Create a Bridge of Trust Between You & Your Patients

Using digital in patient communication

By Robert D. Shorey, DDS Human beings are incredibly visual. used to reveal the condition of teeth during a Nearly half the human brain is dedicated to patient’s dental visit. The intraoral video sys- interpreting visual information. “Seeing is tems are generally awkward to maneuver and believing” is a metaphor that has stood the the close-up nature of these images is often test of time as a testament to the persuasive confusing to the patient. Moreover, many power of visual communication. Most den- patients have difficulty understanding the tists understand trust is a vital part of provid- orientation of the viewed image in the mouth ing quality care to our patients; a foundation and usually don’t want you to produce fur- Digital imaging can be a for trust is connecting with your patients ther images that will no doubt show other through unambiguous and honest communi- problem sites. The digital SLR with cation. Digital-clinical photography is clear macro-lens is a powerful alternative to intra- powerful communication and understandable communication that can oral videocams. The digital SLR lens allows a help dentists better connect with their greater panoramic view (i.e. full arch) of the oral cavity with clarity and high resolution patients. Using during helping your patient understand the anatomy tool to help create a bridge your new patient examination will support and orientation of the subject area. The your clinical findings discussion. high resolution allows you to considerably You don’t need special proprietary soft- of trust between you and magnify images to achieve a close-up view for ware to make digital photography an integral further illustration. part of your daily practice of dentistry. What is different about clinical digital Windows XP, more than previous PC operat- your patients that supports photography compared to the commonly used ing system platforms, has been optimized for intraoral videocams? Some advantages to clin- digital photography. The ability to efficiently ical photography over videocam imaging: import images from your , 1. Higher resolution; and therefore, greater your verbal communication. store and view those images is easily accom- image definition than videocams. plished without special software. Current 2. With appropriately composed clinical digital SLR (single-lens reflex) Macro images the digital clinical image pro- Photography are now an affordable vides easier-to-understand patient ori- adjunctive tool for your clinical diagnosis. entation of the teeth being viewed. The information gained through the use of The full-dental-arch image can be clinical photography may prove to be as viewed in total, and then magnified for important for diagnosis and communication closer viewing and details. Viewing as study models and dental radiography. teeth in the mouth becomes an easy-to- Oral imaging is not a completely new read road map for most patients. concept. Since the 1980s, intraoral video- 3. Portability to multiple treatment rooms is cams and close-up Polaroid photos have been equal or better than intraoral videocams.

48 dentaltown.com May 2006 4. Images can be easily imported into most ond camera is a Digital SLR with Macro Lens Process Sequence dental software or computer file folders and ring . Fuji, Nikon and Canon using an USB (universal serial bus) port are top providers of these cameras. Dental connection or memory card reader. macro photography requires a 90 to 105 mm 5. The cost of a quality digital SLR macro lens. with Macro Lens and is Some prosumer cameras have been specif- generally half of a typical intraoral ically outfitted by dental specialty companies videocam system. to also shoot intraoral clinical photography. Here are some disadvantages to clinical The main advantage to a Digital SLR camera photography compared to intraoral videocams: over the prosumer digital cameras is the SLR camera, lip retractors and photo- 1. You need computers in the examina- greater that can be achieved graphic mirrors. tion operatories to take full advantage with the Digital SLR lens systems. Most pro- of efficiently viewing digital images. sumer cameras have limited f-Stop () 2. You must learn how to acquire intrao- settings. A limited f-Stop is not generally a ral using photographic problem for regular distance and facial pho- dental mirrors, appropriate lens mag- tography; however, with a limited aperture nification and proper lighting. setting for close-up macro photography the 3. The camera body may be cumber- subject tooth may be in perfect while some for small-framed dental assis- the teeth behind and in front of the subject tants and dentists. quickly drop out of focus. A digital SLR will Utilizing the American Academy of provide an f-Stop of 28-32, which allows for Cosmetic Dentistry standards for clinical the proper depth-of-field focus needed for photography is one of the most ideal system- intraoral close-up images. This means the Doctor and assistant taking occlusal image atic methods of acquiring clinical images. If teeth at both the front and the back of the of patient’s teeth. you wish to limit your time gathering clinical mouth will be in focus. images, using three popular views from the Our office staff will generally take a clin- AACD photography regimen can impart a ical photographic series during adult new- mountain of useful clinical information for patient examinations. We set aside about an patient and dentist discussion of clinical find- hour and a half to provide visual charting of ings. I recommend using the upper occlusal, the restorative, occlusion and joint-function, lower occlusal and anterior views as a good oral-cancer screening and periodontal find- starting regimen. ings; as well as take a complete series of radi- The efficiency of making dental photog- ographs. The last step of our examination Transfer images to computer using CF raphy a regular part of your daily clinical rou- process is the clinical series. card reader. tine requires practice. Here are some tips that During the examination process we promise may help to make things more efficient. our patients we will turn our dental charting Have staff members practice on each other jargon into regular plain English as we review until an efficient routine is established. Use their dental photographic images. two cameras so that you don’t have to make To share our clinical digital photos our substantial changes in your camera office uses a wall-mounted computer monitor speed and aperture settings during your pho- for patient viewing while he/she is reposed in tography shoots. I use one (less expensive) our examination operatory. This arrangement camera set to its automatic setting for my allows us to gather clinical information portrait (full facial) views of my patients. You including digital photos and share some of our Move images into patient image file folder. can use a good-quality, box-style camera (4 findings with our patients using the three MegaPixel or greater) or a good quality pro- predominant clinical views. The occlusal sumer, which means a quality between “pro- views allow us to provide a tour of our fessional” and “consumer,” (permanently patient’s mouth like an oral road map review attached lens) digital camera for these photo- of our clinical findings. A brief discussion of graphs. Sufficient lighting in your operatory anatomic orientation sets the stage for a com- will be necessary; plus the use of a blue or plete visual discussion. It is difficult to impos- black flat finish background (placed behind sible for our patients to ignore the close rela- the patient) to produce quality photographs tionships that make up the comprehensive without heavy shadows and dental equip- nature of oral health. The concept that only Review images with patient using WinXP ment showing in the portrait images. My sec- one tooth has a problem is less distinct while Image Viewer.

