Show and Tell

No patient wants to hear that his or her mouth is a disaster waiting to happen. In fact, it’s common for patients to put off needed treatment or live in a state of denial. But thanks to advances in digital technology, tools are now available to help increase case acceptance. Imaging systems can be invaluable in showing patients, in real time, what the heck clinicians are talking about. This can make a significant difference in increasing patient treatment acceptance. Intraoral cameras are among the leaders of the pack in this respect.


Introduced into dentistry in 1987, intraoral cameras have evolved from clunky analog mobile units to streamlined, digital, high-definition magic wands. Today’s intraoral cameras are much more portable than their predecessors, as most can be connected with USBs. In fact, some models are even wireless. This is a huge plus for practices that share one camera among several operatories.

Besides the fact that the emerging class of high-definition cameras delivers improved image quality, these instruments’ method of display further elevates their status as superior patient-education tools. Ted Takahashi, founder and CEO of T2 Consulting, a Minneapolis-based firm that helps dentists navigate the maze of digital technology, notes that unlike standard systems, “A high-definition intraoral camera’s image size fully fills up a widescreen display from end to end without using software graphics as a template to fill the screen.”

Aside from their value as patient-education tools, these cameras offer assorted diagnostic capabilities, and without the radiation exposure of radiography. Says Lorne Lavine, DMD, who operates The Digital Dentist consulting firm in Burbank, California, “High-definition cameras are far more diagnostic than older technologies. While cameras have always had a benefit for patient education and co-diagnosis, they now allow the dentist a high-def, close-up view to assist in diagnosing caries, recurrent decay, open margins, etc.”

In fact, some of the newer models include video modes or offer fluorescence settings that can not only aid in detecting caries, but also identify plaque and gingival inflammation. Others can be used extraorally as well, even for full-face documentation. Many are also able to interface with practice-management software of all kinds, streamlining office operations in an era when electronic filing is simply becoming the smart thing to do. All of this adds up to a platform that facilitates documentation; expedites patient education, diagnosis and treatment; eases case sharing among clinicians; and encourages insurance pro­vider acceptance.


A dentist may be a wonderful clinician, but not the greatest communicator. This can have a negative impact on patient treatment acceptance. Software geared toward patient education can go a long way in encouraging treatment buy-in. And what’s really great is that free demonstrations are often available, simplifying side-by-side product evaluation. In fact, some web- and cloud-based programs are either free or charge a low startup fee with no installation required. This is key information that sales reps will want to share with their customers.

Numerous patient-education packages are now available, offering libraries of countless kinds of dental procedures and related information on techniques and equipment. Some basic programs are free online. Others, offering more treatment scenarios, are available for purchase. Many utilize full-color 3D animation and offer the capability to customize with patient images, records and information for a tailored case presentation. The data can be presented as a complete package via DVD or online, cloud-based or server-based platforms, and delivered to the operatory or reception area monitor through email links or the Internet.


Sales reps can help their customers with initial purchases or upgrades by advising them about what to look for in a camera. According to Lavine, when looking to buy an intraoral camera, the top consideration is image quality. “Image is king,” he says.

Takahashi agrees, explaining, “Image quality is broken down into two subcategories. The first is image clarity and resolution. The ability to see microcracks and minute detail in teeth demands this. The second is color accuracy. The ability to diagnose cancerous lesions in the mouth relies highly on color accuracy.”

Takahashi also points out the value of a good lens. “A good optical system has a wide depth of field and requires little or no focusing during the exam.” He says that if constant refocusing is necessary, the depth of field is inadequate for the clinician’s purposes. Likewise, he notes that proper positioning is key, as most cameras today are connected to a computer in the operatory via USB and a 15-foot cable.

In addition, Takahashi adds, “The intraoral camera should holster into position much like a high-speed handpiece.” He stresses that ease of access is critical. “Products that are difficult to use,” he says, “are far less accepted by dental staff and used less frequently.”

Lavine adds, “Other factors to consider are integration with existing image management software, size of the camera, ability to capture with a button on the handpiece, warranty and, of course, cost. They are not like toasters,” he says of intraoral camera systems.


In lieu of or in addition to intraoral cameras, some practices opt for digital extraoral cameras that are outfitted for dental applications. Lavine explains that these are typically good SLR digital cameras with accessories such as macro lenses and diffusers added to make them more appropriate for dental use. Such systems may also include a ring light or flash system to enhance dental imagery, along with special light attachments.

Because of their familiarity and dropping price points, extraoral cameras are giving intraoral cameras a run for their money. In fact, says Lavine, “The biggest competition for diagnostic intraoral cameras is the cheap eBay cameras that sell for $100.”

Recently introduced multipurpose cameras, capable of handling both extraoral and intraoral imaging in one wand, could also become an attractive option. These would come in handy for documenting full patient smiles, rendering before-and-after shots, and recording other patient information, as well as capturing intraoral images for diagnostic purposes and patient education.


