House Mental Classification System of Denture Patients: The Contribution of Milus M. House

The House classification of complete denture patients has been available to the dental profession from early in the last century and is used to the present day. Advanced education students in prosthodontics, along with undergraduate dental students, have been taught and perhaps questioned about this system on oral and written examinations. The classification system has been cited on numerous occasions in the literature, dental textbooks, and presentations before dental societies and prosthodontic specialty groups. The classification system is based on how patients react to the thought of becoming edentulous and how they adapt to complete dentures. Although attributed to Dr Milus M. House, the origin of this classification system can be questioned.

The House classification system is described in detail in a chapter by S. Howard Payne1 in John J. Sharry's textbook Complete Denture Prosthodontics. Payne attributes the classification to unpublished notes of “Study Club No. 1” on “Full Denture Technique” in 1937. Rahn and Heartwell2 list the classification in their textbook and footnote the narrative with “Lecture by M. M. House.” Craddock3 mentions the classification system in his textbook but provides no reference. Landa4 briefly mentions the classification system in his textbook but does not credit anyone with its origin.

In an article published in 2003 in the Journal of Prosthetic Dentistry, Gamer et al5 credit Dr House with devising the classification system in 1950. Their reference is from Classic Prosthodontic Articles, volume III, published by the American College of Prosthodontists.6 The source of the classification system is Full Denture Technique by Dr M. M. House, “prepared from the notes of: Study Club No. 1, by Francis J. Conley, A. Laurence Dunn, A. J. Quesnell, Ralph M. Rogers, supervised by: Dr. M. M. House, September, 1950.”

House7 published his classic article “Studies in Prosthesis” in the Journal of the American Dental Association in 1931. This article contains no mention of a classification system. Another classic manuscript by House,8 “Art—A Fundamental in Denture Prosthesis,” which appeared in the Journal of the American Dental Association in 1937, also does not mention a classification system. An extensive review of the literature did not find any publication by House that describes a classification system for complete denture patients.

The House classification system places complete denture patients into 4 groups, philosophical, exacting, hysterical, and indifferent, depending on their psychological make-up, experiences, difficulties, and expectations. The philosophical patient is well balanced and depends on the dentist for proper diagnosis, prognosis, treatment, and education or has worn satisfactory dentures and may be in need of further treatment. The exacting patient is concerned about the appearance and efficiency of complete dentures, reluctant to accept the advice of the dentist, and opposed to the extraction of any remaining natural teeth. The exacting patient can also be wearing dentures unsatisfactory in esthetics and function and doubts the ability of the dentist to render a satisfactory service. The exacting patient can request a written guarantee or expect the dentist to make repeated attempts at satisfaction without the payment of additional fees. The hysterical patient is in bad health, has neglected his or her mouth, but submits to the removal of any remaining teeth. This patient is sure he or she will never be able to wear complete dentures. The hysterical patient can also have been unsuccessful in wearing complete dentures and now demands perfection that is unobtainable. The indifferent patient is unconcerned about appearance and does not care about ability to masticate food. This patient will not attempt to learn how to wear and function with complete dentures.

In 1932 Dr Ewell Neil9 wrote a small text entitled Full Denture Practice. Dr Neil began his book with a mental classification of denture patients, similar to that credited to House. Neil writes, “The patient's mental attitude may be classed under one of four possible groups, viz., hysterical; exacting or hypercritical; indifferent; and philosophical.” Neil then describes representative patients in each of these groups.

Dr Neil was professor of prosthetic dentistry at Meharry Dental College from 1904 to 1917 and then taught at Vanderbilt University from 1917 to 1920. At Vanderbilt, he served as associate professor of prosthetic dentistry and was a special lecturer in block anesthesia. He later became a consultant to Coe Laboratories Inc and trained a number of dental laboratory technicians for the Certified Akers Laboratories group. He also presented many lectures on complete denture prosthodontics to the profession sponsored by Coe Laboratories Inc. Neil10 wrote another small text, entitled The Upper and the Lower, which was published in 1941 by Coe Laboratories Inc. Neil's classification system is not included in this small book.

It is not known whether House credited Neil for his original description of the mental classification of denture patients during his many lectures, seminars, and continuing education courses for the profession. There is no doubt that House expanded and popularized the system, which was originally introduced to the profession in 1932 by Neil.

House is also known for his articulator, designed in 1927, which was made by The Dentists' Supply Company of New York, York, Pa (Figure). This fully adjustable instrument contained a rotary grinder that was permanently attached to the upper member. The grinder could be used as a milling device to mill in a ⅓-in elliptical area to free the occlusion.

The instrument is adjusted by means of a Needles-House “chew-in,” which uses 4 metal studs in the maxillary occlusal rim and generates diamond-shaped pathways.11 The rotary grinder could also be mounted on other specially designed articulators, including the Hanau and Gysi. The grinder is powered by a belt drive from a bench engine or laboratory lathe. The House articulator is no longer being manufactured.

A search of the literature suggests that Dr M. M. House was not the first to describe the mental classification system of denture patients for which he is credited. His contribution appears to be a detailed expansion of the classification and popularization of the system. Neil described the system initially in his textbook Full Denture Practice, which was published in 1932.