#3 – Understands Charting Manual and dental terminology | Dental Practice Coaching

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#3 – Understands Charting Manual and dental terminology

Our charts record 80% of all the activity in the practice. A poorly managed system can result in financial errors, misrepresented treatment, furious clients, frustrated staff, and upset dentists.

There are generally 7 parts to charts.

  1. Health history including client registration information – name, address, insurance info; Medical History info and Dental History info
  2. Clinical ledger that records treatment & visits
  3. Diagnosis and Treatment Plans
  4. Case Presentations – only when major treatment needed
  5. Appointment time sheet – to know how much time to schedule the next visit
  6. Preventive care tracking
  7. Periodontal chart

A charting system has the following functions:

1. Describe the diagnosis and treatment for a client so everyone understands what will (and has) happen.
2. Serve as a legal record in case malpractice is considered.
3. Serves as a basis for financial records.
4. Serves as a reference for insurance processing.
5. Keys staff into the sequence and time needed for various treatment appointments.
6. Recognizes and promotes client referrals.
7. Aids in scheduling appointments.
8. A means of communicating information between various dentists and staff members.

Dental Terminology

Abutment A tooth that supports a fixed bridge or a removable partial.

Abscess A localized collection of pus. A periapical abscess is located at the tip of the root of the tooth. A periodontal abscess may be located anywhere within the periodontal tissues.

Acid Etch A technique used that makes it possible to place a composite restoration without as extensive a preparation as would be required for other materials. The acid actually causes bonding of the restorative material to the tooth.

ADA Procedure Codes A system of five digit codes to simplify and speed identification of dental procedures. These codes are most commonly used for insurance reporting purposes.

Aesthetic Restoration Restorative materials that match the color of the tooth.

Alveolar Ridge The bony ridge which supports the teeth in their working position in the arch.

Alveolar Socket The socket in the alveolar bone in which the root of the tooth sits.

Alveolectomy The surgical reshaping of the alveolar ridge.

Amalgam An alloy containing silver and other metals that is mixed with mercury to form dental restorations.

Anterior Teeth Those teeth located in the front of the mouth. The central incisors, lateral incisors and canines.

Apex The tip of the root of a tooth.

Apical Foramen The opening at the tip of the root through which the blood and nerve supply enter and leave the tooth.

Apicoectomy The surgical removal of the root tip.

Attached Gingiva The gum tissue that extends from the tooth onto the bone and is attached to the bone by small fibers. This tissue is important in preventing pyorrhea.

Black’s Cavity Classifications A system, developed by Dr. G.V. Black, that makes it possible to quickly and accurately describe the type and approximate location of a cavity.

Bicuspid See premolar.

Bridge A fixed appliance used to replace on or more adjacent teeth.

Buccal Referring to the cheek.

Calculus (or Tartar) A hard, stonelike material which forms on the teeth through the calcification (hardening) of dental plaque.

Canine The heavy tooth designed to cut and tear those things that are too tough for the incisors to cut. The canine, which is sometimes called the cuspid, is located at the corner of the dental arch and there is one canine per quadrant.

Capitation (Fee) A fixed monthly or yearly payment paid to the dentist in a closed panel by the third party based on the number of patients assigned to him or her for treatment whether utilized or not. (Premium) A fixed yearly or monthly amount paid to an organization such as a prepaid group practice or health maintenance organization to provide dental care to the covered individual.

Caries Decay

Cavity The damage resulting from caries activity. A carious lesion.

Cementum The hard, bonelike covering of the root of the tooth.

Cervix The neck of the tooth. The narrow area where the enamel of the crown and the cementum of the root join.

Charting Any entry that is made on the patient’s clinical record.

Cleft Palate The failure of the parts of the palate to join together properly during prenatal development.

Closed Panel A closed panel practice is established if patients eligible for dental services in a public or private program can receive these services only at specified facilities by a limited number of dentists. If the services are provided in a group practice facility and are prepaid by some agency, the practice is more precisely termed prepaid group practice.

Composite A plastic based tooth colored restorative material.

Contact Point or Area The area where the proximal surfaces of two adjacent teeth touch.

Contour The natural shape of the tooth.

Crown That part of the tooth which is covered with enamel and which is normally visible in the mouth. A crown is also a preformed restoration, usually gold or of a tooth colored material, that covers the entire crown of the tooth.

