Basics of Dental Photography [B2B] – PDP087

Jaz’s Introduction: When I qualified as a dentist, and I got my first ever paycheck, the first thing I did was buy a camera like yes, it was used because I need save money. But it was the first purchase because I knew I was taught by some mentors that to take good dental photographs is so so important to your career development. And I cannot echo this enough. So today I’m joined by Dr. Alessandro Devigus, the chap who owns dentist camera Instagram page, he’s a world leading expert on dental photography. And we’re going to cover the basic settings, how to get consistency and photos, and all the best tips to help you get started in dental photography. So if you’re not already taking photos, you hopefully will be by the end of this episode, feeling more confident to start picking up the camera and taking more shots and becoming more consistent and a better dental photographer. Again, this is another episode as part of the back to basics series of August and this has been incredibly popular. I’ve been amazed at the comments, had one dentist, let’s have a look on the previous episodes, I had Brendon Parker comment on the YouTube channel saying “Hey, Jaz just found this series and love it. I wish I had this 20 years ago.” And honestly I didn’t know the impact of such a back to basic series would have been you know, it’s amazing. And thanks so much for for joining me in these episodes. I hope you find the real value from them. Now we’re going to give you the Protrusive Dental pearl. So if you’re new to the podcast, I give you a Protrusive Dental pearl in every main episode, and then we’ll join the main interview with Dr. Alessandro Devigus. So the Protrusive Dental pearl I have for you is that on the comments below in YouTube or on the website protrusive.co.uk under this episode, I will have you ready to download the AACD Dental photography guide and what this is, and I found this really useful back in 2013 when I qualified the first purchase I made was it was a camera because I valued how important dental photography was and to go along with it, to help teach me the settings I needed and what equipment I needed for every single photography shot, I got hold of the AACD photo guide. So I’ve attached that for you to download. And you should totally have this document at hand when you start taking dental photographs because it will help you to remember your settings and eventually that will become second nature and you won’t need to rely on any more but as a beginner’s guide I think is really good. And obviously with being the AACD is world famous, the VACD also have one but this is the real famous one. The other thing to check out if you haven’t already as part of the Protrusive pearl is the most difficult photo to take is the occlusal photograph. Okay? And one of my most popular YouTube videos is how to take an occlusal photograph. So if you haven’t already seen it, click below description or go website and I’ll make sure I link that YouTube video on how to take really crisp, really clear, really consistent occlusal photographs. Let’s join the main episode now with Dr. Alessandro Devigus, who’s going to help us become better at our dental photography.

Main Interview:

[Jaz]
Dr. Alessandro Devigus, thank you so much for coming to the Protrusive Dental podcast again. We had you recently for a group function about which camera should I buy and you amaze me. You also surprised me with your recommendation for a mirrorless and I’m so excited to have you now for a two-part series. So this episode is about the basics like getting started with dental photography. It’s an episode the Ptotruserati have been asking for since the inception of this podcast and I know you will do it justice. How are you doing?

[Alessandro]
Yeah, I’m doing fine in Switzerland we are getting better and better and we start with the vaccination. We start to getting a let’s say almost normal situation and hoping to open up restaurants and do more what we used to do in the past

[Jaz]
and how is your clinic? Is it full flow busy again?

[Alessandro]
My dental clinic never really had a break down we just, we had a lockdown where we were forced to close our clinics for two months almost. In the dental work I don’t see any decline in work so people need and I tell you in bad times people look more after their health. And so health care, it’s they don’t look after serious diseases. Our son working at Rush, he told me cancer treatments have been postponed. People are not going to the hospital if they feel a little bit of heart problems, but overall people Want to be healthy because then you’re ready to face a crisis.

[Jaz]
This is why maybe the share price of a Peloton, there’s the sort of the spin at home has been climbing, climbing, so many people that are jumping on that. And I agree with you, I think people are looking at how to improve their physical health in whatever way they can. So that’s inspiring, I guess. Just so it’s been introduction for those people who maybe haven’t listened to that episode, the group function that we did, just introduce yourself, and why you are so knowledgeable on cameras in relation to dentistry and beyond?

