by David Gane, DDS, BSc (Hons)

Many dentists today are taking a serious look at digital photography. At least one industry poll indicates that large numbers of dentists are planning to purchase a digital camera for their practice in the very near future. This growing trend toward digital imaging makes solid fiscal sense. Effective patient communication is fundamental to the success of the modern dental practice, and digital photography is a highly effective communications tool. It can assist dentists in building stronger relationships with patients and cultivating greater case acceptance, since an educated patient is more likely to accept treatment recommendations.

Today's high-resolution digital cameras are also affordable. Dentists can expect high-quality images at a reasonable price, and the cost of storage media is lower than ever. Moreover, after the initial purchase of the equipment, the return on investment is relatively swift, because digital cameras are inexpensive to operate.

With such clear benefits, it's no wonder dentists are eager to learn more about how to use digital photography in their practices. This learning curve has three stages:

1. Using the equipment. Generally, the user manual, video tutorials, and manufacturer's customer support services will help with this step.
2. Learning which views to shoot and establishing a routine and protocol for capturing them. In most cases, dentists are encouraged to capture a standardized series of views, which includes full face and profile, smile and retracted views of the dentition, and associated anatomy. Maxillary and mandibular occlusal views are also highly desirable. Most practices will assign this task to an assistant or hygienist to incorporate the digital photography session into the office's routine for new-patient appointments or a subsequent records appointment.
3. Using the pictures. This is when the practice harvests the material benefits of digital photography. In fact, once a dental practice has incorporated digital photography routinely into its patient processing, images can play a fundamental role in virtually every aspect of patient care, from diagnosis and treatment planning through case presentation, to insurance, specialist referrals, and laboratory communication.

Diagnosis
Virtually all dentists are aware of the power of co-diagnosis. When a patient and a dentist learn together what the treatment needs are, the patient is far more likely to accept the recommendations of the dentist. Traditionally, co-diagnosis is accomplished in real time with a hand-held patient mirror. But because digital photography lets dentists generate images immediately, it effectively supports a similar function in today's dental practice. During an initial visit, display images of a patient's teeth on a computer screen. The patient can discover, in striking color, the need for any restorative or aesthetic treatments.

This application is particularly useful in regard to aesthetics, which is often a matter of personal taste and individual preference. By viewing photographs with the patient, the dentist can gather valuable information about possible aesthetic treatments as well as the patient's desires and expectations of such a treatment.

Establishing a protocol to incorporate digital photography as a diagnostics tool need not be complicated. For practices with computers in their operatories, it's simply a matter of downloading the images to a computer and calling them up chairside. Other practices can set up a computer in a treatment consulting area and view them there. Transferring the images from camera to computer is not difficult. For example, with the Kodak DC 290 Dental Digital Camera, it's possible to transfer images using a removable compact flash memory card. With this technology, the camera itself doesn't have to be used to perform the computer download. One staff person could be transferring images to a computer while another is capturing shots of another patient in a different operatory. This camera, as well as others, also allows images to be downloaded by connecting a cable to the computer's USB port.

Digital photography also enables dentists to enhance other aspects of the diagnostic process. Images can be forwarded easily to specialists, for example. This lets the dentist send complete information about the patient's status and treatment goals. For example, when referring a patient to a periodontist for crown lengthening of an anterior tooth, the dentist could include a simulation of the expected results. This ensures the dentist, periodontist, and patient work as a team with a clear vision of the intended outcome.

To use digital images for referrals, they may be emailed, or printed and mailed in hardcopy form. The former option has the advantage of immediacy. Since today's digital cameras support saving files in standard formats such as JPEG, the images will be universally accessible. Using hardcopy has the advantage of forming a physical record of the referral. For this approach, most dentists will do well to choose a photographic-quality inkjet paper, such as Kodak's DMI inkjet paper for glossy-finished, professional prints.

