4 Ways and 6 Great Reasons to Document Your Dentistry – IC046

Jaz’s Introduction:
Hello, Protruserati. I’m Jaz Gulati and welcome back to your favorite dental podcast. This is kind of like the non clinical arm of the podcast, but actually you could argue that it is clinical. I’ve just got so many mishmash of episodes, and because it’s still just about documentation month, like if it’s March, and hopefully we managed, our team managed to publish it in March, then it was documentation month.

In the previous episode, I talked about how I use AI to to auto generate my notes so I don’t have to type my notes anymore, which is the most blissful thing ever. So if you haven’t listened to that, please do check it out. But just to wrap up Documentation Month, I just want to go a bit deeper into what are the ways I’m documenting my dentistry and give you six great reasons to do so.

So the first great way to document the dentistry is with an app. intraoral camera. Now, I know so many of you have suggested I make some content specifically for this and it’s coming soon. We’re just going, literally, by the time you’ll be hearing this, I’ll probably be coming back for my vacation. I’m going to Tenerife.

Family holiday much needed. Oh, it’s been so nice to have this holiday to look forward to. So when I come back, top of my list is to make a video showing you exactly which intraoral camera I’m using. And by the way, it’s like super cheap. It’s like amazingly cheap and it’s been brilliant. I’ll tell you how to look after it.

So it’s essentially nurse proof. And the ROI on that is just phenomenal. So I’ll make bespoke content just about the intraoral camera. And this is just magic. Every dentist I truly believe needs to have an intraoral camera to take a quick snap of a tooth to explain something to a patient or an ulcer or a swelling or a sinus tract or a crack big time.

Like I will air abrade a crack and I’ll take a photo of it. And so just so handy and easy to do it. Like if you have to reach for a DSLR, then you have to get your mirror out and zoom in and take this shot, which I’m totally comfortable doing. Don’t get me wrong, but sometimes for convenience, the intraoral camera is a great way to document your dentistry.

In fact, every patient, every time. Any restoration I’m doing, I’ll always take a pre op photo. I’ll also take a photo with the articulating paper marks. I will then also take a photo once I’ve just entered the caries. Why do I do that? Because medically, legally, like, I want there to be proof that, hey, there was caries, there was a reason to treat this.

And I like to show it to my patient afterwards as part of their story. Their own story of their tooth. I always say, let me share with you the story of today’s treatment. And I just cycle through all the intraoral camera photos that I’ve taken and of course the post op photo and the patient’s like, wow, that’s amazing. And it’s great to add value to your treatment.

The second way I document dentistry is of course with a DSLR camera. This was like my first purchase, my first paycheck. I literally blew 60 to 70 percent of my first paycheck on a used body lens and I used a ring flash. Now that one lasted for eight years and I gave it to my wife and she’s also a dentist and she used it for her dental photography and I managed to get the upgraded camera.

Is there a massive difference in the quality of photos between my old camera and my new camera? Not really. Thing is, to get started, you don’t need the fanciest of gears. And very soon, in the next part of this episode, I’ll go over the six reasons why we should document. But just because you have an intro camera, which I think is foundational, doesn’t mean you shouldn’t have a DSLR camera. A DSLR camera is crucially important in lab communication, portfolio building, a higher level of documentation, also for marketing of the wonderful dentistry that you do.

The third way I’m documenting cases, and I have to really think about whether this is included in like, do I document my cases? I mean, I don’t necessarily do crowns, veneers, and some composites, and then think, oh, let me take a scan to document this, but it kind of serves that purpose as well.

Like you have a record, post op record, like for example, after orthodontics and you’ve got your fix retainers on, you’ll take a scan. You’ve now got your record. You are documenting it in a way and you get a before and after scan and the ability to actually check for changes is one of the top reasons I’ll be coming to shortly.

So I have included intraoral scans. I know so many of us are scanning nowadays, really moving on from impressions. And the last way is using a camera mounted on my loops. Now I already have a video all about how I do this. The brand of camera that I use is OXO and there’s a coupon code that you can use to get that as well.

