Intraoral television cameras were introduced into dentistry several decades ago. I was among the first to investigate the potential viability of intraoral cameras as a tool for patient education and archival documentation of clinical procedures. The original intraoral television cameras were basically endoscopes that had been adapted from other areas of medicine for intraoral use. The intraoral cameras initially introduced were extremely expensive, large and relatively difficult to use, and most of them were positioned atop a large, unwieldy mobile cart. The concept was accepted primarily by academic dentists, but slowly the profession started to incorporate these devices into routine practice. The image resolution produced by the first generation of dental devices was good, and intraoral pictures could be obtained and archived. As the concept continued to be integrated into typical dental practices, competition increased among camera companies, which introduced various designs and control features. The cost of intraoral cameras decreased owing to the significant competition, and some of the initial manufacturers exited the marketplace after seeing the resultant decrease in profit margin.
The image quality of the devices started a slow progress downward as prices came down. The brands that survived were refined and made smaller and easier to use. Both wired and wireless devices entered the market. The CRA Foundation1 recently published an evaluation and comparison of the current intraoral cameras on the market. Today, the price of these devices is many times lower, when adjusted for inflation, than what it was when the concept was introduced. The ease of use of the cameras has improved significantly. However, the image resolution has been reduced markedly, and the usefulness of intraoral camera images for archival purposes has similarly declined.
During the evolution of intra-oral cameras, digital still cameras have become commonplace both among the lay public and in the dental profession. It has been my observation that most dentists seem to be using them for various clinical purposes, a topic I will address later. My research organization2,3 has published evaluations and comparisons of the various cameras on the market and indicated their usefulness for dental applications. It is well-known that the image resolution of digital cameras rivals or exceeds that of conventional film, and the cameras’ ease of use and predictable delivery of archival-quality images are excellent.
Do practitioners need both intraoral television cameras and digital still cameras? I will compare the potential uses for intra-oral television and digital cameras and make suggestions on how to use both types of equipment in a busy dental practice.
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INTRAORAL TELEVISION CAMERAS
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What are suggested uses for intraoral television cameras in light of the introduction of high-resolution digital still cameras? The decreased image resolution of today’s intraoral television cameras versus that of previous generations has diminished their potential for image archiving and reduced their function to primarily that of show and tell. When properly used, these devices can demonstrate to patients various aspects of diagnosis, treatment planning and treatment. They are excellent tools for patient education and for encouraging patients’ acceptance of treatment plans. However, in my opinion, they are not as useful for making archival images.
I suggest that the following are excellent ways to incorporate intraoral cameras into your practice.
Patient education as a part of diagnosis and treatment planning.
Dental hygienists should be educated in the proper use of intraoral cameras and assigned the responsibility of educating patients about all conditions in their mouths, both positive and questionable. At an initial diagnostic appointment and all subsequent appointments, either the hygienist or the dentist can use the following educational technique. Using a sequential and organized routine, the practitioner can analyze each tooth visually and show it to the patient. Any peculiar observations related to each tooth should be recorded in the patient’s paper or digital record (for instance, "Tooth no. 14 has horizontal cracks on the facial surface and may need a restoration," or "The amalgam restoration in tooth no. 3 has significant margin breakdown with minimal carious involvement and may need a crown soon"). At the next appointment, these recorded observations serve to remind the hygienist or dentist that situations of unknown or known consequence were noted previously. Some of the recorded information may be educational only, whereas other observations may be suggestions for elective treatment for either health-related or esthetic reasons. At each recall appointment, the clinician again should observe the teeth with the intra-oral camera and discuss his or her findings with the patient. Periodontal conditions, peculiar tooth wear or other occlusal conditions, as well as any questionable soft-tissue lesions, also should be shown to the patient using intraoral television images. I do not recommend saving these images because of their lack of high resolution.
When properly used, intraoral television cameras can demonstrate to patients various aspects of diagnosis, treatment planning and treatment.
Patient education during treatment.