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Recommendations for Tips I’ve Learned Equipment Needed: Clinical Photography the Hard Way

• Digital SLR equipped with Macro Digital SLR Camera • Digital SLR Camera – The photo- Lens and Ring Flash • Canon 20D, 30D, Digital Rebel, graphic mirrors used in digital clinical • Lip retractors Digital Rebel XT with 100mm macro photography scratch easily when • Intraoral photographic mirrors lens and 14EX Flash system rubbed with most soft cloths or paper • Microsoft Win XP Professional • Nikon D70, Nikon D50 with Nikkor towels. Purchase micro-fiber towels (Multimedia Edition or Home 105 mm Macro and Nikon R1 ring from an automotive store or Costco Edition) flash or SB29 TTL ring flash to wipe your mirrors – they are non- • Windows XP with XP Image Viewer • Fuji S2 or Fuji S3 Pro 105 mm Macro abrasive and will polish the mirrors and • Digital memory card reader or and Nikon SB29 TTL ring flash without making scratches. USB port • Monitor mounted conveniently for Prosumer Camera • Presentation Tip Pearl –When using patient and doctor viewing (for secondary portrait camera): the operatory monitor to display an • Canon PowerShot G6, Canon intraoral image the use of your mouse PowerShot Pro1 pointer is adequate, but you can • Konica Minolta Dimage Z5 enlarge your mouse pointer size using • Sony Cyber-Shot DSC-H1 windows “system settings” or you can use a separate laser pointer for greater emphasis. (for secondary portrait camera): • Nikon CoolPix 5600

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other issues become clearly apparent using a clinical diagnostic findings to your patients for complete occlusal photographic view. Digital cases with minimal to moderate treatment Photography lends substantial support to the con- needs. Complex treatment needs will require cept of comprehensive oral health. additional planning, review of diagnostic This anterior view illustrates the type of models as well as further review of radiographs clinical images we project on our mutually- and clinical images. The case we have used in viewed computer screen. It is important to this demonstration actually has complex use the tools available such as the magnifier needs; for instance, as we start to look more Image from patient/op computer and rotation tools. These menu tools are closely at our patient’s occlusion, lack of pos- monitor for mutual doctor/patient used to zoom down for closer views or rotate terior bite support and heavy occlusal wear on viewing. images when necessary. the left side. Such needs will ultimately neces- Using Win XP viewer and its magnifier sitate a comprehensive consultation visit. The tool allows the close-up view seen in the ability to clearly demonstrate substantial needs second photograph on this page. This image facilitated our patient’s acceptance of schedul- easily and with good definition shows extru- ing a consultation visit before moving ahead sion of #15 and the leakage of the existing with any treatment. We will utilize our images amalgam filling is clearly evident. Notice with PowerPoint presentation software to cover how you are drawn to the recession on #10 in the full comprehensive treatment suggestions at a the same image. As a dentist you might addi- future visit with this patient. tionally discuss the bite characteristics. The In summary: Magnified view of image above. comprehensive issues exceed the capacity to Anterior Image for patient viewing view only one tooth at a time which draws Visual communication, such as digital photography, is a powerful, persuasive medi- and discussion. your patient to a more complete view of his/her oral health condition. um that can be used during your initial We next project the upper occlusal view. patient examination. Again we will use the magnifying tool to look It is my opinion that digital photography more closely and reveal our clinical findings is more conducive to a comprehensive treat- to our patient. ment perspective than intraoral video-cam Notice how easily the broken tooth can be imaging and has greater resolution and clarity. examined. We can describe the additional Making clinical photography a regimented cracks on the mesial ridge as well as the evi- portion of your complete clinical examination dence of leakage around the filling. The will provide communication tools that can be patient can see the many weakened areas and shared with your patient to substantiate your Upper occlusal view mirror image. begins to understand why this tooth cannot be clinical findings. After treatment is delivered, refilled. The canine tooth has decay at the mar- the photographs provide clear clinical evidence gin of its filling that is easy to discuss and is to dental insurance, substantiating benefit effortlessly noted while looking at the molar. claims as well as excellent visual communica- Evidence for treatment needs viewed on tion for any laboratory procedures requiring the contra-lateral side of the mouth is easily shade, shape and surface texture matching. demonstrated. The idea of treating these teeth one tooth at a time seems less appropriate to Resources: “Digital Photography” by Michael Wright your patient when restorative needs and teeth “Digital Photography Hacks” by Derrick Story proximity are clearly seen and understood. A “Digital and Conventional Dental Photography, Close-up of image right side review of the lower occlusal view would be A Practical Clinical Manual” by Irfan Ahmad (mirror image). performed in a similar manner. Photographic Information Website – Utilizing clinical digital images at the ini- http://www.steves-digicams.com Dental Photographic Guidelines – American Academy of tial patient examination visit is a useful and Cosmetic Dentistry https://www.aacd.com/credential- powerful method of communicating your ing/resources/guides_order.aspx

Dr. Shorey maintains a private practice in Roseville, Calif. He gradu- ated from the University of Southern California School of Dentistry. He is a member of the American Academy of Cosmetic Dentistry.

Close-up occlusal view left side.

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