Dental Photography PDF - DENT 4406

DENT 4406 DENTAL PHOTOGRAPHY Dental Armamentarium and Clinical Considerations Dr. Gülşilay SAYAR, DDS,PhD Associate Professor Bahçeşehir University School of Dental Medicine Department of Orthodontics [email protected] References ESSENTIALS OF DENTAL PHOTOGRAPHY IRFAN AHMAD Denta...

DENT 4406 DENTAL PHOTOGRAPHY Dental Armamentarium and Clinical Considerations Dr. Gülşilay SAYAR, DDS,PhD Associate Professor Bahçeşehir University School of Dental Medicine Department of Orthodontics [email protected] References ESSENTIALS OF DENTAL PHOTOGRAPHY IRFAN AHMAD Dental Armamentarium and Clinical Considerations Besides photographic equipment, there are additional items required for taking intra‐oral pictures,as well as specific clinical considerations to bear in mind. Dental Armamentarium and Clinical Considerations Retractors In order to have access to the cavity, it is necessary to retract the surrounding lips and cheeks. The most frequent method for retraction is cheek retractors, which come in a variety of ingenious designs, sizes, colours and materials Dental Armamentarium and Clinical Considerations Dental Armamentarium and Clinical Considerations The basic configurations are unilateral or bilateral. It is helpful to keep a stock of several sizes and shapes to accommodate varying degrees of mouth opening. Cheek retractors are either made of plastic or stainless steel (SS). Dental Armamentarium and Clinical Considerations The plastic variety are gentler but prone to fracture, especially the bilateral variety, and some can only be cold sterilised, but single‐use disposable types are also available. The SS varieties are more rigid, unlikely to fracture and are autoclavable. The choice is a personal preference of both the clinician and the patient. Dental Armamentarium and Clinical Considerations Photographic Mirrors and Contrasters Dental photographic mirrors are used for taking pictures of the occlusal/incisal and buccal/ lingual/palatal surfaces of teeth. The mirrors are available in numerous shapes and sizes catering for macroglossia and visualising any aspect or angle of the teeth and surrounding soft tissues Dental Armamentarium and Clinical Considerations Dental Armamentarium and Clinical Considerations Photographic Mirrors and Contrasters The larger mirrors are used for full‐arch views, narrower types are used for quadrant and buccal or lingual surface views. Intra‐oral mirrors are available in various materials; titanium, chromium, rhodium. The titanium varieties are more durable, costlier and usually only single sided. Glass coated ones are less expensive but have the advantage of high reflectance. Dental Armamentarium and Clinical Considerations The reflectance of titanium is 80%, rhodium‐plated mirrors 75%, chromium 65–70% and SS 50–60% Dental Armamentarium and Clinical Considerations Also, glass mirrors are double‐sided, and if one side becomes scratched, the reverse side can be used without having to purchase a new mirror. Depending on the manufacturer, some mirrors are autoclavable, while others can only be cold sterilised. Decontamination of dental mirrors requires particular attention by using lint‐free cleaning cloths and mild detergents so as not to scratch or degrade the surface coating. Dental Armamentarium and Clinical Considerations There is a trend to photograph a section of the dental arch, especially the maxillary anterior sextant (facial and palatal aspects) with a black background for excluding distracting extraneous anatomy such as nostrils, tongue, opposing arch and soft tissues Dental Armamentarium and Clinical Considerations Dental Armamentarium and Clinical Considerations This is achieved by using contrasters that are made from metal and coated with silicone black paint, and available in various shapes (occlusal, anterior and lateral) for various intra‐oral views, and are usually autoclavable. They are also used for creating a black background for emphasising translucencies at the incisal edges and interproximal areas of the teeth. The contrasters are judicially placed for concealing unwanted anatomy before taking the photograph. Dental Armamentarium and Clinical Considerations Dental Armamentarium and Clinical Considerations Field of View The field of view to photograph should be clean and clearly visible. Having displaced the lips with check retractors, it is essential to maintain a dry field during a photographic session. A dry field is required to capture details of the teeth, free gingival margin, attached gingiva and mucogingival junction, which allows accurate analysis, treatment planning and discriminating healthy and pathological changes for differential diagnosis of oral lesions. Dental Armamentarium and Clinical Considerations The choices are rubber dam, gingival retractor cords, cotton wool rolls, gauze, or aspiration using a slow‐speed saliva ejector or high‐speed suction. As well as maintaining