Clinical Digital Photography is probably the most important tool for communication in the dental office. Digital photography allows the dental team to educate the patient without having to hold a mirror and try to explain what is being changed or enhanced. Digital photography can be fun and exciting. Everything form patient education to laboratory communication can be expedited with the click of a button. Excellent photography will elevate patient’s records to an entirely new level.

 

Before digital cameras, every dental practice I worked with used the Lester Dine slide camera and slide film (Kodak Ectachrome 100, Kodak Dental Systems). The processing fees could cost as much as 40,000 per year. Many also used intraoral cameras for new patient consultation, which allowed them to be stored in the patients file. However, these pictures were often stored in several different places and the team would have to search the patient’s chart to find them. Not only by using a digital camera, can the costs of film be eliminated, the camera equipment is easy to use and the whole team can be trained.

 

Choosing the right digital camera depends on the goals of the practice. AACD Accreditation, Marketing, Possible Teaching and Education, and Laboratory Communication. The three most popular cameras on the market today:

One of the most important items to remember is to always have more than one card in the office. If something happens to the primary card, there should be a backup. Andy Thompson, who works for Norman Camera Company in Michigan, recommends that for every camera there should be a minimum of two cards. Each team member who uses the camera has their own card. This assigns each team member the responsibility of downloading his/her own pictures. If you should delete all the pictures on the card there is software available that can retrieve the lost pictures. This can be purchased at local camera stores or sent to Norman Camera to restore.

 

Setups are made for specific dental procedures and this can be done for digital photography. The tray setup for taking these pictures consists of the following:

Experimenting with different retractors and mirrors will allow you to decide what works best in your office.

 

When taking portrait photography, choosing the background is very important. Neutral light backgrounds are best. Blue, gray and beige colors are recommended for the contrast between the patient’s hair and background. These can be purchased through Norman Camera or you can make your own. Gluing or taping some photography paper to a piece of 2-in x 3-in foam board. This will create a background that can be held by another team member while shooting these photographs.

This board can also be placed directly behind the patient while they are sitting in the dental chair. If your office has the space, you can also use a shade that can be pulled down when portraits are being taken.

 

The F-Stop must be set before taking the pictures. A higher F-Stop setting will result in a smaller aperture opening. This will restrict light from entering and hitting the computer chip in the camera. Always use the highest f-stop possible to capture the greatest depth of field. Depth of field refers to what portion of the image will be in focus. Portraits will be exposed to f-stops at 5.6 and 6.3 when the patient is far away from the camera and the light. High levels of light are needed for the camera to create a clear image. When taking intraoral photographs, the f-stop should be at 22 and 32 because the camera and the light source are closer to the subject and less light is needed to make a clear image.

 

When prospective patients come in for a new patient consult, we interview them and take digital pictures to aid in communicate the treatment the patient may or may not need. This also allows the team to remember who the patient is if treatment has to be delayed or in case that patient only comes back months or a year after the initial consult. In some practices, these photographs are placed in the front of the patient’s chart so when the chart is pulled, the patient can immediately be recognized by the team. Our office takes four frames: full face, retracted smile, and retracted mirror shots for both the maxillary and mandibular arches.

 

In our office, the standard AACD (Academy of Cosmetic Dentistry)-accredited photographs are used to be consistent with a series of 12 required views. The entire dental team should be trained to take photographs using the same techniques and this standard format will ensure consistency. These 12 requirements were designed and produced specifically to give the dentist guidance related to photographic requirements for the AACD accreditation review presentation. These are 24 slides 12 before and 12 after images. All photographs being submitted for accreditation must be in RAW format which means the pictures can’t be altered. AACD format is listed in table A.

 

This shot is framed horizontally. The full face view should show the top of the head to just below the chin. The nose should be in the center of the portrait which will place head in the center of the frame. The patient should be instructed to stand with straight posture. Some patients like to tuck their chin down; when this occurs place your hand under the patient’s chin and ask them to stick out their chin. This gives the appearance of separation between neck and chin. If the patient blinks in the flash, have them turn their head and count to three, looking ahead on three to take the picture. This will take their mind off the camera. Some patients have difficulty smiling or have an acquired smile as a result of low self confidence or low self esteem. Some common errors are head tilting or the head being outside of the center of the frame. The camera may also be too high or low in relation to the patient.

