In a recent article in this photo series, Dr. John Carson discussed the six images to take of every patient. I take those images at the beginning of every new patient exam, and every patient in my practice has those photographs on record. In addition to their value in co-discovery with the patient, they’ve been helpful in reviewing treatment before the patient is in the chair (to mentally prepare for what you’re up against), showing patients comparison photos over time, and referring back when a patient breaks something to see the “before” situation.
Occasionally I’ll have a patient come to the office having “found something new” since recent treatment was provided. It’s invaluable to have a photo documentation of their mouth before you worked on them. If you work on a back tooth and the patient comes in and shows you a small chip on an anterior tooth that they think is new (which happens often when people are hyper-sensitive to their mouth following dental treatment), there doesn’t have to be a discussion about when it happened and “who did it.” I can’t emphasize enough how imperative a camera is to my practice!
While the series of six photographs is extremely helpful for new patient exams, when we have a patient that is interested in a large amount of dentistry or looking to move forward with a complex restorative case, there are additional photographs that are necessary to treatment plan effectively and communicate with the patient as well as the lab or other specialists on the team. Here I’ll review the extended series of photographs.
During the facially generated treatment planning workshop, you’ll learn a series of 21 photos to take in the extended set. Here, I’ll show you some of my favorite additional photos to take and why.
The full face photo
I actually take this photo on every new patient in addition to the six photos discussed in John Carson’s last article of this series. I like having a profile picture in the patient's chart so that everyone on the team can quickly put a face to the name when a patient is scheduled to be in the office, or when they call on the phone.
In addition to helping with the flow of the office, this is an invaluable picture for treatment planning a case. It can allow a patient to show you what they like or what they don’t about their smile from a distance, which can elucidate details they don’t explain to you in the smile photo. I’ll often have patients look at this photo and start pointing out things they don’t like about their face that the dentistry will or will not alter, and it’s good to address those concerns up front.
The lip at rest photo, full face
This photo helps in the same way the full face smiling photo does, but it further allows you to see the lip mobility when compared to the smiling photo, the midline at rest, and the tooth display at rest.
The lip at rest photo, close up
This photo is invaluable in locating the incisal edge positions pre-treatment. Although it is not the only factor that helps to determine where the post-treatment incisal edge position should be, it gives you a parameter or how much length you can add.
The photo above is a great example of how the bottom teeth can show when they are super-erupted as well. I’ll often have patients say “but I don’t care about the bottom teeth because no one sees them.” Sometimes this photo can do everything I need it to by showing the patient what everyone else sees. When this photo doesn’t do that, there’s always video!
The profile photo
A profile shot helps you evaluate where the teeth are in the face in a way that no other photo can. I’ll usually take two profile photos, one in repose and one smiling. Without a ceph, this allows you to see how the teeth and lip support relate to the forehead, nose and chin to get an overall feel for the case. If you’re communicating with a specialist on the treatment, your orthodontist will love this heads up before they see the patient!
Teeth together, retracted
Although the retracted teeth apart photo is my favorite in the photo series, this photo is really helpful in certain situations. When you have a patient with severe anterior tooth wear and supereruption present, this is a great photo to show how the maxillary teeth can completely swallow the mandibular teeth when in occlusion.
Teeth together, retracted lateral view
I usually use these two photographs for myself more than for the patient. The original six photos John Carson talks about in his article show the teeth apart retracted photos, and those are great for helping the patient see their own mouth.
These photos help me in two major ways. The first is that it gives me an overall idea of how the teeth fit together and their occlusal scheme before I’ve taken records on the patient. It allows for communication with specialists and generating initial treatment thoughts before the patient has returned for a review of findings or records appointment. In addition, I like to have these photos on-hand in case the lab calls with a question about articulation. I’m much more confident in answering questions when I can quickly view how the teeth come together. It has occasionally saved me from bringing the patient back for a separate appointment.
Magnified photos using a contraster
My last favorites from the extended photos are the magnified photos with a contraster. I’ve tried all of the contrasters on the market, and still haven’t found one I like. I was recently a patient in Gregg Kinzer's office and he had fabricated his own. I’m waiting for him to bring his Sharpie contraster to market!
I find the metal contrasters to be too reflective, and the ones covered by black silicone tend to pick up dust and debris that becomes visible in the photo. Here’s what the metal one can look like if you aren’t angled quite right:
Although I still haven't landed on a perfect contraster (I’m open to suggestions in the comments section below!), I love taking contraster photos both for myself and the patient.
We as dentists have the ability to hone in on problems like anterior tooth wear, but sometimes the patient becomes so fixated on their need to wax their upper lip area that they completely miss the point you’re trying to make with their teeth! The contraster photo can be an excellent one to highlight tooth wear, malposition, or surface texture. It also makes your before and after photos clean and dramatic.
My final tip when taking photographs is that any time you see something that sticks out to you during your photo series, it’s worth a photograph.
Optional photo of patient's habit position
Although not appropriate on every patient, I’ll often snap a quick photo of a patient's habit position if you continue to watch them go into it when you tell them to close and they go “edge to edge” instead of into their posterior occlusion.
Anything that helps your documentation and your future communication with the patient, specialist or lab is worth taking. With digital photography (although storage and backup is a topic for another day), it’s simple to take as many pictures as you find useful!
Stay tuned for John Carson's next article in the series discussing photos for improved lab communication!
(Click this link for more dentistry articles by Dr. Courtney Lavigne.)
Courtney Lavigne, D.M.D., Spear Visiting Faculty and Contributing Author - http://www.courtneylavigne.com