The role of intraoral photography continues to grow in dentistry
Photographing our lives and posting them on social media is commonplace these days. Dentistry can learn from this "Planet Selfie" world with the routine use of intraoral photography.
While discussions of intraoral cameras often cover increased case acceptance, there are many other reasons for using this technology. Intraoral photographs assist in decision support, documentation, and recording of results. Here are other reasons why intraoral photography will play a larger part in our clinical practice of dentistry in the years to come.
Changing Health-care Metrics
Dentistry continues to address caries as an acute surgical problem. But while restorative procedures repair damaged structures, they do not treat the underlying causes. The same is true for the detection, diagnosis, and treatment of periodontal disease and oral cancer. This approach, though successful and profitable in the past, is changing. Insurance carriers, governments, and others who are paying for health care are seeking different approaches. For example, the US Department of Health and Human Services is seeking "systematic and continuous actions that lead to measurable improvement in health-care services and the health status of patients."1 Photography will play a role in this development.
Radiographic Images Alone Are Not Enough
Annual radiographs, most often bitewing images, continue to be routine in most practices. Dental benefit carriers and governmental agencies paying for health care are beginning to question this. There are people needing many more images than are being taken, while others need fewer. The American Dental Association (ADA) and the Food and Drug Administration (FDA) created guidelines for radiographic images that were updated in 2012.2 As a result, carriers are sending letters, like this one sent to a Rhode Island practice:
The number of x-rays your practice takes per patient is not only well above that of your peers, but also contrary to ADA/FDA recommendations for radiographic examinations. [. . .] Given the gravity of the situation, we are giving you notice that all claims for radiographs after [this date] will be monitored.
There are easy solutions when a letter like this arrives. It should be a matter of simple documentation. Radiographs, per the guidelines, should be taken for specific reasons, with "time" not being one of those reasons.
Even though radiation from dental images is low (particularly with digital images), it is still the responsibility of the dentist to follow the ALARA principle ("As Low As Reasonably Achievable"). Pages 6 and 7 of the guidelines give a list of reasons that will look fairly obvious.
In addition to the reason for taking the images, there also needs to be a documented result: What did the dentist read from those images? Whether there are benefits involved or not, this process is just good practice. Also, although they are important in our diagnostic processes, radiographs alone aren't always enough to show measureable improvement.
Photographs are simpler without ALARA principle concerns. A photographic survey of the soft tissue, including the throat and more, can do more than document soft tissue issues. It can be the beginning of building a sleep case, orthodontic consultation, and much more. Photographs of the teeth can be diagnostic because of the ability to see and track measureable change that cannot be seen in radiographs. No matter how good someone is with descriptions and measurements, we all know a picture is worth a thousand words.
Promise of Teledentistry
The number of ways dental professionals can interact with patients is growing rapidly. A provider may be hundreds of miles away and on a computer screen instead of chairside. Late in 2015, the ADA issued policy guidelines on teledentistry.3 The ADA's policy says third-party providers and benefit plans should reimburse teledentistry encounters at the same rate as in-person services. More and more public and private insurance programs are adding coverage for telehealth and teledentistry nationwide. These opportunities are for private dental practices as well as the public health sector. An excellent intraoral camera is not the only mechanism, yet it is foundational.
Another Planet Selfie Lesson
Not everyone in your practice is a naturally talented photographer. The good news-as we know from our smartphones-is that technology continues to evolve. Intraoral photography is taking more of the guesswork out of the process.
For example, Air Techniques has two types of intraoral cameras available to dental professionals in its CamX line of products. One unit even offers high definition video, and it can focus automatically from tooth surfaces to full patient portraits. The other unit has a fixed-focus feature that keeps objects from 6 mm to 40 mm in sharp detail. What differentiates these cameras from other lines is that the image is captured when the button is released, allowing stabilization of your hand, which leads to distortion-free images every time.
People will go to great lengths to capture a perfect shot of themselves. The reasons are many, including a desire to connect. The same should hold true for dental photography. Before-and-after photos are for more than just showing what a pretty smile a dentist created. Whether used for patient communication, insurance documentation, teledentistry, or other reasons, images can be more powerful than words.
1. Quality Improvement (QI) and the Importance of QI. US Department of Health and Human Services Health Resources and Services Administration website. http://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/. Accessed July 4, 2016.
2. Dental Radiographic Examinations: Recommendations for Patient Selection and Limiting Radiation Exposure. American Dental Association website. http://www.ada.org/~/media/ADA/Member%20Center/FIles/Dental_Radiographic_Examinations_2012.pdf?la=en. Published 2012. Accessed July 4, 2016.
3. House Passes Guidelines on Teledentistry. American Dental Association website. http://www.ada.org/en/publications/ada-news/2015-archive/december/house-passes-guidelines-on-teledentistry. Published December 7, 2015. Accessed July 4, 2016.
Patti DiGangi, RDH, BS, works with dental professionals to improve practice profitability. Patti holds publishing and speaking licenses with the ADA for Current Dental Terminology and Systematized Nomenclature in Dentistry (SNODENT) Diagnostic Coding. She is the author of the DentalCodeology series of bite-size books for busy people. She was invited by ADA to write a chapter in CDT 2017 Companion. Reach her at firstname.lastname@example.org or DentalCodeology.com.