A study made in 2010 by Morse, Haque, Sharland and Burke, published in the British Dental Journal, wanted to assess who used clinical photography and for what purpose?. The results were very interesting, after five hundred and sixty two replies, of the respondents, 48% used clinical photography, with 59% using a digital camera, 34% a 35 mm camera and 19% a video camera. Principal uses of clinical photography were treatment planning (84%), patient instruction/motivation (75%), medico-legal reasons (71%) and communication with the laboratory (64%). The author of this study reports a rising trend of the use of clinical photography by dental practicioners since 2002. It has turned so important that there have been published articles and courses with protocols and tips to achieve the best picture, in order to ensure to the viewers that the information required was very well registered. If the picture is wrongly taken, the information in it, is therefore quite misleading. In order to avoid distortion, a training must be completed by the dental practioner.  
Medical illustration for clinical recordings and education started in Britain with the publication of William Cheselden's "Osteographia" (1733), containing 56 copper-plate illustrations drawn by the author with the aid of a camera obscura. This initial motivation progress in the organization and representation of medical photography within hospitals during and after the war years passed on and started to play a significant role within the NHS since its inception in 1948, motivated largely by local medical staff who appreciated its potential contribution to case records, diagnosis, publication, teaching and research. A specialized personnel was started to be trained for this purpose. 
 
With all the benefits of modern technologies, anyone have access to digital cameras, which employed with the proper technique can produce reasonable clinical dental photographs, although at the expense of proper illumination of the scene due to limitations of their built-in Single-point Flash units. Authors recommend a Digital Single Lens Reflex camera setup with a suitable Ring Flash unit. The minimum accepted image resolution that would provide us with highquality photos for screen presentation or 4x6 prints - if desired - would be around 4 Megapixels. 
 
Taken from Morse, Haque, Sharland3 and Burke. © 2010 Macmillan Publishers Limited. All rights reserved. 
The experts from Clinical Photography UK, published in The Law Society Gazette, a few examples explaining why a proper training is required to obtain the best picture. For example when taking a frontal picture, distance and Perspective must be taken in consideration, because it may produce very important distortion. 
 
"The below two images were both shot on the same camera (Canon EOS 5D Mark II digital SLR), with the same lens (Canon 24-105mm f4 IS) at variable focal lengths. The left image was photographed at 35mm, and the right at 100mm. This is a prime example of perspective distortion. As you can imagine, in terms of expert witness evidence the difference between the two below images could be paramount. Say for example, the below image was taken to portray the physical features of the nose for a clinical negligence claim against a surgeon following a rhinoplasty operation. 
 
The image on the left would suggest an extenuation of the nose and in context, appears substantially large in relation to the face. This is therefore quite misleading. To avoid this distortion, the photographer must increase the subject-to-camera distance, providing a more accurate result and avoiding distortion. This would then display the nose in its true context at the correct focal length". 
Another question comes to our mind. Do the patients feel comfortable when pictures are taken? According to Vasileva et Al. 61,9% of patients interviewed about this matter trust more their dentist when they have used dental photography. Also, this is cited by all consulted authors, as the best way for merchandising and explaining treatment. Finally, a common strategy to protect the privacy of patients when using dental photographs for educational and clinical purposes ismandatory, the dental practioners must prepare a specialized form of informed consent. 
 
In conclusion, when taking a photography to record a clinical case, a lot of factors must be taking into account, it's not just about pressing the bottom and smiling. The profesional must consider the exposure, depth of field, shutter speed, reflective exposure, aperture control, parallax. It sounds like a whole new world, but don't get too overwhelmed by it, with a special training this can be mastered by any dentist. If you would like to know more about this matter we would like to invite you to the most comprehensive dental photography course "WHEN THE PICTURES REALLY MATTER" in London, with international speakers as Dr Eduardo De Aguiar and Dr Jesus Ostos. 
CPD Certified 13 Hours 
BIBLIOGRAPHICAL REFERENCES 
Morse, G. Hasque, M, Sharland M, Burke F. The use of clinical photography by UK general dental practitioners. British Dental Journal 2010; 208: E1. 
Mcfall K. A critical account of the history of medical photography in the United Kingdom. IMI Fellowship Thesis Submission. June 2000. 
Tim Zoltie. Photographic Evidence: Conversational Distance & Perspective Distortion. https://www.clinicalphotography.co.uk.Visited 09/05/2017. 
Sreevatsan R, PhilipK, Peter E, Singh K, Singh M. Digital Photography in General and Clinical Dentistry- Technical Aspects and Accessories. International Dental Journal of Student’s Research, January – March 2015;3(1):17-24. 
Vasileva R. Petrova G, Kolarov R, Nikolov N. Informed consent in contemporary dental photography – ethics and law. MedInform. 2017;1:1-6. 
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