[Alessandro]
Well, my history with dental photography started more than 20 years ago, I was an analog photographer in the early days, and in 1999. So 22 years ago, Nikon introduced their first digital SLR camera, and I was really happy. And it was a coincidence that I got one of the first cameras to try it out in the dental surrounding. It was not easy, because everybody was telling me ‘Yeah, it’s the same as the analog just mount your flash mount your lens. And instead of having a film, you have a sensor, and it’s everything is the same.’ But it really it wasn’t. So I was really struggling, I had to learn, I had to do trial and errors. But it was also interesting timing connecting with the Nikon company, talking to the engineers, professors from universities coming to my office, oh, this guy has something new that a digital camera. And it was exciting because it gave me opportunities to share my knowledge, my passion. I got in touch with the ITI, I was able to really travel around the globe, teaching people on how to use a camera,

[Jaz]
You were like a pioneer when it came to the use of digital dental photography it sounds like. Just a bit of historical perspective, how much should you pay for your first camera setup? I think that’ll be interesting to know.

[Alessandro]
I had to promise my wife not to buy a digital camera before the price was below 10,000. So I looked already before that. So Kodak in cooperation with Nikon came up with a digital camera was, I don’t know 20 a huge thing. But at 40,000. So my wife told me no, no, no, no, no, no, that’s too expensive, don’t. This is a gadget that I don’t allow you to buy. So and then in 1999, the Nikon came up with this camera at 9999 Swiss francs. And this was it. So this was the time to start and explore this exciting new technology.

[Jaz]
I think the number one objection or the reason why the newly qualified dentist or will not buy the camera initially is because of the expense. They can’t just fight yet. And what happens I believe, is that they don’t buy it for after year one, they don’t buy it after year two, and then they’re not taking photos, not used to it. And then to learn that skill is too much out of their comfort zone. So many dentists will go throughout, unfortunately, a large proportion of their career without taking dental photography. And I do think maybe it starts with this mindset that the camera is too expensive. But when you put that into perspective like you have today’s cameras are super affordable and super good.

[Alessandro]
Absolutely. But still I don’t know why the first question or one of the first questions I always get asked, What’s the price? And if you say Well, today I can tell you we you can have a decent dental photography setup for 1500. So with the camera, a good macro lens and the flash. But if you go into high end, then you easily spend 4000 – 5000. And I don’t know why dentists always talk too much about money in relation. If you buy a tool, and you know that this tool can help you, I would say you have to look on a longer term than just saying, okay, I don’t want to spend. It’s interesting dentists buy things that are less than 1500 on an emotional way. So if a nice looking girl comes into the office and says, “Hey, Doctor, I have some nice gadgets for you.” And the doctor asks the girl, “How much is it?” “Yeah, it’s 1400.” And then doctor says, “Okay, I buy it.” If the price is 5000, even if it’s a nice and convincing girl or a convincing, nice young man, then you say, “Oh, I have to think about.” So there’s a barrier and especially I don’t I think not only in dentistry, where you select, where you say yes to something. And where you say oh, I have to think about which is basically no it’s like maybe, the maybe that in some cases is a no. In other cases is a yes. But again, coming back to this, it’s worth to invest money into photographic equipment because it’s the other side of how to look at your patients. So we have X ray to look inside our patients, and photography to look from the outside, and diagnostics, diagnostics is so important. And it’s not only because of smile design and all these digital gadgets around, it’s looking at your patients, see what changes. And this extra oral documentation, I think is crucial. You don’t have to do it with every patient. You don’t have to take either people ask me, “hey, how many pictures are you taking?” I don’t take pictures all the time, the most important thing is, and we can jump into some important tips and tricks already. The most important thing is every picture you didn’t take is a missed one. That’s number one. So what I recommend this, at least if a new patient comes into your office, you don’t even need to do a full status. But maybe let the patient open the mouth, do an overview, then you see the gingivitis or you see the status of the patient when he first stepped into your clinic. And these are very useful information also in the documentation, in the motivation of the patient. And maybe one month later, the patient comes with a broken tooth. So you have the initial situation still there. So what we used to do today is we do a lot of intraoral scans of patients, because it’s very easy. So we take some, maybe if the patient allows we do a portray, relaxed and smile, then we do two, three intraoral. And the rest is done by an intraoral scan. So we have the 3d models, and we have everything. So this is also the future for me of the dental photo status.

