PH-04A: Clinical Photography Production Checklist With A Small Camera Operator Name Total 0-49, Passing 39 Your Score Patient Name Date of Series Instructions: Evaluate your Series of photographs first. Then make an X in the box below for each step not performed properly that resulted in an inadequate photograph in your series. Total all of the correct steps for your score and enter it above. EXTRAORAL SERIOUS 1. Prepare the camera Set camera to Auto Adjustment Set Image Size to 3 Megapixels Turn on the flash No magnification Hold the camera horizontal 2. Position the camera Place your left index finger above the camera lens to be a guide when positioning the lens Point your finger to the area of the subject 3. Prepare the patient No earrings, no glasses, no large collars, hair back Head level with camera, pupils horizontal with camera gridlines, facing directly into camera lens, both ears equally visible, normal bite, lips together 4. Position the camera Stand 2-3 feet in front of patient Zoom in until view is from the top of the head to the collar bone or else you will get a distorted image Lens directed straight onto the bridge of the nose Center the view in the LCD screen Both ears equally visible Pupils horizontal with Gridlines 5. Take the shot Press the button fully to take the shot Review the quality and retake if not acceptable EXTRAORAL SMILING 6. Prepare the patient to show a full natural smile 7. Take the shot Press the button fully to take the shot Page 1 of 8
EXTRAORAL PROFILE 8. Prepare the patient Turn your patient to the right 9. Prepare the patient to produce the exact profile Look straight ahead Hold head straight, not tilted up or down, nor side to side Frankfort Horizontal is parallel with the floor or the head is in a natural head position Turn toward the background, then toward the camera, then back toward the background to get the exact profile. Stop when you see the exact profile and the correct depth of the eye at the bridge of the nose Check that you do not see the patient s other eyelashes or eyebrow in the profile Gently close lips together 10. Frame the view on the profile, not the ear Do not point the camera lens at the ear Point the camera lens to the bridge of the nose Rotate the camera horizontally to center the image in the LCD screen 11. Position the camera Stand about 2-3 feet in front of the patient Zoom in to prevent distortion Top of the head to the collarbone The camera is held at the same height as the patient s head at the level of the nose tip The flash is on the profile side 12. Frame The View Full profile and ear are visible with no hair on the forehead or behind the profile Point the lens of the camera directly to the bridge of the nose, checking the depth of the eye at the bridge of the nose Center the view in the LCD screen by slightly rotating the camera horizontally 13. Take the shot Press the button fully to take the shot Page 2 of 8
CLOSE-UP OF THE SMILE 14. Prepare your camera Change magnification to Magnifying Glass Hold the camera horizontal with the lips View includes all of the lip area 15. Prepare your patient Ask your patient to give you a big broad smile to show Facial asymmetry or slant The amount of tooth and gum tissue display The upper dental midline and upper facial midline The narrowness or broadness of the arch form The upper incisal edge line compared to the contours of the lower lip 16. Position the camera Hold the camera 1 foot in front of the patient s mouth Center the camera lens on the facial midline coming in straight to the occlusal plane not too high nor too low Hold the camera lens horizontally and parallel with the lips Zoom in so that the smile, lips and surrounding area including the nasolabial folds are included in the view Include the nose tip and chin area if there is an asymmetry 17. Take the shot Press the button fully to take the shot SELECTING RETRACTORS AND MIRRORS FOR INTRAORAL VIEWS 18. Assess your patient Evaluate lip tension, lip and cheek tissue fullness, alveolar length and select the best size and curve of retractors to use Check for dental asymmetry or slant to the incisors that you should document Check the upper dental midline in relation to the upper facial midline. Center view on the upper facial midline Check your patient s correct bite 19. Select the best retractors Select wide retractors if your patient has loose lips or long dentoalveolar processes Select narrow retractors when your patient has short dentoalveolar processes. Also select retractors that grip onto the lip. Page 3 of 8
