Are you unsure about taking photos?

Worry no more, says the author. Once you know some tips and tricks, digital photography can be a boon to your practice's success.

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Story and photos by Tony Soileau, DDS

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Note from Dr. Paul Feuerstein, technology editor for Dental Economics: I have come across many talented dentists, many of whom submit photographic examples of their work. Hidden away in Cajun country in Lafayette, La., is Tony Soileau. He is an excellent cosmetic dentist with an avocation of photography. He has the uncanny ability to photograph people, yet highlight his dental results. I spent a lot of time listening to Tony and watching him work his camera magic. The article presented here is a combination of his writings with my interjection and clarification at his request.

Digital photography has exploded into the dental practice. Practitioners are purchasing digital cameras at a mind-boggling rate and gathering as much information as they can about their uses. Courses are given on how to take the best "upper second molar shots" using proper mirror technique. But let's step back, literally. Patients who are looking for cosmetic results want to see how they look in public, not under the magnified eye of the dentist.

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Portrait photography — showing the patient from the shoulders up — can give people a better feel for what we accomplish and become a powerful marketing tool. An attractive patient with an attractive smile will bring in more patients than showing a mouthful of amalgams replaced with tooth-colored composite. Using portrait photos will also tend to bring in patients who desire more comprehensive treatment. Many early adopters sent these "great cases" to professional photography studios for internal and external marketing opportunities. With a little practice and some new digital cameras, the dentist or staff can get remarkable results in-house.

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Most consumer digital cameras are of the point-and-shoot variety, allowing the onboard computer chip to do all of the thinking and composition. With automatic focus and lighting, it is easy to get a nice snapshot and very clear pictures of people's teeth and dental procedures. There are new digital cameras that have the touch and feel of the SLR — traditional 35 mm single lens reflex cameras with through-the-lens monitoring — with the electronic wizardry to automate the focusing and lighting process. After searching the marketplace, the author has found a camera that works well in his hands — the Canon 10D equipped with a 100 mm macro lens and MR14 ring flash. If you are old enough to remember, the SLR 35 mm you used in dental school was primarily manual. You had to deal with film speed, f-stop, and shutter speed. All of these functions in the digital cameras are automated and most allow 100 percent control by the computer if desired. When working with portraits or closeup/intraoral pictures, the higher-end cameras allow complete operator control. This is a mixed blessing since more training (or more trial and error) becomes necessary. We will attempt to give some basics here, using the Canon 10D as the example. The first step is finding the "M" on the camera for "Manual" mode. Using this setting, the user can follow all of the settings discussed below and take a more active role in the composition and desired results.

Film speed

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When purchasing film, the speed is related to the application. If you brought the camera to the beach, you would use an ISO 100 (or lower with slides). This film is very accurate, has a dense grain, and works well with a lot of light. For all-around indoor and outdoor photos, 400 will cover most light situations — for very low lighting indoors, you might use 1000 or higher. With some adjustments in developing and processing ("pushing"), you can also "trick" the camera and use film speeds that were not intended for that particular use. The problem is that you typically end up with an unfinished roll to be developed if you go from one situation to another. Some cameras use different "backs," allowing the option to have different film types preloaded and switchable. The digital camera allows you to change the film speed for each photo if desired. For our portrait applications, we have chosen ISO 200. The computer still follows the film rules — higher speeds will operate with less light but pictures will be more grainy in appearance. To keep things simple in this article, the portraits will be taken without a flash and, in these examples, outdoors (flash will be discussed in a future article as well as indoor lighting).

F-stop

There is a diaphragm in the lens that opens and closes to mimic the iris of the eye. The widest opening, which allows the most light in, determines the rating of the lens — the number used to describe each model. A lens rated f1.4 is usually a higher quality than f2.1, all other specifications being equal. There always seems to be confusion about the f-stop, probably because the values are counter-intuitive. The lower the number, the wider the diaphragm (iris) is open. F2 is wide open and lets in a lot of light while f32 is a tiny hole. This opening also has an additional bearing on what items are in or out of focus.

Depth of field

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When you focus on an object, you also see items in front of and behind it. For example, imagine five football players standing 10 yards apart on a field, starting at the 50-yard line. You are standing on the opposite 20-yard line with your camera. When you focus on the player on the 30-yard line, by changing the f-stop, the other players will be in or out of focus. If the diaphragm hole is very small (high f-stop), all five players will be in focus. The "depth of field" is 20 yards in front and behind that player on the 30-yard line. As you open the diaphragm wider, you will begin to lose clarity of the players on the 50- and 10-yard lines because you are making a smaller depth of field. Finally, with the lens wide open (lowest f-stop number), only the player on the 30-yard line is in focus. This is the smallest depth of field, perhaps a few feet in front of and behind him.

