HOUSE MENTAL CLASSIFICATION SYSTEM OFDENTURE PATIENTS: THE CONTRIBUTION OFMILUS M. HOUSE

Sheldon Winkler, DDS

KEY WORDS

M. M. HouseEwell NeilClassification systemComplete denture patients

Sheldon Winkler, DDS, is professor ofRestorative Dentistry at Temple UniversitySchool of Dentistry, 3223 North BroadStreet, Philadelphia, PA 19140-5096(e-mail: swinkdent@aol.com). He formerlyserved as professor and chairman of theDepartment of Prosthodontics at TempleUniversity.

Although Dr Milus M. House is credited with devising a method to

describe the mental classification of complete denture patients,

a review of the literature raises questions regarding the origin of

the system. Dr Ewell Neil should have received credit for developing

the classification system attributed to Dr House. The contribution of

Dr House appears to be a detailed expansion of the classification and

the subsequent popularization of the system.

The House classifica-tion of completedenture patientshas been availableto the dental profes-sion from early in

the last century and is used to thepresent day. Advanced educationstudents in prosthodontics, alongwith undergraduate dental stu-dents, have been taught andperhaps questioned about thissystem on oral and written ex-aminations. The classificationsystem has been cited on numer-ous occasions in the literature,dental textbooks, and presenta-tions before dental societies andprosthodontic specialty groups.The classification system is basedon how patients react to thethought of becoming edentulousand how they adapt to completedentures. Although attributedto Dr Milus M. House, the originof this classification system canbe questioned.

The House classification sys-tem is described in detail ina chapter by S. Howard Payne1

in John J. Sharrys textbook Com-plete Denture Prosthodontics. Payneattributes the classification to un-published notes of Study ClubNo. 1 on Full Denture Tech-nique in 1937. Rahn and Heart-well2 list the classification in theirtextbook and footnote the narra-tive with Lecture by M. M.House. Craddock3 mentions theclassification system in his text-book but provides no reference.Landa4 briefly mentions the clas-sification system in his textbookbut does not credit anyone withits origin.

In an article published in 2003in the Journal of Prosthetic Dentistry,Gamer et al5 credit Dr House withdevising the classification systemin 1950. Their reference is fromClassic Prosthodontic Articles, vol-ume III, published by the Amer-ican College of Prosthodontists.6

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CLINICAL

The source of the classificationsystem is Full Denture Techniqueby Dr M. M. House, preparedfrom the notes of: Study Club No.1, by Francis J. Conley, A. Lau-rence Dunn, A. J. Quesnell, RalphM. Rogers, supervised by: Dr. M.M. House, September, 1950.

House7 published his classicarticle Studies in Prosthesis inthe Journal of the American DentalAssociation in 1931. This articlecontains no mention of a classifi-cation system. Another classicmanuscript by House,8 ArtA Fundamental in Denture Pros-thesis, which appeared in theJournal of the American DentalAssociation in 1937, also does notmention a classification system.An extensive review of the liter-ature did not find any publicationby House that describes a classifi-cation system for complete den-ture patients.

The House classification sys-tem places complete denturepatients into 4 groups, phil-osophical, exacting, hysterical,and indifferent, depending on

their psychological make-up, ex-periences, difficulties, and expec-tations. The philosophical patientis well balanced and depends onthe dentist for proper diagnosis,prognosis, treatment, and educa-tion or has worn satisfactorydentures and may be in need offurther treatment. The exactingpatient is concerned about theappearance and efficiency of com-plete dentures, reluctant to acceptthe advice of the dentist, andopposed to the extraction of anyremaining natural teeth. The ex-acting patient can also be wearingdentures unsatisfactory in es-thetics and function and doubtsthe ability of the dentist to rendera satisfactory service. The exact-ing patient can request a writtenguarantee or expect the dentist tomake repeated attempts at satis-faction without the payment ofadditional fees. The hystericalpatient is in bad health, hasneglected his or her mouth, butsubmits to the removal of anyremaining teeth. This patient issure he or she will never be able

to wear complete dentures. Thehysterical patient can also havebeen unsuccessful in wearingcomplete dentures and now de-mands perfection that is unob-tainable. The indifferent patient isunconcerned about appearanceand does not care about abilityto masticate food. This patientwill not attempt to learn howto wear and function with com-plete dentures.

