Accessory items used to create communication photographs include: cheek retractors, mirrors, contrasters, and on- and off-camera flashes (Figs. 2–4). Simplified portraits also use backgrounds* and reflectors* (Figs. 5, 6).

This article will describe “artistic” techniques, which can be used to enhance the visual quality of dental photographs with minimal interruption to the dental practice.

Lens f-stop (which determines how much light enters the camera through the lens) should be set to as high a number as possible, and shutter speed (which regulates how long light enters the camera) should be set above 1/100 to ensure maximum focus sharpness. The ISO setting should be between 100 and 200 for highest resolution. Suggested settings are: manual mode, f/29, 1/160 sec, ISO 200 (Fig. 7).

A macro flash adequately lights the dental subject (Fig. 8). Ring lights de-emphasize detail, while point lights can cause excessive shadows. A twin-point light can be used to highlight and also reduce shadows. Point lights also can be rotated to direct light on important subjects.

Proper white balance is the most important camera setting for accurate color, and custom white balance is the most accurate white balance for dental photography. With the camera, lens and flash set for optimum quality, a photo is taken of an 18% gray card. The photo is used as a reference for the custom white balance setting for all dental photos taken at the same camera setting (Figs. 9a–11). (See your camera instructions for specific steps on how to set a custom white balance.)

It is suggested to purchase your dental camera from a company that supplies the camera system pre-adjusted for optimum dental use and includes a quick-start guide* (Fig. 12). The quick-start guide shows you how to reset your system when camera adjustments are deliberately or unintentionally changed.

“Record” or factual anterior photographs, with or without cheek retractors, lack attractive or artistic appeal. An additional off-camera flash wirelessly synchronized with the macro flash, with the photo taken at an offangle position, creates attractive lighting and beauty to a common dental photograph (Figs. 13a–14c). Contrasters* can be used to hide distracting oral tissues and emphasize teeth against a black background (Fig. 15).

Maxillary and mandibular occlusal photos are difficult to capture without excessive lip, nose or vestibular tissue distracting from the image of the teeth. Occlusal contrasters* hide much of the distracting tissue and keep lips, nose and hair hidden with a black border (Fig. 16). Using a combo mirror* or universal mirror handle* allows firm control of the mirror and keeps fingers out of the photograph. The same technique is used to capture quadrant or individual occlusal surfaces (Figs. 17a–19).

The handle of an occlusal contraster can be placed between the teeth and the cheek to give a black background for anterior profile photos. Lighting should be directed toward the facial surfaces of the teeth (Fig. 20).

With cheek retractors in place and the teeth closed, a buccal mirror is placed against the cheek parallel to the occlusal plane. All of the teeth should be visible in the mirror. The flash is directed onto the mirror to allow the light to illuminate all of the teeth. A combo mirror or mirror handle is essential to keep fingers out of the photograph (Fig. 21). The same technique is used to photograph the facial surfaces of one or all of the posterior teeth (Fig. 22).

The lingual surfaces of mandibular teeth are difficult to photograph without the use of a mirror designed with a deep concavity to allow placement over the anterior teeth. The PhotoMed Buccal #3 Mirror* gives visual access to lingual surfaces of mandibular and maxillary posterior teeth. Place the mirror between the teeth and the tongue, and direct the flash onto the mirror to illuminate the teeth (Fig. 23).

Recording tooth shades with photographs is not 100% accurate. However, several techniques are used to maximize accuracy using your dental camera. Set custom white balance and use optimum camera settings for macro photography. Place cheek retractors, but do not allow the teeth to dehydrate. Position an anterior contraster behind the teeth, place an 18% gray card or neutral color tab** behind the teeth, and hold one or more shade tabs close to and parallel to the teeth with the tab identification visible (Figs. 24a, 24b). Take a photograph and evaluate that neither white highlights nor shadows obscure the teeth or tabs.

Writing on dental photos enhances their communication value. Laboratories are given a clear direction to follow, and specialists have a clear idea of what you are requesting or want for your patients. When you send annotated photographs to patients, you increase the opportunity to communicate clearly about their dental condition, their needs or the type of care you have provided. Even with our best intention to make our photographs tell our story, written words on the photographs enhance our message (Figs. 28–31).

Dental and medical portraits are not attractive. If you use portraits as communication photographs, they must portray the person as attractively as possible. Too often after treatment we only show teeth to the patient, forgetting that the patient sees teeth framed with the face. Dr. Norman Huefner has described portrait techniques that rival any professional studio portraits. Huefner’s techniques, however, require adequate space for full professional lighting and backgrounds. It is suggested to use a simplified technique that can be applied in any dental office using a dental chair, a wall or a hallway location (Fig. 32).

The flash with attached diffuser is aimed at the ceiling. The main light is from the side of the diffuser, while the light bounced from the ceiling acts as a hair light and a fill light off the reflector held by the patient. The reflected light fills in shadows on the patient’s face. This portrait setup gives near-similar results to a traditional three-light effect. The results are very attractive and the pictures are simple for the dentist or staff to take (Fig. 35).

Posing the patient is a difficult challenge for anyone taking portraits. Be creative. Try to never take a typical “mug shot” pose. Take a “Wow!” portrait, so the patient is excited to show others what great treatment you have given them. Sources for posing suggestions are listed at the end of this article.

Always have the patient sign a photo release. The best photo release for your location can be obtained from your dental liability carrier.