Episode 133: Requested Replay – Diagnosing on Risk Factors

“I want patients to know their role in the damage in their mouth.” ~Dr. Bruce B. Baird

I thought it was my fault. 

I don’t know about you, but when I see a patient in my chair who is upset with their failed dentistry, I take it personally. Or at least I used to. I came out of dental school thinking if my work was perfect, then my dentistry would last and I spent many frustrating years early in my career redoing failed dentistry that I thought was my fault.

But here’s the thing: it wasn’t my fault. The patients’ history and behaviors were increasing their risk factors and causing the dentistry to fail. You can do the best work in the world but if your patients drink soda all day, take certain medications for other health factors, don’t have good oral hygiene practices, and don’t come in for recare, the work you do won’t last. 

It’s time to start putting the blame for dental problems in the right place. It’s time to start educating patients on what is going on in their mouths. It’s time to start diagnosing risk factors. 

So join me today as I talk about how you can incorporate risk factors in your diagnosing and treatment planning, including:

• How to frame a conversation about risk factors
• Phrases to use with patients to bring up their risk factors
• Framing the conversation so patients take responsibility for their oral health

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EPISODE TRANSCRIPT

Dr. Bruce Baird

Hi, this is Dr. Bruce Baird on the Productive Dentists Podcast I wanted to talk today in general, about risk factors and how important using risk factors in your diagnosis and treatment planning is The first time I heard the term risk factor I was at a program that John Kois was putting on kind of a special program for PDA Docs and he began talking about risk factors and you know, a lot of people you know, he talks about periodontal risk and biomechanical risk, functional risk and aesthetic risk and as I heard him talking about these things, it became apparent to me it was actually like an epiphany.

I wasn’t thinking about the periodontal disease, I wasn’t thinking about those things but what I was thinking is, for all these years, I’ve spent my entire career redoing dentistry that I thought was my fault. I thought it was my fault that something failed. When the truth is every patient had different risk factors. They had different things that they were doing that were affecting them. It might have been the sugar they were drinking, and I never talked to him about it.

So they kept drinking the sugar and guess what they kept getting the decay and I and I thought because, in dental school, they taught me if my margins were good, and if all these things it was perfect, then my dentistry would last when the truth is, it was the risk factor that was causing the problem all of us have seen, oh my gosh, we’ve seen you know, metal cans put on teeth, you know, they use these aluminum cans that were put on and they’ve been in the math for 25 years, and there’s no decay, and there’s no perio but why is that?

Well, for whatever reason that tooth had a problem early on but the factors changed. We know that if it didn’t, then that thing would have decay and periodontal disease. We know that there are some folks who don’t come in for their weight care. We know people that don’t, don’t wear their clothes or guard, we know that those things are there but we don’t really talk to patients about it. We don’t actually get down, in the grass with them and start talking about why are having these dental problems. And why are you continuing to have them? If you think about it, you know, people come in with all different types of things going on.

I like to use the term, you know, I see this every day. You know, everyone who grew up in the timeframe that we grew up, and a lot of my patients are over the age of 50 but they’ve been through all of this. They had mercury fillings, they’ve had Endo, they’ve had an extraction, they’ve had an implant, possibly they’ve had all this dentistry done and the truth is, most of these patients are frustrated. I don’t think as dentists we’ve done a good job of putting the blame in the right place.

You know, we spend our entire career being in rapport and rapport is when you’re just high-fiving people and men are particularly bad about doing that. I mean, we tend to even our buddies, we don’t know a lot about our buddies, but we have five them and we know they hit a seven iron, you know, 170 or one, you know, they can darn sure hit it a long way but we don’t get down to you know, get down in the grass and talk about things that are serious. So I think part of it is just how we’re brought up. I know women, they do a great job. You get four women at lunch and they’re gonna know everything about each other but that’s what you need to know and that’s what when you’re talking with patients, there are times to be in rapport and there are times to be in a relationship. There are times to be in relationships and agreed upon course of action between two parties.

There are times when you got to tell that patient that every appointment This is what I see. These are the things that you’re doing, that you’re doing, that are causing these problems because the patients are frustrated. They look at a dentist, like a mechanic, you fix my car. Why is it not staying fixed? Well, it’s not staying fixed because you’re driving off-road and you don’t have an off-road vehicle. You know, you’re going through rocks, and all these different things and parts are coming loose and it’s causing you problems. The math is the same way.

