Air Water and LCD Screens—Essentials of Dentistry
It’s finally happening in dentistry. LCD screens are taking over the world everywhere--grocery store isles, dashboards, and now the operatory. In fact, the LCD (Liquid Crystal Display, or flat panel screen) in the operatory is becoming as essential as air and water. The list of applications is seemingly endless--digital X-rays, restoration design, implant design, charts, photos, patient education, case presentation, cosmetic simulation, scheduling, caries detection, magnification, entertainment, distraction, and the next yet-to-be discovered technology breakthrough, all express themselves visually via the LCD. This article will show you how to cost-effectively integrate LCD enabled technologies into your practice that pay for themselves and provide immediate benefit to you and your patients. In a modern practice, the operatory LCD is so important that it is now impossible to diagnose, educate, present, treat, manage, and communicate without it. You will learn about operatory configuration options for LCDs, how to implement a variety of tools, and how to derive the greatest benefit from them. The tools include digital X-rays, case presentation, patient education, photography, interoffice communication, practice management, cosmetic simulation, and entertainment/distraction.


Two Ideal LCD Configuration Options

Ideal Configuration #1 consists of twin LCDs; one behind the patient for clinical, management, and HIPAA sensitive data, and one for patient viewing sitting upright or supine. Variations of Ideal Configuration #1 is often compromised so that utilization, ergonomics, and comfort are sacrificed due to suboptimal placement and/or makeshift mounting. The “behind the patient” LCD will be called “BP” (Behind-the-patient) and the patient viewing LCD will be called the “OP” (Over-the-patient) in this article. Ideal Configuration #2, for higher tech utilization, adds a third LCD for the clinician to view during treatment that is more ergonomic and efficient. Configuration number two will not be discussed in this article because it is an emerging configuration that is not yet widely used. Viewing clinical data (X-rays, images, etc.) on the third LCD requires little, if any, head/neck/eye repositioning during procedures and is typically located mid-chair at the clinician’s eye level, similar to the LCD location for a surgical video microscope. Pay close attention to the LCD configuration in your operatory. Malpositioned LCDs can greatly reduce utilization, comfort, and the benefits the technology you purchase provide. Optimally positioned LCDs are more ergonomic and reduce fatigue for the operator and the patient. When you do it right, patients continually comment that they have had the best dental experience ever.


What’s Playing on the Twin LCDs?

The uses for OP (Over-the-patient) and BP (Behind-the-patient) LCDs have become integral to the practice of modern dentistry. Table 1 lists more popular uses and the optimal LCD configuration for them. The BP LCD is principally used for all functions except patient entertainment, distraction, education and case presentation. The OP LCD is used primarily for comforting and educating the patient.


Digital X-rays

The primary application overlap between the BP and OP LCDs is digital X-rays. Because the LCD becomes your electronic X-ray view box, positioning is critical. The BP LCD is adequate during non-operative periods, but involves too much head twisting and eyeball gymnastics when viewing X-rays during procedures. In many cases, the OP LCD works extremely well to view X-rays during procedures. Many dentists overlook the importance of LCD positioning when implementing digital X-rays so be sure to plan carefully where the LCD for viewing X-rays will be placed in the operatory.


Clinical Research Associates recently published a study that compared the diagnostic quality of digital X-ray systems with standard D speed film for patients with minimal caries. “When you spend the time to color, enlarge, and/or enhance the digital X-rays, the diagnostic quality was at least as good as, and sometimes better than standard D Speed film for some of the digital X-ray systems. ”, commented Dr. Gordon Christensen. Growing acceptance of digital X-rays has been accelerated by the added benefits of digital storage/retrieval, convenience, and reduced radiation.


A number of vendors offer a variety of digital X-ray configurations and benefits. Lightyear Direct has more than 3,000 systems installed, offers a two sensor system with open architecture software that integrates with a variety of practice management systems. Glen Bachman, CEO comments, “Digital X-rays offer better diagnostics, improved workflow, and enhanced treatment acceptance at a lower cost than conventional film.” Dexis, which was acquired by Danaher in 2005, has 10,000 installations, “offers a single sensor system, slightly smaller than an #2 film that works in conjunction with one universal mount on the screen.” comments Bruce Servine at Dexis. Suni offers a three sensor system with a five year warranty. “Suni sensors are only 3.2mm thick and provide an easy transition from film to digital.” comments Brian Jaffe, Senior VP of Marketing. Digital X-ray systems are also available from Dentrix, Schick, and Kodak.