  • Digital imaging facilitates patient education, increasing treatment acceptance
  • Digital imaging systems save time and can boost office revenue, while lowering radiation exposure
  • Diagnosis and treatment are enhanced through highresolution images
  • Most intraoral cameras can now be connected with USBs, which enhances portability
  • Some intraoral cameras can now also take high-quality extraoral images and offer video capability
  • Digital systems can enhance office efficiency and facilitate third-party sharing, while also helping practitioners meet electronic health records requirements


Another boon to patient education and diagnostics is digital radiography. This technology also allows instant sharing and discussion between clinician and patient — only in X-ray format. And unlike film radiography, which requires messing around with a darkroom and chemicals and waiting for what can seem like an eternity for film processing, digital X-rays can be shared instantly on a monitor. All the better to foster an atmosphere of “co-diagnosis,” the latest buzzword in the field. So many gains has this technology made in the past few years that, in Lavine’s view, digital radiography has surpassed the use of intraoral cameras. “There are now, in my opinion, more offices using digital X-rays than cameras,” he says.

Still, Takahashi maintains that many of today’s offices continue to use both intraoral cameras and digital radiographic intraoral sensors. “Early adopters are now in a position to replace these sensors with new ones,” he adds.

The two main camps of digital radiography are intraoral and extraoral. There are two types of intraoral radiography: direct and indirect. Direct intraoral radiography employs sensors that enable images to be directly brought up on a monitor for patient viewing. In the case of indirect intraoral radiography, photostimulable sensor plates (PSP) are used to create images that are first scanned and then shown on the monitor. Intraoral X-rays, used in capturing bitewings and periapical images, are invaluable in detecting caries and monitoring the overall health of teeth and bone structure.

The advantage of direct intraoral radiography is speed, as the images can be brought up on screen immediately. The main disadvantages are that the sensors may be bulky and can be uncomfortable for patients. They are also more expensive than plates, meaning they will probably need to be shared among operatories.

The indirect method, while slower, offers thin, flexible plates that are more comfortable for patients, although they may need to be replaced occasionally. They are also less expensive, allowing multiple plates to be distributed around the office, eliminating the need to share.

Extraoral radiography used in dental practices most often includes panoramic X-rays. These types of units employ a camera that circles the patient’s head, snapping pictures in segments. The segments are combined into a 2D panoramic image of the entire mouth, including upper and lower arches. Panoramic systems may be digital and direct, although older systems can be converted into indirect digital systems, using PSP. These images are often used as a baseline for new patients and for treatment planning. They can reveal impacted wisdom teeth and hard tissue problems, and can be used in assessments for treatment of temporomandibular joint (TMJ) disorders or implant placement. Panoramic imaging is also beneficial for taking bitewings in patients who can’t tolerate having sensors, plates or film in their mouths.

Cephalometric units are more likely to be found in the offices of maxillofacial surgeons or orthodontists, as they depict the patient’s entire head in relation to teeth, jaw and profile. They are helpful in orthodontic treatment planning.

If patient education is improved with two-dimensional images, it sings in 3D. Cone beam computed tomography (CBCT) is less often found in general offices, mostly because the units require a dedicated space and are expensive. But that is slowly changing, and many combo pan and ceph units come with the capability to upgrade to include CBCT. This technology is especially of value to clinicians who perform oral surgery, orthodontia or who place implants.

The benefits of digital radiography are many. In addition to saving time and space as well as delivering a high return on investment and space, digital radiographs increase patient buy-in of diagnoses and treatment plans due to the clinician’s ability to show them on a monitor. Through this kind of radiography, clinicians can more easily detect early caries and other developments, including hidden decay, periodontal disease, infections, and other hard- and soft-tissue issues that may not be seen during a visual examination. They may also be able to tweak images digitally to enhance viewing. In addition, intraoral digital imaging technologies emit far less radiation than traditional film radiography. Finally, digital images make for easy storing in electronic health record systems.


  • ALARA: As low as reasonably achievable; refers to the principle of using as little radiation as possible to capture the desired image
  • High-Definition: High pixel count for high-resolution and sharp, highquality images
  • Periapical X-rays: Images that depict root structure
  • SLR: Single-lens reflex cameras use a mirror and prism system, allowing viewing through the lens rather than a viewfinder


In an ideal world, an office would have a range of digital systems at its disposal. But Takahashi says that dental offices with a full suite of integrated systems are the exception rather than the rule. In fact, he points out that some offices have yet to add computers in their treatment rooms. But he observes that sales reps can provide tremendous assistance to their dental customers by fully understanding the products they sell and by educating dentists on how those products will benefit their particular dental practices. In his opinion, the best way to present such information to a dentist is through presentation software such as PowerPoint.

But, he adds, “Just as important is a thorough understanding of how the digital equipment will integrate with an office’s existing software, computers, servers and network. There has to be a systematic plan and a realistic budget to accomplish the goals of the practice. Too much new technology too soon can paralyze a practice until they get far enough up the learning curve for the ROI to kick in.”

“There are many decisions that the rep can help with,” says Lavine. “Will it work with their software? What is the return on investment, and how do you calculate that? How will they get trained on proper use?” Indeed, manufacturer support is vital for training of staff to ensure good images are being taken under the ALARA (as low as reasonably achievable) principle and to reinforce proper handling of equipment. Sales reps can prove particularly useful in this respect.

Digital imaging has gained a solid foothold in today’s dental practices and is gaining more traction every day. Sales reps would be wise to get out in front of it and stay on the leading edge to best help their clients ride the digital wave. But whether they opt for digital radiography or for digital intraoral cameras, their ability to show their patients, through imagery, what their oral health situations are can have a telling affect on patient acceptance — and the bottom line.

MENTOR May 2015;6(5):14–16,18,20.

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