In 1932 Dr Ewell Neil9 wrotea small text entitled Full DenturePractice. Dr Neil began his bookwith a mental classification ofdenture patients, similar to thatcredited to House. Neil writes,The patients mental attitudemay be classed under one of fourpossible groups, viz., hysterical;exacting or hypercritical; indiffer-ent; and philosophical. Neil thendescribes representative patientsin each of these groups.

Dr Neil was professor of pros-thetic dentistry atMeharry DentalCollege from 1904 to 1917 andthen taught at Vanderbilt Univer-sity from 1917 to 1920. At Van-derbilt, he served as associateprofessor of prosthetic dentistryandwas a special lecturer in blockanesthesia. He later became aconsultant to Coe LaboratoriesInc and trained a number ofdental laboratory technicians forthe Certified Akers Laboratoriesgroup. He also presented manylectures on complete dentureprosthodontics to the professionsponsored by Coe LaboratoriesInc. Neil10 wrote another smalltext, entitled The Upper and theLower, which was published in1941 by Coe Laboratories Inc.Neils classification system is notincluded in this small book.

It is not known whetherHouse credited Neil for his orig-inal description of the mentalclassification of denture patientsduring his many lectures, semi-nars, and continuing education

FIGURE. The House articulator. Note the rotary grinder permanently attached to theupper member.

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courses for the profession. Thereis no doubt that House ex-panded and popularized thesystem, which was originally in-troduced to the profession in 1932by Neil.

HOUSE ARTICULATOR

House is also known for his artic-ulator, designed in 1927, whichwasmadebyTheDentists SupplyCompany of New York, York, Pa(Figure). This fully adjustable in-strumentcontainedarotarygrinderthat was permanently attached tothe upper member. The grindercould be used as a milling deviceto mill in a 40100-in elliptical area tofree the occlusion.

The instrument is adjustedby means of a Needles-Housechew-in, which uses 4 metalstuds in the maxillary occlusalrim and generates diamond-shaped pathways.11 The rotarygrinder could also be mountedon other specially designed artic-

ulators, including the Hanau andGysi. The grinder is powered bya belt drive from a bench engineor laboratory lathe. The Housearticulator is no longer beingmanufactured.

CONCLUSION

A search of the literature suggeststhat Dr M. M. House was not thefirst to describe the mental classi-fication system of denture pa-tients for which he is credited.His contribution appears to bea detailed expansion of the clas-sification and popularization ofthe system. Neil described thesystem initially in his textbookFull Denture Practice, which waspublished in 1932.

REFERENCES

1. Payne SH. The person. In: SharryJJ. Complete Denture Prosthodontics.

3rd ed. New York, NY: McGraw-Hill;1974:10.

2. Rahn AO, Heartwell CM Jr. Text-book of Complete Dentures. 5th ed. Phila-delphia, Pa: Lea & Febiger; 1993:131132.

3. Craddock FW. Prosthetic Dentistry.2nd ed. St Louis, Mo: CV Mosby; 1951:51.

4. Landa JS. Practical Full DentureProsthesis. 2nd ed. Brooklyn, NY:Dental Items of Interest Publishing Co;1958:20.

5. Gamer S, Tuch R, Garcia LT. M. M.House mental classification revisited:intersection of particular patients typesand particular dentists needs. J ProsthetDent. 2003;89:297302.

6. Classic Prosthodontic Articles. VolIII. Chicago, Ill: American College ofProsthodontists; 1978:124.

7. House MM. Studies in prosthesis.J Am Dent Assoc. 1931;18:827852.

8. House MM. Arta fundamentalin denture prosthesis. J Am Dent Assoc.1937;24:406422.

9. Neil E. Full Denture Practice.Nashville, Tenn: Marshall & Bruce;1932:15.

10. Neil E. The Upper and the Lower.Chicago, Ill: Coe Laboratories; 1941.

11. Scandrett FR. Articulators incomplete denture construction. In: Win-kler S. Essentials of Complete DentureProsthodontics. 2nd ed. St Louis, Mo:Mosby-Year Book; 1988:145.

Sheldon Winkler

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