Dental Photography is the cornerstone of great clinical work
In modern-day aesthetic clinical dentistry, dental photography is a key foundation of clinical excellence. Taking regular dental photographs has many benefits:
- Improved record keeping – Good pre and postoperative photos give the best visual record of any treatment done
- Learning – Taking before and after photographs and analysing them will improve the standard of your aesthetic dentistry
- Improved laboratory communication – Sending photos to your dental lab on aesthetic cases will improve the standard of the labwork you get back. It can also help communicate staining patterns and shades.
- Marketing – This is becoming more and more relevant with social media and websites. Make sure you get written consent first! As a rule, I always take written consent prior to dental photos.
- Patient education – Showing patients pictures of their teeth builds goodwill and trust. It also helps show them what you can see and why having the treatment done would be beneficial.
- Referrals – Including dental photographs with your referrals will help hospitals or specialist practices correctly triage your case and make sure your patient sees the right person
Cameras for dental photography
Dental photography is a niche form of macro photography. Macro photography is where you take detailed photographs of small things. Thus you will need a specialised camera capable of taking good macro photography. Cameras come in all shapes and sizes. They can be lumped together into the following groups:
- Compact digital or point and shoot cameras – The most basic kind of camera. At a guess, you have probably own or have owned one of these in the past. Flash and lens units are built in. These are not suitable for dental photography
- Smartphone or tablet cameras – Cameras attached to smartphones and tablets. These use digital zoom meaning macro photography tends to become pixelated. These are not suitable for digital photography.
- Bridge compact digital cameras – Sit somewhere between a DSLR and a compact camera. Consider them like an advanced compact camera. Flash and lens units are built in. Some specialised bridge compact digital cameras are suitable for dental photography.
- Mirrorless interchangeable lens cameras – The new boy on the scene. The Mirrorless system was only invented in 2008. Similar capabilities to a DSLR in a smaller package. Flash and lens units are modifiable although limited choices. Some are suitable for dental photography
- DSLR (digital single lens reflex) – What the paparazzi use. They come in three parts, the body, the lens and the flash. Highly modifiable and can be made to be perfect for dental photography. This is the type of cameras we will be concentrating on in this article.
DSLR for Dental Photography
There are many brands out there however the largest two are Nikon and Canon. Out of the two, I prefer Canon DSLR camera’s mainly because of the feel of it and because there is more third party lenses and flashes for Canon. This means that for your overall setup it should be slightly cheaper with Canon. Having said this, what I would recommend is to go into a camera shop and hold a Canon and a Nikon camera and see which one you prefer. As stated earlier there are three parts to the DSLR which I will be covering below:
- The Body
- The Lens
- The Flash
The Best Camera for Dental Photography
I use the Canon 550D however this is now outdated. The new version is the Canon EOS 750D Digital SLR Camera (The Canon 750D is called the Canon Rebel T6i in the US) which currently retails for Out of stockin the US or £579.99 in the UK.
The Canon 750D is a fantastic DSLR Body for dental photography. It can shoot 24.2-megapixels photos which produce extremely high-quality shots. It can also shoot Full-HD video useful for video testimonials. On the back of the DSLR Body is an LCD touch screen which makes the canon 700D easy to use and less cluttered with buttons. The screen also is quite big which means you can check the photo before moving onto the next one. It also has a full manual mode, the mode that you will be using to shoot dental photos. It also has an image stabiliser fitted to the camera, so even if you do not have the steadiest of hands the image will come out fine.
A slightly cheaper alternative to the Canon 750D would be the Canon 1300D.
It is a decent camera however it does miss out on the touch screen and no image stabilisation. It also has a reduced megapixel value of 18 compare to the Canon 750D of 24.2.
The direct competitor to the Canon 750D (or Canon Rebel T6i) is the Nikon D5600 DX.
The Nikon D5600 has many of the same features of the Canon 750D. It has a 24 megapixel sensor, it has built in wireless and a fully articulated screen. The Nikon does have a slightly bigger screen touch screen the Canon at about 1.1 times bigger. It is also slightly lighter at 465 grams. The Nikon always tends to be slightly more expensive than the Canon and also ergonomically I find that the buttons are more natural for me on the Canon. I would recommend trying both out and seeing which one you prefer.
The Best DSLR Lenses for Dental Photography
For dental photography, you will need to buy a macro lens. These come in three main types a 50mm, 70mm and 100mm macro lens. The difference is the focal length. The 100mm macro lens focuses at twice the distance to the 50mm lens which means you can be further away from the patient when taking the photo. This is important in dentistry as 50mm is well within the intimate zone. I personally prefer shooting with the 100mm macro lens.
There are three main 100mm (or thereabouts) macro lenses dependent on price point and image quality.
