|Ahead of print
The use of dental photography in Saudi Arabia: A cross-sectional survey
Department of Restorative Dentistry, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
|Date of Submission||06-Aug-2021|
|Date of Decision||28-Aug-2021|
|Date of Acceptance||02-Sep-2021|
Department of Restorative Dentistry, College of Dentistry, Riyadh Elm University, Riyadh
Source of Support: None, Conflict of Interest: None
Introduction: Dental photography has always been an important aspect of the practice. The basic goal of digital dental photography is to capture the clinical symptoms of the oral cavity as accurately as possible. Secondary applications include dento-legal documentation, teaching, communication, portfolios, and marketing as a spin-off. This study aimed to assess the practice of photography documentation among dental students and dental practitioners in Riyadh using a cross-sectional observational study. Materials and Methods: This cross-sectional study was conducted using a self-administered survey distributed online. The sample included dental students (5th and 6th year), dental interns, postgraduate residents, and specialists. Frequency distribution and Chi-square tests were performed to compare the participant's responses. Results: A total of 218 dental practitioners were completed a structured, self-administered online questionnaire. The majority of the participants were dental interns and specialists, and more than 70% had 10 years or less of experience. Eighty-six percentage study participants reported using photography in their practices. Mobile phones were the most commonly used devices among dental practitioners. Conclusions: The results of the current study showed that the majority of dental practitioners believed that photography is essential in modern dental practice. However, to implement photography in dental practice, clarification of the general guidelines and the need for obtaining written consent must be explained to the patient. Furthermore, there is a need to incorporate photography within the dental curriculum.
Keywords: Camera, dental photography, documentation, mobile phone, survey
| Introduction|| |
The digital revolution has impacted many aspects of the medical field including dentistry, which has shifted toward digitalization over the past 20 years. Today, digital photography is a crucial element of a daily dental practice, although it has been a long journey to reach this point. The use of photography in dental practice started in the 19th century when dentists were the first healthcare professionals to use it, and for decades, it was limited to documentation for publication., In the early 2000s, photography started to become very popular among dentists and an essential component of modern dental practice.
The increased use of photography can be attributed to two technological advances. First, the shift from single-lens reflex cameras (SLR) to modern digital sensor cameras (DSLR) made it easy and accessible for clinicians to integrate photography into their daily practice. Second, rapid advances in the smartphone industry have resulted in mobile phones capable of creating high-quality images that are sometimes comparable to those produced using professional digital cameras. The development of smartphone cameras offers an alternative, cost-effective approach to conventional dental photography. Consequently, photographs became a fundamental part of dental records and pretreatment documentation.
Clinical photography aims primarily at recording and documenting the oral cavity. Thus, dental photography is a valuable tool for examination, assessment, and diagnosis. Pretreatment photos are essential for documentation, communication, and treatment planning. Showing a patient, the results of similar cases will enhance communication between the dentist and the patient. The photos can also be used for dental team members' discussions and consultations with dental colleagues. Furthermore, accurate photos are essential for esthetic cases in which dental laboratory technicians are engaged in treatment planning and assessment.
Dental photography is important for several other purposes including legal and forensic documentation, marketing, insurance verification, education, and journal publication. High-quality clinical photographs are considered critical legal documents that may prevent conflict or prolonged legal battles. They might also be used for verification with insurance providers and to improve and enhance communication for insurance claims. From the dental practice perspective, internal and external marketing strategies designed to gain patient trust and enhance patient confidence in the practice can benefit from the inclusion of photos of previously treated cases.
It must be recognized that, with all the advantages that come from using photographs in daily dental practice, the practice must obtain the patient's consent and permission before photography. Dentists are required to present all information about the process and their rights to their patients and obtain the patient's agreement for using these photographic records. The patient's dignity and rights must be preserved and respected when using their clinical photographs. Medical ethical principles must be followed at all times.
This study aimed to assess the practice of photography documentation among Saudi dental practitioners using a cross-sectional observational study. The study employed a self-administered survey distributed online, and the data were used to evaluate the practice of documentation, equipment used, and legal/ethical considerations.
| Materials and Methods|| |
Description of survey design
This cross-sectional survey was conducted among a sample of dental practitioners in Saudi Arabia. Dental practitioners included (dental students in 5thand 6thyears, dental interns, postgraduate students, and specialists.). A convenient sampling methodology was employed to select the study sample. A structured, close-ended, and self-administered questionnaire was designed using online google forms [Supplemental Material].
A sample of 218 dental practitioners was calculated based on a 5% margin of error, a 95% confidence interval, assuming 20000 dental practitioners, and a response distribution of 17%. The sample size was calculated using Raosoft online tool.
Validity and Reliability of the questionnaire
The investigator designed the survey items after an extensive literature review. The face validity of the questionnaire was obtained from an expert in dental photography. The questionnaire reliability was tested by conducting a pilot study among 20 dental practitioners, and the Cronbach's alfa (0.76) was adequate.