INTRAORAL FRONTAL VIEW 20. Help your patient insert the retractors and instruct him to: Pull them out to the sides Pull each retractor slightly forward Tilt the handles forward so that the lips and cheeks are completely retracted away from the teeth Have your patient bite together correctly again with the retractors in and check that the bite is the same as before 21. Position the camera Place your left index finger above the camera lens to be a guide when positioning the lens Hold the camera two feet in front of the patient, horizontally, with the camera lens at the level of the occlusal plane, not coming in too high or too low Center the camera lens onto the facial midline so that you can see the posterior teeth equally on the right and the left in the LCD screen. Zoom in the camera lens so that the full arch fills the frame focused on the canines showing no lips and little retractors in the view. The view should show the full arch molar to molar and fill the frame with no fisheye distortion 22. Take the shot Press the button fully to take the shot PATIENT S LEFT LATERAL 23. Prepare the camera Keep the setting Magnifying Glass Flash is turned on and will be positioned on the same side as the mirror handle so the light will illuminate the posterior teeth and not be blocked by the incisors Hold the camera horizontal 24. Stand in front of your patient with your patient sitting upright and assess your patient Does your patient have deep vestibules and fleshy loose cheeks back by the last molar that will require a large round-ended mirror? Or is there a small constricted area back by the molars with tight lips where you need to use a small mirror? Are the lips loose enough so you will be able to rotate and hold out the mirror far enough to position the camera lens perpendicular to the mirror? How long is the view? Do you need to use a longer mirror and back up your magnification? Check your patient s correct bite without a mirror or retractor. Will your patient be able to bite together with a mirror in there? Select the best mirror and heat it, coat it, or spray it with air to prevent fog What size of retractor will hold the lips apart sufficiently in the front? Select the largest retractor possible. 25. Help your patient insert the retractor Place it in on his right side and instruct him to pull it slightly toward his right side just enough to keep his lips in the front from collapsing down over his front teeth or over the edges of the mirror. 26. Insert the mirror using your left hand and the crossover technique Grip the handle end of the mirror with your left thumb on top of the mirror side of the handle Insert the mirror flat to the occlusal surfaces moving it into the patient s left cheek area and rotating it so it is positioned vertically into the vestibule Page 4 of 8
27. Rotate the mirror out at a 45 degree angle Gripping the mirror handle with your thumb on top, push the whole mirror out at a 45-degree angle to the buccal surfaces. Hold the mirror out from the last molar for the best view of that tooth Hold the mirror horizontally parallel with the bite plane so that the buccal surfaces of the teeth are not tilted or rotated up or down in the mirror. If there is any excess saliva, have the patient suck in air while still biting together 28. Have your patient turn his head toward his left slightly and tilt his head up so you can position the camera in front of his incisors 29. Check that your patient can bite together correctly again now with the mirror and retractor in. Is the bite the same as before? 30. Position the camera Hold the camera in your right hand and use the crossover technique Direct the flash into the mirror properly to illuminate the posterior teeth (and not be blocked by the incisors) Position the camera so it is just in front of the incisors. Point the lens straight into the mirror so you can see back to the distal of the last molar and capture the true bite. Move the camera back and zoom in so the view shows at least from the distal of the maxillary lateral to the distal of the last molar. It is acceptable to include the maxillary incisors Focus on the distal of the first premolars. Include only the mirror view, no real teeth, no mirror edges, no lips blocking the view or covering the gingiva, no fog, no saliva, no debris or scratches on the mirror or in the teeth Come in straight to the occlusal plane, not too high or too low. Show all the teeth and gum tissue. 31. Take the shot Press the button fully to take the shot RIGHT LATERAL VIEW 32. Position your patient in a supine position and stand at the top of the patient s head Because of the position of the flash relative to the lens it is best to take this view with the patient supine, with you holding the camera from a position above the patient s head. The view in the camera will be upside down and will be flipped in the photo editing software. Keep the same settings that were used for the Intraoral Left Lateral View 33. Help your patient insert the retractor in the anterior Use the same mirror and retractor that were used for the Intraoral Left Lateral View Recoat or heat the mirror to prevent fog Help your patient insert the retractor and separate the lips pulling the retractor to the patient s left side Instruct the patient to turn his head toward his right side and tilt his head up slightly Page 5 of 8