Sigma Macro Lens for Dental Photography (Canon or Nikon)
The cheapest recommended macro lens at the time of writing is the Sigma 105mm F2.8 EX DG OS HSM Macro Lens.
Sigma is a third party supplier of canon lenses and they make great lenses that are affordable. This is the macro lens that my fiance uses for dental photography. The image quality is good and it is easy to use and ergonomic. The focal length is slightly longer than 100mm at 105mm, however, this extra 5mm really does not affect the usability. Sigma also make two versions, one to fit Canon cameras and one to fit Nikon, just make sure you click the right option. It is definitely worth a look.
Tamron Macro Lens for Dental Photography (Canon or Nikon)
The best mid-tier macro lens at the time of writing is the Tamron AF 90mm f/2.8 Di SP A/M 1:1 Macro Lens.
The Tamron 90mm Macro lens is the one that I personally use. It is a good lens with good image quality. Although the image focal length is not exactly 100mm (90mm) it is still good for dental photography. The zoom function is simple to use and it focuses well. It also can take good portrait shots for aesthetic dentistry or orthodontics. It also has the advantage of Tamron making two different versions one to fit Nikon and one to fit Canon cameras.
Canon Macro Lens for Dental Photography (Canon Only)
The best top-tier macro lens at the time of writing is the Canon EF 100mm f/2.8L IS USM Macro Lens for Canon Digital SLR Cameras.
This is definitely the money no object option for dental photography. I would definitely recommend shopping around as prices can vary enormously. At the time of writing, looking on Amazon you can purchase it for £685 or £1125 for the same Lens! Out of the three lenses, the image quality of this lens is undoubtedly the best. It has the perfect focal length at 100mm and it also features Canon’s sophisticated image stabilisation. If you want to treat yourself go for this lens.
Nikon Macro Lens for Dental Photography (Nikon only)
Nikon Also make there own Macro lens the Nikon AF-S VR Micro-NIKKOR 105mm .
The Nikon AF-S VR 105mm macro lens is a fantastic lens for dental photography if you have a Nikon Camera. It is the world’s first macro lens that features vibration reduction and silent wave motor. This means when it is focusing the Nikon lens is extremely quiet and the vibration reduction helps with image clarity. The Nikon Macro lens also features image stabilisation so your dental photos should come out crystal clear.
The Best Flash For Dental Photography
The ring flash was invented in 1952 specifically for dental photography. It is almost criminal not to have one in your set up. It allows you to take crisper photos with a better depth of field and reduces shadow. Ring flashes come in two types: Through-The-Lens (TTL) and Light Emitting Diode (LED). Do not buy LED ring flashes for dental photography because all your pictures will come out dark. Stick to TTL ring flashes.
Sigma Ring Flash (Canon or Nikon)
The best cheap ring flash at the time of writing is Sigma EM-140 DG Macro Ring Flash.
This is the ring flash that I use and it is an excellent ring flash. It provides all the light that you need for dental photography and there is not much light reflection on the photographs. In the five years that I have owned it the only bit that has broken is the plastic bit that holds the ring flash in the camera. It cost £50 to repair so no biggie. You will need to use 4 x AA batteries, I would recommend getting rechargeable batteries as you will frequently need to recharge the batteries. It comes with adapter rings which you literally screw onto the macro lens, it takes only about five minutes to set up. It also comes in two versions one for Canon and one for Nikon.
Canon Ring Flash (Canon Only)
The Canon “official” ring flash is the Canon MR-14EX II Macro Ring Lite (Black)
In many ways this is similar to the cheaper Sigma ring flash however it does have one main advantage. The recycle time is a lot lower. What this means is that the canon ring flash takes less time to recharge between shots, meaning you can get through your dental photography faster. The recycle time of the canon ring flash is 0.1-5.5 seconds whereas the sigma ranges from 4-6 seconds.
Dual Flash vs Ring Flash for Dental Photography
If you have researched dental photography, you may have come across another type of flash called a dual flash. A dual flash is effectively two flashes that have been mounted on two long metal arms. It is often advertised at dental trade shows and it does have some advantages over ring flash:
- You can control the direction of the flash
- The colour detail is more accurate.
It is however very bulky and unwieldy to use and a lot more expensive than a ring flash. It is also more complex and if used correctly (which is an art in itself), it will produce only a fractionally better result. Then on top of this you have the problem of storing this massive contraption. My advice is if you like to keep your life simple, I would stick to a ring flash.
Second hand equipment
Buying second hand equipment is a cheaper way of purchasing a camera for dental photography however dependent on the supplier, the equipment may be less reliable. Always look for a second hand supplier who gives a 1 year warranty. If you want a more detailed guide to purchase second hand camera equipment click here.
