The Economics Of Digital Photography and Imaging
By Dr. Thomas K. Hedge
Richards Report, August 2001

With digital camera's overwhelming the Christmas gift list this past holiday season, most of us are contemplating how digital photography might fit into our practice. Barriers to "pulling the trigger" are inevitably the cost of the hardware, a lack of a turnkey product, the learning curve, and the existence of a good 35 mm photography system that has become the standard in dentistry. The question of return on investment may seem questionable. I will try to answer this question in this article.
A digital camera package will cost between $1000 and $5000. In most cases, a $2000 package will give great results. This will include a 2 Megapixel or greater camera, a card reader, a ring flash, lenses, software, and a printer. Most of these items are available from a variety of sources and are usually not packaged together.
Kodak is the first manufacturer of digital photography products to offer a complete kit. The Kodak digital photography kit includes a camera with a ring flash that was developed especially for dentistry. In addition to the camera, the kit also includes software for image download, storage, and manipulation that was also specifically developed for dentistry by Dicom Image. Other components of the kit include a printer and paper.
Kodak’s solution does not even require a computer, because the image storage cards from the camera can be plugged directly into the printer allowing images to be printed directly.
Storing images in Dicom Image software is simple, and easily retrievable. Slide storage is cumbersome and is usually fragmented throughout patient files or in volumes of notebooks. A roll of film shot with a 35mm camera must be sent to a laboratory for developing. Upon return days to weeks later, the slides must be sorted according to patient and placed into a slide holder sheet and stored in note books or in the patient folder. Both of these options make retrieval a burden compared to software-based storage. Images stored on a server are available anywhere an office has a computer. Hardware disc drives are dropping in price making storage of high resolution images cost effective. A 10 gigabyte drive will hold 4000 high resolution 2.5 megapixel images at a cost of about $200 for the drive.
Film cost for 35mm slide photography is about five dollars per roll. Sometimes you have to send in a roll that is only half exposed to get images on a timely basis. I calculated my cost on slides at one dollar per image based on pick up and next day delivery on the slides. Although it was in the back of my mind, I always considered the cost when taking images. I have increased my camera use by a factor of four compared to when I used slides. Film cost for digital images is almost nothing. Once you have paid for the cards, your cost is zero for as many images as you want to take. This will allow you to take more images improving your photographic skills through the direct feedback of your images – immediately.
Prior to my use of digital photography, I almost never took occlusal images. When I did take them, the results were never great. Occlusal images are never lit well in the viewfinder, so it is hard to compose the image, focus, and assure that the mirror is fog free. Digital images allow for immediate feedback of the quality of the image, and adjustments can be made immediately. The way to become better at anything involves practice and feedback, both of which are expedited by digital photography. Occlusal images are very powerful in case presentations. Patients can see in high resolution what their dental arches look like. Ownership of problems by the patient are enhanced.
Patient enthusiasm – We all have been through the car salesman routine. They try to tell you that the deal that you have negotiated is only good today. They want you to sign before you have a chance to allow your enthusiasm to buy, to wane. This is, however, a very effective sales technique – although detested by most of us. This concept applies to dentistry very well. If a patient can review their condition immediately, or in short order, their desire to "buy" is greatly enhanced. Digital photography allows you to get them while they're hot.
Slides have been a great presentation method with respect to image quality for decades. The problem lies in the fact that the presentation with a projector cannot be modified or enhanced. Digital images can be cropped, resized, adjusted for color and brightness, and inverted. Cropping eliminates the need to frame the image exactly as you want it. You can adjust the image boundaries as you wish. These images can then be viewed on any computer monitor or printed for presentation.
Powerpoint is a very powerful software program for giving presentations. It has become the industry standard in business. This relatively inexpensive program will create custom slides for presentation. Colorful backgrounds serve as a palette for images and text. X rays can be photographed and imported into these presentations.
These Powerpoint presentations can be burned to a Compact Disc to give to the patient for later review. This is a huge "WOW" for the patients.
Enhancement of laboratory communication – Less than five per cent of dentists communicate with their laboratory utilizing photography. Of this five per cent, very few of the images are as good as they could be, or are judged as such by the technician. When given a choice, technicians will opt for the benefit of having a visual image EVERY time. No tooth ever looks exactly like a shade guide. Posterior teeth are usually darker at the gingival third than a shade guide.
The introduction of digital photography into a dental practice will result in a dramatic increase use of images. These images enhance everything from case presentation, to laboratory communication. This enhancement results in increased efficiency and an increase in case presentation and acceptance. Digital photography is here to stay. You decide when, not if you will incorporate it into your practice.