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Dr. Lisa Knowles has a unique ability to see the whole picture in dentistry as well as the whole patient. In addition to practicing, she is a public speaker, writer, and dental consultant. She shares her knowledge with colleagues looking for more peace and a bigger piece of the pie. Dr. Knowles is a social butterfly: Follow her blog at beyond32teeth.com. Tweet or Instagram with her @beyond32teeth. Facebook or LinkedIn with her at Lisa Lynn Knowles. For more fun and peace of mind, find her website at IntentionalDental.com
Strategic use of an intraoral camera is essential. New cameras can be pretty exciting, and the urge to take pictures of everything is tempting. When we got new cameras, I found the hygienists to be a bit unclear about their usage and even unclear about what to show me and not to show me during the periodic oral exam. With good intentions, consultants, salespeople, and doctors say, “I would like to see five pictures (or six, or 10, or whatever magic number desired) of the mouth on every patient.”
In our office, the hygienists started snapping pictures left and right, and literally had five to 10 photos ready to review upon exam time. Perfect, right? Not so fast. After looking at the 15th picture of disclosed teeth and cleaned off teeth, it became apparent we did not know why we were taking pictures. The hygienists thought it would be good to show me the pictures of EVERYTHING every time. In reality, the doctors do not need to see the educational hygiene photos utilized so nicely with the patient - unless the hygienist truly wants the doctor to reinforce this issue for dramatic effect or influence. Typically, though, these pictures are for the patient’s benefit. A quick recap of what was done and why it was done from an oral hygiene standpoint is suffice and can shorten the doctor exam time.
So what should be photographed and what should be reviewed with the doctor? To help your team know why your office is using an intraoral camera, here is a devised acronym (PEPPP) to share with your office to help everyone remember what, and more importantly, why something should be photographed and discussed.
1. To Prove something - A baseline tour of the mouth should be on file for each current and new patient. It’s the safety net in any legal dispute. This can be used to verify what was and was not done prior to a certain date. It also provides a “before” shot to any “after” shot that may be needed later on.
2. To Educate-This usage is vital for helping a patient own his or her disease. If patients are missing an area while brushing or want to know what a perio pocket looks like, you can show them up close and personal â¦ right in their own mouth. Also, if case acceptance is low, it may mean the patient does not believe you. Educating a patient with pictures can help convince a patient there is a problem. Providers may also want a picture of something so they can use it later to educate others in a lecture or classroom setting.
3. To show Pathology - Any pathological condition that is diagnosed or looks suspicious in the mouth should be photographed.
4. To show Proposed treatment - Any treatment that is needed should be photographed: a crown that has loosened, a diastema that a patient may want to close, or a broken cusp. Interproximal cavities, in my opinion, can be reviewed on X-rays and do not need to be photographed unless visible in the mouth.
5. To show something Probably never seen before (anomaly) - If there is a dental anomaly so interesting and never seen before, this would be a good reason to snap a picture.
Early in the doctor’s exam, while both hygienist and doctor are looking at the computer screen - with the patient looking on as well - the hygienist should start off with an intraoral camera summary script like this: “I took five baseline photos today of Jasmine. I took two photos of her with disclosing solution on her teeth - one before and one after we removed the plaque. I took two photos of that crown we talked about doing last time and the diastema between her teeth that she does not like. I also took a picture of a suspicious area on her tongue.” The doctor needs to listen to the first two parts and see the last two parts (the possible treatment areas and the suspicious area on the tongue).
The other items may warrant further review upon request, but since time is of the essence during the exam, the hygienist and doctor must work together to transfer the knowledge from what the hygienist observed and heard from the patient to what the doctor is going to dial in on for his or her 5-10 minute exam. The patient is given the opportunity to confirm or add in information at this point. Then, the doctor can sit down, affirm intraorally what he or she has discussed with the hygienist, and listen further to the recommendations the hygienist has already discussed with the patient.
With these tips, I imagine your team will have more PEPPP when using the intraoral camera because they will know WHY they are using it â¦ and they will know what to use it for.
Editor's Note: To learn more about the Academy of Dental Management Consultants, please click here.
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