Finally, digital photography can be used diagnostically to track hard- and soft-tissue pathologies over time with incredible accuracy and color fidelity.

Treatment planning
During treatment planning, it is valuable to have patient images on file. No matter how good the memory of the doctor or the completeness of his or her notes, there is no substitute for having full-color digital images of the patient's teeth on hand for treatment planning. Used in conjunction with radiographs and study casts, images are especially effective for dentists who are interested in comprehensive treatment planning.

Case presentation and treatment simulations
As previously mentioned, a patient who is effectively educated about his treatment needs is far more likely to accept treatment than one who isn't. There is no better way to educate people than with pictures. Case presentations that make use of digital photography are powerful and efficient — the images allow patients to 'see the dentist's words" clearly without ambiguity. The images act as silent motivators compelling patients to accept treatment and better understand their treatment options. This serves as an important practice-building strategy.

Visual case presentations can accomplish two objectives: They can show patients the current conditions of their teeth, and, with specialized treatment-simulation software such as DICOM Imaging Systems Simulator software, they can show patients what can be achieved through restorations or aesthetic treatments such as porcelain veneers or tooth whitening.

Dentists can choose from a number of media for presentations. A computer slide show provides a series of images of the patient before a proposed procedure, followed by images showing the expected outcome. Slide shows can be automated or controlled by an operator. ImagExplorer, also available from DICOM Imaging Systems, is an example of a custom image-management software application that enables dentists to create real-time slide show presentations quickly.

Using such programs is easy. Operations are all mouse-driven, point-and-click. In ImagExplorer software, all images in the database are displayed in thumbnails, making it easy to identify which are suitable for the slide show. Simply select the appropriate images, insert them into a sequence, and the presentation is ready to run.

Another option for creating slide shows is to import the images into an off-the-shelf program such as Microsoft PowerPoint. PowerPoint slide shows can be enhanced further by using custom "dentist-designed" case presentation templates such as those created by Dr. Michael Couch, of Orlando, Fla., or Dr. Tony Soileau, of Lafayette, La. These can assist to create and display highly personalized and very professional treatment presentations.

Once the presentation is created, it can be viewed on a computer monitor or, using a signal converter, a standard television screen.

Case presentations also can be delivered in hard-copy form. Simple "before-and-after" images may be enough to educate patients in some instances, such as for whitening. Hard copies have the advantage of being portable; patients can take them home to share with other decision-makers. Dentists can create stand-alone prints or import the images into word-processing documents. For creating prints, a computer isn't necessary. For example, the printer sold with Kodak's digital photography kit will print directly from the camera's compact memory card. Using word processors is also simple. Just follow the menu prompts to insert a picture into a document, then select the image. Again, using high-quality photo paper ensures professional hard copies of the proposed treatment outcome — and from a patient's perspective, the quality of the case presentation is a reflection of the quality of the dentist's work.

Many dentists choose case presentations that involve treatment simulations using images to show patients what their smiles will look like after a restoration or aesthetic procedure. Simulations can be used to depict the benefits of tooth whitening, amalgam removal, tooth replacement, veneers, and more. In most cases, I recommend that simulations be created beforehand, when the patient is not present. The exception is tooth whitening. Simulation software enables dentists to show patients, on the fly, how their teeth would appear if whitened.

Other uses of digital images
Using images for diagnosis, treatment planning, and case presentation alone provide decided benefits to dental practices. Images can support efficiencies in other areas as well. They can be used for more efficient record keeping, for communicating with dental laboratories, and for in-house marketing activities such as "cavity-free clubs" for kids and building Web sites. Another valuable use is for documentation for insurance benefits, particularly when radiographs do not document a condition clearly, such as a missing cusp.

Regardless of the application, images function efficiently. Once captured, they are available for any number of uses, with little extra handling by staff members. By conveying comprehensive information in a compact form, they enhance communication with any party, from patient to lab technician to insurer. It's little wonder that digital photography is assuming a critical place in the modern dental practice.