Dental Photography: An Insight

Author: Dr. Honey Singhal

A picture speaks a thousand words, is indeed true for a dental photograph too.

Dental photography is an excellent way to gain access to what is not readily visible. Like other techniques, dental photography is also evolving with need and innovative ideas. Present-day equipment has made it easy and comprehendible for all those who like to achieve a niche for their practice. These equipment are such that it is not necessary to be skilled or experienced in photography and any dentist can easily benefit from the same. Modern technology helps us store the images not just as physical hard copies but also in a digital format.

Why?

A fun fact – ‘Happiness is health and a short memory’ could be true for many aspects of life, but could be problematic for a dentist if patient does not remember what he/she looked like before the aesthetic treatment.

Doctors start their journey with clinical photographs throughout their learning process in books, journals or websites. Documentation is an important aspect practiced by most of the dentists to keep the learning process going. Primary reason for taking patient’s photographs remain diagnosis, but the use of photographic records extends to sharing and comparing during discussions, lectures or in publications. Dental photography is not only a diagnostic tool for initial examination but it has many other rewarding aspects. Information in words has to be visualized to know the case but a few images can bring the case alive and way more understandable.

Dental photography has become an integral part of clinical practice but it also richly employed for marketing purposes by dental practitioners. One would seldom find a dental set-up without any photographs on their walls.

What?

As access to oral cavity is limited, digital dental photography plays an important role in fetching and retaining much more accurate details.

Any patient’s time inside the clinic is limited but patient’s clinical photographs make the patient’s details available at any point of time. Hence it saves time and energy of both the patient and the dental surgeon. It also brings a chance of detailed analysis of the case in particular and also for similar cases for reference in future. Since digital photographs can be easily stored and kept, they become the preferable means.

How?

An accurate dental picture acts as a diagnostic tool which aids in investigation and treatment planning. Role of resolution is very important to gain maximum knowledge of the case from the image itself. Therefore, selection of the camera becomes an indispensable prerequisite to achieve a high-quality photograph.

Photography in a dental set-up can be divided into 2 categories:

Extra-oral photographs are normally taken to analyse the orthodontic alignment of teeth, front and side profile of the patient’s face and to assess visibility of teeth with a smile. 

There is a list of steps to be followed to ensure a good intra-oral image like positioning of the patient, light source, selection of the intraoral mirror, selection of cheek & lip retractors, and preparing the oral cavity:

• Moistening of the patient’s lips is essential before putting in the retractors
• To minimize fogging of the mirror, it is advisable to immerse the mirror in warm water for a couple of minutes followed by drying.
• Counselling the patient to continue breathe through nose
• Retraction of tongue so it does not obstruct the view
• Steady placement of the camera right in front of the patient’s mouth
• Ensuring that light, angle of the camera and distance remain the same in all the pictures

Actual colour of soft tissues and good resolution are two key factors to be undertaken while analysing a dental photograph. Photographs are to be taken more than once for a patient to compare pre and post treatment changes. Patient satisfaction being foremost and of paramount importance, photographs make it possible as it becomes easy to share and discuss visible results with the patient.

Selection of the case for photography: Due to time consumption and elaborate documentation later, all cases are not photographed and kept as records. It is most essential for surgeries and in cases where aesthetics is involved. Growing inclination towards a perfect smile has led to an almost different branch of dentistry commonly termed as cosmetic dentistry. Photographs play a vital role in cosmetic treatments where a ‘before’ and ‘after’ image is a mechanism to mark achieved result.

“Leave a little sparkle wherever you go.” Dentists are not behind in adding more sparkle to the world by creating twinkling smiles with tooth Jewelry. Swarovski, gold or even diamond crystals are available to add more glamour to the smile. When it comes to beauty, it is always showcased and captured via pictures to cherish the look and memories for a long time.

Equipment – Extraoral camera

A DSLR (digital single-lens reflex) camera with a high precision lens is efficient for taking nice photographs. Most of the doctors also prefer a DSLR over a point-and-shoot camera for they lead in properties like supreme image quality and adaptability. The role of light is another significant component which may alter the representation of structures quite varied from as they look like in the mouth. A suitable extraoral camera must have a flash-diffuser, adjustable manual settings, macro lens, and a ring flash.

Intra-oral camera

The most astonishing feature of intraoral cameras is that it helps the doctor to educate his patient about the treatment planning and show results later. These pen-shaped machines are designed with an inbuilt light source which gives easy access to structures which are difficult to assess with naked eye. An intraoral camera can be connected to a display unit via Wi-Fi to have a magnified view. Along with magnification, it has a sensor, built-in memory for storage, LED light for continuous light source, curing light, caries and inflammation detection features. They are light in weight and are also cordless now for a superior user-friendly experience. They have been proven to be useful for better clinical assessment in cases like tooth fracture, marginal defects or fractured fillings.

Photography Contrasters

Occlusal contrasters are designed in a way so as to add subsequent contrast to the image and helps to hide what is not required in the picture. Make the picture more presentable and to retain focus to the main concern. Its black colour efficiently omits unwanted background. They are mostly made up of black anodized aluminium, so can be easily disinfected.

Cheek & lip retractors

Cheek retractors are a necessity for intraoral photography as they provide an unhindered view of the oral cavity by retracting undesired soft tissue structures like lip and buccal mucosa. They are available both in plastic and in metal which could be either be single-ended or double-ended. They come in varied sizes to suit different sizes of the mouth.

Intraoral Mirrors

Intraoral mirrors are crucial and irreplaceable for buccal and occlusal views since a direct view is difficult to capture. They are available in several sizes and also with or without handle to simplify the process of producing an exact image reflection. They are to be handled with care since they are fragile but asepsis is not a concern as they are autoclavable. They have an optical coating on their surface which makes the mirror corrosion resistant, stronger reflectivity and more durable. Most commonly used metal coatings on the intraoral mirrors are of rhodium, chromium and titanium. Rhodium being lighter in colour and resistant to tarnish,  is the most preferred coating in the dental mirrors.

There are also double-sided mouth mirrors and dual dental mirrors to further aid the photography process:

Role of background is also to be considerable when ruling out dentin and enamel shades, shape analysis, translucent masses etc.

Conclusion

With advanced technology and techniques, dentists today can equip themselves with required skills and armamentarium to diagnose, document and treatment plan cases in the most effective manner. It is an undisputable fact that dental photography has manifold applications in oral health care. An added advantage to digital photography is that knowledge and experience now can be easily shared and discussed with other practitioners or for continuing dental education to further propagate development in this field.

Dental photography is imperative and inescapable from the research point of view also, as it keeps the knowledge and experience streaming to dentists today, tomorrow and for coming generations.

Author: Dr. Honey Singhal

She is the content expert at Dentalkart.com. A dental surgeon by profession, a researcher by choice and a writer at heart.  She endeavours to culminate both her skills of dentistry and literature via this platform to enlighten the readers. When not with patients, books and laptop, she is found either chatting with friends in a café or painting a canvas or listening to her favourite music.