#4 – Photographs

Portraits of Patients

Due to the size of our staff and the great number of clients it’s impossible to remember everyone. These photographs are lifesavers! They will make it possible for you to walk confidently out into the reception room, approach your client, and warmly greet him/her and escort them back to your area. Without this picture, you are forced to stand at the entrance to the reception area and yell out their name. Whoops! No one stood up! Awkward silence, people looking at each other. Do you yell again? Do you check with the front desk? Avoid looking like a fool. Professionals are in charge of their environment! Take pictures and get signed releases!

Our clients that want significant esthetic changes in the appearance of their teeth need to clearly see where they are now and what they want to accomplish.

Help pose the client. Do this while you are waiting for the doctor to check you. Remove the bib, make sure their face is clean, get a good smile, have then sit up with their head away from the headrest, take pride in doing everything with high quality! Use the backdrops located __________________ for all portrait views, or have the patient stand against a plain wall in the hallway.

RELEASE AND CONSENT

In furtherance of the profession of dentistry and the dental health of the public, I, _____________________________________ consent to the dentists __________________ to take my photographs, video, or slides, with or without my name, for any lawful purpose and I release and forever discharge said dentists from any claim, demands, or liability on account of such use or for the quality of the reproduction of the photograph of photo copy provided.

Signature ___________________________________

Date _________________________

MINORS ONLY :

If signature above is by a person under age 21, Parent or Guardian

should sign here: I, ___________________________________________

Parent or Guardian hereby consent to the foregoing.

Uses for photos
1. Before and after pictures
2. Full face photos for client recognition
3. Medico – legal records
4. Client education
5. Shade communication with lab

Poses
1. Full face
a. Not in the dental chair, ask if client would like a mirror to straighten hair/etc., glasses on or off? Stand against wall or use material back drop. Stand 2-3 feet from wall to avoid shadow
b. Natural smile, chin up
c. Get 6-8 feet from client turn camera sideways for this, face should fill frame(top of head to bottom of chin)
d. Keep shoulders at an angle to the camera
e. Have client “wet lips,” full smile
f. Nose at center of picture

2. Profile teeth together
a. Right angle and left angle oblique
b. Not in a dental chair

3. Center 6 anterior teeth – un-retracted smile, tell client “Give me your biggest smile.”
a. Camera at occlusal plane
b. Don’t show nose or chin
c. Keep tongue away from lingual of anteriors- will increase darkness and reduce translucency.
d. Teeth centered, show corners of the mouth
e. Exaggerated smile- show as much teeth as possible.

4. Center 6 anterior teeth – retracted
1. Client hold retractors
2. Teeth slightly apart (incisal edges visible)

5. Right lateral- client smiles, no retraction
a. Lateral incisor is the center of focus, include upper and lower lips
b. See both centrals
c. Camera at occlusal plane
d. Head turned to the right
e. Move chair up so you are parallel with client’s face
f. Must see all posterior teeth
g. Try to avoid seeing the edge of the mirror in the viewfinder
h. Teeth together, occlusal plane level
i. Focus on the 2nd bicuspid area
This shot requires the use of one of our polished metal mirrors. These mirrors are easily scratched. Never let any other metal on the instrument tray touch this mirror. If the client’s breath fogs the mirror, put the mirror under warm water.

6. Left lateral
a. Same as right lateral

7. Maxillary occlusal
a. Warm photo mirror in water and dry (if needed)
b. Place mirror behind last teeth and tilt down –have client hold.
c. Focus on second bicuspids trying not to include mirror edges
e. Retract lip/cheeks
f. Tilt head back as needed
g. Maximum opening
h. Use 2 plastic retractors with a slight upward tilt
i. Make sure arch is centered
j. Keep nose out of the picture

8. Mandibular occlusal
a. Same as maxillary occlusal- use a mirror
b. Client’s head tilted up

9. 2-4 anterior teeth for shape and texture (crown and bridge)
a. Place a black/gray background behind teeth (increases contrast)
b. dry the teeth (wet teeth look flat)
c. camera perpendicular to tooth

10. 2-4 anterior teeth for translucency (crown and bridge)
a. place black background (black felt held by forceps)
b. camera shot down on tooth at 60angle

11. Color of teeth (crown and bridge) – 2 views
a. use an 18% reflective gray card as background in the mouth.
b. pick a shade tub that matches
c. place incisal edge of the tab against incisal edge of tooth
d. angle camera 30 from above
e. place shade tab over the prepared tooth

______________________ _________________
Lev 4 or above Assistant                     Date

Using the Digital Camera

We have an Canon Rebel T3 digital camera that has been modified for dentistry by adding an extra flash and a Pentax Digital Camera. This camera is used for before / after pictures, color variation for crowns, close up smile shots, full face pictures and pictures of staff activities that we can use for our website.