The questionnaire consisted of general inquiries of participants' gender, employment, degree, and years of experience in dental practice and dental specialization. The use of photography in dental practice was elicited based on a Yes/No response. A multiple-choice or specified answers were used for other questions. Participants were asked if their use of photography was common in their dental practice, what kind of devices (camera/phone) were most commonly used, any previous education in photography they had, and if there were specific types of cases where clinicians chose to take more often photographs. Ethical approval was obtained in June 2021 from the research center at Riyadh Elm University (FRP/2021/341/444/429). The first page of the questionnaire included a description of the study aim and consent for participation. Confidentiality of the responses was assured by collecting the data anonymously.
The questionnaire link was distributed through E-mail and social media networks (Twitter, and WhatsApp) to reach the dental practitioners. The survey link was made accessible for the first 3 weeks in July 2021. It took almost 5 min to respond to the questionnaire. All the duplicated responses were identified and removed before the final analysis.
The data were collected and composed in a Microsoft Excel file and then transferred to the Statistical Package for Social Sciences IBM SPSS Statistics v23 (Chicago, IL, USA) for statistical analysis. Descriptive statistics of frequency distribution and percentages were calculated for the categorical variables. Figures and tables were constructed to visualize and summarize the findings. Chi-square test was used to assess the associations between the use of dental photography and participants' characteristics. A P < 0.05 was considered significant for all the statistical tests.
| Results|| |
Characteristics of the study participants
A total of 218 dental practitioners (Male = 48.6% and female = 51.4%) including dental interns (28%), dental students (18.3%,), postgraduate residents (8.3%), general dentists (18.8%), and specialists/consultants (25.2%) were participated in this study.
The majority of specialized dentists who participated in this study were from advanced general dentistry (36.8%), followed by restorative dentistry (14.5%), and prosthodontics (13.8%). Regarding the participants' level of experience, the majority of participants had 5 years or less of experience (41.9%) followed by 5–10 years of experience (32.5%), whereas only (3.40%) had 20 years of experience. Most of the dentists working in the governmental sector (43.6%) participated in the study compared to the private sector (40.20%) [Table 1].
When the participants were asked if they used photography in their daily practice, nearly half (49%) reported using it, whereas 37% used photography sometimes. On the contrary, 14% mentioned that they did not use photography [Figure 1]. The results show that dental practitioners working in the private sector used photography more often in their practice than practitioners in governmental institutes.
Ninety percentage of dental practitioners reported that photography helps to improve the quality of dental procedures, as shown in [Figure 2].
Interestingly, the majority of participants (46.30%) reported that they were self-learn the skills of dental photography. Other participants reported learning the skills through continuous education courses (37.00%), undergraduate courses (15.10%), and postgraduate courses (12.80%) [Figure 3].
The mobile phone was the most commonly used piece of equipment for taking clinical photos [Figure 4]. Specialists/consultants reported using DSLR or mirrorless cameras as often as mobile phone cameras, but dental interns, dental students, and general dentists used mobile phone cameras more often. Postgraduate residents tended to use DSLR or mirrorless cameras more often.
Regarding knowledge and awareness of the guidelines for using photography, 25% of the participants reported that they were not aware of the rules and regulations at their workplace for taking clinical photos [Figure 5].
When asked about the reasons for not taking clinical photos, patient refusal was the most frequently selected answer by the participants. Similarly, the participants were then asked about the purpose of taking clinical photos, and the responses are summarized in [Table 2]. The majority of respondents reported using photography more often for documentation (75.8%), treatment planning (60.9%), and discussion with their patients (52.1%). Furthermore, a high percentage of participants shared that they use photos for education (42.8%), marketing (38.1%), and communication with the laboratory (27.9%). However, <1% of the participants used these photos for discussions with the dental team. The most commonly used method for gaining consent from patients was reported to be verbal consent (54.6%). Interestingly, only 4.1% of the respondents reported using a specific form for photography, whereas 6.4% depended on the general consent form in the patient's file [Table 2].
|Table 2: The reasons for taking and avoiding photographs and method consent documentation|
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Association between the use of dental photography and participant's characteristics
The Chi-square test showed that dental practitioners working in the private sector than the government sector used photography more often in their practice (48.0% vs. 35, P = 0.020). Dental practitioners with 15–20 years of experience (90.9%) were more often than others used dental photography in their practice. Postgraduate residents are inclined to use DSLR or mirrorless cameras more often than others. While photography was least often used by the endodontists (64.3%). The use of dental photography did not show any significant relationship with gender, type of specialty practice, and years of experience (P > 0.05).
| Discussion|| |
In the current study, there was a reasonable distribution of participants across gender, level of education, specialty, and years of experience. Dental interns showed an excellent response rate. The participation of specialists/consultants is low, with more appropriate responses. Most of the participants were recent graduates with <5 years of experience, and accordingly, a recommendation of this study is related to improving the curriculum of dental schools.
Notably, most of the participants (90%) believed that taking photos improved the quality of dental work. However, the results showed that 14% of dental practitioners do not use photography, and 37% only use it sometimes. The study disclosed the reasons that might prevent them from using photography in daily practice. The results of this study are therefore critical for policymakers to expedite the use of photography.