Dental Photography mirrors
Stainless steel vs chromium plated glass
Mirrors are used in dental photography mainly to get the occlusal surfaces of the teeth. They can also be used for buccal surfaces however this is less common. Dental photography mirrors can be made out of two different materials:
- Highly polished stainless steel
- Chromium plated glass
At my practice I use highly polished stainless steel. It is durable and it is autoclavable. It’s main disadvantage is that it does scratch easily so needs to be handled with care especially when it is being disinfected. Chromium plated glass is autoclavable however it is not as durable as stainless steel. As it is glass, it is also at risk of cracking especially if it is accidentally dropped. Both type of dental photography mirrors are fine to use and it will be mainly dependent on preference.
Handled vs non handled dental photography mirrors
Non-handled dental photography mirrors are really tricky to use. The reason for this is it is really easy for you to get your fingers accidentally in the shot. Generally the longer the mirror handle the better. You can actually get dental photography mirrors from Wrights where the handle doubles up as a buccal mirror as well. A very clever design and means you need one less mirror.
Tricks to prevent the dental photography mirror from steaming up
One of the difficulties with mirrored dental photography is condensation. As soon as you put the mirror in the mouth, it starts fogging up which prevents you from taking a perfect photo. Here are some great ways of preventing this from happening:
- Get the patient to breath through their nose instead of the mouth whilst taking the photograph. The human breath is humid which causes condensation to start on your mirror.
- Pre-warming the mirror in some warm water. Condensation in dental photography occurs when water vapour (from the breath) cools down to form water droplets. If the mirror is warm the water vapour will remain as water vapour and not form condensation.
- Get your nurse to hold the 3 in 1 and constantly blast air at the mirror. This will remove the water droplets from the mirror leaving a clear surface for you to take your dental photograph.
- A combination of the above to completely eradicate condensation.
Cheek retractors for dental photography
C shape vs double headed cheek retractors
One of my pet peeves are c shape cheek retractors for dental photography. C-shape cheek retractors is a single cheek retractor that retracts both cheeks and are connected by a C-shaped bit of plastic. The problem with these type of retractors is that they give no control. You cannot stretch one cheek more than the other, if you want to take a right or left buccal view. Also I find them extremely difficult to place and the patients don’t find them comfortable.
The double headed cheek retractors are far more versatile and comfortable for your patients. The double ended cheek retractors come in two pieces and are held in place either by your nurse or the patient. I have noticed that if the patient holds the cheek retractors they will retract far further than you would. Patients also find it more comfortable because they are in control. A good tip is to always Vaseline your patients lips before using cheek retractors. This will reduce friction and make the process go more smoothly.
Lip retractor is something that I have only started using in the last 6 months however I have noticed a vast improvement in my occlusal photography. If a patient has high lip tonicity when they open up to take an occlusal photograph, the lip covers the occlusal surface of the teeth. Previously I would get my nurse to move the lip out the way with fingers however this would mean I would have to crop out the fingers in the final photograph. The lip retractor has completely revolutionized this process as it is colorless and moves the lip out the way. I would recommend it to any dental professional looking to take good dental photography.
Dental Photography Contrasters
A Contraster is a black piece of metal or plastic that is used to darken out bits of unneeded anatomy from the photo. An example would be an occlusal contraster is used to remove the lip from an occlusal photograph. They are usually used in very high end dental practices for marketing photographs. I would not recommend them to dental professionals just starting out in dental photography however for those looking to take their dental photography to the next level or going for an award it is worth taking a look at.
SD cards for dental photography
The SD card is where photographs are stored on your camera in digital format. There are two main types of SD cards used in cameras:
- Normal SD Cards – SDSC, SDHC, SDXC
- Wifi enabled SD Cards like the Toshiba Flashair or Eyefi
Normal SD Cards for Dental Photography
To transfer photos from a normal SD card to your computer usually requires an SD Card reader unless your camera has wifi capability (more on this later). Most computers now have this inbuilt however for the older generation of computers you may need to buy a SD card reader and to plug it into a USB slot. For wifi capable DSLR camera’s like the Canon 750D or the Nikon D5600X, these will be able to transfer via wifi with a normal SD card. I would recommend getting at least a 32 GB SD card as it will take a lot of memory to save all of your dental photographs. A good SD Card would be the SanDisk Extreme Pro 32GB
Wifi enabled SD cards for Dental Photography
If your camera body does not have wifi capability then to be able to transfer pictures wirelessly you will need a wifi enabled SD card. As I use a Canon 550d which is not wifi enabled, I personally use the Toshiba 32GB FlashAir I find it simple to use and also it does not require an annual subscription cost like it’s main competitor the eye-fi card. It can also be used as a standard SD card or a wifi enabled one dependent on choice.