34. Insert the mirror Stand at the top of the patient s head at the top of the chair Hold the mirror handle with your thumb on the mirror surface for a strong grip Using the crossover technique insert the mirror flat to the occlusal surfaces positioning it into the patient s right cheek area and rotating it so it is positioned vertically into the vestibules. Position the end near the oblique ridge back by the last molar. Push the whole mirror out at a 45-degree angle to the buccal surfaces. Check that the mirror is held parallel horizontally with the bite plane and parallel to the buccal surfaces vertically not tilted or rotated up or down. Hold the mirror out from the last molar using care to not rest the sharp edge of the mirror on the buccal tissue. Instruct your patient to bite together as before If there is any excess saliva, have the patient suck in air while still biting together 35. Position the camera Using the crossover method again, hold the camera lens with your right hand Position the camera and lens just in front of the incisors. Point the lens straight into the mirror so that the true occlusion is evident. Back up or zoom in so the view shows at least the distal of the maxillary lateral to the distal of the last molar. It is acceptable to show the maxillary incisors. Focus on the distal of the first premolars. The view should show only the mirror view, no mirror edges, and no real teeth The view should be horizontal with the occlusal plane coming in straight, not too high or too low. The view should show all the teeth and gum tissue, no lip interference, little mirror edge, no fog, no excess saliva. 36. Take the shot Press the button fully to take the shot MAXILLARY OCCLUSAL VIEW 37. Keep your patient in a supine position and position yourself the top of the head of the patient The Maxillary View is easy to take with the patient in a supine position It may also be taken with the patient sitting upright with this camera because the flash source is close to the lens This camera has a sufficient depth of field to produce a clear image of the palate and of the occlusal surfaces of the teeth Keep the same settings that were used for the Intraoral Lateral Views 38. Assess your patient and select the best small retractors that will grip the lip to hold it out Assess the ability of your patient to open wide and the tightness of the lips Select small retractors that will grip and hold the lips back yet not interfere with positioning the mirror. 39. Assess your patient and select the best mirror Select the largest mirror that will show the full arch but not interfere with the patient s ability to open wide or make it difficult to position the retractors Coat or heat the mirror to prevent fog Page 6 of 8
40. Help your patient insert and hold the retractors Place the small retractors on the inside of the upper lip Instruct the patient to pull the retractors up in a happy face, out from the teeth, and forward stretching the lips out to block the view up the nose 41. Insert the occlusal mirror Insert the mirror flat to the occlusal surfaces and instruct your patient to open as wide as possible Position the back end of the mirror behind the last molars evenly up off of the terminal molar on each side to produce a better view of these teeth Tilt the whole mirror away from the occlusal surfaces so it is at a 45-degree angle to the occlusal surfaces of the full arch Check that the midline of the palate is in the center of the view Hold the mirror evenly off of each side of the arch Recheck that the lips are pulled away from the teeth 42. Position your camera and frame the view Position the camera lens just in above the maxillary incisors Point the lens straight into the mirror perpendicular to the mirror surface Back out or zoom in so that the view shows the full arch Focus on the distal of the first premolars but check that all teeth are in focus Check that there are no mirror edges in the view and no real teeth from the upper arch, only the view in the mirror 43. Take the shot Press the button fully to take the shot MANDIBULAR OCCLUSAL VIEW 44. Return your patient to an upright position in the chair Take this mandibular view from a position standing in front of the patient Keep the same settings that were used for the Intraoral Maxillary Occlusal View 45. Use the same retractors and mirror that were used in the maxillary arch Coat or heat the mirror to prevent fog Help your patient place the small retractors on the inside of the lower lip Instruct the patient to pull the retractors down in a frown, out from the teeth, and forward stretching the lips away from the teeth. When the patient opens wide it will be more difficult for him to hold his lips off of his front teeth Instruct your patient to tilt his head up and back Page 7 of 8