Frequently, clinical conditions that are unknown to patients become apparent during treatment. Showing these conditions to patients with an intraoral television camera makes it much easier for them to understand the situation. Everyday examples are cracked teeth, pulp exposures or near-exposures, gingival recession that requires more apical extension of tooth preparations, the need to change from an intra-coronal restoration to an extra-coronal restoration, the depth or inflammation of a periodontal pocket, or finding additional canals in an endodontic procedure. Patients appreciate receiving the education, and providing it often assists the clinician in explaining additional or changed fees.
Images to be sent home with the patient.
Often, clinical situations arise and clinical plans are made that require thought by the patient and/or education of a spouse or parent at home. Intraoral camera images, although of low resolution, can illustrate the situation in the patient’s mouth. (However, as noted below, digital still cameras can provide much better images to send home for this purpose.)
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DIGITAL CAMERAS
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Digital cameras—ranging from simple, relatively easy-to-use point-and-shoot models to more expensive, fully adjustable through-the-lens models—are available from many dental and nondental photography companies. Most dentists have a digital camera for personal purposes, and some have an additional camera for dental use. How should digital photography be used to augment intra-oral television camera use, or do digital cameras replace intraoral television cameras?
The ease of use and high resolution of today’s digital cameras make them excellent for numerous uses. Among them are the following.
Documenting existing oral conditions before treatment.
I suggest using a digital camera to document the patient’s oral condition at the beginning of treatment. These images should be placed in the patient’s digital record to provide long-term historical information. How many images to make at the beginning of treatment is the dentist’s decision. I prefer the following images:
- – full face;
- – normal smile;
- – anterior teeth with lips retracted;
- – mirror-image occlusal view of the maxillary arch;
- – mirror-image occlusal view of the mandibular arch (some practitioners also take mirror-image photos of the facial surfaces of both right and left sides).
These images are invaluable for patient education and documentation of the patient’s condition before, during and after treatment. An educated staff member can make the images easily. The printed or electronic photos can be sent to third-party payment organizations when requested, sent home for patient education, used when treatment is challenged legally or used for making projected presentations before lay or professional groups.
Altering images for treatment planning or educational purposes.
Software for altering digital camera images (examples include Adobe Photoshop [Adobe Systems, San Jose, Calif.] Canvas [ACD Systems of America, Miami] and Corel Paint Shop Pro Photo XI [Corel Minneapolis, Eden Prairie, Minn.]) is available in your local electronics or computer store. Using the software effectively and efficiently requires some learning time, but the results are well worth the effort. For example, you can manipulate photos to demonstrate the closing of diastemas, the changing of tooth color, the movement of teeth, the lengthening or shortening of teeth, the changing of gingival levels, the covering of old and unsightly restorations and the movement of midlines. Pretreatment and altered images can be e-mailed or sent home with the patient in printed or e-mail form to facilitate further discussion with or education of a spouse or parent.
Sending images to dental laboratories to assist technicians with color selection.
Matching tooth color always has been a difficult and unpredictable task. One of the most helpful and influential dental uses of digital cameras is making images of teeth that are to be indirectly restored and sending hard copies of or e-mailing the photos to the dental laboratory. When the image is made, the selected shade guide tooth should be held adjacent to the tooth being matched, and the image should show both the natural tooth and the appropriate shade guide tooth. Both dentists and technicians report to me that their color matching is improved greatly when they use this simple procedure.
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SUMMARY
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Both intraoral television cameras and digital still cameras are excellent pieces of equipment to have in a dental office. Their uses overlap, but they do not replace each other. Intraoral television cameras provide simple, readily available patient education while patients are in the office. Because of their relatively low resolution, they are not as valuable for long-term archival documentation as were previous higher-resolution intra-oral television cameras. Digital cameras provide easily obtained, high-resolution, long-term documentation of any oral condition, and the images they produce can be altered for treatment planning and patient education purposes. It appears that in 2007, both devices are useful for dental practices.
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INTRAORAL TELEVISION CAMERAS
DIGITAL CAMERAS
