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Using Digital Photography to Increase Case Acceptance in Hygiene

Have you ever wondered how patients let their teeth accumulate so much plaque and calculus buildup? Better yet, have you ever wondered why periodontal patients don’t agree to have their condition taken care of? Well, the truth is that we may not be doing a great job of educating and helping our patients understand the benefits of treatment.
Let’s face it—hearing that you have a disease is scary, and hearing that you will have to come back several times to get numb and have your teeth scraped is even more scary. And then hearing that even if you complete therapy you will still have periodontal disease (by definition periodontal disease is the loss of bone) doesn’t make a very compelling argument even to start the therapy. I propose we use photos of the patient’s condition combined with a step-by-step series of another, similar patient’s photos to help our patients understand and, more importantly, see the benefits of periodontal therapy.


Figure 1. Preoperative photograph taken during new-patient visit showing patient’s periodontal condition.

Imagine that a new patient comes in for a comprehensive exam with obvious signs of periodontal disease and heavy tartar buildup (Figure 1). Your first inclination is to sit the patient upright in the chair (hopefully you aren’t talking to him while he is laid back) and begin admonishing him about his home care and hygiene. Instead, maybe the education could go something like this:
“Mr. Jones, would it be okay if I take some digital photographs of your teeth so you can see what I see? ... This is a picture of your front teeth and gums. Do you see anything here that concerns you?”
Now pause for about 10 seconds and give your patient an opportunity to respond. If the patient points out the obvious (by the way, it is only obvious to those who value oral hygiene), then you have a patient who has acknowledged the condition and is ready to move forward with hearing about periodontal therapy. If the patient doesn’t see anything of concern, then that is the signal for you to go into education mode and discuss the calculus buildup process and the long-term adverse effects, clinical signs, and symptoms before discussing the actual treatment process.


Figure 2. Example case similar to patient showing buildup of calculus and resultant gingival inflammation. Figure 3. Example case showing difference between treated and nontreated halves of mouth. This helps reinforce treatment benefits.
Figure 4. Example case showing both sides completed. This highlights healing of previously treated quadrant versus immediately treated quadrant. Figure 5. Example case after healing. This helps to showcase long-term benefits of treatment.

Once the patient has accepted and acknowledged the presence of disease, it is time to begin “show and tell.” Instead of simply verbally explaining the painstaking process of scaling and root planing, why not show the patient through an example of another, similar patient? (I recommend showing a case that is a little worse than the current pa-tient.) Quite often we scare our patients,  but we don’t discuss enough of therapy’s benefits to motivate them to move forward. Let’s face it, we are a visual society, and seeing is believing. So the conversation would go something like this:
“Mr. Jones, I’d like to show you another case similar to yours and show you step-by-step exactly what you can expect to accomplish by completing our recommended treatment. Here’s another patient just like you (Figure 2) who completed the recommended periodontal therapy. As I mentioned earlier, it will take us 3 visits to get you back to baseline level. At your first visit we will be taking care of just your left side. This is the difference you can expect to see after the first visit (Figure 3). As you can see in this picture, we will be removing all of the major buildup on your teeth and giving your gums a chance to heal. On your second visit, about a week later, we’ll then complete the right side. This is the result you can expect from that visit (Figure 4). Notice how much better the left side already looks from your first visit. Your last visit will be about 4 weeks later, and this is what you can expect your gums to look like then (Figure 5). As you can see, there is a big difference in the health and appearance of the gums.”
Now you have explained to your patient, both verbally and visually, what to expect and the benefits of treatment. Furthermore, we have eased the patient’s mind by letting him know that there are other patients with similar or worse conditions, and reassured him that there is a solution and he is not alone. Believe it or not, sometimes patients don’t proceed with treatment because they are embarrassed and feel they represent the worst type of case.


Now that the patient has accepted treatment, don’t let the visual education stop. Just like the step-by-step case above was documented, document step by step, or at a minimum, the before-and-after photos of this case. This will allow you to do two very important things. First, it will allow you to show the patient the progress along the way (helps keep the patient motivated) as well as the final result when finished. Second, you will continue to grow your library of different ex-amples for other patients. To really make a greater impact, you should print the before-and-after results for your patient and combine that with your colored graphical chart of his or her periodontal pockets pretreatment and post-treatment; you will have an impressive documentation record for your patients. Don’t forget to print copies for yourself to place in your very own before-and-after perio album.


Figure 6a. Patient smile before periodontal treatment.

Figure 6b. Patient smile after periodontal treatment.

Figures 7a and 7b. Close-up view of lower anterior teeth showing gingival health before (a) and after (b) treatment.

Figure 8a. Before photo, which can be printed and given to the patient, to remind him of the difference periodontal treatment can make.

Figure 8b. Photo taken after periodontal treatment.

As you can now see, periodontal treatment case acceptance can be greatly enhanced by using visual examples in a story form. You will not only help educate your patients,  but you will build a great library and have hygienists who will improve their level of care because they will be able to evaluate their work. By the way, I have a requirement that my RDH must document at least one case step-by-step every month to build our library. For those who don’t have photos like these, please feel free to contact my office to inquire about purchasing them.
Just in case you were wondering about our new patient, you can see his before-and-after results in Figures 6 to 8.

Dr. Agarwal maintains a full-time private practice emphasizing aesthetic general dentistry in Raleigh, NC. He has been featured on ABC news, NBC news, and CBS news, and was chosen as the official dentist for Raleigh’s Monday Makeover series. He conducts management, digital photography, and clinical seminars nationally and is available for personalized, in-office photography team training. More information can be found at thecompletepractice.com. Dr. Agarwal can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it..

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