This Black SLR camera was purchased from:
Fred Friedman
11924 West Forest Hill Blvd.
Ste. 22-228
Wellington, FL 33404
Tel: 561-793-41423
Fax: 561-798-6721
Email: clinipix@bellsouth.net
For any questions, please contact Fred at the contacts above.
Paper – To get the best pictures, you must use Epson photo quality inkjet paper – use the matte paper for everyday photos and if we wanted to present a case, we could use the glossy.

Lighting – Sit your patient up straight in the dental chair and never turn off the lights in the operatory. The digital camera automatically adjusts to the amount of light on its subject.

Flash – For close up shots, make sure the camera is set to macro flash and the intensity dial set to about ¼ . For Rebel T3 – turn flash on.

TV – You can reduce the amount of color on the screen which will make the images more realistic. Using the remote, push the menu button, then use the up and down buttons to choose video, then choose color select and reduce the color a few tickmarks. Also add green tint and set the background on all tv’s to black.

Image FX software – To get a more realistic color, go into the Image FX software, click on Modules, capture 1 setup, enhance then set color boost to –48, Set red to –32, set Green to 5, set Blue to 24.

Image type – The digital camera uses targa files .tga these are the best for color.
Printer – set the HP2000 printer properties – setup – HP Premium Inkjet paper.
For shading with a new digital camera, here are some requirements:
1. Minimum of 3.5 Megapixels
2. Single lens reflex (not a range finder)
3. Daylight balanced and sufficient intensity
4. Work with Image FX software
5. Designed for non-photographers – point & shoot?

Procedure

A. Take the picture
1. Frame the image
2.Press shutter button ½ way down to activate auto focus
3. Press down completely and hold 2 seconds for delayed exposure, breath, and wait for the flash.

B. Download image into computer

C. Use the picture
1. Print a hard copy
2. Transfer to client’s file
3. Show on client monitor

Take some shots as intro-oral camera series
Show Dr. all final shots (intra-oral and digital)
See the information in the manual

______________________ ______________
Any Level 4 C/S or above date

Uses Intra oral and Digital Camera Routinely

(Same as RDH Lev 2 #21)
Our hygienist and chairside assistants/EFDA’s are our resource in communicating with our clients. Most clients are intimidated by the dentist. They are afraid that if they ask a question, the dentist will think they are stupid. Also, the dentist may not have time (or our clients may think they don’t!) to start a long involved conversation with the client.

Well, why should you bother? Why not just tell the client what they need and then they decide. Aren’t we going overboard: the computers, camera’s, etc.? No, not really. Our task is to communicate as clearly as possible with our clients and, today, most people are most comfortable learning from a monitor (that resembles a TV).

Clients will turn down our treatment recommendations for 3 main reasons.
1. Fear of the procedure
2. Money
3. Don’t understand the need

Our intra oral camera helps to answer the third problem. Seeing is believing. Seeing the problem makes it real and helps to build our credibility. People remember 11% of what they hear and 83% of what they see.

Here is a list of uses for our IntraOral Camera.

A. Improved client communication
B. Documenting before/after treatment
C. Insurance reimbursement
1. We can show the company why a treatment needs to be done rather than describe it.
2. ADA code 0471 “Dx photo” allows us to charge for these photos (although most insurance companies won’t pay it)
D. Allows us to see difficult access areas
E. Increase client involvement
F. Increase credibility for treatment ideas
G. Help clients to see us as a state of the art office
H. A great PR, marketing tool to give a client the picture
I. Stimulate referrals
J. Pictures are an aid to staff training
K. Reduce time needed for client consultation a picture is worth a thousand words
L. Increase case acceptance (the American Dental Association estimates the 68% of patients accept their dentists’ treatment recommendations
M. Showing excellent dentistry as often as problems
N. 30 times magnification helps client see more clearly
O. helps parents see child’s teeth
P. improves view of x-rays
Q. good impression for new clients
R. take to health fairs as an attraction
S. use in children’s tours of our office