But it’s not for everyone, to actually record video, I have to be in a really good mood and I have had to not yell at my children. To record, people don’t appreciate that actually record clinical footage, you don’t just walk in and switch the camera on and start recording. You have to do so much set up and get the framing right and pick the right patient and have that conversation with the patient telling what you’re doing and then constantly check that the quality is good.

And it’s just a lot of effort. And if you’re already running late, or you haven’t got a clear mind that day. Or your nurse is just not in the mood today. She’s fighting her own battles and she’s a bit stressed out. Then it’s very difficult to actually record clinical video. Not to mention that once you’ve recorded your video, what do you do with all those massive files?

So, it’s a beast of a thing to do. Like, it’s amazing. And I’ll talk about it in the six reasons why we should be documenting, but the video one is the least applicable for our daily dentistry. So now that we know the four main ways I document my cases, let’s talk about the six top reasons to document your dentistry.

Number six is portfolio building. Now, let me tell you a quick story. I was part of something called Toastmasters. And this is like a group of people that come together and they practice improving their speaking skills. Think over public speaking, think of thinking on your feet. And I’d always been inspired by people who’d done Toastmasters.

So I joined my local club and I went every week and then we had a competition, like there’s an annual cup that they have. And I gave a five minute speech on how we named my first born son, added some humor in it. I watched some Ted talks and how to make my talks more engaging. And I thought it went really well.

And actually I won the cup. And you know what happened afterwards? So we just finished, they awarded me the cup. This guy who was in the audience, he comes up to me saying, wow, I was blown away. I really want to be your patient. Let me say that again. He was like, wow, this is brilliant. I really want you to do your dentistry in my mouth.

And I’m thinking, hang on a minute. You just know that I’m a dentist. I’ve just given a speech completely unrelated to dentistry about my son and how we named him in my culture. And I just made it humorous. You know nothing about my dentistry or me as a dentist, but you are excited at the prospect of me becoming your dentist.

Now, I always knew that communication mattered, but that experience I had really hit home for me. And so the lesson here, guys, is that our communication skills and our interpersonal skills, whether you love this or hate this, outweigh and are far more important than our clinical skills, i. e. how you make the patients feel and how you greet them and how you talk to them and how you explain things to them, and your charisma and your emotional intelligence, is more important than the degree of taper on your crown preps.

Now, how is that related to point number six about portfolio building? Well, there’s a reason why it’s point number six and not point number one. I think portfolio building is really important, right? When you’re documenting your cases and you’re making a portfolio and eventually you are looking for an associate position, for example, you have proof, you have proof of your dentistry, you are proof you’re a good dentist, but you know what?

More important than that proof is you and your persona and how much that employer or how that principal likes you. So the number one aspect is you as an individual, your communication. But to have a good portfolio is still important. And all these ways I talk about documenting, especially the DSLR photos, like intraoral camera photos are great for patients.

But when you are building a portfolio, ideally you should have photos with a DSLR. Now we’ve done a few episodes before about portfolio building. I even have an episode about how to find an associate position in four minutes. So if you’re interested in that stuff, Check it out. But to have some good DSLR photos to build a portfolio is important for those early in their career trying to establish themselves. It doesn’t all need to be fancy dentistry. Even just simple stuff, nice photos, nicely framed with some reflection. It’s just absolutely fine.

Reason number five to document is that we are in the business. As general dentists, we are in the business. of monitoring changes. If you are fortunate enough to be able to practice in one place for many years, and you do all your hard work in the first few years and you stabilize these patients, and once they really buy into your philosophy and improve their oral hygiene and all the cracked teeth have now been fixed, they’ll hopefully enter a period of stability.

And what ends up happening at these recall exams or checkups is a nice greeting, a nice chat, and you’re just basically having a look around and looking for changes. This is where the bite wing radiographs come in every so many years, depending on the risk of the patient. But the power of the intraoral photos for this is absolutely brilliant.

Like, someone’s concerned about lower incisor crowding. Over the years, take some photos, you can see, hmm, is that happening? And you can even do that with an intraoral scanner. For example, the iTero that I use, the time lapse function is absolutely brilliant. If someone’s ever concerned that, oh, I think my teeth have moved, and if you’ve got an old scan from a few years ago and you scan them again, the time lapse function will show you.

