Video cameras insight converts the skeptics

Feb. 1, 1996
Intraoral cameras hold much promise for converting reluctant patients into believers of good oral hygiene. Why?

Intraoral cameras hold much promise for converting reluctant patients into believers of good oral hygiene. Why?

The "inside view" has a lasting impression.

Steven M. Seltzer, MBA

Hygienists tense up when doctors compliment patients for what amounts to poor oral hygiene and infrequent hygiene visits. "You`re doing just fine," the doctor says to the patient. "Keep up the good work." Doctors are unaware or unappreciative of the extensive scaling and effort the hygienist exerts during her treatment of a patient.

If an intraoral video camera takes images of the patient before and after hygiene treatment, however, dentists would immediately know what to say to patients. Intraoral video imaging is a powerful tool that dramatically enhances patient education efforts undertaken by dentists and hygienists. The visual aids, in turn, make patients more appreciative of their caregivers` skills, abilities, and knowledge.

The intraoral camera is a valuable tool. Hygienists build trust while making their jobs more interesting. The camera can boost incomes and strengthen teamwork among staff members.

Patients see the images and react to things they could only think about abstractly before, such as: gingival inflammation; bleeding on probing; large, broken down amalgams; tartar; weak cusps; and open margins.

Kristen Crawford, RDH, values her own intraoral camera so much that she takes it with her when she works at different offices as a temporary hygienist.

"I couldn`t practice hygiene without it," Crawford says. "Patients could actually see and react to things that words alone and a mouth mirror could not convey. The doctors also appreciated me more because patients became conditioned through video images and education to accept their treatment recommendations."

The recall visits

The intraoral camera is also responsible for changing the hygienist`s role in dentistry. The successful hygienist recognizes that good communication skills with patients is critical. Persuading patients to accept treatment is just as important for the hygienist as it is for the doctor, if not more so. The intraoral camera permits the hygienist to visually magnify the images of teeth and gums, allowing the patient to truly see the need for treatment.

The camera is used on every patient for three to five minutes. During this time, the patient experiences a "video tour of the mouth." The hygienist moves the camera around the upper arch, then the lower arch. Along the way, she pauses at teeth or areas that require special attention and captures any important images.

The hygienist, for example, might comment, "Do you see how this tooth has a large silver filling? It has held up well, but can you see how there is very little tooth structure here? (She moves the camera as needed to point out the cusps.) These areas are called weak cusps. Because there is not much tooth remaining, the cusps could break off, or fracture without warning, which may cause a dental emergency. The doctor may recommend that you have a crown or cap put on the tooth to protect the tooth and keep it from fracturing."

Most hygienists will always emphasize positive aspects of the patient`s mouth along with negative ones to balance the overall tone of the video tour.

At first, giving every recall patient a video tour may seem excessive. But the reality is that showing a patient her mouth for six to 10 minutes a year during two recall visits is very reasonable.

Many patients have never seen a detailed view of their mouths. So they may express shock and amazement when seeing the true condition of their mouths. Some patients will be so appalled that they will be ready to accept treatment immediately.

In addition, hygienists are often surprised at how this "inside view" prompts a more sincere effort to comply with home care regimens. It also becomes easier to maintain appropriate recall intervals. These routine appointments, of course, often reduce the level of scaling effort and time required per patient visit.

A candid view of perio

Periodontal disease is often difficult for patients to comprehend. Symptoms are painless and generally do not interfere with normal functioning. In some cases, particularly when periodontal disease was not adequately emphasized by previous dentists and/or hygienists, great care must be exercised when explaining disease progression to patients. Instead of trusting and believing the hygienist`s credibility, some patients may disregard the diagnosis entirely and question the motives of the people who first bring periodontal disease to their attention.

The intraoral camera visually shows patients symptoms such as inflammed gingiva, bleeding on probing, and periodontal pockets. It is useful to have patients watch their own gums bleed spontaneously as you remove the probe from a pocket.

Several manufacturers offer color-coded probes that visually allow patients to watch the probe disappear into pockets. Patients can be prepared for viewing with a description of a pocket and what the probe colors signify before you probe.