Digital Photography

General dentists have finally discovered what orthodontists have known for years—digital photography is so hot that it melts film away and may be the single most valuable patient motivation tool. Last year digital camera sales exceeded film camera sales and image quality and value have never been better. Every practice should own and use a quality digital still camera purchased off-the-shelf or from a company that configures digital cameras specifically for dental applications. Photomed International, for example, provides unlimited phone support for its camera systems preconfigured for clinical dental photography. I recommend two cameras for every practice; one is a simple, lightweight point-and-shoot camera that staff can easily learn and use with only two hands (after all, your staff, not you the dentist, should be taking 95% of the pictures), and the second camera is a higher quality camera for taking high-end clinical photos. Mike McKenna, a Photomed Vice-President who has more than 20 years experience with clinical dental photography says, “Photomed offers a 30-day money back guarantee. Two popular cameras are the $1,245.00, 7.0 megapixel Canon A620 System (smallest and lightest weighing in at 21 ounces) and the 8.0 megapixel Canon Rebel XT System ($2,395.00 with 100mm lens and flash weighing 53 ounces for the basic camera).


Orthodontic records have always included a standard series of photographs. I strongly recommend that general dentists have a standard series of patient photographs I call an FMI, the abbreviation for Full Mouth Images, that is taken for every patient and updated every 3-5 years. Another powerful documentation and education tool is what I call a “Panorimage” taken with a 6.0 megapixel or higher camera, consisting of 4 simple views: 1. Full face, 2. Smile (closed bite), 3. Upper arch, and 4. Lower arch. By using these photos to digitally zoom in and out while educating patients, they will not only understand treatment needs, but clearly understand the precise location in their mouths. With a high resolution image, you can smoothly zoom from a close-up of a single, unpixelated tooth to a full arch.


Cosmetic Simulation

During the past decade there has been broad consensus that simulating patients’ post-treatment smiles is a huge case acceptance tool. Slow acceptance of this technology has been due to the steep learning curve for most software programs and concerns about meeting patients’ expectations. Practices that have implemented cosmetic simulation have been very pleased with the results. To speed up implementation in your practice consider using basic features of cosmetic simulation software for simple tasks such as closing diastemas or bleaching. If hygienists incorporated a three-minute bleaching simulation into every recall visit for patients who would benefit from bleaching, there would be a lot more WOW in the practice, hygienists would become more comfortable using cosmetic simulation for other tasks, and you would be bleaching a lot more teeth.

Another option is outsourcing cosmetic simulation with companies like Smile-vision where you e-mail a patient’s pre-treatment smile and receive a simulated smile by return e-mail to present to your patient.


Patient Education

Convenience of the OP LCD is a major factor contributing to better patient education and treatment acceptance. The intraoral camera can be used, even for brief periods, without the awkwardness and disruption of repositioning the patient to view a malpositioned monitor. Applications such as CAESY contain quality images, illustrations, and animations that enhance patients’ understanding and compel them to accept treatment. Applications for specific procedures such as DentalImplan provide new tools that dentists and staff can use to present treatment easily, educate patients effectively, and motivate them to accept implant treatment. Dr. Jeffrey Ganeles, DentalImplan’s developer who has an implant and periodontic practice in Boca Raton, FL says, “Multimedia tools like DentalImplan provide general dental practices new and simple ways that motivate patients to accept treatment for more complex procedures.”



OP LCDs that patients use to watch TV or movies are becoming as indispensible as anesthetic. Patients are demanding more comfortable and relaxing treatment environments where they have some control, even if it only involves allowing them to change channels or adjust the volume. “If my dentist went away, I would only go to a dentist who has an optimally positioned over-the-patient LCD, such as the TLC System. It totally transformed my dental experience and I would not be without it.” says John Sabina, a territory representative for Patterson Dental who has been seeing Dr. John Herzog in Beverly, MA for six years. While some dentists feel TV and movies are inappropriate for patients to watch during treatment, most recognize that relaxing patients in this manner reduces stress for patients as well as clinicians.


Recent studies have shown that patients who listen to music during surgical procedures require less anesthetic. Major clinical studies have proven that some forms of visual stimulation, such as virtual reality programs, are extremely effective at reducing pain for burn patients while surgical dressings are being changed—an excruciatingly painful procedure.


OP LCDs that are properly positioned provide the greatest benefits when used for patient entertainment/distraction with dentists reporting 10%-30% increases in efficiency because patients’ heads do not move, chins are up, and they lie perfectly still for extended periods of time.



OP (over-the-patient) and BP (behind-the-patient) LCD screens and the applications that use them now provide dentists with powerful tools to provide better dentistry more comfortably and efficiently than ever before. A typical investment of $5,000-$20,000 per operatory in this exciting technology (computers, LCDs, applications, sensors, etc.) will pay for itself in less than a year so there is no danger of obsolescence. The investment may seem high to those inexperienced using the technology, but knowledgeable users will tell you that has improved their dentistry, enhanced their lives, and is as indispensible as air and water. Many vendors have reduced or eliminated the risk to implement this technology in your office which makes your desire to change and improve the only obstacle. Update your practice today, even if you only implement this technology in one operatory. After you have gain enough knowledge and experience you will want to update your other operatories as well.