[Jaz]
Excellent. Well, I think the people who listen to this podcast, the Protruserati, they already converted, most of them are good dentists who have already got cameras. But this episode is really for those people who are in that “maybe” category to just convince them. And maybe if you’ve recently bought a camera, maybe upon your advice, Alessandro recently from a previous episode we did, and they’re just unhappy with the settings because the settings once you buy the camera, the second barrier I find Dentists have in terms of actually picking up and using it. It’s because they’ve never devoted the time to actually sit down and learn what is the aperture? What is ISO? Why is this relevant. And then what they do is they just haphazardly put it on auto and they take photos and they get unpredictable inconsistent results, they get frustrated, and then the camera collects dust again. So hopefully with this episode, we can cover some fundamentals of how to get more consistent photography, and just the basics of the settings and why. So where should we start with this journey.

[Alessandro]
So the first we have we have bought the camera, we have the macro lens, we have the flash. Now the setup, I think everybody interested can visit my Instagram account or send me a message. And I can share my one slide with a set, with a summary of all the settings. So go for manual and all the settings, it’s really easy, it’s an easy setup. Look that your camera is able to save settings. So all modern cameras have like numbers or letters where you can save presets. So follow the basic settings I recommend or also others are recommending. And then save the settings. So if my, if you take your camera home, and you go back to your office that you just switch the button, and you have to go back to the basic settings. That’s number one. Number two, if you’re really absolutely a beginner and have no clue on what you want, I would recommend a short private coaching. A short private coaching, this can be done online, I can do some advertisement, I do that and very successfully. So you don’t need to spend hours. It’s a really, it’s a short thing. And I experienced this also in my workshops. The workshop is nice to socialize to do but at the end, you have to tell people now you have to go back to your office and practice. Some guy, some people are a little bit quicker. And it’s the thing, If you look through your camera, you have to visualize what you want to capture. So the basic message how to learn to take dental pictures is look through the viewfinder frame what you want to see and if you see in your viewfinder, what you want to capture, then push the button. It’s the same when you’re doing a holiday pictures, how many people are walking around and randomly clicking on their phones and shooting hundreds and thousands of images which is absolutely useless. I look through my camera and even if I take a picture with my iPhone, or my smartphone, I look at the subject I want to take a picture of, I frame it, if I like it, I take a picture. If I don’t like what I see, don’t take the picture. And it’s the same in dental. So you avoid this initial frustration. So this is one number one. Number two, the most common error people are doing is they don’t go close enough to the patient. And this brings me back to the viewfinder, look through the viewfinder. And if you want to take a picture from canine to canine, then if you don’t see canine to canine on your viewfinder, don’t take the picture, if you still have the half of the patients, the face on your viewfinder and think, okay, I take the picture, and then I do some Photoshop, this is waste of time, this is absolute waste of time. If you want to have fun with dental photography, do the right settings, and then do the click, click only if you see what you want to get. And these are the two key messages. And I can tell you if you follow these. And no matter if you are trying to take pictures with mirror or so. All this, some people say complicated stuff. If you follow these very simple rules, you will see that it’s fun, and it’s easy to learn. But at the end of the day, it’s really practice, practice, practice, practice.

[Jaz]
100%. I just feel like I’m such a so much better of a dentist from taking photography and reflecting on my work over time. And that’s a given. And also when I when I bought my first DSLR I started to actually use it outside of the clinic as well. And, you know, I think most dentists who are now comfortable in taking dental photography and doing well with that, they are also exploring the use of the camera outside of the clinic. And it almost brings another dimension to your life in a hobby. I know it affects lots of people, I’m sure you’re probably an avid photographer as well. And just so I can. So I don’t forget those settings that you suggested. I mean, I agree the way you said it, because we want to be able to refer back to that because people who are driving right now or listening, there’s no chance if we say oh f22, ISO200 you’re not gonna remember it. So it’s so much better to have like a PDF or an image. So we’re going to get that from your Instagram handle. What is the Instagram handle again?

