Dental Charting

What is Dental Charting—An Introduction

Dental charting is a foundational tool of dentistry, acting as the real-time map of a patient’s mouth. As an unsung hero, it is probably the least discussed dental tool yet guides every diagnosis, treatment, and long-term oral care plan. In essence, a dental chart is the patient’s dental record that uses standardised scientific symbols, icons and pictographic references to transform complex dental data into clear, actionable insights. Advancements in technology like dental AI and 3D imaging have made dental charting smarter and more precise now than ever, revolutionising how dentists care for their patients.

The Evolution of Dental Charting Systems

From their humble beginnings as hand-drawn diagrams and tables on paper, dental charts have evolved into premade, clickable digital tools.

The paper charts laid the groundwork for these modern systems by introducing a standardised approach to documenting oral health.

Paper records often had errors, inconsistencies, and limited functionality when it came to referrals, reviews and multispecialty care, demanding the need for its digital counterpart.

The introduction of computers in healthcare transformed dental charting systems.

Paper charts gave way to Electronic Dental Records (EDRs), with faster data entry and retrieval, easy access to dental data in real-time, remotely, and easier integration of digital X-rays, 3D CBCT scans and intraoral cameras.

The next milestone came with digital platforms, cloud-based systems and Artificial Intelligence (AI).

Digital platforms with cloud-based storage allow the storage of and access to dental charts and related information easily. They also ensure that dental charts are updated seamlessly, with no repetitions, errors, or wastage of resources like paper and time.

AI-driven dental charting systems are reshaping how dentists diagnose and treat patients. They detect early-stage cavities, fractures, or abnormalities, prepare dental charts, predict disease progression and provide real-time suggestions.

Types of Dental Charts

The GDC needs dentists to maintain dental charts that are detailed and updated on every visit. Here are the different types of dental charts that give a holistic overview of a patient’s mouth:

Anatomic Dental Charts: These depict the actual shape of teeth and their placement within the jaws. They help record cavity fillings, dental crowns and bridges, tooth wear, and missing teeth and also aid in orthodontic planning.

Periodontal Dental Charts: These focus on gum health and bone support around teeth. Periodontal dental charting includes measurements of gingival pocket depths, gum recession levels, visible bone loss around a tooth with furcation exposure, tooth mobility and other signs of gum/periodontal disease [1].

Geometric Dental Charts: The teeth are represented as circles or squares here; each divided into quadrants in each jaw to represent different tooth surfaces. This is ideal for routine documentation, focusing on basic conditions like cavities or fillings.

Key Components and Symbols of Dental Charts

Dental charting involves several critical components and uses standardised symbols to precisely record the data.

The components of a typical dental chart include:

• Patient’s details:
  • Patient registration forms (medical and dental history, consent form)
  • Diagnosis and treatment plan documents
  • Radiographs (X-rays)
  • Financial details, including private insurance.

• Odontograms (a chart that depicts a client’s current and planned dental conditions and procedures) that record:
  • Possible issues like missing teeth, deep gum pockets, bleeding during probing, and gum recession.
  • Cavities or areas of early-stage decay.
  • Dental crowns, bridges, implants, fillings, dental implants, etc.
  • Tooth mobility and gum bleeding.
  • Dental abnormalities like tooth rotations, erosion, abrasions, and enamel damage [2].

The symbols used in dental charts are:

• Tooth Numbering Systems

Key findings in a dental chart are indicated using specific global notation systems that dentists worldwide can read consistently [3]. The four common notation systems to differentiate between permanent and deciduous teeth are:

Alphanumeric Notation: This system divides the mouth into four sections: upper right (UR), upper left (UL), lower left (LL), and lower right (LR). Permanent teeth are numbered from 1 to 8, while deciduous teeth are labelled A to E, starting at the midline. For instance, 1 represents the central incisor, while 8 corresponds to the wisdom tooth or third molar.

Palmer Notation: Palmer notation combines numbers and symbols, using the same markers for permanent and deciduous teeth as the alphanumeric system.

