Paul Feuerstein, DMD
I turned to Marty Goldstein at a recent Generation Next photography course and bragged, "Hey Marty, mine is smaller than yours!" I reached into my pocket and pulled out my new Casio Exilim 4 megapixel camera. As it turns out, Marty's (Pentax Optio) was in fact smaller as he took it out of the Altoids box (although it does have fewer MPs). As with all electronics, miniaturization follows technology. With small digital cameras, there are some limitations on the lens size in order to get high optical results. I was hoping that this digital camera would be small enough to fit in the mouth for direct intraoral photos. Alas, not quite yet, which brings me to this discussion.
Some individuals proclaim that the increase in megapixel resolution for digital cameras makes the intraoral camera obsolete. In the "new" new patient exam, we have pointed out that a full series of radiographs is accompanied by a full series of photos. If a full-arch photo is taken, usually in a mirror, details of the restorations, enamel, and soft tissue are vivid when zoomed in. The anterior teeth and tissues are easily seen and shown for co-diagnosis with the patient. However, unless a few more pictures are taken from buccal and lingual in the posterior areas, some areas of the dentition are not visible. Photomed has helped resolve this problem with their "dual viewing mirror" - a unique B and L mirror that shows all of the views of an arch with one photo. Still, there is a lack of immediacy in most situations. Although some cameras can duplicate the image that is shown in the viewfinder on a computer monitor, there are usually a few steps necessary to get the picture on the screen. Kodak's 4900 speeds this process by using a USB docking station. The camera is placed on a small "stand," a button is pushed, and the photos appear on the screen.
Still, if you are in the middle of a procedure, it's not as simple as grabbing an intraoral camera wand, looking up on the screen, and stepping on a foot control. I have sometimes (unfortunately) found a fracture line at the floor of a pulp chamber, running from mesial to distal, after removing the Cavit and cotton placed by my local endodontist. This is the patient who claims to still feel "something" even though the tooth is "dead," which, "by the way, cost a fortune." With Cavit and tooth dust on your gloves, it is not easy to stop in midstream, pick up a camera and mirror, take the picture, click on the program, and load the photo. However, some practitioners, like Dr. Goldstein, can make this happen in an instant. In additional, courses such as Genr8tnext's are helpful in this regard.
What about sterilization and cross-contamination issues? I find that when I de-glove, white powder has dusted everything I touch. The camera has a lot of buttons and knobs that can easily pick up the powder residue, and they are hardly user friendly when it comes to wiping them down with disinfectant. Will I ask my assistant to drop the suction, rinse her hands, and pick up the camera? Are you all familiar with an assistant who gives you "the look!"? (Hi, Sheila!) The intraoral camera usually sits near the handpieces and is always ready to go, having been pre-cleaned or prepared with a clear, plastic sheath. It can be put into service in an instant, and the picture frozen on the screen with the touch of a finger or toe. The zoom is done on the spot — no need to use software, mouse, or other external tools. It's simple to explain to patients during procedures too.
So what is the answer? If you already have the I/O camera, don't get rid of it right away, and keep in mind that there are several companies out there that can refurbish them (even, in many cases, those from companies that are out of business.) Here is where I get big hugs from the manufacturers. You really need both. For your routine initial exams, the digital camera is essential. But to zero in on a tooth or area instantly, the intraoral still shines. Have a nice time clearing counter space.
Dr. Paul Feuerstein installed one of dentistry's first computers in 1978. For more than 20 years, he has taught courses on technology throughout the country. He is a mainstay at technology sessions, including annual appearances at the Yankee.Dental Congress, and has been a part of the ADA's Technology Day since its inception. A general practitioner in North Billerica, Mass., since 1973, Dr. Feuerstein maintains a Web site (www.computersindentistry.com) and can be reached by email at [email protected].