[Alessandro]
It’s dentist.camera.

[Jaz]
It’s a great page. I love it. It’s everyone who is taking photos, sharing their story sharing their setup, every dentist has a story behind their camera setup and their photography. So it’s a lovely page. I’m a huge fan of it. So do check that out. And I’ll grab the settings from you as well and put it on the show notes. So you can click on to that and then go to a Alessandro’s page, so you’ve got the settings. So you’re going to the first homework you have is to find the settings. Okay, the second one is to practice and only take the photo when you are happy with the viewfinder. Now one thing that we can tackle now, which I think will help dentists who are beginning with photography is the whole concept, like you said about not getting close enough to the patient. So I think dentist need to understand that the magnification ratio that you select on your lens. So for example, for a crop sensor, it’s 3:1 magnification, which would typically be so that means that you, when you want to take consistent photos, you don’t mess with the lens anymore, you keep it to one place, and you move in and out. And what you find dentists, when the beginning is they’re doing this, they’re doing that you see them do this sort of in and out like a whole meter. But once you practice, practice practice, you’ll just know a tiny bit of adjustment will do. And so can you just explain why they need to do that to get the right photo?

[Alessandro]
It’s all about standardization. So what we are looking for, and there’s especially on social media, there’s a huge problem of too much artistic photography. I like artistic photography, because it’s fun, and it’s something to share and to enjoy. But this is not the daily work. Daily work is to trying to be consistent, to be standardized, to be reproducible. And that’s correct what you were saying all good macro lenses have a magnification ratio on top of them. So you can select already the magnification. So if you want to say okay, I just wanted two centrals then go to 1:1 and go out the further away you go from the patient. And then again, it’s if you have the same patient. it’s framing it’s the distance is given by the frame you want to capture. So I have like this includes the lips, just with the retractors in place, I want to see the full mouth, I just want to see canine to canine, I want to go closer to my patient and just go into having one or two teeth on that. And this basically gives you the standard views with the standard magnifications if you don’t change your equipment every other day. So that’s why it’s important to stay with the same lenses. So fixed lenses, fixed macro lenses and camera can be changed over time that’s not an issue. You can also change your light. If you want to be more creative, maybe we can talk about that in the next episode, there are different lighting options, but basically stick with the lens, which offers a 1:1 magnification ratio. So this is also questions I get asked, do I, why should I buy a macro lens? Can I, there are some zoom lenses out there where I can have macro options, but they don’t have these 1:1 magnification ratio. So this is one piece, the most important piece of the equipment in dental photography is the macro lens, allowing this reproducibility, quality and making it easier at the end to get nice pictures.

[Jaz]
I just thought it was worth mentioning because I have seen some lenses before using their cameras or first time. And what they’re doing is they’re standing at random distance from the patient, and then they’re moving their lens to put it in focus. But then the next time you do it, then how will you ensure you’re the same distance away and they never get the standardization. They never get the consistency. So that’s just like you know, a lot of people that are sound very obvious, but if you’re starting out, I’m sure that might actually help you to realize that actually you to set your magnification first, then move in and out. That’s at the very basics of dental photography. One question I want to ask is, I don’t know how to split it in terms of this episode and the next episode, because I really want to just hammer down the basics. So everyone’s ready for that next episode A month later, when we talk about the more definitely, lighting, we can talk about it next time because lighting, softer lighting, dual flash, ring flash, we can talk about that, that’s a bit more advanced, I think. But any tips that you can give to people in terms of selection of materials. So for example, when you get your camera set up, you also need to then invest in mirrors and retractors so which retractors and mirrors would you recommend? My personal favorite, Alessandro, is and you might disagree and that’s fine is the called Columbia retractor. So they’re the metal ones. I don’t like the plastic ones because I find that I can’t insert the occlusal mirror in with the plastic ones, there’s no space by like the ones which are just like the metal wire. And it’s like I think they call the Columbia ones. I’m happy to put a photo up as I’m saying this at the moment. But which ones have you found work for you and your students?

