Digital Imaging: Make It Routine

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Digital Imaging: Make It Routine
September/October 2007
Victoria Tatum and Izette Moore
Contemporary Dental Assisting

When it comes to relating to our patients, dental professionals increasingly are acting more like counselors and advisors, rather than instructors and treatment directors. Today, most patients expect information and guidance through the decision-making process. With this in mind, digital imaging has become an instrumental tool in helping patients codiagnose their conditions and decide on an appropriate treatment plan. Digital imaging helps patients come to own and accept their treatment; it is a tool that every dental professional should use in some capacity to provide comprehensive dental care.
The Right Equipment

As with any task you set out to do, you must start with the right equipment. The right tools are critical in helping you thoroughly and efficiently collect information on patients' conditions, as well as determine the best options for treatment. For digital imaging, this means having the right cameras to capture images and a dependable way to organize and store them.
Cameras

Ideally, practices should be equipped with both extraoral and intraoral cameras. In our practice, the dentist and assistants are all trained to take digital extraoral and intraoral images, as well as digital radiographs. The usefulness of digital images should not be underestimated. As you take photographs, you can store them using practice management software, and in minutes you and your patient can view those images on a screen in the treatment room. This allows the dentist and assistant to point out visual examples immediately during their discussion with the patient. The patient receives information visually as well as orally to help increase their understanding and involvement in their diagnosis and treatment.
Extraoral Cameras

Extraoral cameras are fairly simple and quick to use. Two styles are available: point-and-shoot and single-lens reflex (SLR). The learning curve on these types of cameras is generally easy to manage. Numerous resources and articles are available detailing digital cameras for use in the dental office, as well as various lighting options. Most cameras come with extensive user manuals and troubleshooting guides. Additional re?sources are typically available online and through customer support.

Once you are familiar with your camera and its functions, you are able to concentrate on other issues that affect the quality of the images, such as lighting and other conditions in the surroundings, angles you want to capture, and the distance of the zoom. In our office, we use a standard flash and try to use as much natural light as possible when capturing portraits. In cases where color is especially important, we take photographs outside or next to a window to capture the most realistic image possible. As you experiment with your camera and your comfort level increases, you will find your own tricks, methods, and tools that help capture the ideal image.
Intraoral Cameras

We also use intraoral cameras with approximately 80% of our patients and have them available in every treatment room. However, because most intraoral cameras are more expensive than extraoral ones, many practices choose to do without them. As an alternative, start with an extraoral camera and use mirrors to capture a few intraoral images. For instance, we have found that cheek retractors and mirrors help to capture occlusal and lingual angles. In our experience, even inferior pictures are better than none at all; your time and effort will never be wasted. Images may not appear detailed enough to a trained eye such as yours, but even basic images can help patients visualize what is going on in their mouths, increasing comprehension and opening the door for treatment.
Digital Radiographs

Figure 1
Figure 1 Û Contrast, colorization, and a variety of other image enhancements can be made with the Advanced Im?aging feature in Patterson EagleSoft clinical and practice management software.

We take digital radiographs of every patient and have found these images to be extremely beneficial for the patients and the practice. The ease and speed with which the images are captured cannot be compared with the time spent waiting for film to be processed. Images of the patient's dentition are available seconds after they are captured and can be pulled up on screen in the treatment room to augment discussion with the patient. Additionally, images are easily stored within each patient's computerized record in our practice management software. Saved there, they are conveniently accessible at any time from all the treatment rooms or the front desk for future reference. Then we can use features within the software, such as the Advanced Imaging feature in Pat?terson EagleSoft (Patterson Den?tal Supply, Inc, St. Paul, Minn, www.eagle?soft.net), to manipulate images and call attention to certain areas and/or details, providing a visual representation of patient conditions and treatmentsÛand increasing their understanding (Figure 1).
Technique

The technique used to capture images should be based on the individual patient, the equipment available, and your personal preferences. Our practice uses 2 main techniques for capturing digital images. With both techniques, we have found that clinical software maximizes the images' usability.

The first technique involves capturing digital photographs of the patient's dentition, as well as the surrounding facial features, and uploading the images to our clinical and practice management software (Patterson EagleSoft). In our practice, we use the FinePix S3 Pro (Fujifilm USA, Inc, Valhalla, NY, www.fujifilmusa.com), a professional-grade digital camera, a macro lens, and a ring flash for close-ups. Then, by using the software's features, we change tooth shape, lighten or darken teeth, correct spacing, and change gingival height to show the patient a preview of the end result. We take a full-face frontal photograph as well as profile shots from the left and right sides. Capturing all of these angles is important, because some procedures can change the patient's facial features in addition to his or her smile. Ad?ditionally, profile images show the patient a view he or she rarely sees. The second technique involves creating composite mock-ups of the patient's pre- and posttreatment dentition. In our practice, we make an impression of the patient's teeth and create a stone cast that precisely details the current condition. Then, we amend and improve the model with composite to show the posttreatment results. We take pictures of the models from various angles and upload the images to our clinical and practice management software system. The dentist, assistant, and patient can review the photographs together on the computer screen, assessing changes and raising and answering questions.
Putting Images to Work
Figure 2

Figure 3
Figures 2 and 3 Û Digital before-and-"after" images are essential in cosmetic cases. Before images serve as a basis for pretreatment discussions with patients about their posttreatment expectations, while "after" images allow practitioners and patients to closely examine the potential outcome.

