Chairside - Glidewell Dental Labs

is one little spot where there’s a little recurrent decay or a
little recession, I think an intraoral camera is great for that.
I always use my digital camera, mostly for new patients. I
want them to see their whole mouth. I want to be able to
talk to them about that ugly, old black filling on their lower
first molar, and have them be able to see, without me saying
it, that there are four more on their lower teeth, because
they are all in the photograph.
MD: I take it you’re not just showing them this on the little LCD
screen on the back of a camera after you shoot these four shots.
LB: No. Our protocol is I take the four photographs: upper
and lower occlusal, full smile, and then with retractors
in and the patient’s upper and lower teeth apart so both
occlusal planes are visible. Then we take the card out of the
camera, throw it into a card reader that’s connected to a PC
in my office, Microsoft Photo Viewer comes up, which is
preprogrammed on every Windows PC in the world, and it
lets us print those four pictures on a single sheet of paper.
I actually do it on plain paper; I don’t buy photo paper. I’ll
print them and take them to the patient. My conversation
with patients will be, “We’ve got these in your chart as a
part of your permanent record, but I thought you might
want a copy of these,” and I’ll hand them to the patient.
Most patients will then look at them. As soon as they do, my
next comment is: “Do you see anything in the photographs
of your teeth that you’re curious about or that you have a
question about? Let’s really make sure we talk about that,”
and I’ll hand them a pen.
MD: Wow. See, I hand it to them and say things like, “I bet you
didn’t know your smile was so ugly!” That’s too strong maybe.
LB: (laughs) That might be less effective. So I can’t imagine
practicing without photography. For me, when I’m sending
stuff to the laboratory, I actually need to go overboard and
send too many photographs. This has made such a big
difference for me as far as what I get back in shade matching.
People say to me all the time, people who are techie, “But
it’s not all color corrected,” and I say that’s almost not the
point. The point is that the technician can actually see,
relative to the other teeth, what that looks like. They can
see nuances from the standpoint of chromo-gradient and if
there are little decalcification spots. My experience is that
every technician I’ve ever met sees 100 times more in a
photograph of teeth than I do as a dentist because they
have that eye.
MD: Exactly. Technicians love to have, not only the picture of
the teeth, but let’s say an A2 in there next to the adjacent tooth.
It doesn’t need to be a perfect match. They just need to see how
it looks relative to the A2 shade tab because they’ve got that
same shade tab in the lab and they can use that as a reference.
Are you taking all of those pictures, or is your staff able to take
those four pictures if you’re off doing something else?
LB: My assistants are all trained to use the camera and take
digital photography. I’d say that a few of them are better
photographers than I am. So we can switch in and out to do
that. If I’m doing a single central and it’s really challenging
because it’s a high-esthetic-demand patient, I’ll probably go
in and do the photographs, because then I can get analretentive
and do stuff like exposure bracketing, give the
ceramist one that’s a little dark and one that’s a little light.
But that’s not my routine. My routine is usually two to four
photographs with the shade tab in there, without the shade
tab in there, and the ladies in my office all do that very well.
MD: I bring that up mainly because I want dentists to
understand that this isn’t something they have to do themselves.
In fact, my assistant is as good as I am at this point, and she
complains less. If I have to take those four photographs, and
she’s not in there to help me, I’m pissed! But somehow she does
all four without me anywhere near her, so in that respect I
guess she does it better than I do. But I don’t want the doctors
to feel like this is something else that’s thrown on their plate.
This isn’t. You could just walk into the operatory and have the
patient already be holding the sheet with the four pictures on it,
and you could just sit next to them, say hi, ask them what they
think, and let them tell you.
LB: Exactly. I’m a huge fan of photography, and it’s so
much easier than it used to be. Most of the cameras we
use in dentistry now are basically the same camera bodies
that you can buy anywhere, so you can learn to use them.
Dental photography companies have training sessions,
there’s online stuff, there’s stuff on YouTube. There are so
many resources now to get over the initial learning curve,
and most of the new cameras can be set on automatic.
MD: Exactly. I understand why dentists were turned off from
it in the past. I remember you would shoot Kodachrome
or Ektachrome, and you would have to send it out for E-6
processing and you’d get it back a week later. Before you could
even prep the case, you had to make sure the “before” pictures
turned out. That was crazy. But it’s instantaneous feedback
now and, literally, any dental assistant can be taught to do it
now. There are plenty of good classes like yours, and there are
tutorials on YouTube. For all we know, we’re two years away
from taking these pictures with our iPhone and then sending
them to the laboratory.
LB: Exactly.
MD: As you do a lot of stuff with adhesive dentistry, I want
to talk to you about self-etching adhesives. One of the things I
noticed after I came out of LVI and started doing a lot of deep
veneer preps using the total-etch technique was that I had more
postoperative sensitivity than I cared to see. It always bothered
me when a patient came in, completely asymptomatic, and we
did 10 veneers on them, and now he had two teeth that were
pretty hot for a few months and maybe one of them needed
endo. That was always one of the things that disappointed
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