Photographic imaging for esthetic restorative dentistry

Patient dental records are the most critical component of every dental practice. Whether these records are maintained in traditional cardboard folders or as digital bytes of information, the completeness of their contents is important to successful patient care. Two trends are expanding the contents of the dental record to include photographs. One of these trends is the widespread interest in esthetic restorative dentistry and the other is the increasing level of expectations by the public. More than ever, patients are seeking dental treatment to alter the appearance of their teeth. Unfortunately, esthetic restorative dentistry often is not part of a formal dental education. In addition, esthetics is a subjective topic, and patient demands and expectations can easily exceed a dentist's skill and expertise. This can ultimately lead to an "unhappy patient syndrome" and cause conflict between the patient and the dental team. Sometimes this conflict can result in litigation, which is another reason that photographs are a valuable addition to the patient record. The information that is contained in a good-quality set of "before" and "after" photographs cannot be duplicated with other components of the dental record. Taking the time to assemble adequate baseline records is always critical before any patient care is initiated. In restorative dentistry, this includes the standard of care elements: a health history, soft-tissue examination, periodontal examination, teeth and restoration examination, study casts, and an adequate radiographic survey. The use of photography in dentistry has historically been limited to the field of orthodontics. It is the standard of care for orthodontic baseline records, but has not been mandated for restorative dentistry. Memories are rarely accurate about subtle details of one's appearance and people can easily forget what their original smiles looked like even though treatment time may only be a matter of days. Baseline photographs provide an irrefutable record of pretreatment conditions in correct context. More importantly, you do not have to be a dentist to interpret the general information that is displayed on a photograph. To gain additional perspective on this issue, we consulted a panel of three dentists who are well recognized for their expertise in dental esthetics and imaging.