Cuspid See canine.

Decay See caries.

Dental Public Health That dental specialty which deals with the prevention and control of dental disease and promoting dental health through organized community efforts.

Dentin The bone like structure which makes up the bulk of the tooth.

Dentition The natural teeth in their normal positions in the mouth.

Denture A removable appliance used to replace all of the teeth in an edentulous (toothless) arch.

Diagnostic Casts See study models.

Direct reimbursement mechanism A method of assistance in which beneficiaries are reimbursed by the employer or benefits administrator for any dental expenses, or a specified percentage thereof, upon presentation of a paid receipt or other evidence that such expenses were incurred.

Distal The proximal surface of the tooth which is away from the midline.

Dorsum of the Tongue The top side of the tongue which is covered with tough protective oral mucosa.

Dovetail A widened or fanned out portion of a tooth cut for a filling that is used to increase retention.

Drifting The movement of a tooth out its normal position due to the loss of an adjacent supporting tooth

Edentulous Without teeth. Most commonly used to refer to the condition that results after all the teeth have been extracted.

Embrasure The “V” shaped space between the prixmal surface of two teeth in contact.

Enamel The hardest substance in the body which covers the crown of the tooth.

Endodontic Treatment The removal of all of the pulp tissue from the tooth; sterilizing and enlarging the root canals and pulp chamber; and filling these areas with an inert material.

Endodontics That dental specialty which deals with the diagnosis and treatment of the pulp and periapical tissues.

Eruption The movement of the tooth into its normal working position in the mouth as a child develops

Extraction The removal of a tooth.

Facial That surface of the tooth which is toward the lips or cheek.

Fee for service The traditional method of billing by dentists in private practice, whereby the dentist charges for each dental service performed.

Fissure A deep and narrow groove that is particularly susceptible to decay on the crown of the tooth

Free Gingiva That part of the gingiva which surrounds the neck of the tooth above the cervical line and is not attached to the tooth.

Frenum See labial and lingual frenum.

Frenectomy The surgical cutting, of a frenum.

Gag Reflex The protective reflex which prevents foreign objects from accidentally going down the throat.

Gingiva The specialized oral mucosa that covers the alveolar bone and surrounds the teeth.

Gingival Sulcus The space between the tooth and the free gingiva.

Gingivectomy The surgical removal of diseased gingival tissue from around the necks of the teeth.

Hard Palate The bony anterior part of the roof of the mouth.

HMO Health Maintenance Organization An organized system of health care that accepts the responsibility to provide or otherwise ensure the delivery of an agreed upon set of comprehensive health maintenance and treatment services for a voluntarily enrolled group of persons in a geographic area and is reimbursed through a prenegotiated and fixed periodic payment made by or on behalf of each person or family unit enrolled in the plan.

Immediate Dentures A denture that is placed immediately following the extraction of the remaining teeth.

Impaction A tooth that is blocked from erupting into its normal position.

Impression reproduction of the teeth, plaster is poured into it to make a stone cast

Incisal Edge The cutting edge of an anterior tooth.

Incisors Those teeth with a thin, sharp cutting edge which are used for cutting and biting. There is a central and a lateral incisor in each quadrant.

Inlay A cast restoration, most often made of gold, that is fabricated outside of the mouth and cemented into the tooth.

Interdental Papilla The gum tissue which fills the space between two teeth in contact.

IPA Independent Practice Associations A legal entity organized and operated on behalf of individual participating dentists for the primary purpose of collectively entering into contracts to provide dental services to enrolled populations. Dentists may practice in their own offices and may provide care to patients not covered by the contract as well as IPA patients.

Labial Refers to the lips. That surface of the anterior tooth which is toward the lips.

Labial Frenum The band of tissue which passes from the inside of the lip to a point midway between the central incisors.

Lingual Refers to the tongue. That surface of the tooth which is toward the tongue.

Lingual Frenum The band of tissue which passes from the underside of the tongue to the floor of the mouth.

Malocclusion Crooked teeth

Mandibular Arch The arrangement of the teeth in the mandible.

Masticate To chew

Matrix A metal band used to hold a filling in the tooth while the filling is being placed. So it won’t squash out the sides of the tooth filling.

Maxillary Arch The upper teeth

Margin The junction of the tooth and the restorative material.

Mesial The proximal surface of the tooth which is toward the midline.