46. Insert the mirror Insert the mirror flat to the occlusal surfaces and instruct your patient to open as wide as possible. Double check that the lips are off of the lower front teeth. Position the back end of the mirror behind the last molars and up evenly on each side off the terminal molars Tilt the whole mirror up at a 45-degree angle to the mandibular occlusal surfaces Check that the mirror is held evenly horizontally, not tilted up on one side or the other Check that the lower dental midline is in the center of the view 47. Position the camera Position the camera lens just in front of the mandibular incisors pointing it up into the mirror Point the lens straight up into the mirror perpendicular to the view Back up or zoom in so that the view shows the full arch terminal molar to terminal molar without showing any real teeth, just the teeth in the mirror 48. Frame the view Focus on the distal of the first premolars but all teeth should be in focus from terminal molar to terminal molar Show no mirror edges, only the mirror view, no real teeth from the lower arch Recheck that the lower lip is retracted off of the teeth 49. Take the shot Press the button fully to take the shot Page 8 of 8
Name: PH-01A: Clinical Photography Criteria Checklist Total 0-148, Passing 111 Your Score: Date: Instructions: Make notes in the space below about the quality of each criterion. Total the points earned for the entire checklist and enter your score above. EXTRAORAL SERIOUS 1. Lighting and background 2. Focus on eyes, eyes horizontal 3. Top of head-collar bone 4. Hair back and off the forehead 5. Both ears equally visible 6. Line of focus straight onto face, no distortion 7. Eyes looking at camera with no glasses 8. Lips relaxed, gently closed 0-16 EXTRAORAL SMILING 1. Lighting and background 2. Focus on eyes, eyes horizontal 3. Top of head-collar bone, same size as Serious 4. Hair back and off the forehead 5. Both ears equally visible 6. Line of focus straight onto face, no distortion 7. Eyes looking at camera with no glasses 8. Full smile 0-16 Great 2 Good Retake 1 0 EXTRAORAL PROFILE 1. Lighting and background, no shadows 2. In focus on eyebrow, no distortion 3. Top of head-collar bone, same size as others 4. Forehead and ear visible, profile not blocked 5. View straight onto profile 6. Correct profile evident 7. Eye looking straight ahead 8. Lips relaxed, gently closed 0-16 Clinical Photography 2009 PH-01A Clinical Photography Criteria Checklist Page 1 of 3
PH-01: Clinical Photography Criteria Checklist (continued) INTRAORAL FRONTAL 1. Proper lighting 2. All teeth and gum tissue visible 3. Focused and no distortion 4. Centered on facial midline, posteriors equally visible 5. Bite plane is horizontal 6. Directed straight into the plane of occlusion 7. Patient biting together correctly 8. No debris, lips, or tongue MAXILLARY OCCLUSAL VIEW 1. Proper lighting and exposure, no shadows 2. All teeth visible terminal molar to terminal molar 3. Lips off incisors completely 4. No fog, scratches, or debris 5. Occlusals even horizontally, palate centered, no tilt 6. No mirror edges, fingers, or shadows 7. All teeth in focus 8. Perpendicular to occlusals, showing arch form 9. Shows condition of teeth MANDIBULAR OCCLUSAL VIEW 1. Proper lighting and exposure, no shadows 2. All teeth visible terminal molar to terminal molar 3. Lips off incisors completely 4. No fog, scratches, or debris 5. Occlusals even horizontally, dental midline centered, no tilt 6. No mirror edges, fingers, or shadows 7. All teeth in focus 8. Perpendicular to occlusals, showing arch form 9. Shows condition of teeth 0-16 0-18 0-18 Clinical Photography 2009 PH-01A Clinical Photography Criteria Checklist Page 2 of 3
PH-01: Clinical Photography Criteria Checklist (continued) RIGHT LATERAL INTRAORAL 1. Proper lighting and exposure, no shadows 2. Correct molar and canine occlusion 3. Shows distal of mx lateral back to distal last molar 4. No mirror edges, retractors, fog, or scratches 5. All teeth in focus 6. Bite plane is horizontal across the view 7. Directed straight into plane of occlusion 8. Perpendicular to surfaces so Angle class evident 9. Shows condition of teeth and gum tissue 0-18 LEFT LATERAL INTRAORAL 1. Proper lighting and exposure, no shadows 2. Correct molar and canine occlusion 3. Shows distal of mx lateral back to distal last molar 4. No mirror edges, retractors, fog, or scratches 5. All teeth in focus 6. Bite plane is horizontal across the view 7. Directed straight into plane of occlusion 8. Perpendicular to surfaces so Angle class evident 9. Shows condition of teeth and gum tissue 0-18 CLOSE UP OF LOWER THIRD OF FACE 1. Proper lighting, exposure, no shadows 2. In focus on lips, no distortion 3. Includes all lip area but no nose or chin 4. Shows full smile, tooth and gum display, midlines, arch width, and smile line 5. View is horizontal with the lips 6. No debris : 0-12 Clinical Photography 2009 PH-01A Clinical Photography Criteria Checklist Page 3 of 3