Article and Clinical Photos
by James R. Dunn, DDS
Other authors have described the importance of understanding the power
of "visual learning"* in dental communication,1 as well as the traditional
guidelines for dental photographs as suggested by several dental organizations.2 These authors have also argued for extensive use of photographs
in dental practice.
Dentistry has traditionally followed the suggested standard guidelines of
lighting, composition, magnification, orientation, retraction and mirror
use. Dental photographs taken when using these guidelines give a clear
visual record of the dental subject (Fig. 1); however, the photographs can
become static clinical records in spite of their importance to the dentist.3
Photographs used for communication are just modifications of these
basic clinical record photographs. Our subject is still the same – teeth,
oral and para-oral anatomy – we are just using more artistic photographic
techniques (Fig. 2). In general photography, these photographic
differences are described as "factual" versus "artistic" photographs.4
The primary difference between dental record photographs and "presentation"
or "communication" dental photographs is that communication
photographs are created specifically for the benefit of the person we
want to receive our dental visual message.
COMMUNICATING IN DENTISTRY USING ART-QUALITY PHOTOGRAPHY
When communicating dental information to patients, peers, laboratories,
or in marketing or publishing, we have to ask the question, do my photos
show the story I want to tell? Photography is visual storytelling. To
tell a clear story or show a clear visual of specific dental information, we
have to understand the characteristics of a good photograph.
Describing what makes a photograph effective is difficult, but one of
the best checklists I have found is by photographer Charlotte K. Lowrie.
Although Lowrie describes general photography, I have paraphrased her
checklist for dental photography.5
WHAT ARE THE CHARACTERISTICS OF A GOOD DENTAL PHOTOGRAPH?
1. Is there a clear center of interest?
a. When you look at the photograph, is the first thing you see what
you want to show?
b. Are there other things in the picture that distract from the center of
c. Does the quality of light or direction of light and depth of focus add
or distract from what you want to show (Figs. 3, 4)
2. Is the photograph composed well?
a. Is the picture cropped to show only what you want to show?
b. Is the picture in proper alignment and perspective?
3. Is the picture in focus and does it have proper exposure?
a. Is the dental subject of interest in crisp focus?
b. Is the depth of focus adequate to clearly show the surrounding
c. Is the exposure adequate to clearly see the subject?
4. Does the picture tell the story you want to show?
a. What change could be made to show a stronger story?
5. Does the lighting enhance the visual story you want to tell?
a. Is the intensity, direction and color of the light correct for your
b. Does the lighting enhance your visual message?
6. Is your photograph creative?
a. Will your photograph stimulate viewer interest in the subject of the
b. Will the intended viewer be able to clearly see the dental story you
want to show (Fig. 5)
It is important to take adequate dental photographic records. The uniform
guidelines described by the American Academy of Cosmetic Dentistry
(AACD), the Pankey Institute and other groups are essential as part of
basic dental records. However, to communicate with both dental and non-dental viewers, we have to present photographs that meet the artistic
criteria of professional photography. The photographs we use in any
presentation compete with professional photographs seen in commercial
advertising, glamour publications and on websites. Whether we like it or
not, the quality of our photographs is seen as representing our quality
as dental practitioners.
How do we as dental practitioners take professional quality photographs
of dental subjects? One of the first things to remember in dental photography
is that the eye of the photographer is more important than having
the most elaborate camera equipment. The dental message we capture
in our presentation photographs is what matters.
CAMERA EQUIPMENT IS IMPORTANT, HOWEVER
The best camera system is a system that is easy for you to use. If your
camera system is cumbersome and not adjusted for quick use, you will
not use it. You may want to use a point-and-shoot camera modified for
dental use, such as the Canon G11 with the PhotoMed Closeup Attachment
Kit* (Fig. 6).
A more complicated but higher-quality image can be taken using one of
the single-lens reflex (SLR) cameras with a 60 mm or 100 mm macro lens
and an adjustable "macro" flash. An example of a quality SLR dental camera
system is the Canon EOS 7D with a Canon 100 mm Macro lens and the
Canon Macro Twin Lite MT-24EX flash with Sto-Fen flash diffusers* (Fig. 7). SLR camera systems are inherently more complex than point-and-shoot
All dental camera systems must be properly set for optimum quality
dental images. Settings include the white balance (Fig. 8), shutter
speed, f-stop and picture style. Each of these settings affects the quality
of the photograph. I suggest you purchase a dental camera system
from a company that supplies you with the system already adjusted
for optimum dental use, in addition to a quick-start guide* (Fig. 9)
to quickly reset the camera to dental specifications when the camera
adjustments are deliberately or unintentionally changed. Artistic quality
dental photographs can be made with both of the aforementioned types
of camera systems when used by an artistic photographer.
