - mesio-occlusal, MODL - mesio-occluoso-distal-lingual and so forth.

Materials

‍Am                 -  Amalgam
Comp.            -  Composite
GI                   - Glass Ionomer
Au                   - Gold
P.                    - Porcelain
MC                 - Metal Ceramic

Restorations

‍Acryl.              - Acrylic
Co-Cr.             - Cobalt-chrome
FS                    - Fissure enamel sealant
MCC               - Metal Crown
GSC                - Gold shell crown
PD                   - Partial denture
Cu                    - Complete upper denture
CL                   - Complete lower denture
Temp.             - Temporary dressing or filling
RCT                - Root canal Treatment required
RCF                - Root canal filling present
+pin(s).           - Pins used for retention
+post or +p/c   - Post or post and core
BR                   - Bridge retainer
BP                    - Bridge pontic
IMP                  - Implant
PV                    - Porcelain veneer

Other abbreviations

‍+++                  - Root retained/ present
35S                  - Supernumerary present
PE                   - Partially erupted
UE                  - Unerupted
#                      - Fractured
NV                  - Non vital tooth
NCTSL          -Non carious tooth surface loss

There is a growing emphasis to have a clear and unambiguous charting system. By following the guidance on using the right symbols and notation systems, we can reduce the chances of errors and hence the risk to harming patients and inadvertently our reputation as dental professionals.

With dentistry moving more towards a digital workflow, clinical notes is evolving from paper-based health record to computerised charting programs. Sign up with Kiroku to try any of your preferred choice of notation chart, as well as scoring systems like BPE and BEWE. You can also customise the templates to easily record and individually identify your patient’s carious teeth, defective restorations, tooth surface loss, crowding or spacing, gingival recession, prostheses, incisive class and LHS/RHS guidance, all these with just a few clicks away!

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