[Alessandro]
There’s a huge a large variety of mirrors and and retractors out there. I have posted some tips and tricks on that. And I’m reposting this because this is a question I always or very often get. So basically, I go for this plastic retractors because we use a lot of them. So metal retractors Yes and No. At the end, it’s really a personal preference. It’s really a personal preference. The most important thing is that you insert them correctly, that the patient is not pulling the retractors back. So to avoid that with the retractors you even get more lips and cheeks on your image than rather than taking them out of your image. With mirrors, I’m a fan of coated mirrors, not metal mirrors. So glass, basically glass mirrors, that have a coating from, there exists from different companies. So I was with Filtrop, which is a company in close to Switzerland. They’re producing mirrors for decades. And they have a mirror system they introduced in in the 1970s. This was done by a professor in Basel who was a periodontist. And when he wrote his book, he was looking for good mirrors to do his clinical photography. And these are very old, I have two or three kids in my office for over 20 years. So they’re very resistant. So but again, in this short time it’s too much information. So I would also here refer to some tips and tricks I have posted on my account. And at the end it really comes to personal preferences. What I do not recommend is don’t go for colored retractors. So if you choose retractors they should be almost let’s say transparent, or black. Very popular retractors are have a light blue. And you don’t, you know by the way, you know why they’re light blue?

[Jaz]
I don’t.

[Alessandro]
If you put the transparent retractor in the disinfectant, it gets yellowish so blue is the opposite color of yellow. So if something that is blue, gets in a disinfectant, it also gets more yellow, but because being that the opposite color you don’t see it that quickly so they look nicer over time. But at the end, it’s personal preferences. The only thing I don’t go because there’s some fancy colored retractors for children, and for bleaching procedures, they might affect the colors of your photography. So I found if you use this pink or whatever colored retractors, they have an impact on the color of your photography.

[Jaz]
Right. Well, I’m going to share, I’m going to show you, if you can see my screen in a moment. I’m going to show you the mirrors. Sorry, the retractors that I like using. They don’t have a, Ccan you see this Alessandro?

[Alessandro]
Yeah, I seen it. Yeah, I see it. I have them as well. The advantage is they they last a lifetime. There’s no problem, but some patients have an issue. And with this, especially if you have patient with a bit larger lips, the lips overlap the retractor. So the let’s say a final recommendation, there are two forms of retractors, C shape and V shape. So the V shape retractors allow much more retraction and are very common used in the orthodontist offices. Because then especially for children who have really soft, let’s say soft tissues, you can retract the cheek and do the lateral images without the use of a mirror. So that’s a huge advantage. And so they are very popular in orthodontics. So and then there are cheek retractors which have on one side, the C shape, and the other side the V shaped form. So you have both just in one piece. So this will be something that for a beginner, is something to take a look into.

[Jaz]
Brilliant. I just want to ask you, what are the other things that are, one of the questions I want to ask is how to make your photos unique. But I think to make your photos unique, that might be more of advanced technique. Now let me tell you why I asked this, right? Because whenever I see photos from dentists that I admire, dentists I respect, right before I even read the name on Instagram or on Facebook, I know whose photo it is, because every photographer, their photos, they have the signature sort of lighting, the signature colors and stuff, right? So how would you go about developing your own style of photography, because what you will provide us and what I will share with everyone is the standard settings. But then how do you suggest? Because if everyone did that, then everyone’s photos will look the same. Right? So how can we add our own signature to our photography?

