by Martin B. Goldstein, DMD
Wolcott, CT

Our profession is often accused of being slow to adopt new technology. Digital photography is no exception.

But from the inquiries that I’ve been receiving lately as well as the multitude of articles appearing in recent dental magazines, it appears that digital imaging is finally making a charge. An increasing number of dentists are acquiring digital cameras and using them both for documentation and practice-building.

It would seem that even the manufacturers have been surprised by the sudden increase in demand. Popular digital systems, such as those marketed by Photomed, frequently go on backorder. Apparently, the profession is finally going digital.

I recently had the pleasure of co-hosting a hands-on Comfort Zone Cosmetics course with SmileVision, Inc. They offer an imaging service to help dentists explain cosmetic case presentations. The dentist uploads an image and prescription to their web site and they show what the patient would look like with the proposed restoration; a rock solid marketing strategy when it comes to marketing cosmetic rehabs. During a break in the program, I snuck a peek at patient images that had been recently received for dental simulation.

The brief tour was inspirational!! Among those pictures were every photo-faux-pas possible with a digital camera.

True…digital had arrived but basic photo techniques remained on the doorstep.

Here are the five most common errors I saw - and how to avoid them.

Take a look at figure 2. The angel pictured is my dental assistant, Amy. Now look at figure 1. Yep, it’s still Amy, but not so angelic. In fact, in this view, she’s all nose and teeth.

That’s what you get when you take a picture leaning over a patient seated in the chair with the lens just a few inches from the nose.

You clawed and scratched to have a 3X optical zoom on your camera. You weren’t sure why, but you knew you needed it. Amy’s portraits demonstrate why. In order to obtain proper facial perspective, minus the exaggerated nose and teeth, the digital dentist must back away six to eight feet and use the 3X zoom to ... you guessed it! ... ZOOM IN!

Backing up and then filling the LCD with face using the zoom is the ticket to success. Oh, and one more thing. Stand the patient up against a wall, as I did here, so you can place the lens on a straight line to the middle of their face. Avoid the shots taken with the patient seated. In most instances, the results will be less than stellar.

Which provides us a lead - in to crime #2 ..
What’s so “great” about the wall in figure 3? It takes up more than 2/3rds of the image! Why waste the camera’s resolution by including so much background?

The solution: Turn the camera vertically and crop out most of the wall as you zoom in (figure 4).

Remedying offenses #1 and #2 will produce much better portraits, which, by the way, are very useful when seeking meaningful cosmetic simulations.
Confess !! You’ve seen too many pictures like figure #5 already. Unlike film-based cameras, digital cameras have a noticeable time-lag between the instant you push the button and the instant the image is captured.

If you fail to allow for this slight hesitation, you’re going to be looking at a lot of fuzzy pictures.

Not to get too scientific, just remember that things happen a bit more slowly when a CCD (the chip in the camera) is called upon to render an image than when snapping a shot with our tried-and-true SLR’s.

The solution is simple. Can you say “one - one thousand”? If so, you’ve got the fuzzys licked (figure 6).

You know how people often press down on the shutter button rather abruptly and in doing so, move the whole camera ...even if only half an inch? To obtain sharp images you must attempt to keep the camera absolutely still and steady when depressing the shutter button. It actually helps to momentarily hold your breath while doing so.

So the sequence goes as like this: (1) Frame your image (2) Half a press on the shutter button to allow the auto-focus to lock in. (3) Once locked, finish the shutter button travel (4) Wait for the flash (now don’t move!!!) count “one - one thousand” and (5) breath.
When the digital smoke clears (i.e. the digicam has focused, fired its flash and captured the image), you’re still maintaining the pose you assumed when you pushed the button. After you’ve finished counting out as instructed, you’re at ease.
This digital crime is more of a collection than a single offense. These trip-ups occur when we lose track of where the camera is in space relative to the subject framed.

Refer to figure 6 again, as the control. In figure 7, the shooter is simply coming in too high to an imaginary line that is perpendicular to the central incisors. In figure 8, the shooter is coming in from below that same line. The net effect on both is a distorted look that is less than pleasing.

In figure 9 we see the anterior retracted version of the Great Wall offense. Again, why bother including the retractors, cheeks and chin when all we really want to see here are the teeth as they appear in figure 6? Again, back up and zoom in to fill the LCD with teeth ... not cheeks.
This one’s easy. Look at figure 10 for a glimpse at what I call “fog-area” ... pronounced kind of like diarrhea. (You know those signs on the highway?) This occurs when you take an occlusal view in a mirror without someone (your assistant) present to blow air on the mirror.

Figure 11 shows the same picture with Amy using the air-syringe. Other than having missed the second molars in this shot, all is clearly visible. If an extra set of hands is unavailable, try running the mirror under hot water for a minute or so to reduce fogging.

A Misdemeanor?
There you have it! Five easy considerations to help you become a better dental digital photographer. There’s one other offense I should mention before signing off. And that is the “We have one but don’t use it” offense.

This sorry story occurs when the fired-up doc and staff take the plunge, buy the camera, and then leave it in the box.

In my photo seminars I usually ask for a show of hands of those who own digital cameras but never use them. I’m always surprised at the number of hands I see. And these are just those who ADMIT it! We all know the cure for this one. Damn the pixels, full speed ahead. RIP OPEN THE BOX!! Now where’d you put that battery charger??!!

Happy imaging!



Dr. Goldstein is a 1977 graduate of the University of Connecticut School of Dental Medicine and practices general dentistry in a group setting in Wolcott, Conn. He enjoys promoting the cosmetic side of his practice and has found it helpful to incorporate digital photography into his daily routine as a practice builder. Recently, Dr. Goldstein has been appointed to the staff of Contributing Editors at Dentistry Today. In addition to writing for Dentistry Today, Dr. Goldstein also writes for DentalTown, Contemporary Esthetics and Dentistry, the UK’s version of Dentistry Today.

Doctor Goldstein can be contacted at martyg924@cox.net or at his office at 203-879-4649. He is available for speaking engagements on both digital imaging in dentistry and the use of high tech methodology to further the cosmetic practice.

His step-by-step technique article discussing Direct Bonded Veneers (Report #47: The Three-Hour Cosmetic Rehabilitation) can be found here [PDF format]


For a summary of Dr. Martin Goldstein's upcoming lectures and courses, go to
http://www.drgoldsteinspeaks.com