18 DentalTown Magazine December 2001

My practice is a busy one; we have two offices that each seearound 85 patients daily. We use imaging in a variety of ways.One is diagnostic. We use intraoral and extraoral x-rays fortreatment planning and evaluation and to document referrals to specialists.

Photography also plays a role in treatment planning andevaluation. For example, it allows us to show patients how theirtreatment is affecting their smiles. But photography has manyother uses as well. It is very helpful for patient communication. Ifwe notice that a young patient has hygiene problems, for instance,we may photograph the patient and send a hardcopy home witha note that the youngster needs some help with oral hygiene. Weoften recommend the picture be put up on the refrigerator or eventaped to a bathroom mirror as a graphic reminder to brush.

We have found photography to be useful for communicating withour patients’ other dentists or specialists. For example, a copy ofthat same photograph showing oral hygiene problems might besent to the patient’s general dentist, along with a recommendationthat a hygiene appointment be scheduled. As another example, weoften see children with particular abnormalities in facial bonedevelopment. In these cases, we forward photographs of theabnormalities to oral maxillofacial surgeons during the referralprocess. Even in routine correspondence with other dentistsinvolved in a case, I incorporate the patient’s headshot into my letters so the readers know, in a glance, what patient is being discussed.

Finally, we use photography for practice-building. If a mombrings in a new baby, or if a teenage patient shows up with orangeand yellow hair, we snap a photograph to give as a keepsake orpost on our office bulletin board.

For our photography, we use digital cameras exclusively. Ourradiology systems, however, are film-based. But because our officerecord-keeping is computerized, today we scan all our x-rays andfile them electronically.

At first glance, it would seem that, once our x-rays are digitized,we could work entirely from our digital records. Yet we’ve foundthat we still need to generate hardcopies of our radiographs.

During chairside consultations, forexample, we present prints of both x-rays and photographs to help explainprocedures to our patients, or to showhow treatments are progressing.Typically, these include two photo-graphic montages, one of the patient’shead (profile, relaxed frontal and

broad smile) and one showing three or more standard intraoralviews. But we also present printouts of the patient’s panoramicand lateral head films; these help us describe elements of the casethat the photograph cannot show.

Together, the printed photographs and x-rays aid in our ability todiscuss the case by giving a hands-on feel to our casepresentations. This approach also means we don’t have to installcomputer screens in each operatory.

Why Digitize X-Rays?In the future, our office will consider direct digital x-ray systems.Today, we have achieved many of the benefits of direct digitalradiography, with far less expense, by digitizing our films.

We started scanning our films about three years ago. Since then,we have realized the efficiencies associated with computerizedrecord-keeping. For example, our access to patient records is farless cumbersome. We can call patient files up from any of ouroffice workstations with just a few keystrokes.

We have also found other advantages to digitized x-rays. Forexample, we can use imaging software to enhance dark areas of aradiograph. Sometimes we zoom in on areas of interest, and printonly those areas. For example, if we find a patient has a cyst, wecan isolate the cyst and surrounding tissues on the patient’spanoramic x-ray. We can then create a print showing just that area

Hardcopy Plays Important Role Even When Imaging Goes Digital Hardcopy Plays Important Role Even When Imaging Goes Digital

By: Elizabeth B. Spannhake, DDS, MS, MPH

As dental practices become increasingly computerized, more offices arecapturing images digitally. Yet my orthodontic practice is probablytypical in one regard: we still rely heavily on hardcopy output for

patient communications as well as other applications. In fact, we generateseveral hundred prints of digital images daily, including a hundred or so thatwe mail to referring general dentists or specialists.

Often, Dr. Spannhake’s office digitizes x-rays, such as thispanorex, and prints them on Kodak DMI Inkjet Paper. Theprints are then used for case presentation, to help patientsunderstand the basis for recommended treatment options.

to send to a maxillofacial surgeon forpathological review.

The quality of our output is very good,owing to several factors. First, we originateon the highest quality film (KodakEktavision G Extraoral Film for ourextraoral imaging and Kodak InSightIntraoral Film for our intraoral exams).Second, we pay attention to theperformance of our x-ray systems and ourprocessing, and make adjustments asneeded to keep our image quality tostandard.

We’ve also found a significant differencein the quality of available inkjet papers.Like most dentists probably do, we startedwith the brand of paper recommended byour hardware manufacturers. But afterexperimenting with many brands of paper,from the least expensive to the highest-priced, the best we’ve found is Kodak DMIInkjet Paper for Dental Imaging. We’venoticed that this paper gives excellentcontrast and density, which is particularlyimportant for printing x-rays. But inaddition, the Kodak paper also seems todo a better job handling color than otherpapers. In our experience, other brandstend to add a red or blue cast to prints, butKodak DMI paper gives consistent, truercolor. This paper also has a glossy finish,which gives the images we print aphotographic look and feel. It is pricedcomparably to other top-tier inkjetpapers.

The Digital Future As dentists become more comfortablewith digital technology, digital imagingwill play a greater role in their practices.Today, for example, only a fraction of theoffices we work with can receive patientdocumentation electronically. As morepractices develop websites and incorporateemail into their practice management,that will change.

Until that day, hardcopy prints of imageswill remain an important part of thereferral process. And even when electronicfile exchanges become more commonplace,hardcopy prints will continue to play arole. An analogy can be found in theworld of commerce, where customersprefer to buy clothes from conventionalshops, rather than over the Internet,because they want to touch that sweater orpair of jeans before they buy.

Hardcopy images have a similar appeal.They give dentists something they canphysically hand to their patients toexamine or take home. By adding ahuman element to case discussions, theyplay an irreplaceable role. DT

(Note: Kodak, Ektavision and InSight aretrademarks.)

Dr. Elizabeth B. Spannhake, DDS, MS, MPH is a specialist in Orthodontics. She is in private practice with offices inWestminster and Mount Airy, Maryland. Dr. Spannhake is a member of the American Association of Orthodontistsand the American Dental Association, as well as, a Diplomate of the American Board of Orthodontics. She is activein both state and regional dental societies and is currently the President of the Maryland State Society ofOrthdontists. Dr. Spannhake has published and lectured on the topics of Infection Control in Dentistry, ClinicalNutrition and Orthodontics.

For more information contact:Dr. Spannhake, E 602 Center St., Suite 101, Mount Airy, MD 21771 or ebspannhake@home.comor Eastman Kodak, 343 State Street, Rochester, NY 14650 or www.kodak.com/go/dental

The image is an example of a photo montage that would be printed and showto a patient to help communicate case treatment planning.

20 DentalTown Magazine December 2001