Even tooth wear, it will show you. In a nice, like, a little heat map, like a yellow, orange, red. I love that function. I also use it for cracks. If I see a crack and it maybe is asymptomatic, and I just don’t think it’s a nasty one, but I take a photo of it and then we see over the years, is it changing color? Is it getting wider? And on that evidence, it may escalate the need for treatment and patients really appreciate it. They really appreciate they’re looking for these changes and you’re taking so much care and you’re very attentive to these details.

Reason number four is the overarching umbrella of patient communication. Now all forms of those four ways of documenting that I mentioned are actually pretty decent for patient communication. I think if I had to pick one, it would be the intraoral camera. The quick snap of the before and after in terms of restoration or just showing them a cracked tooth just speaks thousands of words.

And recently in PDP 175 with Dr. Lane Ochi, he gave a great tip of getting the patient to take a photo on their phone, right? A photo on their phone of their intraoral photo on the big screen. And they keep that. In fact, one of the Protruserati on the Protrusive Guidance app Dr. Ratia, she wrote under the episode where Dr. Lane Ochi said, Dr. Lane, thank you for sharing your invaluable knowledge and approach to cracks in teeth. I tried your tip on having patients capture photos on their phone today and oh my god, treatment acceptance rate increased undoubtedly. Thank you so much. This is going to be my everyday protocol now.

Even though we have an intraoral camera, but this way of doing is so educational and motivational for the patient. And then Dr. Lane Ochi, the Dr. Ochi replied saying, love it. Co discovery at its finest. Also, if concerned about nerve involvement, take a photo after old restoration removal and show the depth or any cracks to the patient.

This is exactly what I mean. Like, this is absolutely fantastic. By the way, if you want to be part of the nicest and geekiest community of dentists in the world, check out Protrusive Guidance. The website is protrusive. app. We even have a really flash iOS and Android app, and I’m pretty sure it’s gonna blow you away.

So if you’d like to have these discussions and share these tips, then that is a great place to do so. But I cannot emphasize enough the power of intraoral camera photos for patient communication. Of course, having the DSLR photos, if you’re doing aesthetic dentistry, to show them their entire series of photos in like a plan, explain step by step what you’re going to do.

That is higher level stuff and that’s, that’s brilliant. That is the gold standard. But for daily bread and butter dentistry. Nothing beats the intraoral scanner. And once again, once you’ve actually picked up on the changes, reason number six, we’re looking for the changes to show the patient the changes.

So easy to go back in time and say, hmm, well, the crack looked like this in 2019. And now it looked like this in 2023. Or the patient that comes back with pulpitis and you show them the photo of the cavity. Oh, do you remember in 2018 we did this tooth? Yeah. Can you see how huge the hole was in your hole in your mouth? Your decayed tooth was not in a good state. Your nerve was already very upset. Do you see where I’m going with this? Patients need to take ownership, and it’s all part of just like Dr. Ochi said, co discovery.

Now as I mentioned, Dr. Lane Ochi, he’s been a great mentor to myself and Dr. Mahmoud Ibrahim, and so reason number three to document your dentistry is to get good mentorship. Look guys, I love you guys. Honestly, Protruserati, you are the best. I love you guys so much. However, can we please stop this, right? Stop sending essays and saying, okay, so I have this scenario whereby the upper right first molar is 15 degrees mesio-buccally rotated, and it’s got deep caries, and the opposing tooth has this situation, and the tooth in front has a post, and there’s not much tooth tissue, and there’s a crack in it, and I don’t know what to do.

Should we go for the crown or should we do this? No one wants to read these essays. If you just posted one photo, that speaks to a thousand words. Look, when you’re seeking mentorship or advice, the quality of the input will determine the quality of your output, i. e. the better photos and details you can provide us, the better mentorship you will get, the more specific mentorship you will get.

Now, I know life gets busy and I still help my colleagues all the time. When they mess with saying, Hey Jaz, what do I do in this kind of scenario? And I will say, look, with the limited information I have, I would do this. I’m quite direct. But when you have photos, you have so much more information. So if you struggle with daily questions and doubts, and you really want to get some clarity on some areas of dentistry, then just take some photos.