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When taking a portrait of a patient, if you open the lens to allow in a lot of light (low f-stop), the depth of field will be small and the background is essentially eliminated by becoming blurry and out of focus. When we bring our patients outside for portraits, they are often pictured in an unattractive parking lot. Even if it were a beautiful background, the idea is to focus on the person and the smile. In the parking lot, with a shorter depth of field, the cars become colored blobs and brick walls appear as a reddish textured background, making for interesting effects. However, the brightness of the photo is not only controlled by the f-stop but also by the shutter speed.

Shutter speed

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Since we have chosen a film speed that needs light (200), and we opened up the f-stop to get a shallow depth of field, we may have a situation where the photo will be too light or overexposed. In order to let less light in while maintaining these settings, we have to make the shutter close faster. Once again, the numbers seem to work backwards. The shutter speed represents the fraction of a second that it opens. A shutter speed of 250 is actually 1/250 of a second. Remember, the higher the shutter speed, the less light in. Also, the higher the f-stop, the less light in.

The wonderful thing about using a digital camera with a monitor screen on the back is that you can take the photo, review it, and change settings if you did not get the desired result. You DO get a second chance.

Technique

We define a portrait shot as one from the top of the head to the chest. The technique here is one for outdoor photography. There is still something more beautiful outdoors than in a studio with artificial lighting, but you have to be up to the lighting challenges. It is best to start about 6 feet from the subject, setting the f-stop to 6.7 and shutter speed at 250. A look at the monitor shows the image and gives a hint about the clouds, shadows, etc. A few test shots will determine, for example, that the shutter speed has to increase to 350 on a sunny day. A series of images with different poses and angles of both the subject and the camera are taken, adjusting the settings as the images are viewed. The second series of portraits are taken about 2 feet from the subject (we just want the face in the viewfinder). At this distance, the f-stop has to be increased to 11 for more depth of field. The original setting of 6.7 would, for example, only have the tip of the nose and chin in focus, making the smile somewhat out of focus. Increasing the f-stop now means less light so the shutter speed has to be adjusted down to 180 to allow more light.

Note the mention of subject and camera angles. A common error in portraits is taking a photo straight on, head centered, and everything vertical. With a little creativity tilting the head or the camera, as well as using shadows, more flattering photos can be obtained. Look at fashion photos as well as examples on various dental Web sites where cosmetic results are being featured. Hands-on courses are also quite valuable — the return on investment of time and tuition will be far outweighed by the marketing possibilities that can be created. Working with groups of colleagues, models, and instructors can help refine your photography skills and bring these ideas immediately back to the office.

Editing and printing

Despite the preliminary assessment on the camera's small LED screen, the photos have to be carefully scrutinized. The camera stores the images on a compact flash card which is brought to a workstation and downloaded with a card reader. Once on the computer, sorting and editing can begin. A favorite program is ThumbsPlus (cerious.com) which costs $50 to $90 depending on the version. Although inexpensive, it can make many sorting, resizing, and printing chores a breeze. For more complex editing, ImageFX (scican.com) or photoshop (adobe.com) are more robust. For seamless integration into your practice-management system, you might look into Dentrix (dentrix.com). Due to the professional grade sensor and optics in the Canon 10D or equivalent cameras such as Nikon's D100, very little color correction is necessary. Printing with ThumbsPlus is done simply by clicking on the paper size. The software also allows the photographer/dentist to superimpose a logo or signature which could lead to interesting marketing possibilities. Due to the high resolution of the camera, these pictures can be blown up to poster sizes for display on the office walls as well as decorating other public areas for external marketing (with the patient's permission of course). An example is offering to place these photos in local beauty salons. If the dentist's signature is on the print as described, the photo becomes a giant business card. More ideas on this will be forthcoming in future articles.

Two printers that are well suited for this are the Canon i9000 and the Epson Stylus Photo 2200. Both can print a variety of sizes up to 13 by 19 inches, but the more expensive Epson cannot only go up to 44 inches, but also has slightly better color reproduction. Paper is certainly a factor. For larger prints, matte (satin) or glossy finish can be used. Although glossy gives more detail, there can be glare problems at certain viewing angles if the pictures are mounted on a wall. Two favorite papers for matte and glossy are Olmec Satin and Pictorico Pro Glossy. One note on the quality — printing can be done at a variety of resolutions measured in dots per inch (dpi). Higher settings are perhaps better quality, but use a proportionally increased amount of ink and increased printing time. A good starting point is 720 dpi for good saturation and excellent detail. Keep in mind that these settings and paper size and styles are for larger display, not casual prints. If you do plan on hanging these on walls, you do not need frames. It is quite elegant to mount the prints on foam board, and attach by simply using glue sticks.

By using the ideas expressed in this article, you should see how easy it is to expand your photographic horizons from snapshots of teeth to portraits of the patients. This can lead to expanded marketing ideas, beyond showing the patient simple before-and-after photos. There is certainly a considerable investment in camera equipment, printers, and paper, but the returns can be remarkable.

Author's Note: I get my cameras and printers from Norman Camera (www.normancamera.com, 800-900-6676).

Editor's Note: More information will be forthcoming in future articles, but for some insight as well as course information, look at the author's Web site — smilesbysoileau.com.

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