FDI World Dental Federation Notation: This two-digit system designates the quadrant of the tooth with the first number (UR = 1, UL = 2, LL = 3, LR = 4) and the specific tooth within the quadrant with the second number, following a pattern similar to Palmer notation. For example, 36 identifies the lower left first molar. Deciduous teeth use quadrants 5 through 8 (UR = 5, UL = 6, LL = 7, LR = 8).

Universal Numbering System: This method assigns numbers 1 through 32 to teeth, beginning with the upper right and proceeding clockwise. For example, tooth 18 corresponds to the lower left first molar.

• Surface Notations

Each tooth has five main surfaces that are charted:

Occlusal: Biting surface.

Mesial: The side closest to the midline.

Distal: Side farthest from the midline.

Buccal: outer surface facing the cheek.

Lingual: inner surface facing the tongue.

• Periodontal Measurements

Pocket depths: Measured with a periodontal probe to assess gum health.

Bleeding Points: Documented as indicators of inflammation.

Attachment Levels: Helps diagnose gum recession or bone loss.

• Symbols and Abbreviations

There aren’t many standardised symbols for dental charting. However, the most common ones are:

‘X’ to denote a missing tooth; ‘R’ or a line through the centre of the tooth to denote RCT, etc.

Modern dental charting combines X-rays, intraoral photos, and 3D scans with the dental findings entered by the dentist to create a dental chart using these notations and symbols.

Steps in Dental Charting

Dental charting is a structured process typically carried out by the dental hygienist and the dentist. This is how dental charting functions in modern patient management software:

The dentist begins by recording the patient’s chief complaints, personal details, and dental and medical history. This follows a visual examination of the teeth, gums and mouth for visible issues such as cavities, discolourations, missing teeth, etc. The dentist may complement the exam with additional X-rays, images and scans.

This follows the entry of data into the dental charts using dental charting tools. Records are typically charted in the following order:

• Teeth findings: cavities, fillings, crowns, bridges, missing teeth, fractures, abnormal wear, malocclusions, alignment issues, or signs of bruxism.
• Periodontal evaluation: gum recession, bleeding points, gum pocket depths, signs of bone loss or periodontal disease.
• Findings from X-rays, CBCT scans, or other imaging tools: These validate the clinical records and look for abnormalities such as impacted teeth, cysts, or infections.

All relevant images or scan results are then attached and visual aids or imaging overlays are used for clarity. The dental charts must be updated regularly to reflect changes in the patient’s oral health or completed treatments.

The Challenges in Dental Charting

Dental charting is the first step to a successful treatment plan. Despite being a brief portion of the overall dental procedure, a dental chart error can occur in a number of ways, like:

• Inconsistencies in charting that make the process complex and non-decipherable.
• Oversights due to the burden of checking large volumes of patient data
• Time limitations and rushed charting: dentists and hygienists may struggle to balance charting with other patient care responsibilities.
• Failure to update dental charts; over time, patient charts can become extensive, making it difficult to manage and update information effectively.
• Mismatch and swapping of patient charts
• Outdated systems that may not integrate with modern imaging tools
• Inability to easily retrieve dental charts
• Restricted remote access and interprofessional sharing of dental charts
• Data overload; imaging results like X-rays and CBCT scans into charts can overwhelm practitioners
• High overhead costs on dedicated dental charting tools and staff to manage them.

A modern dental practice must address these challenges and invest in an all-in-one diagnostic tool that will aid the dentist in dental charting, treatment planning, and boosting patient outcomes.

Technological Advancements in Dental Charting

The evolution of technology has transformed traditional dental charting into a more sophisticated and efficient process. With AI in place, a variety of dental charting tools are incorporated into most dental diagnostic software. For instance, Diagnocat AI offers automatically generated dental charts that are prepared after reading the clinical data as recorded by the dentist and the dental images, X-rays and 3D scans [4].