Digital images are an essential tool in education and codiagnosis. With any image-capturing technique, the digital images enable you to sit down with the patient before treatment begins , discuss options, and potentially provide a look into the future using pictures to support your talk (Figure 2). In our office, we use a dual-monitor system in our treatment rooms. This system allows the staff to view scheduling and office information on a monitor behind the patient, while a monitor in front of the patient displays images and serves as the center of attention and discussion. When patients see images illustrating their posttreatment results they get excited about the treatment process and attaining the end result (Figure 3). Our patients love to provide input, and our process of listening to their wants and concerns helps them feel more comfortable and take ownership of their care. Patients often initiate treatment and ask about the first steps. Our process helps patients become a partner in their treatment, rather than simply an object being worked on. Best of all, their belief in the treatment and their dedication to it increase the likelihood of attaining the positive results they desire.

It is a good idea to provide patients with personalized take-away items that will equip them with the tools they need to consider their options once they leave the practice, to share information with other decision-makers at home, and ultimately to make a well-educated decision regarding their treatment. Take-away items may include a detailed description of the patient's condition, with an explanation of the short- and long-term effects on their oral as well as overall health. Example images of the condition, or even better, images of the patient's own mouth, can help drive home the severity of the condition and the need for treatment. A proposed treatment plan, including an approximate timeline and the estimated financial expenditure required, are important factors in the decision-making process and also should be included.

As a paperless practice, we achieve all of our charting and digital imaging using Patterson EagleSoft clinical and practice management software. The integrated tools within Patterson EagleSoft make it easy and convenient to use images and notes in a myriad of ways. For example, we are able to burn images onto CDs for patients to take home or create informational charts for chairside use.

For crowns or more extensive procedures we also use our patient education software (CAESY Education Systems from Patterson, Vancouver, Wash, www.caesy.com) to create CDs for our patients to take home. These CDs include digital images and photographs, digital radiographs, postoperative instructions, and treatment plan files that may be opened at home and printed. Patients can follow the plan line by line and view corresponding images. CAESY contains videos for a wide variety of procedures that can be placed separately onto the patients' CDs (Figure 4) and viewed individually for comprehensive education.

For offices that do not use software, handouts and notes that include images and patient education information can easily be photocopied or printed using a basic computer program. Also, simply jotting down a few key points regarding diagnosis and treatment on a sheet of paper can help patients recall specifics and provide a basis for later discussion at home.

Figure 4
Figure 4 Û CAESY offers presentations on a variety of preventive, restorative, and esthetic treatment options; images can easily be printed or burned to a CD.

Assistant Advantage

As dental professionals, we do our best to provide high-quality oral health care. In some cases, patients may be more comfortable with the assistant than with the dentist. Assistants should be prepared to take questions in the dentist's absence regarding procedures and treatment. An assistant's input may serve as a trusted second opinion, and patients often seek out these thoughts and weigh them heavily in making their decision.
Conclusion

In today's dental practices, digital imaging at all levelsÛintraoral, extraoral, and radiographicÛis vital. Taking images of your own work not only helps with patient education, but also helps the dental team to deliver better dental care. Displaying your workÛwhether on screen or in printÛprompts you to examine your work more closely, paying closer attention to detail and precision. Without digital imaging, we only can guide a patient through the treatment process relying on our interpretation of what we think they want. Digital imaging transcends language, equipping us with a tool to get to the core of patients' feelings about their teeth, helping them to own and accept treatment, and helping them become a partner in their care.
Tips for Getting Started

* Don't worry about the pictures you haven't taken; just get started today. With the freedom to review pictures and choose which to save, there is no excuse for not taking pictures.
* Make a goal to photograph 1 patient per day. There is a slight learning curve with digital photographyÛas with anything, it gets easier with practice. It will take some time initially to experiment and learn from your mistakes. Remember: Every image you take doesn't need to be shown to the patient. It is easy to take multiple images and choose 1 or 2 to keep on file.
* Set aside time for staff members to practice taking photographs of each other. Put together a slide show of the pictures and discuss results, including improvements.
* Standardize a picture-taking protocol or series that is required for each patient. By taking the same types of photographs repeatedly, you will gain consistency in capturing images.
* Many practices have cameras that are underused. If this is the case, take the initiative and begin taking digital images yourself.