Robert E. Horseman, DDS

The Great Debate

Whether to assess each ADA member $300 for the next three years to finance a nation-wide advertising campaign or not, that is today's burning question. And the answer is: 1. You bet! Best idea the ADA ever had! 2. Absolutely not! I'm not giving $300 over to such an ill-founded notion!

This is dentistry at its finest, two opposing factions thoughtfully proposing their views in an atmosphere of give and take and mutual respect, not unlike Israel and Palestine. A profession founded on the Scientific Principle can do no less than question everything, whether it be political or technical, didactic or clinical. For example, the Great Reciprocity Debate, now in its 100th year, has united us all in our amicable attempts to discover if Dental School A in State 1 graduates dentists comparable to those from Dental School B in State 50. If so, then should we allow those malcontents from State 1 to invade our sovereign state? Yes! No! And the beef goes on.

Out of all the debates dentists have had with each other over the years, only one springs to mind as having had a reasonably satisfactory conclusion and it took a war to do it. This had to do with the assignment of a designation, universally recognized, to each of the 32 teeth. It was initially acknowledged that there were, in fact, 32 separate teeth and that each of them should have a name if we were to have any sort of intelligent conversations about them. That was the only point that all parties could find mutually acceptable. An inkling of what lay ahead could be seen when some fancied the name "pre-molars" and others kind of liked "bicuspids" The people who wanted to refer to them as "those two ones just back of the eye tooth" found favor with neither camp. The "cuspid" people bickered with the "canine" crowd, while in the background the "3rd molar" faction snickered at the "wisdom tooth" bunch as being no more dedicated to science than the Tooth Fairy fans.

Things came to a head in Chicago in 1878 at a meeting of dental leaders to determine, once and for all, how to properly differentiate one tooth from another. It was, predictably, a disaster. Delegates had to be restrained from physical contact with one another and cries of "Moron" and "Fathead" could be heard above the din. Families were split asunder, brother against brother, father versus son like the Civil War a decade or so earlier. The upshot was that at least three or four tooth numbering systems, each with its vociferous adherents, became deeply entrenched.

My own dental school, in its infinite wisdom, insisted on drilling this premise into its 1939 freshman class: There are four quadrants in the mouth. Each quadrant has eight teeth. Each of these teeth has a partner lurking in another quadrant someplace. So the maxillary (upper) central incisors (front teeth) shall be "1," the lateral incisors (those littler ones next to the big front one and between it and the cuspid (eye tooth/canine) will be "2," etc. back to "8" (3rd molar/wisdom tooth).

Everybody with me so far, students? All righty then, same thing with the mandibular (lower) teeth. Now all we've got to do is figure out how to tell right from left, upper from lower. Here's how: we draw a little bracket like this around the tooth number. So then number "1" has four possibilities. 1 is the upper right central, 1 is the lower left central, etc. In Dental School X the freshman class is being taught the same thing except 1 is the upper left central at that school. This is the same camp that insists on viewing x-rays with the dimple towards the viewer, another area of dissension.

At some point any student with an IQ higher than shrubbery would immediately wonder why all 32 teeth just didn't get a number from one to 32, starting with the upper right 3rd molar and ending with the lower right 3rd molar. No, wait, starting with the upper left 3rd molar, or maybe the lower right 3rd molar. Well, the hell with it, he's only a dental student, what does he know?

In the meanwhile, there are at last count 20 deciduous (baby) teeth waiting to be assigned. We can't have quadrant numbers here, they've already been used, so we'll have four "As" four "Bs," and so forth back to four "Es." The same bracket system is used depending on whether your left is the patient's left or his right. Or your right. A numbering or lettering system from A to T is too simple--unthinkable.

So after about a hundred years or so, we've got that ironed out to the point where most of us agree that "1" is the upper right 3rd molar, "A" is the upper right 2nd deciduous molar. Blessed are those dentists who attended school after WW II when this foolishness was resolved. Regardless, I have no doubt that somewhere is a dentist still busy making little brackets around teeth and confusing the heck out of an oral surgeon asked to extract number 5.

That's what's so unique about our profession, nobody is going to tell us rugged individualists what to do or how to do it, except HMOs, PPOs, DPOs and the government. We don't need any outside help in generating dissent and confusion, we can do it ourselves. Now, about that $300.