We aim to introduce a standardized and systematic approach for intra and extra-oral documentation via digital photography. A digital documentation technique that encompass simplified methodology that is easy to adopt, reproducible and can be routinely incorporated in everyday clinical practice. The purpose of this technique is not just for medical legal records.
Photography records also allow for more effective communication between practitioners and patients. This enhances the overall standard of care that we as clinicians can provide. Dental photography can be overwhelming.
However, we have simplified the approach and technique such that everyone can watch the video today and start shooting tomorrow. Begin by positioning the patient straight across the photographer against the background. Align the patient's head to ensure that the interpupillary line is parallel to the horizontal frame of the camera view finder.
For standard documentation purposes, position the patient at a 90 degree angle and capture the straight frontal photo followed by the right and left side profile photos. Ask the patient to sit on a dental chair at a 45 degree inclined position. Ensure that the photographer is at the patient's nine o'clock position with the armamentarium for photography located within arm's reach.
Turn off the dental operatory light to prevent light interference with the photos. Acquire frontal photos by positioning the patient in the maximal intercuspal position. Place and position the retractors intra-orally into the mouth and recruit the patient to hold the retractors.
Position the operator such that the plane of occlusion of the camera is parallel to the horizontal frame line in the camera's view finder. Acquire intra-oral photos. Align the patient's head toward the operator.
For acquiring photos on the patient's right side, place the retractor on the left side of the patient's mouth. Utilize the narrow mirror for the buccal photos. Warm the mirror with a commercially available blow torch before insertion.
Insert the mirror into the patient's mouth parallel with the occlusal plane. Then, gently move it to the left buccal vestibule and rotate it 90 degrees. Use the mirror to stretch the patient's cheek and simultaneously reveal a reflection of the buccal surface of the right maxillary and mandibular posterior dentition.
Repeat this process for the left side. To acquire occlusal intra-oral photographs, position the retractor in the patient's mouth. Use the large mirror for capturing this photo.
Before insertion, warm the mirror using a torch and insert it into the patient's mouth. Request the patient to open the mouth as wide as possible to reveal the entire maxillary dentition from molar to molar. For mandibular occlusal photos, change the retractor positions appropriately to reveal the mandibular dentition and associated buccal vestibule.
Warm up the occlusal mirror and subsequently insert it gently against the ventral surface of the tongue. Request the patient to roll back their tongue to reveal the floor of the mouth. Acquire the lingual intra-oral photographs by using the retractor to pull back the left maxillary lip to view the maxillary palatal sextants.
Warm up the small mirror, insert it in the patient's mouth and position it to reveal the palatal surface and mucosa. To view the mandibular lingual sextants, warm up the small mirror and insert it between the tongue and the lingual surfaces of the mandibular dentition. Gently align the mirror medially to reveal the reflection of the lingual surface of the dentition on the left side.
Repeat the process for the right side. The three composite positions used for the oral photographs included repose, natural smile and widest smile. The photographs were taken in the suggested composite positions to illustrate the facial changes observed in the patient while in function.
The musculature surrounding the oral cavity was influenced by restorative work performed in the oral cavity. The images were captured during documentation, allowing the operator to understand all aspects of the patient's facial features to guide treatment appropriately. The intra-oral images illustrated all the aspects of the buccal, lingual and palatal soft tissues.
Correctly employed techniques completely captured the oral dentition uninhibited by soft tissues. These images allowed clinicians to study the patient's soft and hard tissue in conjunction with models long after leaving the clinic. These photographs serve the purpose of clinical documentation for before and after procedures.
The most important aspect is patient comfort. Sometimes we can be so engrossed in trying to capture the perfect picture, not realizing that we are overstretching the patient's cheeks or positioning them in such a way that they become uncomfortable. Dental examinations typically include intra-oral measurements and radiographs.
As such, current modalities do not include techniques that monitor soft and hard tissue outcomes. Photography provides a quantifiable approach to visual measurements for the purpose of measuring longterm procedural outcomes.
