A Picture Is Worth a Thousand Words

As the saying goes, “A picture is worth a thousand words,” and today, intraoral cameras are a popular component of digital dental technology. The frequency of their use as educational tools to enhance the dental appointment has increased substantially from their inception in the late 1980s.^1,2 Intraoral cameras originated as bulky systems housed in cabinets that were transferred between operatories, which made them cumbersome to use. Over time, the technology has evolved, and modern intraoral cameras are light-weight, easily portable, and commonplace in today’s technologically advanced dental offices.^1,2

Intraoral cameras capture images of the oral cavity that can be projected to a screen that displays the magnified images for improved readability. The images then are stored and saved using a digital imaging software system. Digital imaging has replaced analog imaging as the optimal choice for most dental offices, as digital images require less storage space, can integrate with dental practice management software, and deliver high image quality.^1–3

Intraoral cameras provide oral health professionals and patients with a magnified digital image of oral structures, including both hard and soft tissue.³ These images can be captured during the initial patient examination, as part of the hygiene recare appointment, or during operative procedures. Images of decay, fractured teeth and/or restorations, calculus, decalcification, gingival recession, leukoplakia, and other soft tissue lesions are just a few of the problems that can be captured and stored in patients’ digital records. Open margins and cracks around restorations that harbor bacteria are easily visible when magnified and projected onto a screen. It can be challenging for clinicians and patients to see these issues with the naked eye. Furthermore, patients who do not experience oral discomfort may need to “see to believe.” Demonstrating patients’ oral health status in real time can enhance clinical diagnosis and patient understanding and increase case acceptance. Soft tissue lesions can be monitored and tracked for changes, assisting the decision on when to refer to a specialist for more advanced diagnostic testing.

Images captured with an intraoral camera can be actively used to involve the patient in all aspects of the appointment, including assessment, diagnosis, education, treatment planning, and, ultimately, case acceptance. Patients may be wary of accepting treatment if they do not understand the problem. Images produced by an intraoral camera enable patients to see anomalies as clinicians do.⁴ A problem like a fractured restoration may be easier to note and more difficult for the patient to ignore when it is magnified and viewed on a computer monitor.⁴ Intraoral camera images can be used as communication tools between clinicians and patients, and they may help bolster patient/provider trust. Intraoral cameras also can motivate patients to become active participants in their oral health.

CHOOSING EQUIPMENT

There are several factors to consider when choosing a intraoral camera for integration into a digital dental office, including ease of use, clarity of images, compatibility with computer software, size and weight of the device, and cost. Dental hygienists typically have a limited period of time when working with an intraoral camera, so the equipment must be easy to use yet capable of producing high-quality images. While designed for intraoral imaging, these cameras also can capture portrait and smile images for use in patient records.

Shaped like a small wand, many intraoral cameras are highly portable and easily connect to a computer via a USB cable or a docking station.⁵ Intraoral cameras that use a USB cable—the most common type of computer connection—offer quick disconnection to allow for easy transport between operatories.⁶ When not in use, intraoral cameras should be stored in their docking cradles to avoid accidental dropping. Many cameras are lightweight and provide ergonomically designed handles to support optimal clinician positioning. They may be designed with a sleek profile, slim head, and angled design to make for easier viewing of the posterior teeth.⁵ A variety of options are available to help capture images—from a foot rheostat to a button placed on the cord or handle. Some cameras have a highly sensitive button that requires only a swipe of the finger to capture the image. Such ease of use increases the utilization of intraoral cameras in the dental office, which leads to successful patient education and may increase case acceptance.

IMAGE CLARITY

One key to image quality is the clarity of the lens. If the resolution of a photo is not clear, it has limited value. With focal ranges of 1 mm or greater, taking crisp, clear images creates endless opportunities for improved patient education and communication. Intraoral cameras have a built-in microprocessor enabling them to auto-adjust certain settings, such as brightness and focus, to create sharp, clear images. The newest and more advanced intraoral cameras require little or no focusing. Most intraoral cameras include LED lights that are built in a ring around the lens to provide balanced, consistent illumination, enabling image capture without the need for external lighting.⁴