Written consent and dental photography
I would highly recommend taking written consent for all your dental photography. This is not only to protect you but to make sure that your patient’s are fully consented for photographs. This is especially the case if you plan on using the patient’s photograph for marketing purposes. If you would like the consent form that I use please fill in your email address below.
Dental Photography techniques
Taking dental photographs in manual mode
Now we have discussed the equipment you will need, let’s go onto the settings you will be using to take dental photography. The mode you will always use is manual as it allows the most customization. I covered manual mode in detail here. Manual mode allows you to change:
- Shutter speed
These three factors allow you to control the photographic exposure. Exposure is the amount of light reaching the camera sensor. If you just want a quick summary and to write down the correct settings, here are the settings I advise.
Optimal manual Settings for dental photography
- Aperture is F32 for intraoral photography and F5.6 for portrait photography
- Shutter speed is 1/250 seconds for both intraoral and portrait photography
- ISO is 100 for both intraoral and portrait photography
Dental Photography Jargon
Aperture is a hole through which light passes to enter into the camera. It is measured in f-stop. A small f-stop means a large aperture and a large f-stop means a small aperture. The aperture size affects the depth of field of a photo. In intraoral dental photography, you are using a large f-stop number which means a small aperture which in turn means a large depth of field. In portrait dental photography (full face), you are using a smaller f-stop which means a large aperture which in turn means a smaller depth of field.
Shutter speed is the amount of time that the shutter is open. A camera shutter is a curtain that covers the camera’s sensor so a larger shutter speed means the sensor receives more light. Shutter speed is displayed in fractions. In dental photography, you want a short shutter speed (1/250 second). This is because a shorter shutter speed decreases blurriness.
ISO is a measure of sensitivity of the camera’s image receptor. A high ISO means a high sensitivity. An ISO of 100 gives a perfect balance for dental photography.
The main views of dental photography
In dental photography, there are standardised views that dental professionals tend to take. Here they are listed below with pictures and some tips about how to take them:
Extraoral – Front Smiling Photograph
When taking this photo get the patient to move any long hair away from the face and get a natural smile. It is important to take the photo from the same vertical height at the patient. This photo can be done with the patient sitting or standing.
Extraoral – Three Quarter Photograph View
This view is mainly used for orthodontics however could be useful in restorative dentistry if altering Occlusal vertical dimension or occlusion. Get the patient to move 45 degrees to the left. This photo can be taken with the patient sitting or standing.
Extraoral – Lateral Photograph View
This view is again mainly used for orthodontics. Get the patient to move 90 degrees to the left and make sure the camera is horizontal with the frankfort plane. This photo can be taken with the patient sitting or standing.
Intraoral – Buccal Smiling View
A close up photo of the patient’s natural smile. This photo is particularly useful for any aesthetic restorative dentistry. Centre the camera on the midline of the patient and make sure you are the same vertical height as the patient. The patient is usually sat on the dental chair for this photo.
Intraoral – Buccal Retracted View
The first photo using cheek retractors. Make sure to apply Vaseline on the patient’s lips to make it as comfortable as possible. The cheek retractors can either be held by the nurse or the patient. I often find the patient will be the best person to retract their own cheeks. Centre the camera on the midline of the patient and make sure you are the same vertical height.
Intraoral – Buccal Retracted View (Right)
This view also uses the cheek retractor and I would always advise to use Vaseline on the patient’s lips to make it more comfortable. Get the patient to move their head to the left and keep their teeth together. Centre the camera on the upper canine and keep the camera horizontal to the frankfort plane. An ideal view would capture the distal of the first molar.
Intraoral – Buccal Retracted View (Left)
Exactly the same as the buccal retracted view right however on the opposite side.
Intraoral – Upper Occlusal View
This photo takes the occlusal surfaces of the upper teeth. As mentioned in an earlier section, I would highly recommend getting a lip retractor to retract the lip. Rest the mirror on the distal aspect of the upper molars and use it is a fulcrum. You are aiming to get at least the upper first molars on the photo. To prevent condensation on the mirror, I would highly recommend pre- warming the mirror in some warm water and asking the patient to breath through their nose. To get the best photo make sure the camera is perpendicular to the mirror. After you have taken the photo, you will need to rotate the photo 180 degrees and horizontally invert it.
Intraoral – Lower Occlusal View
The same as the upper occlusal view however now for the lowers. Ask the patient to tilt their head slightly back and to pull their tongue back. Rest the pre-warmed mirror on the distal aspect of the most posterior lower molar. Again you will need to rotate the photo 180 degrees and horizontally invert it.
Books for Dental photography
If this detailed post is not enough and you want to find out even more about dental photography then Clinical Photography in Dentistry: A New Perspective is a great book with good reviews.
Dental photography is a key area in modern clinical dentistry. I hope this post helped you improve your dental photography. Any comments or questions are most welcome. Thank you for reading and happy snapping!