Other Uses
1. Child portrait, dentist, hygienist, smile
2. Child silly shots portrait in center and silly shots(8) around it
3. Keep picture of missing teeth in folder to remind client

4. Be able to show
a. Poor contact
b. Occlusal wear
c. Erosion/abrasion
d. Discoloration
e. Cracks
f. Need for sealants
g. Gum problems (probe in sulcus, etc.)
h. Before/after photo album

5. Give the client the camera and let him/her “look around” while you are out of the room
6. Helps on consultations with specialists (avoid client’s trip)
7. Take pictures of tray set ups

The main barrier to dentists and staff presenting the best treatment to clients isn’t that we are uncomfortable with the cost, and we’re afraid they will reject our suggestions (and us). The real problem is that we’re in a hurry and don’t want to spend the time to answer all the client’s questions and explain everything.

Besides the fact that now we can communicate more effectively and allow our clients to appreciate our recommendations more, we can also become more productive. For example, to increase our production by $100,000, we would have to add $500 each day for 200 days. This could be achieved by adding: Sealants, Crowns, Plastic fillings.

The more convenient the system, the greater the chance you’ll use it. Please use it this way.

Hygienists take one picture in the morning and one in the afternoon the first week. Each week add one more picture each half day, so by the 4th week you are taking 8 pictures per day. Don’t worry about the time. There’s usually some waiting time until your dentist arrives. Every new client gets a fourplex (full face, smile, upper arch, and lower arch). Every problem area should be documented and discussed. Show probing depths, bleeding points or take 16 pictures of a kid making funny faces, or Mom and kids, or kid’s face, bleeding gums, and or picture of the word floss or you holding the floss! If you are going to leave the room, let the client share the camera to look around their own mouths.

Chairside take a picture of all significant cases before treatment, emergencies, and full face for charts.

Chairsides will be using the Digital Camera on New Patient & 5 year reviews in the following manner:
Do the 4 views:
A. Nice full face picture of patient standing against the wall or with the blue back drop
B. Close up of frontal smile – must see the teeth!
C. Full lower arch – make sure you have a picture that shows all teeth in the lower arch – ask your client to move her tongue back if it covers the teeth.
D. Upper arch – this picture will need to be taken with the mirror. Client can slide mirror in her mouth, resting on the lower front teeth. Take the acucam and place on mirror – camera lens side straight on mirror on lower arch – will reflect the upper arch – make sure all teeth are visible

Also make sure you are documenting the areas of concern:
If they have esthetic concerns, a lot of plaque buildup, broken down teeth or missing teeth please take pictures as well. Make sure to label the pictures with what tooth #, etc. This is really helpful to the Dr. & the patient.
Show your client each picture that shows an area of client concern and see how she feels about it. Write down her comments.

If you are discussing possible treatment with a client, here are some suggestions:
1. Always print out a picture even if the client has already agreed to treatment. This helps them reinforce their decision to themselves and others later.
2. Always use “because.” This word will increase case acceptance 60 90%. “Mrs. Jones this tooth needs a cap because a filling won’t be strong enough.
3. Dental care is a bargain. What else do you buy and expect it to last at least 10 years?

How to Use the Intra Oral Camera

The I.O. Camera is used to take pictures of patients specific teeth so they can see what is going on inside their mouth and to keep in the file for future reference. We have a portable system, which means that camera wand can be shared between any docking stations. To remove the camera from the cord, pull the grey ring down to release the wand. You can take the camera wand to another docking station. This means that only one person at a time can use the I.O. Camera – sharing is a virtue.

The I.O. Camera uses a single lens concept.
Close up – to take picture of one tooth

To maintain a disinfected environment for the patients, a sheath is placed over the wand for each patient you use the I.O. Camera on. To put a sheath on the wand – insert the wand face down into the sheath, then remove the extra plastic. To remove the sheath when finished – pull from the bottom, it will roll up onto itself to catch saliva.

The I.O. Camera is a whole body experience. Use your hands to position the wand to get the picture you want on screen. There are two buttons that you press. One is FREEZE(top button) – used to take a picture, and the other is SAVE(bottom button).