Another key to image quality is the optic system. The best optic systems are created by placing the charge-coupled device (CCD), a type of digital imaging sensor, at the end of the camera next to the lens.¹ The CCD chip captures light and converts it to digital data that are recorded by the intraoral camera. When the CCD chip is placed in the middle of the handle, which is less expensive to manufacture, an additional prism is necessary to direct the incoming image farther down the handle to the CCD chip. This degrades image quality and can produce artifacts, which may result in an inaccurate imaging. Ideal image quality is best achieved through the use of high-end glass optical lenses combined with high-resolution CCD chips.¹

SOFTWARE CONSIDERATIONS

Intraoral cameras can interface with most practice management computer software systems, so images can be stored in patient files and transmit magnified, high-definition oral images and video. The ability to capture clear images for a visual record of diagnosis and recommended treatment and then transfer them throughout the office helps increase communication between front office administration and clinical staff. Once patient images are stored and saved, they can be accessed any time and sent to patients, insurance companies, referring dentists, and specialists. This is extremely valuable when documenting treatment for insurance claims.

EQUIPMENT COST

Cost is a consideration when deciding on which intraoral camera system to implement. While most intraoral camera models cost between $2,000 and $4,000, bare bones models can start as low as $250. High-end versions with additional functions and features can cost upwards of $15,000. Prior to purchasing an intraoral camera, it is important to remember that durability and longevity are associated with reliable manufacturers who produce a quality product made to last at least

10 years to 20 years.¹ Care should be given to researching the available intraoral cameras, including compatibility with existing computer software and quality of images, before committing to a purchase.¹

The coupling of an intraoral camera and caries detection device in one unit is a new development. This allows for excellent patient education, diagnosis, and treatment planning. The camera captures the intraoral image and the caries detector demonstrates areas of potential decay. These devices capture information in a variety of ways, including light-induced fluorescence. Fluorescence technology emits LED light at specific wavelengths for the detection of caries.¹ The spectrum, or color, of the fluorescence signal is green for healthy tissue and red when the tissue is diseased.⁷

IMPLEMENTATION

Learning how to use the intraoral camera may take some practice, as the clinician will typically maneuver the camera while looking at a monitor rather than the patient. This skill, however, is easily attained with experience. To prepare for imaging with an intraoral camera, the patient typically is placed in a supine position, with the dental light off to prevent glare.?Place a plastic sheath over the camera for proper infection control. Select the setting for the desired image, such as portrait, smile, macro, or micro, prior to intraoral placement of the camera. Dry the area to be imaged with an air/water syringe to remove saliva; a dry field will greatly enhance image quality, as saliva can mask conditions that may exist on the tooth or oral structure. Once a dry field is established, place the intraoral camera in the area to be photographed, simultaneously looking at the monitor and moving the camera to access the desired image. Images captured and saved can then be magnified and viewed by both the clinician and the patient for increased understanding of the patient’s oral health status.

Digital technology is advancing the dental profession. Intraoral cameras are now more user-friendly and time-efficient than ever, enhancing the dental appointment. They are excellent patient education and case acceptance tools that are indispensable in today’s digital dental office.

REFERENCES

1. Obrochta JC. Efficient and effective use of the intraoral camera. Available at: dentalcare.com/media/en-US/education/ce367/ce367.pdf. Accessed June 17, 2015.
2. Attanasi K. Digital dental imaging. Dimensions of Dental Hygiene. 2013;11(1):48–51.
3. Attanasi K. High-tech tools for patient education. Dimensions of Dental Hygiene. 2013;11(4):46–47.
4. Dentalcompare. Dental intraoral cameras. Available at: dentalcompare.com/ Dental-Digital-Imaging-Dental-Imaging/4477-Dental-Intraoral-Camera/?search=intraoral+cameras. Accessed June 17, 2015.
5. Plummer K, Metzler K. Capture high-quality images. Dimensions of Dental Hygiene. 2013;11(6):20–22.
6. Sleeper LJ. Technology evolution. Dimensions of Dental Hygiene. 2012;10(6):42–44.
7. Panayotov I, Terrer E, Salehi H, et al. In vitro investigation of fluorescence of carious dentin observed with a Soprolife® camera. Clin Oral Investig. 2013;17:757–763.

From Dimensions of Dental Hygiene. July 2015;13(7):28,30.