A hygienist might say, for example, "This tool is called a periodontal probe that measures any pockets, or spaces between the gum and tooth. Note the colors on the probe. If you see the red line disappear into the pocket, it indicates that you may have a mild case of periodontal disease. If you see the green line disappear, it indicates you may have a moderate case of periodontal disease.

"Don`t be concerned about any particular probing as I go around your mouth. When the doctor examines you, he will evaluate all of the pocket depths and give you a score for your overall periodontal health."

A roaming camera

A camera system on a cart usually stays in one treatment room. But offices should try making the system more portable. Most carts are clumsy to move and, even though they have wheels, are not very mobile. If your camera is sitting around idle, or is only used in one room, I suggest you purchase a new cart that is truly mobile. You might also consider purchasing TV monitors that cost around $300 for each treatment room where you plan to do video imaging. When the TV monitor on the cart is removed, the weight on the cart will be significantly reduced, and the cart will be easier to move.

Position the cart between the entrance to the treatment room and your chair, after the patient is seated. If someone else needs the camera, it can easily be moved since it is already near the entrance to the room.

The TV monitors in the treatment rooms can be positioned with mounting brackets that allows optimum patient viewing. Choosing the right mounting brackets for the video monitors is critical. An excellent manufacturer is Pivotelli. You can order a catalog from the distributor, located in North Reading, Mass., by calling (508) 664-8350.

`Slide show` reinforces words

The other portable option is multi-op capability. Most intraoral camera vendors offer configurations that allow you to easily move a camera from room to room using a hand-held portable unit that "plugs" into the rest of the system. If you plan to use more than one camera in more than one room at a time, look closely at the multi-op options.

Visual images are powerful persuaders. Showing a patient images - whether prints are archived on a floppy disk recorder or on a computer system - helps make changes in oral health between visits more visual. Patients can visibly see improvement (or lack of it). The camera can be a strong motivator compared to simply talking about how much tartar, stain, or inflammation has changed since the last visit. Words alone cannot replace the impact of a visual image.

As a result, patients are more cooperative. They respect and appreciate the care they receive, keep appointments. They take more responsibility for their oral health.

Access to a video monitor allows the addition of multimedia patient education programs that cost less than $2,000. Most are based on CD formats that allow you to play professionally developed and presented education that runs the gamut from a "slide show" to a mini-movie. The information is educational, persuasive, and interesting to watch. Many systems include sections about periodontics, endodontics, restorative and cosmetic procedures, and oral surgery. Most of the presentations run one to two minutes.

The role of the dental hygienist is expanding to include more comprehensive patient education and practice marketing. The hygienist plays a vital role in the success of the dental practice. The intraoral camera is just one of many high tech tools that the hygienist can incorporate into every patient visit. It makes patients enthusiastic about taking better care of their mouths thereby motivating them to schedule appointments at regular intervals and practice better home care.

If you already have an intraoral camera in your practice, make sure you are using it to the fullest. If you do not have one, encourage the doctor to purchase a camera. If he is not interested, perhaps you should offer to purchase it yourself and have the doctor compensate you for the increase in procedures that patients accept once they truly understand their treatment needs.

Steven M. Seltzer, who has a MBA from Harvard, publishes DDRT: Dentists` Desktop Reference to Technology. He lectures internationally about high-tech dentistry and practice management, and he appears in a video education series titled, "Maximize Your Intraoral Camera" with Dr. Bill Kimball and Kristen Crawford, RDH. He can be reached at (800) 229-8967.

Communicating the need for multiple appointments

A patient presents who has not had a recall visit for two years. He has substantial buildup that with major effort and stress you could probably take care of in one visit. To do so would put you 5-10 minutes behind schedule. Should you reappoint the patient?

I suggest you explain how skipping recall intervals cannot be resolved in one visit. Use the camera to show the patient the extent of the buildup and inform him that you will require two visits, perhaps three to treat his condition. Once a patient understands that it is more advantageous to schedule regular appointments, he will be more cooperative.

The intraoral camera visually persuades the patient to take better care of himself. The final result is that you don`t stress yourself out trying to do in one visit what would otherwise be spread over four visits during a two-year period.

Use the camera to your advantage. Both you and the patient will be more satisfied with the results.