a contamination‐free environment for dental procedures, a rubber dam is also an ideal method for isolating both the anterior and posterior teeth. Dental Armamentarium and Clinical Considerations Dental Armamentarium and Clinical Considerations Accumulation of surface biofilm, extrinsic stains, or food debris lodged between contract areas are annoying since they obscure the underlying enamel and dentine. Unless it is the intention to photograph these deposits, flossing and polishing with prophylaxis paste is recommended before taking photographs. Furthermore, gingival embrasures obscured by unwanted debris hinder diagnosis of interproximal carious lesions as well as accurate shade assessment for artificial restorations. Dental Armamentarium and Clinical Considerations For dento‐facial clinical images, it is advisable to tone down or remove lurid lipstick and flamboyant make‐up. However, for marketing and promotional images, make‐up is justified for beautifying an individual or conveying their persona. Dental Armamentarium and Clinical Considerations Cross‐infection Control Emphasising the importance of cross‐infection control to dentists is preaching to the converted. Whenever possible, an asepsis protocol is adopted. First, the camera and lens are appropriately draped with cellophane covers, not excessively, as plastic coverings are slippery and prevent access to camera settings. Dental Armamentarium and Clinical Considerations Cross‐infection Control 1- All camera, lens and flash settings are set beforehand to prevent unduly touching the equipment during a photographic session. 2-All team members participating in a photographic session should wash their hands with soap, or alcohol gel, before wearing gloves. To wear gloves while taking photographs is recommended. The operator and staff should change gloves when pausing treatment procedures to take photographs, and wear a new pair when continuing treatment. Dental Armamentarium and Clinical Considerations Cross‐infection Control 3-A remote camera shutter release, preferably via foot control is invaluable for hands‐free operation. Photodocumentation during surgical procedures is ideally delegated to a ‘dirty’ dental assistant, who can operate the photographic equipment. 4- Intra‐oral accessories such as retractors, mirrors, contrasters and reflectors should be appropriately sterilised, disinfected or discarded. 5- Corrosive sterilizing solutions and paper tissues are not recommended for cleaning photographic equipment, since they may cause irreparable damage Dental Armamentarium and Clinical Considerations Health and Safety It is mandatory for the entire team to be aware of, and conform to, personal protection equipment (PPE), and for the patient to be offered safety sunglasses for protection and shielding from intense light burst from flashes. It is prudent to place the camera in a safe and secure zone of the operatory where it can neither be knocked over, nor interfere with routine treatment, but nevertheless be readily accessible when needed. All batteries for flashes, camera and computer should always be charged in readiness. The edges of cheek retractors and lips are liberally lubricated with petroleum jelly for facilitating insertion and removal, and avoiding chapping of the lips. Dental Armamentarium and Clinical Considerations Location The location where dental pictures are taken is a contentious issue. For portraiture, there is little disagreement: an allocated room, or a tailor‐made studio away from the clinical environment. For intra‐oral images, the ideal location is debatable clinical setting is best suited for intra‐oral photography, fulfilling both clinical requirements and having access to essential dental armamentarium. Dental Armamentarium and Clinical Considerations Location Moving essential dental equipment to a non‐clinical setting with the associated compromises in cross‐infection and health and safety. This is particularly pertinent when photographing surgical procedures, when draping and other asepsis protocols are mandatory for avoiding contamination and ensuring treatment success. Dental Armamentarium and Clinical Considerations Dental Armamentarium and Clinical Considerations Supports Another point of disagreement is whether the camera and mounted flashes are hand‐held or supported by a tripod. In this case, the answer is not so clear‐cut. The advantage of hand‐held cameras is manoeuvrability, and the photographer is free to position himself or herself in any position without being encumbered by a tripod. This is particularly helpful for accommodating children, or the elderly and frail, who may find a photographic session arduous and trying experience. If the camera is hand‐held, to prevent it falling accidentally, it is advisable to use a hand and neck strap. Dental Armamentarium and Clinical Considerations Supports The tripod option offers a rigid platform, allowing the photographer to be