Midline An imaginary line that divides the head and face into two identical halves.

Mixed Dentition That stage at which the child still has some of his primary teeth and some of his permanent teeth.

Mobility The loosening of a tooth. The classes of mobility are: Class I, Class II, and Class III.

Molars The posterior teeth with a broad working surface which is used for the grinding of the more solid pieces of food which require the use of heavy forces. There are two molars in each quadrant of the primary dentition and three molars in each quadrant of the permanent dentition.

Nitrous Oxide (Laugh gas) – A combination of nitrous oxide and oxygen that clients breathe through a nose piece that helps them relax for dental treatment.

Occlusal The chewing surfaces of the posterior teeth.

Occlusion The relationship between the biting surfaces of the upper and lower teeth.

Onlay A cast restoration, that restores the entire occlusal surface, and some of he proximal surfaces, of the tooth.

Operative Dentistry That phase of dentistry which is primarily concerned with the restoration of decayed or fractured tooth structure.

Oral Mucosa The specialized mucous membrane that lines the inside of the mouth.

Oral Pathology That dental specialty concerned with the study of disease processes of the hard and soft tissues of the oral cavity.

Oral Surgery- That dental specialty dealing with the extraction of teeth, and with other surgical procedures on the jaws, oral tissues and adjacent tissues.

Orthodontics- That dental specialty which deals with the causes, prevention and treatment of the irregularities of the teeth and arches.

Osseous- bony

Parotid Glands- See salivary glands
Partial denture- A removable appliance used to replace some but not all teeth in the same arch.

Pedodontics That dental specialty dealing with the diagnosis, treatment, and prevention of dental disorders in children.

Peer review organizations A professionally sponsored and operated system for the rendering of professional judgment on disagreements between or among dentists, patients or third parties relating to quality or appropriateness of treatment and related matters.

Periapical Abscess A localized collection of pus found at the tip of the root of the tooth.

Periodontal Disease (Pyorrhea) Pathology which affects the tissues surrounding the tooth.

Periodontal Ligament A series of bundles of fibers which support and suspend the tooth in its position within the bony socket.

Periodontal Pocket A diseased area in which the gingival sulcus has become greater than 3 mm in depth.

Periodontics That dental specialty concerned with the study, prevention and treatment of diseases in the tissues and bone supporting the teeth.

Periodontitis Gum infection

Permanent Dentition The 32 teeth of the adult which are designed to last a lifetime.

Pit A depression on the biting surface of the tooth.

Planing The use of cleaning instruments to smooth a surface.

Plaque A sticky mass of food debris, dead cells and bacteria that accumulates and grows on the surfaces of the teeth. Plaque causes gum disease and tooth decay.

Pontic A dummy tooth used to replace a missing tooth in a fixed bridge.

Porcelain Jacket Crown A glass like crown used for front teeth very beautiful

Post Operative Treatment A return visit by the patient to check healing and for treatment of any problems that may have arisen as the result of the surgical procedure.

Posterior Teeth Those teeth located toward the back of the mouth. The premolars and molars.

PPO Preferred provider organizations A PPO is a practitioner, institution, or a combination of both that enters into an agreement with a group purchaser of benefits to provide services in a manner that is more economical for the purchaser, the members of the group, or both, than the conventional service delivery arrangement. In return, the purchaser agrees to publicize this agreement to the group members. Unlike “closed panel” alternatives PPO arrangements are not commonly presented to subscribers (employees) as an option to which they must commit themselves for a specified period, but rather as an additional benefit to supplement a benefit program already in place.

Premolars Those teeth which are like the canines in that they have pointed cusps for grasping and tearing; however, they also have a somewhat broader surface for grinding and chewing food. They are sometimes referred to as bicuspids. There are two premolars in each quadrant of the permanent dentition and no premolars in the primary dentition.

Primary Dentition The first 20 teeth of life which will be replaced by the permanent teeth also called deciduous or baby teeth

Prophylaxis The professional cleaning of the teeth to remove all accumulated plaque, calculus, and stains.

Prosthodontics That dental specialty dealing with the replacement of missing teeth and with the replacement of other missing or deformed oral structures by artificial substitutes.

Proximal Surfaces Those surfaces of the teeth in the same arch. Also referred to as interproximal surfaces.

Pulp The sensitive living tissue of the tooth which is made up of nerves and blood vessels held together by connective tissue and is located in the pulp chamber and root canals of the tooth.

