As more and more dentists upgrade their office technology systems, they are often faced with a tough choice. Many dentists use camera systems in the workplace for a variety of reasons. Cameras can be used to document cases, simulate treatment results, to communicate more easily with labs, and to correspond with fellow colleagues. While analog intraoral cameras and film-based 35mm cameras were the standard for many years, most of the newer systems are digital. While some dentists elect to have both intraoral and extraoral digital camera systems in their practice, the average practitioner will only use one system, and the decision then becomes which system to get. The sheer number of choices perplexes most dentists. This is the first of two articles that will examine a number of issues that need to be answered when adding digital imaging to the dental practice. I will explore the pros and cons of intraoral cameras and will look at extraoral cameras in a subsequent article. I will examine the criteria that dentists should use in picking a digital camera for their office. I will also consider the software choices that exist for storing and manipulating these images.

Intraoral Cameras

Intraoral cameras have been used for dental applications since the early 1990s. One of the first products was the AcuCam, made by New Image Industries. At one point, New Image held over 40% of the market share for these systems. For many years, intraoral cameras were the cameras of choice. Although there was a bit of a learning curve, they were relatively easy to master and still have widespread acceptance today. Recent surveys have shown that intraoral cameras are found in about 50% of all dental offices, which seems to indicate that they may have reached their peak in this regard. Anyone that has used an intraoral camera is aware of the advantages that these systems offer:

1. Most cameras are capable of magnifying images at 40-52X normal. This can be an invaluable tool in allowing the dentist to see pathology, such as open margins, fractures, and caries, that wouldn’t easily be seen without this level of magnification.
2. The ability to have images on a computer monitor screen that is visible to the patient is a large benefit. Most experts agree that one of the keys to improving patient acceptance to our treatment plans is the concept of “co-diagnosis”. In other words, allowing the patient to see the problems that we see will allow them to participate in the diagnosis of their dental problems, and they will then be more inclined to accept our recommendations for treating problems that they may have been previously unaware that they had.
3. The cameras allow us to have a permanent record of a patient’s condition before we begin treatment. This can be quite beneficial for cosmetic cases where we can show patients before and after photos of their teeth. Also, for legal reasons, it will often be valuable to have a record of a patient’s condition before treatment began, just in case the patient is unhappy with the results and is considering legal action.
4. Intraoral cameras can be used to document cases for lab use. Allowing the lab technician to have an idea of the patient’s existing dentition and, especially, the appearance of their teeth, can be an invaluable aid in proper treatment planning and will improve your level of communication with the lab.
5. The cameras can be used to take photos of x-rays, which frees us from having to send in our original radiographs to the insurance companies. Also, adding photo documentation to an insurance claim will often speed up the approval of that claim.

Of course, intraoral cameras do have their downsides as well. They can be quite expensive, especially if you are trying to provide access in multiple operatories. Intraoral cameras do have a bit of a learning curve since, in most cases, the image is reversed and it is similar to using a dental mirror. Image quality can vary greatly between different systems and you must use a protective plastic sheath between patients. Although not as much of a problem recently, the camera lenses do have a history of fogging up, especially if the unit is cold.


When evaluating intraoral cameras, there are a number of factors to consider. I would highly recommend that anyone considering the purchase of an intraoral camera should attend a dental meeting where many of the different vendors will be on hand, so that you can evaluate the different aspects of the cameras:

a. Ability to handle multiple views. According to Clinical Research Associates, there are 6 standard intraoral camera views that should be evaluated when choosing a camera. These are divided into intraoral and extraoral views. The intraoral views are the distal of the upper last molar, the buccal of the upper last molar, and the lingual surfaces of the lower anterior teeth. As far as the extraoral shots are concerned, test the camera’s ability to take a full lower arch, a full-face photo, and a photo of a bitewing radiograph that is being lit by an x-ray view box. Test all of these shots to see which camera can handle the majority of them with ease.
b. Portability. Many dentists have large offices and to save costs, they will consider using a camera that can easily be moved from one operatory to another. Do not fool yourself into believing that if a camera system is on a large cart that you will easily be willing to wheel the cart from room to room; I tried it myself years ago and it just doesn’t work! Some of the more popular models that allow for this are manufactured by Digital Doc (www.digi-doc.com), AcuCam Concept IV (www.gendexxray.com/concept_iv.htm), the Quick Cam (www.videodental.com), ViperCam (www.vipersoft.com/product_vipercam.html), and ImageCam (www.dentrix.com/Products/DDO/Image30/ImageCAM.asp).
c. Ease of focus. Does the camera require manual focus or is it autofocus? Most cameras have an adjustable focus, so you should evaluate how easy it is to change the focus. The focus should be well labeled, and should have a range of motion that is less than 100 degrees so that you can easily change the focus setting with one hand.
d. Built-in freeze-frame. Many of the older models do not have this feature, and most people prefer this element to be included with the system.
e. Capture button location. Most units use a foot pedal to capture individual images, but other models have the capture button right on the handpieces. For many dentists, this is simply a matter of personal preference, so you should try both types of systems to see which feels most comfortable for you.
f. Single lens system. Many earlier systems contained two wands, one for true intraoral photos (90 degree lens) and one for extraoral photos (0 degree lens). Many of the newer systems now use one wand for both types of photos. Since you may want to use the camera to take photos of x-rays on a view box, the key factor is the ability of the camera’s built-in light to be turned off when taking these types of photos.
g. Maximum number of images displayed. The standard number is 4 images that can be displayed simultaneously. However, I’ve seen systems that only allow 1 image at a time, and other systems that can allow 16, 20, or 25+ images to be displayed.
h. Unique features. Most camera manufacturers will add special features to their systems to differentiate themselves from their competitors. Some of the features that you will see include flexible cords, extraoral light adjustments, printing from a portable unit, light and color adjustments, and image scrolling through the foot pedal.

Intraoral cameras are an excellent addition to any office that wants to add clinical photography. In the next article, we will evaluate extraoral camera systems, and I will explain why I feel that they may be a better choice than intraoral cameras for many dental practices.