To take a series of photos:

1. Click on the patient’s appointment
2. Click on the link icon (looks like a little chain)
a. This will bring up the FX button
3. Click on the FX button
a. This will give you the FX SCREEN
b. Make sure you are in the correct patient’s file
4. Click on the Intraoral camera icon (looks like a wand with a tail)
a. The computer screen should go black
5. Turn on the Intraoral camera on the docking station.
6. If an image shows on the screen, start taking pictures. If not:
a. Hit esc. and click on wand icon again.
7. Get a remote and change the TV to the image channel
8. Pick up wand
9. Position wand for first picture. Still center the picture.
10. Press FREEZE, press SAVE if you want to keep the picture. Freeze again to delete
11. Position wand for the next picture. Repeat steps 3 for the next pictures
12. Put wand back in the holder
13. Turn off the Intraoral camera
14. Turn the TV back to the smile channel
15. Go to the computer and hit ESCAPE, your images will appear
16. Make sure that all the images you want to print have a check mark in the corner
17. Click on the printer icon, select how many images you want on a page, click OK, select which printer you want to use (the color printer is HPZZ30c) and click print

Thorough exam give yourself an extra 30 minutes at first, later you’ll only need 15 min.
1. Tip client back and note any obvious areas of concern calculus, stain, broken tooth/filling, discolored areas, missing teeth, lesions
2. Take pictures of all these concerns
3. Save pictures for dentist

Trouble Shooting

Occasionally the intraoral camera won’t work correctly. When this happens, write down the problem & which room & let the dentist know.

How to Use the Olympus Digital Camera

Take Picture

1. Turn camera on – green square
2. Turn flash on
3. Locate what you are trying to get
4. Turn lens to the right to find what you would like to locate
5. Focus on that shot, may need to adjust a little
6. Nine squares in eye lens that shouldn’t be moving – if moving try to adjust
7. Turn camera off before removing card reader

Download

1. Open end
2. Card pops out
3. Dentrix links
4. FX
5. Patient
6. Click on camera
7. Picture ok
8. Downloads
9. Click red (i) (image info)
10. View
11. Print
12. Card back in camera gold up snap closed

Delete

1. To delete images off the camera
2. Card in – On D – View
3. OK to menu
4. Arrow down
5. Go to card on the side – left arrow 2 times
6. Down arrow 2 times
7. Right arrow 2 times
8. Top arrow 1 time yes
9. OK
10. Off

Pentax Digital Camera

* For close-ups and intra-orals (P) program mode (P) will appear upper left corner
* For close-ups and facials “Green mode”

To get between these modes hit the button lower right green dot

To take Pictures

1. Turn camera on – button on top of camera
2. Choose which mode to use (P) or Green mode – pressing green dot button. Keep
pressing until your mode appears
3. Stand 8 inches from subject
4. Use zoom keys to isolate area – Long key button – Blue square and magnify glass
5. Press shutter button down ½ way to focus. Small bracket in center of screen will be
green if in focus, and will beep
6. Hold shutter button down all the way to take picture

To view taken picture

After you finish taking picture to view press blue arrow button.

To scroll through pictures use the 4 buttons left and right.

To download photos

1. Put card into card reader
2. Open image FX for your patient
3. Click the digital camera icon
4. This brings up all the images on the card
5. Click ok to download all images or unclick the checkmarks to only download the
images with a checkmark – and click okay

To delete pictures from Pentax Camera

1. Press blue arrow to view taken pictures
2. Find what picture you want to erase by scrolling through
3. Push green button (trash can) once
4. Highlight delete will appear blue – push up once
5. Press OK

* Will double beep when picture is delete

To delete all pictures from Digital Camera

1. Press blue arrow to view taken pictures
2. Push green (trash can) button twice
3. Scroll up one
4. Press OK

Placement – Charging Battery for Pentax Digital Camera

Plug AC plug cord to battery charger
Plug into outlet
Place battery into the charger making sure Pentax faces up

* When red light is on battery is charging / light is off charging is finished
* Time required to fully charge battery 120 minutes
* DO NOT use any other battery inside charger. Will over heat or damage
* If battery is inserted correctly but red light fails to appear battery may be faulty

Only use Lithium – Ion Battery D-L163