Sir,- I am writing in response to the discussion regarding tooth notation in the change in wording of tooth notation in the BDJ (BDJ 2003, 194: 387) and comparisons with the American system. I wish that the system in the United States was as clear as G Belok (BDJ 2003 194: 646) would suggest. Unfortunately, I have to tell you that there is almost as much confusion here as in other places. The Palmer Classification is still widely used in the USA by orthodontists and some general dentists, whilst the so called Universal System (which is actually anything but universal since it is only used in the USA and parts of Canada) is the one that was introduced by the Delta Dental Insurance Company to make their lives easier for billing purposes and has therefore become the standard for insurance billed cases.

As someone who is involved in dental medical legal work in the USA, I am asked for advice several times a year regarding extractions of the wrong tooth because two people used a different classification.

It is generally because the orthodontist used the Palmer Classification whereas the oral surgeon used the Universal Classification and therefore the upper right 4 for the orthodontist is actually tooth number 5 for the oral surgeon.

The Palmer Classification has advantages when you want to compare one side with another, or even all four quadrants, so that you can talk about 'four 8's' or 'four 4's' instead of having to give the individual tooth numbers.

As if that wasn't enough, we now have the FDI Classification which is being taught in many American dental schools and is already starting to be used very selectively in correspondence and even clinically. It may therefore mean that rather than having one system in the USA, we could actually end up with three systems trying to work side by side.

This is just to say that nobody has the right answer with this, but it does appear to me that the FDI system has a lot of sense associated with it and combines some of the better points of the Palmer System and the so called Universal System.