Spear recommends a series of 18 photographs to completely document the current state of your patient's facial and oral status. This series of photographs is used in the Facially Generated Treatment Planning concept and includes facial and intraoral views. These photos are used:

  1. As a visual representation of the patient's status, and should be incorporated into their clinical record.
  2. As a communication aide when leading the patient on a guided discovery to identify existing problems and suggest possible treatment options.  
  3. For diagnostic purposes.
  4. As a visual aid when communicating with interdisciplinary team members.  

Composition of each photograph is critical so the information being assessed is accurate. Improper angulation can cause distortion of the photograph, which leads to an improper perspective of the problem. Please refer to my article “Composing Photographs: Capturing the Correct Perspective” for techniques to improve the accuracy of your clinical dental photographs. 

Extra-oral Photographs

There are eight photographs in this series. The photographs of the head must be taken in a natural, posturally-correct position.

1. Portrait full-face frontal view with lips in repose (approximately 4.0 mm apart). This is used to evaluate:

full face dental portrait
  • Facial proportions/symmetry/skeletal-jaw relationship
  • Interpupillary line relative to the horizon
  • Length of upper lip
  • Anterior tooth display

2. Portrait full-face frontal view of the patient's maximum smile. This is used to evaluate:

maximum intercuspation portrait
  • Facial proportions/symmetry/skeletal jaw relationship
  • Interpupillary line relative to horizon
  • Relationship to face and horizon:
    • Base of nose
    • Upper and lower lips
    • Incisal and occlusal planes of both arches
    • Gingival display and level
  • Tooth display, position, arrangement and proportion
  • Lip dynamics

3. Portrait full head sagittal view, right side in repose. This is used to evaluate:

full head sagittal view portrait
  • Facial/skeletal jaw relationship
  • Tooth display

4. Portrait full head sagittal view, right side in maximum smile. This is used to evaluate:

full head sagittal view dental portrait
  • Facial/skeletal jaw relationship
  • Tooth display, position, and inclination

5. Frontal view (close-up, 1:2) of lips in repose. This is used to evaluate:

dental portrait frontal view
  • Anterior tooth display
  • Incisal plane

6. Frontal view (close-up, 1:2) of patient maximum smile. This is used to evaluate: 

maximum smile dental portrait
  • Tooth display, position, arrangement, and proportion
  • Incisal and occlusal planes of both arches if visible
  • Gingival display/level
  • Lip dynamics

7. Three-quarter view (close-up, 1:2) of maximum smile right side. This is used to evaluate:

maximum smile right side dental portrait
  • Tooth display and angulation
  • Gingival display/level
  • Incisal and occlusal planes of both arches if visible

8. Three-quarter view (close-up, 1:2) of maximum smile left side. This is used to evaluate:

how to photograph dental patients
  • Tooth display and angulation
  • Gingival display/level
  • Incisal and occlusal planes of both arches if visible

Intra-oral Photographs

There are 10 photographs in this series taken close-up at approximately 1:2 magnification.

9. Frontal view with teeth in maximum intercuspation. This is used to evaluate:

frontal dental portrait maximum intercuspation
  • Anterior overbite
  • Tooth condition, position, arrangement, and proportion
  • Gingival condition, gingival, and papillae level

10. Frontal view with anterior teeth separated by 2 to 4 mm. This is used to evaluate:

recommended dental photographs
  • Tooth condition, position, arrangement and proportion
  • Incisal plane of both arches
  • Occlusal plane of both arches
  • Gingival condition and papillae levels

11. Buccal view, right lateral posterior with teeth in maximum intercuspation, taken into the mirror. This is used to evaluate:

buccal view right lateral posterior
  • Tooth/jaw relationship
  • Tooth condition, position, arrangement and proportion
  • Gingival condition, gingival and papillae levels left lateral posterior

12. Buccal view left lateral posterior with teeth in maximum intercuspation, taken into the mirror. This is used to evaluate:

recommended dental patient photographs
  • Tooth/jaw relationship 
  • Tooth condition, position, arrangement, and proportion
  • Gingival condition, gingival and papillae levels

13. Buccal view, right lateral posterior with teeth separated by 2 to 4 mm, taken into the mirror. This is used for:

right lateral posterior photo
  • Incisal and occlusal planes
  • Inclination of anterior teeth relative to occlusal plane
  • Tooth condition, position, arrangement, and proportion
  • Gingival condition, gingival, and papillae levels

14. Buccal view, left lateral posterior with teeth separated by 2 to 4 mm, taken into the mirror. This is used for:

left lateral posterior dental photo
  • Incisal and occlusal planes
  • Inclination of anterior teeth relative to occlusal plane
  • Tooth condition, position, arrangement and proportion
  • Gingival condition, gingival and papillae levels

15. Maxillary anterior teeth. This is used to evaluate:

maxillary anterior teeth
  • Tooth condition, position, arrangement and proportion
  • Incisal plane
  • Gingival condition, gingival and papillae levels 

16. Mandibular anterior teeth. This is used to evaluate:

mandibular anterior teeth
  • Tooth condition, position, arrangement, and proportion
  • Incisal plane
  • Gingival condition, gingival and papillae levels

17. Maxillary arch occlusal view taken into the mirror. This is used to:

maxillary arch occlusal view dental patient
  • Tooth condition, position and arrangement
  • Arch form

18. Mandibular arch occlusal view taken into the mirror.

mandibular arch occlusal view
  • Tooth condition, position and arrangement
  • Arch form

An additional photograph I find extremely valuable is a frontal portrait, natural head posture, with the lips retracted and anterior teeth separated by approximately 2.0 to 4.0 mm.

natural head posture dental patient portrait

In this one photograph, I can compare the interpupillary line with the incisal and occlusal planes. The composition of this photograph is explained in the article “My Favorite Photograph: it Tells the Whole Story (Almost).”  

If you would like to engage your patient in discussion about airway supplemental photographs would be helpful. These are:

1. Throat: tonsil area (use mirror to depress tongue)

throat tonsil photo dental patient

2. Tongue: in resting position, and lingual frenum (place the tongue on the palate and then have the patient open as wide as possible, keeping the tongue on the palate. Take the photograph with the tongue in this position.

tongue photo dental patient
lingual frenum dental photo

3. Nose: basal view relaxed and with deep inspiration

basal view dental recommended photo

Recording the patient's current condition is extremely valuable from a diagnostic prospective and as a communication tool. The article “Composing Photographic Images of Your Patients” describes how to capture each image so they convey the most accurate information.  

(Click the link for more articles by Dr. Bob Winter.)  

Bob Winter, D.D.S., Spear Faculty and Contributing Author