Getting started in clinical dental photography

Ash Parmar provides guidance on how to incorporate digital dental photography into your clinical practice.

Photography is an essential part of modern dentistry. Just like taking radiographs to assist us in making diagnoses, dental photography can be an important diagnostic and treatment aid. Dental photography is used for:

• Recording the baseline situation when seeing a new patient
• Communicating the patient’s dental situation to them
• Creating accurate treatment plans in conjunction with other diagnostic data
• Laboratory communication. For anterior aesthetic dentistry, it is essential that the dental technician has clear photographic guidance alongside other patient information to ensure aesthetic ceramic restorations suit the patient
• Referrals, to provide the referral clinician with a clear picture of the presenting case
• Marketing your services on your website, through social media, in advertisements and clinical articles, once patient consent is obtained.

Starting dental photography

The first step to begin incorporating dental photography into your clinical practice is to acquire some photography equipment.

For a clinical dental photography novice, I recommend that clinicians obtain the following equipment:

1. Digital single-lens reflex (SLR) camera body
2. Macro lens
3. Ring flash
4. Retractors
5. Adult occlusal mirrors
6. Black contrasters.

Once you have the equipment, it’s important to familiarise yourself with it before you begin incorporating it into your clinical work. Practise using the camera on members of your team, and get to know the equipment’s functions.

Attending dental photography training courses may also be helpful in the early stages of dental photography. Additionally, the British Academy of Cosmetic Dentistry has published guidelines on dental photography, along with other various published texts on the subject.

Technical details

Touching on a few technical aspects of digital photography, I believe that one of the most important functions to understand is aperture control (also known as f-stop).

According to photographylife.com: ‘Aperture is a hole in your camera’s lens that lets light pass through… there are differences between photos taken with a large aperture versus photos taken with a small aperture. Aperture size has a direct impact on the brightness of a photograph, with larger apertures letting in more light into the camera compared to smaller ones.’

For example, when taking a portrait photograph, I set my Nikon camera to f5.6; when I take 1:2 magnification ratio photographs, I set the f-stop to f22; and when I take 1:1 magnification ratio photographs (a close-up photograph using black contrasters), I set the f-stop to f40. Using the histogram on the back of the camera is also very important to ensure the photograph is correctly exposed.

Photographing patients

Once you have familiarised yourself with your photographic equipment and feel ready to photograph patients, it’s useful to know what to photograph. For a new patient who requires comprehensive dental care, I would recommend taking the following photographs:

• Full face image with a blue background – both smiling and no smile (at a ratio 1:10)
• Full smile at rest, full smile anterior, full smile right side, and full smile left side (all at a ratio of 1:2)
• Retracted anterior (open and closed), retracted right side (open and closed), retracted left side (open and closed) (all at a ratio of 1:2)
• Upper and lower occlusal (at a ratio of 1:2)
• Upper anterior, and upper right and left sides, with a black contraster (all at a ratio of 1:1)
• Retracted upper anterior with shade tabs (ie the current colours of the central incisor and canine, and the desired colour) (at a ratio of 1:2)
• NB: I appreciate that other photographs are required for orthodontic treatment.

The blue background that I recommend when taking full face images is a large piece of card bought from an art shop. This is easily placed behind the patient whilst sat in the dental chair. This will standardise all your before and after dental photography, and adds professionalism.

Other tips in dental photography and video use

A great way that dental photography can aid in engaging patients in cosmetic dental treatments is through the use of mock-ups. You can photograph the patient with direct composite mock-ups in situ – it takes me about 20 minutes to mock up the upper anterior eight teeth without any wax-ups – and then let the patient view their preoperative and mock-up images side by side for comparison.

It can be a good idea to take some photos on the patient’s own smartphone, as well as a short video of them smiling and talking, so that they can garner opinions from friends and family.

The emotional impact of seeing a change in their smile is very effective in encouraging treatment uptake.

A similar outcome is achieved taking preoperative situation impressions and having additive wax-ups made.

Using a putty index of the wax-ups and a temporary material, you can create a trial smile in three minutes. This gives the patient an instant idea of how they might look if they went ahead with cosmetic dentistry. Once again, taking photos and a video on the patient’s own smartphone can be helpful.

Summary

When a patient sees their photographs on a screen for the first time, they are often motivated to go ahead with the treatment they may need or want. Therefore, I believe a digital SLR camera is the single most important piece of equipment for a dentist starting in general practice.

It will not only help you communicate effectively and increase your case acceptance, but also enhance your ability to take on more private clinical cases.

For more information visit www.theacademybyash.co.uk, call 07971 291 180 or email [email protected].

Resources and personal recommendations

• www.dpreview.com – a great website to review the latest in digital camera equipment. Most dentists either buy Nikon or Canon equipment
• www.photomed.net – this is an American company from which I personally purchase my cameras. The company specialises in providing cameras to dentists and the cameras arrive set up ready to use. Photomed also provides an abbreviated manual that is relevant for dentists
• One person I recommend for photography training is Cheryl Tonkinson. Cheryl is my treatment coordinator; she has her own business in training dentists and their teams in the practical aspects of photography. Cheryl’s details can be found at www.focusphotographytraining.co.uk
• I recommend a software called Smile Imaging. In my opinion, this is the best clinical dental photography software available to conduct accurate and aesthetic computer smile imaging (www.smileimaging.co.uk).

Published first in Dentistry magazine. If interested in signing up to receive Dentistry magazine, visit www.fmc.co.uk.