Protocols for Mobile Dental Photography with Auxiliary Lighting. Louis Hardan

This is a reality that we cannot deny. Because our memories can be unclear and lack detail, to keep them alive we often try to capture moments with photographs and videos. Inventor Nicéphore Niépce is credited as the first to take a partially successful photograph in the early 19th century. This technology was slow to evolve, eventually picking up pace in the late 20th century with the introduction of pocket cameras, followed by the integration of cameras in mobile phones in recent years.

      In 2011, only about 10% of the world’s population used a smartphone. In 2018, that figure jumped to 36%, with an estimated 3.8 billion users in 2021. Because smartphones are relatively similar in design, utility, and performance, smartphone companies are shifting their attention to the quality of their products’ cameras to give them the competitive advantage in the marketplace. After all, billions of photographs are taken worldwide each day, and most of them are captured with a smartphone. Improved optical zooming (10× or more), 360-degree video, and 3D imaging with depth sensing are the serious projects of the future for smartphone cameras, and there are plenty of other innovations on the horizon. This technology war between the dueling smartphone companies has spurred rapid evolution in the capabilities of smartphone cameras, leading even some professional photographers to start using their smartphones to take high-quality photographs with great definition.

      We know that many dentists already use their smartphone cameras to document their cases and communicate with their laboratory because they do not have professional cameras, but a poorly taken photograph can compromise the quality of the dentistry delivered to the patient. Therefore, it is important to understand how to properly use a smartphone camera in the context of clinical photography. That is why we started the Mobile Dental Photography (MDP) project in 2012; we wanted to find a way to make documentation and communication easy and affordable to all dentists and laboratory technicians, including students. Even in hospitals, the trend of using smartphones and wireless technologies is increasing with the aim of providing high-quality, cost-effective, and altogether better health care.

       Why Document?

      The primary reason to document in dentistry is to record with precision the actual oral situation or procedure performed, and as part of this process dental photography can be employed for diagnostic, clinical, and medicolegal purposes.

      Patients’ dental records comprise documents concerning the history of their dental conditions, clinical examinations, diagnoses, and treatments. The primary reason to document in dentistry is to record with precision the actual oral situation or procedure performed, and as part of this process dental photography can be employed for diagnostic, clinical, and medicolegal purposes.

      High-quality photographs are required to obtain more information from the images, allowing their use in multiple fields of dentistry. Photography can be used for treatment planning, documentation and self-evaluation, communication with the patient and laboratory technician, tracking the evolution of treatment, as well as for publishing, lecturing, and marketing; it can also be used for artistic, insurance, or legal purposes.

      Treatment Planning

From the patient’s first visit to the dental clinic, dental photography can prove its worth as a diagnostic and evaluative tool. A complete set of oral photographs is essential to create a thorough treatment plan. It can be a very useful implement for the analysis of facial profiles, for the evaluation of prosthetic rehabilitation, for the detection of caries or enamel defects, and for the assessment of gingival health and periodontal pocket or ridge morphology prior to implant placement. Moreover, photographs can be sent to external specialists for a second opinion without need for patient consultation, facilitating better diagnosis and optimized treatment planning. For esthetic cases, photographs can be used to build a smile design so the patient can see the final outcome via a virtual mockup on screen that can be printed and transferred to the mouth with bis-acryl material (Figs 1 and 2). Many smile design softwares are evolving to be used on smartphones as an app or on a website where you can upload photographs directly from the image gallery.

      

      FIGS 1 & 2 The patient can see his final smile design before beginning treatment. The photographs serve to build this smile, and if the patient approves the design, the dentist can begin the treatment in a guided way.

      Documentation and Self-Evaluation

      For many years documentation in dental records relied on handwritten notes, radiographs, study models, and clinical photographs. Today most of this documentation is digitized for accessibility purposes. Photographs constitute a very effective archiving tool, providing improved documentation of clinical conditions over time and facilitating observation and monitoring.

      Photographs also allow a more precise assessment of the completed work and the procedures followed, enabling effective self-evaluation. Details imperceptible to the human eye without magnification all of a sudden become clear. Moreover, the practitioner can easily examine and compare different procedures for different patients to determine which led to a better outcome, potentially improving future treatment planning.

With the evolution of smartphone cameras, accessibility is further enhanced because every dentist has a phone in his or her pocket that is designed to be user friendly. Photographs taken on a smartphone can be organized into folders by case and later evaluated on a larger screen to evaluate the quality of the work in hopes of improving it in future cases (Figs 3 and 4).

      

      FIGS 3 & 4 Before and 4 weeks after restoration of the first molar (and 1 year after restoration of the second molar). Examination of these photographs allows better assessment of the work performed than direct examination in the mouth and exposes any problems that can be corrected in the future.

      Communication with the Patient and the Dental Technician

      Effective communication between the practitioner and the patient is crucial for the success of any dental treatment, and a photograph is the simplest way to communicate dental information to patients. Images leave an impression on the patient and give him or her the sufficient confidence to move forward with treatment. Sometimes it is only by seeing photographs of their teeth that patients really understand their current dental situation and the treatment planning that the dentist proposes. This is especially true for patients who have sought dental advice elsewhere with negative experiences.

Patients often appreciate viewing photographs of their dental procedures to see exactly how their treatment was carried out. Patients can hence visualize things that they were only capable of imagining before, such as the presence and size of carious lesions (Figs 5 and 6) or the shape of pulp chambers during root canal treatment. Furthermore, by showing photographs of the clinical sequence of similar cases to the patient during the treatment plan presentation, he or she is better able to understand the procedure and predict the result. This is often helpful in justifying the cost of treatment, especially in advanced cases.

      

      FIGS 5 & 6 Patients should know that sometimes a small black line on a tooth can hide a big carious lesion and that they should consult a dentist when they see such a lesion on their teeth. This information