Digital photography: the first step in the records process

By Shannon Pace Brinker, CDA
Editor in Chief, Contemporary Product Solutions

A picture is worth a thousand words is a proverb that refers to the idea that complex stories can be described with just a single image, or that an image may be more influential than a substantial amount of text. Digital photography allows us to do just that. Before the dentist can do a treatment plan, the patient must first go through an extensive records visit. Gathering patient information and understanding any signs of instability are important. With this series of articles, dental assistants will see the value of the records visit and be able to understand their role in this process.

At the Dawson Academy, we recommend 20 photos. Below are some of the examples of these photos and how to take them.

• Full face
• Profile headshot
• Smile (3) views
• Rest
• Tipped down
• Profile smile
• Maxillary and mandibular occlusal views
• 1:1.2 (close up) (3 views)
• Retracted 1:3 — 3 views teeth apart
• Retracted 1:3 — 3 views teeth together

Full face: 1:10/F-stop 5.6/Lens on auto-focusThis shot is framed horizontally. The full-face view should show the top of the head to just below the chin. The nose should be in the center of the portrait, which will place the head in the center of the frame.

Full faceProfile headshot 1:10/f-stop 5.6/lens on AIn this photo the patient’s head is turned to the side and the condyle should be the center of the view. The mouth should be at rest position.

Profile headshotIntraoral photographyManual setting on the lens/f-stop 22 1:2Full smile: Frontal view 1:2The central incisors are the focus of the full smile, frontal view. This view should include the corners of the mouth. The patient should exhibit a full, natural smile. The nose and chin should not be in the frame.

Full smile, frontal viewFull smile: Right and left lateral views 1:2 The lateral smile view is made with the lateral incisor as the focal point and center of the image. The frame of the picture should include the upper and lower lips, as well as equal amounts of skin above and below the lips. Avoid taking this photo like a profile photo.

Full smile, left lateral viewRest position view: 1:2In this photo we simply ask patients to wet their lips and let them fall open. In the photo the mandible should be loose and relaxed. This will allow us to see how much of the anterior teeth are showing at rest. Adequate lip support is shown as well as lip shape.

Rest position view“E” position view: 1:2The central incisors are the focus. Patients are simply asked to say “eee” to show us how much tooth structure is showing when they pronounce their words. This view should include the corners of the mouth, and patients should exhibit a full, natural smile.

“E” position viewTip down view: 1:2This photo is shot with the patient’s head tipped down and a full smile shown. In the frame the tip of the nose should be seen. This photo is to show us where the teeth fall in relationship to the patient’s lip.

Tip down viewProfile smile 1:2In this photo the patient’s head is turned to the side and the condyle should be in the center of the view. The patient should be smiling.

Profile smileUpper arch: Occlusal view: 1:2The upper arch occlusal view is always taken as a reflected view using a high-quality mirror. The lips and cheeks should be retracted for all the gingival to be seen in the arch. The distal of the second molars should be in the frame.

Upper arch, occlusal viewLower arch: Occlusal view: 1:2The occlusal view is always taken as a reflected view using a high quality mirror. The lips and cheeks should be retracted for all the gingiva to be seen in the arch and the distal of the second molars should be in the frame.

Lower arch, occlusalClose-up centered 1:1The upper or lower (whichever arch is being treated) should be the center in this view. All teeth and gingiva should show with no lips or retractors showing.

Close-up centered 1:1 viewRight and left lateral views 1:1These lateral views are made with the lateral incisor as the focal point and center of the image. All teeth and gingiva should show with no lips or retractors showing.

Left lateral viewUpper and lower teeth: Retracted frontal view 1:2The upper and lower teeth should be slightly parted so the incisal edges are visible. The retractors should be minimally visible and the lips should not approach the frame. The maxillary central incisors are the focal point of this image. The camera lens should be parallel to the plane of occlusion. Upper and lower teeth: Retracted right and left lateral view 1:2The upper and lower teeth should be slightly parted so the incisal edges are visible. The right and left laterals are the focal point in these frames. The retractors should be minimally visible and the lips should not be in the frameUpper and lower teeth: Retracted bite together frontal view 1:2The retractors should be minimally visible and the lips should not approach the frame. The patient is asked to bite together and hold. The maxillary central incisors are the focal point of this image. The camera lens should be parallel to the plane of occlusion. Upper and lower teeth: Retracted right and left lateral bite together/view 1:2The right and left laterals are the focal point of these images. The camera lens should be parallel to the plane of occlusion to avoid the appearance of occlusal plane discrepancies, which may not be present. Conclusion Patients should take part in their examinations so that they can see and understand each problem. If patients don’t see what we see, how can we expect them to understand and be on the same page? Digital photography plays a vital role in this process.Author bioShannon L. Pace-Brinker, CDA and a 1994 graduate of the dental assisting program at Bowman Gray School of Medicine, works with Dr. John Cranham in his private practice in Chesapeake, Va. She has been a dental assistant for more than 20 years. Shannon is the past president of the Metrolina Dental Assistants Society in Charlotte. She is also on the advisory board for the dental assistant program at Central Piedmont Community College. She is a member of the AACD and serves on its New Member Committee. She is also on The Journal of Cosmetic Dentistry’s editorial board. Shannon is the first auxiliary to sit on the AACD Executive Board. She is an evaluator for Dental Advisor and consultant for many dental manufacturers. To visit her new venture, Contemporary Product Solutions, click here. On her CPS site, Shannon will provide editorial that combines product review for the whole team — dentists, assistants, hygienists, front desk associates, and dental laboratory personnel. This full-service publication will inform the dental team of the latest comprehensive clinical product information.