Intraoral Cameras
Giving patients the ability to see their own mouths really brings the concept of co-diagnosis alive. Ownership of any problem is now transferred to the patient, where it belongs in the first place. When a patient can see his/her own mouth, aggressive salesmanship is less necessary (and probably less desirable in any situation). This means that you will not have to spend so much time listening to the practice management gurus who keep trying to teach us those trite phrases which should be used to close the sale.
Often, we will see a molar that has been previously restored with amalgam and now has fractures all through the enamel. Radiographically, this restoration might look quite small, but you know there will be a battle with the insurance carrier over whether the cusps should be covered or not. Since you save virtually all images on the hard drive of your computer, you can then print a hard copy of the tooth captured by the camera so it can be sent to the insurance company in lieu of, or in addition to, a radiograph. If you communicate with insurance companies electronically, then you do not even need to print the image at all and you can transmit them along with the insurance form and digital x-ray.
The uses of an intraoral camera are virtually limitless, ranging from the hygiene room for recall exams, during the initial examinations and consultations, and even during restorative procedures. For example, a patient complains about a tooth that is sensitive to mastication. The tooth appears to have a fracture line running mesiodistally, but the extent of the fracture is unknown. You open the fracture line with a small diamond or an air abrasion unit and use a caries detecting dye to stain it.
Once the extent of the fracture is evident and visible, you can capture an image to show the patient what you are seeing. The patient can then make an informed decision on the treatment options. In this scenario, the patient can feel good about the decision-making process since he or she actually saw the problem with his or her own eyes. You win since you do not have to convince the patient that there is potentially a serious problem. This example illustrates that it is important to have this equipment just as available as a handpiece.
System Components
Base Unit/Docking Station Usually mounted on the wall or on the back of a monitor. At least one system has a wireless docking station that does not even require mounting and another has a USB connection directly into the computer, eliminating this component entirely.
Wand/Handpiece Actual instrument that goes in the mouth and records the images. Some wands have a set focal length while others have a focusing mechanism to vary the focal length and still others are autofocus. It may also have the capture button for each image. All should provide custom barriers for asepsis.
Footpedal Most systems no longer include foot controls, at least as standard equipment, for operation, although there are still some holdouts. A footpedal is just one more item to move if you have a stand-alone system that is transferred from room to room. And it clutters the floor. This is especially treacherous in the hygiene room where the floor is already crowded with irrigators, ultrasonics, and handpiece foot controls.
Light Source All the systems have automatically adjusted light sources to illuminate the field. The newest system utilize LED technology. The illumination of the subject is very important for clear visualization.
Monitor Usually, the bigger the better. But this depends on how far the patient will be sitting from the monitor.
Printer Printers are commodity items, with many models selling for under $100. Therefore, it is easy to buy a high resolution printer today. Once you purchase the printer, you should try several settings to see which gives you the best images for intraoral shots as well as x-ray prints, since you will probably be using the printer for both, assuming you have switched to a digital x-ray system. Using glossy paper will also help to improve the quality of the printed image.
Computer Buy the fastest model and as much memory as you can afford.
Video Exam
Recline the patient in the dental chair, as you would for a conventional exam. Place the barrier-protected camera intraorally and start the exam in your usual intraoral location. It is much easier to capture the images you wish to show the patient, rather than attempting to let the patient watch live during the actual exam. That approach does not allow you to point out areas of concern on the screen and does not let the patient ask questions.
When you finish the exam, sit the patient up and show him/her the images. From a communication standpoint, it is advantageous to sit by the side of the patient and use the mouse to scroll through the captured images. You can use a small laser pointer, an arrow, or draw with color (some software allows you to do it) to pinpoint the areas of concern, thus keeping the co-discovery on a personal level and less of a teacher lecturing the student approach.
POTENTIAL ADVANTAGES
+ Improved communication with patients
+ Increased acceptance of necessary treatment
+ More comprehensive dentistry such as restoring more quadrants than single teeth
+ Patients readily accept ownership of the problem
+ Appears state-of-the-art
+ Potential for increased referrals
+ Ability to generate hard copies and/or transmit digitally for patients to show to family
+ Easier insurance acceptance of treatment
+ Saves time since patients can see problems with their own eyes
+ Minimizes patient fears that you are proposing unnecessary treatment
POTENTIAL DISADVANTAGES
- Cost
