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CLINICAL PHOTOGRAPHY GUIDELINES

Academy of Laser Dentistry’s Annual Conference

• Observe good clinical practice:


o Ensure protective eyewear is worn
o Adhere to all relevant safety measures
o Wear examination gloves
o Apply rubber dam as appropriate
o Employ other techniques as necessary.

• Take intraoral photographs in the landscape mode of camera orientation. For extraoral
photographs, use portrait mode.

• For intraoral photography, use a camera with a macro lens or facility with the ability to produce 1:1
images. In general, use the smallest aperture to maximize depth of field.

• Calibrate the camera system to determine and become familiar with the optimal settings for intraoral
and extraoral photographs.

• Clean the target site of debris, excess saliva, blood, air bubbles, impression material, excess cement,
glove powder before taking photograph. Target area should be moist but not desiccated. Change
surgical drapes as needed to avoid bloodstained images.

• Isolate the target site (include only what is necessary in photograph)


o Use clear plastic retractors as appropriate to afford an unrestricted view of the target area. Use
bilateral retractors for anterior areas, unilateral retractors for posterior and lateral views. Position
the retractors symmetrically to avoid the appearance of a canted image. Pull the retractors out
and away before taking the picture.
o As needed, use a black spatula to prevent coverage of the front teeth by the lips. Position any
contrasting device so that it does not create a shadow.
o For occlusal, lingual, palatal, and lateral views of target areas, use front-coated chromium,
rhodium, or titanium mirrors to provide maximum reflectance and avoid reflection distortions
and double images. Use special care in cleaning and storing these mirrors in order to maintain
their delicate surface coasting in a scratch-free condition. Control fogging by dipping mirror into
hot water then drying it with a soft tissue. Alternatively, use a light stream of air from the air
syringe to keep the mirror from fogging.
o Keep the patient’s nose out of a palatal view of maxillary incisors.
o Avoid beard hairs.
o Retract the tongue with a mirror or have the patient move the tongue to the posterior so as not
to obscure the teeth.
o It is helpful, but not mandatory, to include the laser handpiece in the intraoral view. The laser
need not be operating when this “During Procedure” picture is taken.
o Keep fingertips, mirror edges, and retractors out of the picture as much as possible. If patient
assists in holding retractors, have patient wear examination gloves.
o It is suggested to obtain slightly larger image frames to allow cropping as necessary.

© 2014 The Academy of Laser Dentistry Page 1 of 4


Guidelines for Clinical Photography 2015 v3
• Ensure optimum visualization, lighting and exposure
o As much as possible, keep viewpoint, positioning, lighting, color, magnification, perspective,
contrast, and background the same. Standardize photographic conditions so that direct
comparisons are possible, even if successive photographs are taken by different photographers
over long time intervals.
o Select a flash system designed specifically for macro photography. Use a ring flash for posterior
teeth or areas of difficult access. Use bilateral flashes mounted on a bracket for anterior areas to
help capture fine detail, texture, translucency, and subtle color transitions within individual teeth.
Do not use an LED flash which provides relatively low intensity illumination and compromises
image quality and depth of field.
o Photograph the teeth in correct axial alignment (for example, the occlusal plane should be
parallel to the horizontal in the photograph, not canted).
o Align the optical axis perpendicular to the row of teeth to be photographed to maximize
consistency and depth of field.
o Long-handled, front-silvered, glass mirrors are preferred.
o When using mirrors, try to photograph the mirror image only. Frame the image so that lips and
mirror edges are minimized. Do not show unreflected teeth. Having both the direct and mirror
image appear in the same photograph is confusing.
o Use of manual focus is recommended, as auto-focus is unreliable in the oral cavity. In general, for
anterior shots, focus on the central and lateral incisors to ensure that the maximum number of
teeth are in focus.
o Avoid shadows. As a general rule, when using a single (not a ring) flash in conjunction with a
mouth mirror, keep the flash on the mirror side.
o Strive for optimum exposure. Keep in mind that mirrors absorb light, and exposures will have to
be adjusted accordingly. Light absorption characteristics vary from one mirror to another.
Generally, use an aperture compensation of +1 f-stop to help ensure proper illumination of mirror
shots.
o If using a digital camera, check the overall brightness of the image with the histogram function.
The peak should appear in the middle of the histogram for extraoral views, and slightly to the
right side for intraoral views, consistent with a somewhat brighter image.
o Unless the clinical condition warrants otherwise, keep tonal values uniform throughout,
especially in pre- and postoperative images. If using a digital camera, recalibrate the white
balance if the control screen shows inaccurate color shades.
o Include reference measuring device (as for biopsies).
o Use clean, neutral backgrounds for tabletop photography (instruments, impressions, materials,
and so on).
o To photograph a radiograph, mount the camera on a tripod and align it with the center image on
the light box. For digital cameras, set the camera to ‘black and white’ mode to reduce file size.
Turn off the room lights and block any light from doors and windows. Use black cards to block
excess light from the light box. Use the camera’s self-timer setting to avoid camera shake from
the long exposure.
o To photograph a monitor, mount the camera on a tripod and align it with the center image on
the monitor. For cathode-ray tube monitors, set the camera to ‘night’ mode to produce a long
exposure and avoid horizontal bands across the monitor. Turn off the room lights and block any
light from doors and windows which cause reflections in the monitor. Use the camera’s self-timer
setting to avoid camera shake from the long exposure.
o Eliminate poor quality images (over- or underexposed photos, out of focus images, poor
orientation, etc.).

© 2014 The Academy of Laser Dentistry Page 2 of 4


Guidelines for Clinical Photography 2015 v3
• Take full photographic series:
o X-ray
o Before procedure
o During procedure
o Immediately postoperative
o Short postoperative time interval (3-14 days)
o Moderate postoperative time interval (1 month)
o Longer postoperative time intervals (minimum of 3 and 6 months).

• If appropriate, perform bilateral study (laser vs. conventional).

Intraoral Photography References

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© 2014 The Academy of Laser Dentistry Page 3 of 4


Guidelines for Clinical Photography 2015 v3
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© 2014 The Academy of Laser Dentistry Page 4 of 4


Guidelines for Clinical Photography 2015 v3

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