CAMERA ACCESSORIES USED
WITH COMMUNICATION DENTAL PHOTOGRAPHS
Five accessories are essential when taking communication dental
1. Metal frame cheek retractors (Fig. 10)
a. To retract lips to expose intraoral anatomy
b. To retract lips when using mirrors
c. Can be autoclaved
2. Combination occlusal/buccal mirror* (Figs. 11a, 11b)
a. For occlusal views (use buccal mirror as a handle)
b. For quadrant occlusal views (use occlusal mirror as a handle)
c. For lateral views (use occlusal mirror as a handle)
3. Buccal mirror* (Fig. 12)
a. For taking lingual views of posterior teeth
b. For taking occlusal views of posterior teeth
4. Anterior "contrasters"* (Fig. 13)
a. To create a "black" background for anterior teeth
5. Occlusal "contrasters"* (Fig. 14)
a. To create a black border for maxillary occlusal views (hides lips,
hair or nose)
b. To create a black border for mandibular occlusal views (hides
c. Handle used as a black background for profile view of anterior
teeth (hides cheek)
Each of these accessories allows for better framing and isolates distracting
anatomy in dental photographs. The proper use of mirrors also
allows for a direct view of areas that are difficult to see using direct
vision, while contrasters hide distracting anatomy such as lips, tongue,
palate or, in a lateral anterior profile, the cheeks. Using these accessories
effectively may require additional hands, but they will enhance the
attractiveness of the photograph.
APPLYING GOOD PHOTOGRAPHIC PRINCIPLES TO DENTAL PHOTOGRAPHY
1. Determine that your camera system is adjusted to optimum dental
settings. Check battery strength in both the camera and the flash systems. Have the necessary accessories ready to use.
2. Know before you take the photograph what you want to show in
the photograph and what you want to exclude. Crop the photograph
to show only the area of interest. Focus closer. Use contrasters
(Fig. 15) to exclude distracting anatomy. Use mirrors if you are unable
to get a clear image using direct vision (Fig. 16). Align the subject to
the best viewing position. Know who will view the photograph, and
take the photograph so that they will be able to understand your
visual dental message.
3. Position the flash to direct light on the dental subject to best highlight
anatomical detail. If taking the photograph directly, use a flash that
allows side lighting. If using a mirror, direct the flash onto the mirror,
which will reflect the light onto the subject (Fig. 17).
4. Use a large f-stop number. Focus on the subject of interest.
5. Immediately evaluate the photograph on the camera's LCD screen. If
the image does not meet your criteria, retake the photograph.
ADDITIONAL APPLICATIONS FOR QUALITY COMMUNICATION DENTAL PHOTOGRAPHY
1. Annotations on Photographs. Writing on photographs enhances
the message by combining visuals and words (Fig. 18). Tablet PCs
and graphic tablets have programs to conveniently annotate words
on the photograph that can be saved to a new image. This image is
an enhanced message to the recipient. I use this method to communicate
with dental laboratories, when referring to dental specialists and
communicating with patients. Annotations decrease the chance of our
dental message being misunderstood.
2. Dental Portraits. Medical-style portraits can send negative messages
to the recipient. Most patients do not want to see themselves in the
harsh lighting and posing of our dental record portraits. Professional
portraits are lighted and posed to show a person's maximum attractiveness.
Huefner6 has described professional portrait techniques for
the dental photographer, and Dunn and Young* have developed a
simplified in-office portrait technique that can be used in most dental
offices without architectural modification or multiple external lights.
The simplified portrait uses a single flash, photo reflectors and a black
background* taken with the patient in the chair, in front of a wall or
in a hallway (Fig. 19). A quality patient portrait can be given to the
patient or used for marketing (Fig. 20).
For dental photographs of communication quality, use professional photographic
principles to take attractive, but highly effective photographs
that convey a visual dental message. This visual dental message can be
sent to patients, specialists, dental laboratories, and used in presentations,
publications or marketing. The quality of our images publicly reflects
the quality of our dental treatment and competes with professional
photographs found in commercial advertising, magazines, periodicals
and on the Web.