Take a Look at Me Now

Paul Feuerstein, DMD


A common scenario after a new patient exam is that the findings do not concur with what the previous dentist had found or had been “watching.” The patient often leaves, stating that he or she could not believe “all that work” that was needed. The patient laments, “I have been seeing ‘Dr. Oldguy’ for years, and I’ve never had to have a filling replaced, and I haven’t had a cavity for ages!” If there is not a careful discussion and explanation of why these things need to be done, the situation can end with a disgruntled lost patient. In this info era of Yelp, Doctorbase, Healthgrades, Angie’s List, and others, this can be a disaster. In earlier years, you could shrug this off, and the worst-case scenario would be that the patient would converse only with family and a few co-workers. This situation can be turned around, however, with a beaming clinician review if you let the patient see what you are seeing. The use of intraoral and digital cameras allows this to occur, giving the patient an instant understanding of open margins, fractured teeth, and more. And with some of the new digital caries detection units, an online clinician review could be one of amazement, highlighting how high tech and thorough his or her practice is. (There also has to be a bit of respect for the previous clinician since it was a long-term relationship, and as we all know, some patients present un­foreseen challenges.) There are many practice management consultants who can help you with your presentation skills and verbiage as well as explaining value and ROI. The basic information of show and tell, though, is still to me the beginning of this process.

Figure 1.Video Dental Concept’s QuickCam Duo. (See p. 41.)
Figure 2. Shofu Dental’s EyeSpecial C-II.
(See p. 30.)

There are plenty of serviceable 50-year-old-plus amalgams, and we have all heard patients’ reasons for keeping things status quo. How many times have you heard this: “Doc, if it ain’t broke, don’t fix it.” We have to define “broke.” It is good to be proactive, but you must use all of your tools to do this, and this is where documentation becomes critical. The late Dr. Robert Barkley, whose untimely death preceded intraoral cameras, stated that you should show pa­tients their teeth and explain in simple terms what you see, then leave them alone for a few minutes. There will always be questions asking what can be done, and you can easily lead the patient toward your proposed treatment. The intraoral camera is one of the best tools to accomplish this. The simple image of a tooth with a fracture in the enamel or a lost cusp appearing on a screen in front of the patient almost always evokes a question.

Many offices have an intraoral camera, and as we all know, it is never located in a room where you or someone else has to go get it. Due to time constraints, we often grab a hand mirror, pencil, and paper and try to ex­plain what is going on. Even with today’s digital patient education systems, patients still have to see their own issues. Although it would be ideal to have a camera in each treatment room, newer designs simplify their relocation. Newer dental units can be designed with a holder next to your handpieces, where a camera can be placed, and when it is picked up, much like the handpiece, it activates. If you are not purchasing new units and will be using one or 2 cameras for multiple rooms, connectivity is something to consider. Most of the newer cameras connect to your computer with a USB connection. To move it room to room, some cameras move with the cable, which you will have to plug into the USB port. If that port is on the computer itself, it could be a physical challenge. However, many of the new treatment room designs put a remote USB hub in an easy-to-access location for both these cameras and other devices you may add. Other camera systems re­quire you to install a cable in each room and use a quick disconnect, which for example could be in a holder next to the air/water syringe. In either situation, as long as everyone knows where the camera is stored, it is easy to get at. (Note that you will need barriers with the cameras, so they also have to be easily accessible.) There are many intraoral cameras on the market, and costs range (rather wildly) from $500 to more than $6,000, but you get what you pay for; obvious variables are image quality and lighting. In this day of multimegapixel cameras that fit in a phone, it shouldn’t be too hard to get a high-definition image at a reasonable cost. In fact, there are apps and accessories for camera phones to be used in this manner, although this might not be the most clean or efficient method to use. New LEDs are brighter and more color-corrected. For my own use, where I need images for publication and presentation, I need a high-end camera. I also have some others that I have accumulated throughout the years. The early ones are in a box somewhere in the office, and I often tell my staff, “Well, maybe I will need the old one some day.” When I look at the earlier images in my database, they actually were adequate for patient discussion. The newer models’ images are surely clearer and have features such as macro/zoom, which allows you to put the camera right on a fracture and look into the crevice. This is quite dramatic and often the best explanation to a patient why sometimes the tooth hurts when they bite on something hard. There are also ergonomic features to look at; location of the capture buttons and ease of operating them have to be considered. Also, ask yourself this: “How complex is it to change settings for one tooth, one quadrant, one arch, or the macro setting?” There is a photography parameter called “depth of field.” To me, this is one of the most critical parameters. How much range from the tooth out do you have to get a sharp image? Some are very tight and re­quire a setting change, while others are more flexible. What about image stabilization? It is not always easy to maintain a steady camera position.

Some of us believe we can use a standard digital camera for our imaging needs while being used for smile design, full-arch photos, and full-face photos. This is true, although a digital camera is not as quick as an intraoral camera when you have to get it, turn it on, get retractors and mirrors, and upload the image. (Not to mention the challenge of disinfection if you are in the middle of a procedure.) Although I have evaluated many excellent cameras, I would be remiss in not mentioning 2 solutions that have ap­peared at recent meetings. One, QuickCam Duo (Video Dental Concepts [Figure 1]), is an intraoral camera that has 2 lenses—one for intraoral on the wand tip and another for full face on camera’s main handle. Also, Shofu Dental’s remarkable EyeSpecial C-II SLR camera (Figure 2) is totally sealed, can be easily disinfected, has image stabilization, yields high-quality images (including zoom), and has special setting for taking shades. It connects with your computers via wi-fi, which bypasses cables and again maintains the sterile chain. I will soon be reporting on details of these as well as many other cameras with the presentation of everyday images from my practice. In the meantime, reassess your workflow, dust off that old unused unit, or look at some of the newer options.