 

Full Face	Full Smile

 

The central incisors are the focus of the full smile, frontal view. This view should include the corners of the mouth, and the patient should exhibit a full, natural smile. The nose and the chin should not be in the frame, and the smile should show an equal mount of skin and below the lips. The camera should be at the same level as the patient. Encourage the patient to give an exaggerated smile to show as many teeth as possible. Make sure there is no evidence of saliva, food, lipstick, impression material, plaque or other distracting debris in the picture.

 

RIght Lateral View	Left Lateral View

 

The lateral smile view is made with the lateral incisor as the focal point and center of the image. The frame of the picture should include the upper and lower lips, as well as equal amounts of skin above and below the lips. Once again the camera should be at the same level as the patient. The relationship of the anterior teeth to the lower lip is important in the view, as you want to avoid taking this photography like a profile photograph.

 

Retracted Frontal

 

The upper and lower teeth should be slightly parted so the incisal edges are visible. The retractors should be minimally visible and the lips should not approach the frame. The maxillary central incisors are the focal point of this image. The camera lens should be parallel to the plane of occlusion to avoid creating the appearance of occlusal place discrepancies which may not be present. Avoid tilting or off centering the frame, and be sure that the camera is neither too low nor too high in relation to the face.

 

Right Retracted Lateral View	Left Retracted Lateral View

 

The upper and lower teeth should be slightly parted so the incisal edges are visible. The retractors should be minimally visible and the lips should not be in the frame. The frame of this picture should include the upper and lower lips and equal amounts of skin above and below the lips. The camera should be at the same level as the patient. The relationship of the anterior teeth to the lower lip is important in this view. Once again, avoid taking the view like a profile.

 

Treated Teeth Frontal View

 

The upper or lower central incisors (depending on which arch is treated) should be centered in this view. There should be no lip or cheek tissue or retractors visible in the image. The opposing teeth should not be visible in the frame. Be careful that the camera angle is not too low or too high.

 

Right Treated Lateral View	Left Treated Lateral View

 

The right or left lateral incisors (whichever arch is being treated) of the upper or lower teeth should be centered in the frame. There should be no lip or cheek tissue or retractors visible in the image. The opposing teeth should not be visible in the frame. Be careful that the camera angle is not too low or too high.

 

Upper Occlusal Arch

 

The upper arch occlusal view is always taken as a reflected view using a high-quality mirror. The lips and cheeks should be retracted for all the gingiva to be seen in the arch. The distal of the second molars should be in the frame. You should not see any lower teeth in this picture. By using a mirror that has a handle, gloves and fingers will not been seen on the edges of the mirror. Ask the patient to lift the head, with the chin up. This will allow the tongue to relax. The mirror should be placed a little further back for those last molar shots. To keep the mirror from fogging up, run it under hot water. It may also be necessary to blow air across the mirror. Avoid the facial surface being cut off in the frame, and keep the patient’s nose out of the frame.

 

Lower Occlusal Arch

 

The occlusal view is always taken as a reflected view using a high-quality mirror. The lips and cheeks should be retracted for all the gingiva to be seen in the arch and the distal of the second molars should be in the frame. (The mirror should not rest on the lower posteriors since this allows an image of the upper posterior to be in the frame. By using a mirror that has a handle, gloves and fingers will not be seen on the edges. Ask the patient to lift their head, with their chin up. This allows the tongue to relax. The mirror should be placed a little further back for those last molar shots. To keep the mirror from fogging up, run it under hot water. It may also be necessary to blow air across the mirror. Avoid the facial surface being cut off in the frame, and keep the patient’s nose out of the frame.

 

Proper Digital Photography is crucial not only to the esthetic dental office but also for the office reaching for that next level of care, and should become apart of the everyday routine. Without photography, patient will forget how they used to look; I did when I had my own teeth done. Heaven forbid you should ever have to go to court. Remember there is no better record than a photograph. It is important and should become apart of your everyday routine.