By: Mike Esposito, DDS

I’ve been asked what the turning point in my dental career was and have always answered, Dentaltown, of course! But if I had to choose an earlier critical crossroad, it would be my decision to implement the then “new” technology of digital radiography. This decision came at a time before Dentaltown was in existence and that made the choice all the more difficult.

The attraction of digital radiographs for me in 1998 was threefold; first, it would allow me to reduce radiation exposure up to 90%. This would be a win-win situation for me and my patients as they would appreciate the reduced amount of radiation. Second, it would be a terrific time saver, as it would speedup a full-mouth series dramatically. Because no time was wasted going to the dark room, peeling back the films, placing them in the developer, waiting for them to develop, and then finally mounting the films (assuming none had been “eaten” by the automatic processor or need to be retaken due to misalignment). The digital system was almost instantaneous, the entire series was available as soon as you finished taking the shots! No muss, no fuss, and if by chance a particular shot was not up to standards, then it could be retaken immediately. No need to re-shoot after finally getting the pictures developed and mounted the conventional way. Third, and most importantly (at the time anyway), I felt it gave me an edge from the standpoint of being on the “cutting edge”. I was sure patients would be significantly “wowed” by this new technology.

All of the above reasons did indeed prove out. But the biggest boon to my practice had nothing to do with the above points. Yes, patients loved the fact there was less radiation, and I and the staff loved the time savings. Yes, patients were immediately “wowed”, no question, the computerized radiographs seen on the monitor were seen by patients as a great technological advancement, something they had never been witness to previously. But the greatest achievement of the digital radiographs was their INSTRUCTIONAL benefits. I would never in my wildest dreams have envisioned this technology as the greatest teaching tool I had ever seen––before, or since! If I had, I would never have bought the digital intraoral camera available for an additional $5,000 (everyone’s allowed one mistake, right?). I felt that the intraoral camera would be the teaching tool. WRONG! Patients were accustomed to conventional pictures…sure, you could show them a fracture line, or that huge old amalgam. But most of them just seemed, well, disinterested. But show them a similar fracture or carious area (or better yet––bone loss) on the monitor…enlarge it to your heart’s content, colorize it, and, the effect was nothing short of amazing!

Back in 1998, when I purchased my Schick system, this technology was still a novelty for most areas, especially for a rural one where my practice is located. The local newspaper, the Pocono Record, was all over it and immediately sent a photographer and writer over to see it for themselves. The result was a multi-page color article on our office (Photo 1). You couldn’t buy advertising like that; we had new patient phone calls for many weeks after the story appeared. Although the initial newness of this technology may have worn off a bit due to the passage of time, I believe there is still sufficient room for promotion of such equipment, especially if combined with other current advancements. By the way, we still include it in our Yellow Page advertisement and it continues to bring comments from prospective patients looking for a new dentist.

So, now, how exactly does this advancement in radiographic methodology become a teaching tool? Well, I can honestly tell you it took absolutely zero effort on my part. If you look at our operatory set up you will see the monitor is visible to the patient and sits at eye level (Photo 2). In the case of a new patient, the hygienist has already taken a medical history, full-mouth series of radiographs and completed soft-tissue probe readings. When I enter the op I go directly to the patient and shake his/her hand. I let them know we will look at the films together and then do a clinical “in the mouth” exam. When the patient leaves he/she will have a report of what will be necessary to achieve ideal oral health.

Oh, I should point out, I don’t make a big production about the digital system, sometimes the LESS you say, the better. The exam proceeds with me clicking on the first of the full-series films. There it is, larger than life on the monitor, the patients are always impressed by this if their previous dentist didn’t have a similar system. Comments have ranged from, “Wow, this is really neat, I can’t believe I can see this all so clearly…so THAT’S what the decay looks like,” to, “You sure have the latest thing in technology doc, this is great stuff, I wish my old dentist could have shown me this.”

This is no exaggeration. Patients are impressed with this view of their mouth. Where else can you demonstrate the level of bone loss like this (Photo 3)? Can patients do it while squinting at a tiny conventional black and white film? No way! Here on the screen it’s something they can see without any effort whatsoever, heck, they can almost touch it! Case acceptance has skyrocketed and there is no “selling” involved. The radiographs are presented and the patients see for themselves the degree of bone loss, extent of caries, fracture lines––you name it!

To say I simply enjoy working with digital radiographs would be a huge understatement; it’s a win-win situation all around. Patients love it because they can actually see the underlying etiology of the disease in black and white…or color…or even in a negative image––by the way, this is sometimes the easiest way to view a problem (Photo 4). Having a patient refuse a quadrant-scaling program has been a thing of the past. Honestly, I can’t remember a patient NOT going through with the program since going to digital radiographs. Let me tell you, it’s awfully difficult for a patient to ignore 5mm of bone loss when it’s presented to them on a 21-inch monitor. So, the end result is the patients accept treatment and get a realistic opportunity to have a healthy periodontal condition. As the treating dentist, I win twice. Once, because I have fulfilled my duty as a doctor––having properly instructed and informed patients of their condition––and elicited patient behavior consistent with eliminating a disease process, in other words, they go ahead with the recommended treatment. As you know, that is not always such an easy task! Secondly, I win from a profit prospective, the more accepted treatment, the higher production and, if done correctly, a higher net.

Let me explain that last statement on higher net. Higher production is fantastic, but if the net does not increase, I think we can agree, this is not an optimal end result. Purchase and implementation of new technology is oftentimes expensive. In my case, I invested in the technology, but did not go overboard. With a relatively small office of three operatories (I work out of one op and I have hygienists in the other two) the desire to outfit all three rooms with digital radiographs was almost overwhelming. But with careful analysis I was able to reduce the cost by putting the system in only one room. You see, all new patient exams and recalls requiring radiographs are directed to this particular operatory. It took some time to learn how to juggle this workload, but now its second nature. Yes, I still have the good-old developer to help out when a BWX is done in the “other” hygiene room or an emergency film is taken in mine. No system is perfect, but for these few exceptions, all radiographs are digitally taken.

Now, if I were to do it all over today, I’d still only go with one system; however, there are now products out there that are completely self-contained mobile systems. Heck, you would need only one and be able to carry it from op to op. This way, I’d still buy only one system, but would have the advantage of portability, which I do not have at present. The developer would be a thing of the past. I personally think too many dentists are urged into large multiple package purchases. Taking a step back and putting in a little thought and planning might well be a more practical approach to outfitting an office. So, with apologies to Robert Frost, I might be tempted to say that I took the road less traveled and that, has made all the difference.

Michael A. Esposito, DDS, practices general dentistry in Stroudsburg, PA. Dr. Esposito is a graduate and former clinical instructor of the School of Dentistry at SUNY-Buffalo. He is a boater, an avid fan of his daughter’s basketball team and occasional contributor on clinical subjects to various dental publications. Dr. Esposito has no financial ties with Dentaltown or any of the companies mentioned in his article. Currently, Dr. Esposito is lecturing on “Practical Dentistry” both nationally and internationally, he can be reached at espo28@fast.net.