comfortably seated, freeing the hands for precisely positioning cheek retractors, mirrors, or holding intra‐oral instruments to demonstrate a particular clinical technique. If the camera is mounted onto a macro focusing stage, precise focusing is ensured. Dental Armamentarium and Clinical Considerations Supports Furthermore, a series of images can be taken with similar framing for demonstrating a particular treatment protocol. The drawback of a tripod is that another piece of hardware needs to be accommodated in the clinic, which may already be restricted for space. Dental Armamentarium and Clinical Considerations Supports Ideally, it is best to use both options depending on the type of photograph being taken. In order to expedite a photograph session for compromised patients, or where access to the posterior regions of the oral cavity is limited, hand‐held equipment is the best option without fettering with a tripod. Dental Armamentarium and Clinical Considerations Supports Alternately, for certain dental applications where composition and framing are paramount, the solid platform of a tripod is indispensable for standardisation. Lastly, whichever option is chosen, it is helpful to draw markings on the floor for the location of the photographic equipment, the patient, photographer and assistant for repeatable positioning. Dental Armamentarium and Clinical Considerations Dental Armamentarium and Clinical Considerations Delegation Another frequently asked question photographs?’ is ‘Who should take the It is tempting to delegate photographic documentation to ancillary staff or assistants or indeed a professional photographer. Delegating has its advantages; it frees up valuable time during a busy daily schedule to concentrate on other pertinent clinical matters. In addition, the clinician may lack competence, or be indifferent to taking pictures. Dental Armamentarium and Clinical Considerations Delegation It is simply allocating tasks that an individual is best trained for, and proficient in, for the followings reasons. First, the assignee should have adequate training in dental photography and be versed with taking both extra‐ and intra‐oral pictures. Second, trying to explain to assistants what an image should depict, is asking for a miracle. After carrying out an examination of the patient, it is the clinician who possesses the depth of knowledge and experience for assessing the dental status, including the visual appearance of dental and oral pathology. Dental Armamentarium and Clinical Considerations Delegation Ideally, a photographic session should be performed as a team including the clinician with the help of an assistant, no different to four‐handed dentistry. Also, an extra pair of hands is essential for positioning cheek retractors, contrasters, mirrors, flashes, reflectors, etc. The assistant is able to hold instruments adjacent to the teeth or oral mucosa that are essential as reference markers, as well as using a three‐in‐one syringe for maintaining a dry field of view and clearing condensation from mirrors Dental Armamentarium and Clinical Considerations Patient Consent In the current climate of escalating patient litigation and increasing demand for elective dental therapies, it is wise not to tempt fate, and to obtain written consent even for the most innocuous treatment. Dental Armamentarium and Clinical Considerations Patient Consent Before embarking on photographic documentation, patient consent is unquestionably obligatory, and without a signed consent form a photographic session should not be contemplated. Dental Armamentarium and Clinical Considerations Patient Consent The patient should be briefed about the intended use of the images, whether they are purely for clinical documentation, liaising with specialists, monitoring treatment progress, or whether the images will be used for marketing (including social media dissemination and websites), research, education, public relations, patient counselling, staff training, lecturing and publishing. Various consent form templates are available from defence societies, dental academies and organisations or publishers. Dental Armamentarium and Clinical Considerations Patient Consent For certain treatment modalities, dental photography is an essential diagnostic and communication tool. These include orthodontics, diagnosis of pathology by specialists, or shade analysis for artificial restorations, and so on. In these circumstances, if patient consent is not forthcoming, consent is still necessary, with the proviso that the images will not be used for any purpose other than the treatment in question. Dental Armamentarium and Clinical Considerations Patient Consent Also, after completing treatment, the images can either be handed over to the patient for safekeeping or permanently destroyed or deleted. Another method for ensuring anonymity is by pixelating the eyes using image manipulation software. Thank you...