[Alessandro]
This is a very good question. And my answer is the signature should only be in artistic photography. In everyday, in daily documentation, all pictures of all dentists should look the same. It’s like if you would ask me, oh, wow, I immediately recognize who did this x ray on this tooth. Because it has his own style. That’s his own style. Nobody’s talking about individual style on taking x rays. There’s a standard. And every now and it’s really important. That’s why this is a very great question. All pictures of clinical documentation of all dentists around the globe should look the same. If you want to stand out, clean the working field, avoid saliva bubbles, make it look clean. And this is the difference. This is the difference, you know, make it clean and sharp, crispy. This is it. But at the end, all images of all dentists should be comparable. And not say Ah, this is because I remember one dentist, one famous dentist from Spain. He started many years ago of using bouncers. And he created this Photoshop look in his images. And everyone say wow, this is amazing. And my answer as as editor of a journal was, oh no, no, I hate this. Because I want a clear documentation that is repeatable and looks always the same. So if I take a picture of a patient today, and in five and 10 years, it should look the same. We cannot repeat that enough. Don’t try to be artistic on your clinical daily documentation. There, it’s scientific photography, it’s documentation. It’s like taking an X ray, you don’t experiment taking your x rays. You know, and this should be how you use dental photography in the first place. This is 95% of your dental photography should be scientific, standardized photography and then the rest, the 5%, you can freak out and do some makeup, work with your patient and do shootings and..

[Jaz]
Put a kiwi in the mouth.

[Alessandro]
Yeah, all this stuff. You’re free to do whatever you want. You can freak out but Again, try to be consistent, try to be standardized in your documentation because it’s a legal document. And it’s not fancy fashion photography.

[Jaz]
I’m so glad I asked that, because I wasn’t expecting that. But you’re so right. Honestly, I never thought about that way before. But you’re so right. Because like I said, when you take a photo from now, and five years later, you want consistency. But wouldn’t it be great as a dental community worldwide, that, patient now move somewhere else to a different country. And that dentist that takes a new photo will also be calibrated with you. And I think that there is a lot of beauty in that. And yes, we can have our fun for the 5%, for the after shots, for the you know, for the Instagram, for the gram, that kind of stuff. But I actually I like what you said that and I respect that a lot. Alessandro, my last question before we next time do a more advanced discussion is this, the storage of your photos, just tell us talk us through the software that you’d recommend the backup procedures that you recommend to actually store and organize your photos.

[Alessandro]
So basically, I started so there are different options. Option one is you have an office administration software, where you store your digital x rays and you store also your digital photographs their. Option two, what I prefer because I have so many pictures that I think it was like overloading my office administration, I started using a very simple folder structure. And I still have this folder structure. So name of the patient, number of the patient in my administration software and the keyword and you find everything. So and then, on top of this, I tried out all the different libraries or tools. And recently, two, three years ago, I started using a software from France, named Kitview. Kitview basically is this a software that allows the management of digital data, not only photographs, but also x rays, and whatever you want. And the beauty of it is that I can transfer my images wireless to the software. So I select the patient in the software, I push the button and the picture goes directly to the patient. But this is something a workflow that I have to explain in detail, maybe in another session or because a lot of people have asked, and if you have it in the database, backup is crucial. So we are using a network attached storage device, one in my office and one at my home. And all the data is synchronized. So this is in short terms. This is how I so, what my workflow of storage of my dental photography is all about.

[Jaz]
Brilliant. I think it’s going to help some people to give them ideas about how they could be storing it. Alessandro, thanks so much for covering some of the basics. I’m really keen to get out the sort of your recommendation settings because we are so great to have that from you. So I’ll reach out. I hope you have a good day at work today. But then we’ll catch up and I’ll get that out to everyone. And then also just where everyone’s appetite for the advanced one. And it’ll be great to have you on again.

[Alessandro]
Thank you stay safe, stay healthy. And don’t forget to push the button.

Jaz’s Outro: So hope you enjoyed that episode with Dr. Alessandro. Thanks for listening or watching all the way to the end. I hope you found some good nuggets in there so you can get started in taking consistent dental photographs, something which I think is probably been the most important tool in my personal and clinical development as a dentist. If you’re listening on your favorite podcast player, do hit that subscribe button. And if you’re watching on YouTube, hit that subscribe button. So I’ll catch you in the next episode, which is all about treatment planning 101. Back to Basics guys, it’s almost finished because August is almost coming to an end. But don’t worry, I always have splintember ready for you. Catch you Same time. Same place. Next week.