Some of the typical features of digital dental charting using AI that address the routine challenges of traditional dental charting are:

• Accessibility and cloud storage: prepares digital records that are automatically reviewed on every visit; allows for real-time updates, remote access, and integration with practice management software.

• Comprehensive diagnosis: Software like Diagnocat can read 35 conditions in 2D images, bitewings, FMX, and panoramic radiographs; read over 65 dental conditions on CBCT images, including uncommon pathologies and non-dental findings like sinus problems and bone structure deformations. This reduces the chances of errors and missed findings.

• Speed: Diagnocat AI can do all the reading and analysis to generate a dental chart in less than 10 minutes.

• Automated tasks: With a few clicks, the dentist can confirm a pre-filled dental chart and add/edit it as needed. These include pathologies and conditions that are colour-coded on the dental chart.

• Predictability: The machine learning AI model can correlate the dental charts and the patient’s history to predict differential diagnoses and suggest treatment plans.

• In-depth analysis: These dental charts can guide the dentist to focus on their desired area on the 3D image to verify the condition.

• Final reports and better patient conversions: They can generate a thorough report outlining the conditions and findings as confirmed in the dental chart.

This report comes in a handy printable PDF file that includes a dental chart with personalised descriptions for every tooth. It is easy to use for patients, highlighting any teeth with conditions in red. This report improves the acceptance rates of treatment plans by linking the patient’s conditions to the necessary treatments in a visually appealing way [5], [6], [7].

Future Trends in Dental Charting

Dental charting is much more than a record-keeping task—it’s the backbone of comprehensive oral healthcare. The future of dental charting lies in tomorrow’s innovations in dental tech. These may include hands-free documentation using voice recognition technology, enhancing workflow efficiency, interactive charts that patients can view and update via apps to ensure engagement and proactive care, and more.

FAQs

• What is the method of dental charting?

The method of dental charting takes about 15-20 minutes and is a part of the dental consultation. The dentist uses universally accepted industry-standard dental terms and signs to record the status of the patient’s oral health into a digital chart.

• Are digital dental charts secure?

Yes, modern digital systems use encryption, are HIPAA compliant, and adhere to regional regulations to secure cloud storage and protect patient data.

• What is the most common charting system used in dentistry?

FDI World Dental Federation Notation is the most popular notation used in dental charting systems worldwide.

References:

1. Sweet J. Periodontal charting. Dent Update. 1987 Oct;14(8):362-3, 365. PMID: 3503792.
2. Villa Vigil MA, Arenal AA, Rodriguez Gonzalez MA, Llompart RC, Gonzalez Menendez JM, Diez FR. Simplified method of odontograms for individual identification. Quintessence Int. 1990 Dec;21(12):1013-8. PMID: 2082418.
3. https://spsdentalacademy.com/demystifying-dental-anatomy-a-guide-to-how-dentists-number-teeth/
4. https://diagnocat.com/sa/products/radiology-report/
5. Katsumata A. Deep learning and artificial intelligence in dental diagnostic imaging. Jpn Dent Sci Rev. 2023 Dec;59:329-333. doi: 10.1016/j.jdsr.2023.09.004. Epub 2023 Sep 30. PMID: 37811196; PMCID: PMC10551806.
6. Kabir T, Lee CT, Chen L, Jiang X, Shams S. A comprehensive artificial intelligence framework for dental diagnosis and charting. BMC Oral Health. 2022 Nov 9;22(1):480. doi: 10.1186/s12903-022-02514-6. PMID: 36352390; PMCID: PMC9647924.
7. Yasa Y, Çelik Ö, Bayrakdar IS, Pekince A, Orhan K, Akarsu S, Atasoy S, Bilgir E, Odabaş A, Aslan AF. An artificial intelligence proposal to automatic teeth detection and numbering in dental bite-wing radiographs. Acta Odontol Scand. 2021 May;79(4):275-281. doi: 10.1080/00016357.2020.1840624. Epub 2020 Nov 11. PMID: 33176533.