It could be intraoral scan photos, it could be a DSLR, it could even be some scans. And showing this to someone to get some advice is absolutely a great thing to do and a great way to learn. Because how else can we get mentorship for our cases? How else can we serve the patients that we see day in day out and improve their dentistry, and get help for the dentistry that we want to do on them, without sharing aspects of that patient? So photos and records with our mentors.

If you are someone, and I think very few of you are, you guys are very switched on bunch, but if you are someone who just doesn’t document their work, this would be a great reason to do so. Cause if you really want to level up your dentistry, documenting is like your passport to getting advice and improving your dentistry on your own patients.

Okay. So now the last two left. Okay. So number two, reason to document your cases is medico-legal. Let me give you an example story that happened to me. I whitened this lady’s teeth, and her teeth whitened fairly well, and so she was happy with that. Except she came back and she said that, oh, I think the whitening caused this recession on my canine.

And I just went back to her photos from two months ago, and I showed her the pre op photos with the darker, yellower teeth, and I took her the new photo of her whiter teeth, and I put them side by side, and say, as you can see, the teeth are now whiter, but can you see that you already had that recession?

It’s just that your eye is now drawn to it. And she said, oh, so you’re right. Okay. Thank you so much. And that was that. Now imagine you didn’t have a photo in that scenario. You don’t have a leg to stand on. And I can think of many of these such scenarios like, oh yeah, you treated this tooth and you’re supposed to treat that one.

But when you have photos to show them, Medico-legal, it really protects you. It really captures the tooth, the whole tooth, nothing but the tooth. Okay. Sorry, bad joke, but I had to get that in there. So I’m sure we can agree that’s a really important reason to document your dentistry.

Now, I hope you’re ready for reason number one. I think, for me anyway, this is all like my personal stuff, right? The number one reason to take photos, to take videos, take scans, but especially those step by step DSLR photos that you sometimes take, is simply because the days where I haven’t taken a photo is a pretty rubbish day. It means that I’ve been doing checkups all day long, and there was nothing exciting, and I wasn’t my most enthused, I wasn’t my most engaged.

And conversely, on the days where I’ve taken loads of photos, I put my SD card on my laptop and I see all these photos, that’s been a really fun day at the office. I got to fall in love with the little details of dentistry. To zoom in one to one ratio, zoom in and capture those micro details. I tell you, there’s a real beauty in that.

So I think for your mental health, for your fulfillment, for your enjoyment of dentistry, that, for me, is the number one reason to document your cases. Dr. Koray Feran, someone I respect really much, 10, 11 years ago, it was at his lecture, and he said, isn’t it sad that some dentists will retire and they don’t have a single photo of any of the dentistry that they did in the thousands of patients mouths?

That’s really sad. So I’m going the opposite direction. I’m taking thousands of photos per patient. Okay, maybe not that many, but you see what I mean? Sometimes good, so nice to look back at your work from years ago. You know how people think on like social media and oh, this dentist is awesome. That dentist is awesome.

Look, if you scroll all the way back to years ago, you’ll see that actually we’re all on a journey. We’re all learning. We’re all improving daily. So it’s daily improving 1% every day. And your documentation is a big part of you improving daily. They say that if you want to improve, take photos.

If you really want to improve quickly, share those photos publicly with colleagues. That’s really going to step you up really quick because it’s quite daunting to do that for the first time. But once you do it, you become numb to it. And then you do it more and more and you become reflective and it really raises your level.

Jaz’s Outro:
So I hope you enjoyed that just to wrap up documentation month. I know it was a short episode, but this episode is eligible for CPD. So if you’re a premium subscriber on the app, just scroll down, answer a few questions. You might as well get a certificate for this. Please go ahead and do that. And of course, if you’re watching on Protrusive Guidance or on YouTube, just comment below, which is your favorite reason to document your dentistry?

Or maybe you have a new one, you have a reason that I didn’t think of. I’d love to read it. And as ever, I appreciate you listening all the way to the end. Next month, we’re actually taking a focus on mental health. It’s really, really important. So I’ve got some great episodes revolving that theme. And so I’ll catch you same time, same place next week. Bye for now.