Pulp Cap A protective lining placed under filings next to the pulp to allow healing or avoid sensitivity to heat and color.

Pulp Chamber That space in the center of the crown of the tooth that contains the pulp.

Pulp Testing A diagnostic measure to determine the health and vitality of the pulp of a tooth.

Pulpitis An inflammation of the dental pulp.

Pulpotomy The partial removal of the pulp of a tooth.

Quadrants The imaginary division of the mouth into four parts.

Radiographs See X-rays.

Restorative Dentistry See operative dentistry.

Root That part of the tooth which is covered with cementum and which helps to hold the tooth in its bony socket.

Root Canal The continuance of the pulp chamber through the root of the tooth.

Root Canal Therapy Another name for endodontic treatment.

Rugae The wrinkles, or folds of tissue located on the hard palate just behind the anterior maxillary teeth.

Salivary Glands The glands which produce the saliva which provides lubrication and moisture for the mouth. Saliva enters the mouth through the salivary ducts. The three pairs of salivary glands are the: parotid glands, submandibular glands, and the sublingual glands.

Sealants Plastic used to prevent decay in the susceptible pits and fissure areas of the occlusal surface.

Sedative Treatment Treatment to soothe and promote healing.

Silicate Cement A tooth colored restorative material.

Soft Palate The soft tissue posterior portion of the palate.

Space Maintainer An appliance that holds space for the permanent tooth if a primary tooth is lost too early.

Study Casts A plaster model of the patient’s mouth.

Subgingival Under the gums around the tooth.

Sublingual Glands See salivary glands.

Submandibular Glands See salivary glands.

Super Eruption A tooth erupts further than it naturally should.

Supernumary An extra tooth

Tartar Same as calculus.

Temporary Treatment A restoration that is placed as an interim measure until the permanent restoration can be placed.

Temporomandibular Joint The joint where the mandible articulates (hinges) with the skull.

Tofflemire A metal band and retainer system used to replace the proximal walls of a back tooth during its restoration.

Topical Fluorides Application of fluoride solutions directly to the teeth as a means of preventing decay.

Universal Numbering System The tooth identification system officially adopted by the American Dental Association. Permanent teeth are numbered from 1 32. Primary teeth are lettered from A T. (We use a numbering system again for primary teeth)

Uvula The “U” shaped projection of tissue which hangs down from the posterior edge of the soft palate.

X rays Radiographic pictures of the teeth used as a diagnostic tool.

Terminology

Anterior – Front of Mouth
Posterior – Back of Mouth
Deciduous Teeth – Primary or Baby teeth
Edentulous – without teeth
Caries – dental term for decay
Gingiva – tissue around teeth
Periodontitis – Gum disease also called pyorrhea
Interproximal – between teeth
Maxillary – Upper arch
Mandibular – lower arch
Endodontic treatment – root canal therapy

Surfaces of Teeth

Mesial – toward midline of month
Distal – away from midline
Incisal – biting edge front teeth (anterior)
Occlusal – chewing side of bicuspids & Molars (posterior)
Buccal cheek surface & Facial also
Lingual tongue surface
Labial lip surface
Facial same as Buccal and Labial

Dentists

  • Oral surgeon removes teeth
  • Orthodontist does braces & is concerned with malocclusion (poor relationship between upper & lower arch)
  • Pedodontist specializes in children’s dentistry
  • Periodontist handles gum disease & is concerned in supporting tissues of the teeth
  • Endodontist does root canals

To get signed off on this section, you need to understand how the charting works in this office. Both any papers/forms as well as the computer chart. Clinically, you need to be able to treatment plan diagnosed treatment in the computer system  including existing conditions and missing teeth. To practice, choose some existing patients that have completed significant treatment – then enter their treatment into a fake patient.

You should be able to treatment plan all fillings, crowns, bridges, implants, partials, dentures, extractions and all STM. For specialty referrals, you should treatment plan the extraction of wisdom teeth; fillings, stainless steel crowns and extractions for baby teeth; gingival flap surgery; braces for teens, adults, invisalign and phase 1 ortho.

Print the graphical tooth chart and have a top level secretary check your work. To be signed off – do 3 of these samples and then do this for a handful of new patients in for a comprehensive exam. Be sure your dentist knows you did the charting.

Have the highest level person in your career track check you off.
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