Dental photography has changed many aspects of the daily dental practice, especially patient communication, case presentation, and discussion. In this study, 86% of the study participants used dental photography in their practice. This finding is higher than that reported by studies conducted by Sharland et al. and Morse et al. in which 36% and 48% of the general dental practitioners of the United Kingdom used clinical photography. This difference could be due to the advancements and easy accessibility of photography devices today.
The previous study has pointed out the main uses of clinical photography were for treatment planning (84%), patient instruction/motivation (75%), medico-legal reasons (71%), and communication with the laboratory (64%). In this study, most of the respondents utilized photography for documentation and treatment planning. Whereas <40% used it for marketing. Using photos from the previous cases is a very common approach for both internal and external marketing of dental practices worldwide. Photos can be used on all forms and cards given to patients. The relatively low use of photos for marketing can be associated with two factors: the high number of dental practitioners at governmental hospitals and the unclear health authorities' guidelines.
It was observed that half of the participants used mobile phones for dental photography, and <30% used DSLR cameras. While phones can be accessible and easy to use, professional communication and quality are improved when DSLR cameras are used. However, the patient's records should not be stored on a personal device. Clinicians must be careful when using their phones to not compromise the infection control protocol. Many dental laboratory technicians depend on professional photos obtained using DSLR cameras to improve the shade matching of indirect esthetic restorations. As dental photography has gained popularity and become more widely used, dental education has improved. Our findings imply that <30% of the respondents learned photography skills undergraduate/postgraduate courses. This indicates that there is a need to update dental colleges' curricula to include these valuable skills. In addition, the percentage of dentists who learned through continuing education courses is relatively low; therefore, dental institutes and postgraduate training centers could do more to encourage practicing dentists to develop their photography knowledge and skills.
We found that up to 25% of dentists were not aware of the rules and regulations for taking photos at their workplace, illustrating the need to increase awareness of the regulations, and improve communication between dentists and employers. On a related note, our results showed that 63% of clinicians were not taking photos due to time limitations during appointments and refusal from patients. These problems might be resolved by improving communication with patients and by employers providing time, equipment, and other resources that support efficient photography during appointments.
Dental practitioners are responsible for obtaining patient consent, explaining the patient's rights, and informing them about the specific purposes of the photos and how they will be used. Clearly, the current study results showed that more than half of the participants relied on verbal consent, whereas only 4% used a specific form for photography consent. Overall, patients must be assured that they have the right to withdraw their consent at any time and that it will not affect their treatment.
The low response rate indicates that the sample population in the current study is not representative of all dentists and dental students in Saudi Arabia. The generalizability of the results has a limitation due to the use of an online format. Although this study sample may not represent the Saudi dental community, it provides valuable information about dental photography in Saudi Arabia. Language may also be considered a limitation, as the survey was structured in English instead of Arabic.
| Conclusions|| |
The findings of this study show that photography is frequently used in daily dental practice. However, many dentists reported concerns about guidelines and patient approval. The lack of training in this field demands the attention of dental colleges and training centers. Moreover, there must be an emphasis on developing a clear written consent form, and dentists must discuss it thoroughly with their patients. Furthermore, dentists should improve the use of dental photography for communicating with the dental team and laboratory. Further studies on this topic with a large sample would provide better insight into dental photography.
Ethical approval was obtained in June 2021 from the research center at Riyadh Elm University, Saudi Arabia. Reg. No. FRP/2021/341/444/429.
The author is grateful to and appreciates the help and support provided by colleagues at Riyadh Elm University.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| Supplemental Material|| |
Supplemental Material (Questionnaire) 1: Photography in dentistry. A crosssectional study
- Gender *
Mark only one oval.
- Your current position *
Mark only one oval.
Dental student Skip to question 6
Dental intern Skip to question 6
General Dentist Skip to question 3
Post graduate resident Skip to question 3
Specialist/Consultant Skip to question 3
Speciality enquiry in case of certificate in dentistry
- Years of experience in dental practice * Mark only one oval.
Less than 5 years
15-20 more than 20 years
- Dental specialization *
Mark only one oval.
Oral and maxillofacial surgery
- Place of work *
Check all that apply.
Photography use in dental practice
- Do you use photography in your clinic? *
Mark only one oval.
No Skip to question 11
- Do you think taking photos is improving the quality of your dental work?
Mark only one oval.
- What do you use dental photography for? *
Check all that apply.
Discussion with patients
Communication with laboratory
- What type of equipment do you use? *
Mark only one oval.
Compact camera (point-and-shoot)
DSLR or mirrorless camera
Mobile phone camera
- How did you learn the skills of dental photography? *
Check all that apply.
Continuous education courses
Enquiry on legality of photography in dental practice
- Are you aware of the ethical guidelines and regulations for using photography at your workplace ? *
Mark only one oval.
- Do you use any kind of patient consent forms for use of photography in dentistry? *
Check all that apply.
Patient signature in dental chart
Special consent form specifically for use of photography in dentistry
Included in a general consent form that every patient has to sign Other:
- What are the reasons that may prevent you from taking photographs? *
Check all that apply.
Refusal from the patient
Not allowed by employer
No previous training in photography
Not enough time
No need to take photos in my speciality
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
[Table 1], [Table 2]