Use digital photography to put your dental treatment case acceptance rate on steroids!


A picture is worth a thousand words when it comes to dental case acceptance. Dr. Gregory Wych details the photo series he uses for case presentations and explains how his team incorporates digital photography into the practice schedule to help patients engage and get excited about their dental treatment .

This article first appeared in the newsletter, Breakthrough ED Clinic with Stacey Simmons, DDS. Subscribe here.

We all know the saying “A picture is worth a thousand words”. Nothing is truer than when it comes to digital photography and accepting dental treatment cases.

Intraoral photography was first developed in the 1980s. Mainly used in dental hygiene operating rooms, showing images of teeth to patients was a rudimentary way to increase awareness and, hopefully, acceptance of cases. Certainly, for unit dentistry and quick reminders of undiagnosed and unfinished dental work, intraoral photography can be useful. A hygienist or dental assistant capturing an image to show a patient a problematic tooth is a quick and easy tool in the hygiene operating room.

For years, hygienic and dental consultants have taught the “mouth trick” during new patient and care appointments. Clinicians take a number of photos of a single tooth as they go from numbers 1 to 32 and beat the poor patient to subject him with an overwhelming volume of photos that show the mouth in poor condition.

In my experience, however, intraoral photography is limited. Once patients have seen multiple photos of teeth, they tend to walk away and disengage or even fidget under the onslaught of single tooth photos showing cracks and worn restorations. “Enough”, they say, “enough!”

It’s old technology!

In the early 2000s, digital photography began to supplant 35mm slide photography. With slide photography, we often took many images in the hope that at least some would be presentable enough to show the patient later. Obviously, digital photography allows us instant feedback, easy editing and immediate presentation to the patient. We are also able to manipulate images, dropping smiles from a library to allow patients to see expected treatment results even before the case begins.

The type of camera I use and recommend is an SLR type camera, such as the one pictured below (Nikon 7100, This camera is lightweight, easy to use and looks impressive to the patient.

Nikon 7100 camera

Several organizations, such as the American Academy of Cosmetic Dentistry (AACD) and continuing education institutes (such as Spear Education) teach advanced photographic techniques. The photo sets they advocate are great for documentation and treatment planning, but they tend to be overkill when used in treatment presentations to our patients.

The photo series I have had the most success with in case presentations is “The Magnificent Seven” (or eight or nine). The photos, in order of display, are:

  1. full face
  2. Lip at rest
  3. Full retracted smile (with or without separated teeth)
  4. Right side retracted
  5. Left winger retracted
  6. Maxillary occlusal
  7. Mandibular occlusal

Here are examples of photographic series that we show to our patients:

full face

Lip at rest
(If you are familiar with the concept of Face Generated Treatment Planning,
then you know the value of that particular photo and how to explain it to the patient.)

Full retracted smile

Right side view

Left side view

Maxillary occlusal

Mandibular occlusal

End result—before and after!

I have found that this series of photos will give patients everything they need to see, own and accept their dental care, without overwhelming them or being redundant with information.

In my practice, we take photos during all examinations of new patients and for targeted hygiene reminder appointments. During our morning huddle, when we discuss hygiene patients, we plan to take pictures of any patient who has received a diagnosis, unfinished treatment, and is due for hygiene re-care X-rays (usually four bitewings and two anterior periapicals).

Choreography with staff is the key to effective and efficient photography and presentation. No photographs should be taken by the dentist! Of course, having enough team members is mandatory. When a new patient is scheduled, the new patient coordinator first tours the office and then interviews the patient. When ready to begin collecting patient data, the coordinator will summon another assistant to help with the photos. While the new patient coordinator collects the radiographic information (3D scan, full mouth series, etc.), the second assistant takes care of the photographic images. All of this is completed before the dentist enters the room for the examination of the new patient.

The photographic series is treated as another part of “what we do here”. The series lasts about three to five minutes. The second assistant then loads the images into our software, edits them and sets up a standardized slide show for the dentist. We use old image storage software called ImageFx, but there are many other image storage and editing software on the market, including PowerPoint, Keynote, Photodirector 8 and Paint Shop Pro 8.

Likewise, we target patients undergoing hygiene treatment who have an unfinished treatment. At the start of the hygiene appointment, the hygienist calls an assistant to help take and upload the digital photos, usually before routine x-rays are taken. The process is simplified, as all of our team members wear walkie-talkies (Kisco Dental) for intra-office communication. All data is collected before the hygienist begins the treatment and before the dentist performs the hygiene examination.

Oversized monitors are mounted on the chairs in the treatment rooms. This gives patients an unobstructed view of their mouth. After the examination and reading of the x-rays, I take off my mask, gloves and loupes, sit next to the patient and relate exactly what I see as we review the images together. Patients become amazingly engaged with the photos and start self-diagnosing!

Many dentists think they are the only ones who can take pictures…that they have to be perfect. However, the team members can actually take better photos than the dentist, and with a few simple editing software tools, the images turn out great. The photos just need to be good enough to show the pathology.

The key is that patients don’t need to be lectured; they need to be interested and engaged. When they engage in their photos, they own their disease. And when you show them photos of other patients who have accepted and completed treatment, they become enthusiastic and move forward with their own treatment.

We will often present the treatment plan during the first appointment with the new patient. But when a case is large or the patient has many options, we will invite the patient to return for a treatment planning consultation. For these appointments, we print the photos and give them to the patient (hopefully their partner will also be present), along with a cosmetically enhanced image of their smile and the final result. We use cosmetic imaging software called Envision A Smile, but there are others on the market (Snap, SmilePix, etc.). All of these tools help patients engage and get excited about their treatment.

This is how you use digital photography to put your case acceptance rate on steroids!

This article first appeared in the newsletter, Breakthrough ED Clinic with Stacey Simmons, DDS. Subscribe here.

For more articles on clinical dentistry, click here.

Gregory Wych, DDS, is a respected dental practitioner with over 33 years of experience in his field. He is a recognized dentist throughout the Columbia-Irmo, SC area for helping people feel better about themselves, their smiles, and going to the dentist. Her priority is to achieve the results desired by patients, while putting them at ease with her expertise and gentleness. Visit his website at

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