You know, you keep getting this case, that has to be pretty frustrating Mary, oh, it’s it crazy. You know, I had this done and this dentist did this work and it only lasted for like two years. You know, I’m always having to have my dentistry redone. Every time I go to the dentist, there’s always something else. Well, Mary, what would it be like if we set up a game plan where you knew exactly why things were happening? And here’s what’s important, I don’t want you to waste a penny in our office, I really don’t want you to waste a penny but here are the things that we’ve got to do together to make sure that that doesn’t happen. First of all, let’s look at you know, let’s look at your risk factors. These are the things that whether it be genetics, whether it be your habits, whether it be things, there’s a reason why this, that you got the cavity in the first place, there’s a reason you started to have the periodontal problem in the first place.

There’s a reason why your teeth were being ground down. We have to identify those things and figure out what is what are your risk factors ? What are the things that are affecting your long term, we know that if you sit on the couch and never exercise, you’re probably going to gain weight. We know that if we, you know, smoke cigarettes, you know, all day long, we know that that’s probably not the best thing for us. We know that if we sat around and you know cheeseburgers all day long.

You know, we know as people as human beings, there are things that we do that are destructive but we rarely ever talk to patients about things that are destructive to their mouths. To me, that is oh my gosh, I never did it before I heard John talk about it and once John talked about it, I thought, Gosh, this isn’t my fault. You know, we’ll delve into each one of the risk factors individually and I’ve added a couple of risk factors since hearing John talk about it but what I look at is I say to the patient, let’s make sure we don’t waste money and let’s look at your risk factors. What are you drinking? What do you what are you drinking during the day? You know, what is your favorite drink? You know some will say I like beer.

Or some will say well, I drink milk all day long? Well, milk can be broken down into simple sugars and can cause decay. Especially if you throw in a few medications with it. When was the last time you had your teeth pain, Mary? Oh, it’s been probably four years or five years? Well, this is a bacterial infection with your teeth and it’s important that, you know we get that under control and that we keep it under control. Because of your genetics, you know, your mom, you know, we’re gonna find out did mom or dad lose their teeth because of gum disease? Oh, yeah, my dad lost his teeth. He was probably 30. Do you know if he had cavities? Or did he have gum problems?

Well, I don’t know and I said, Well, looking at your own genetics, I think it looks like you know, your problem is mainly with decay. So maybe that’s why your dad lost 30 A lot of the habits that people have not gone to the dentist, I use a really good one, which I see often a patient who’s never had cavities as a kid, they become periodontal patients later because they never go to the dentist they never had to and they think well, I’m fine.

I don’t have to go to the dentist, I never had a cavity. I never had anything hurting. Those are patients that I want to educate and education to me is critical and productive. When you go through risk factors with patients. At the end of going through that, you’re going to have patients say and you’ll hear them say it. If not every single time 90% of the time, they’re going to say and they’ll a lot of times not ask me but they’ll ask my treatment coordinator, gay or summer or Shannon. They’ll say Why is no one else ever gone over this stuff with me before?

So what is that doing for the patient’s perception of the value that they’re getting? Because, you know, value is a perception. They don’t know what the margin should look like. They don’t know those things but their perception of the quality of care that we’re going to give we have to show them what that quality of care is. We have to show them why things fail in the mouth and we also have to show them why things are successful in the mouth and if we’re able to go through and do those things with our patients, what you’ll find is when it comes down to treatment plans, that’s great. You go through the treatment plan with a patient, and they, you know, they understand it, because now we’ve gone over risk factors.

First, why do we do risk factors? First, why do I go through my exam process by laying the patient back and then bringing them back up? And then talking about risk factors because then I want them to know their role in the damage in their mouth, I would do the same thing. If I was a physician, you know, I would talk to them that these are the things you’re doing that are not helping you. I went through Brad Bradley’s bail and Amy don’t Ames program, bailed on me, and it’s beating the heart attack gene and I went through and my wife and I both went through an entire day with Brad bale and he went through all of the risk factors that we had, he went through all of our genetics, he went through this stuff.

Now we don’t have time to spend a whole day. I can do it usually in five minutes or eight minutes but the thing that struck me, was when Brad ended our conversation, he said, Bruce, I’ve given you everything you need to be healthy, and live the rest of your life healthy. I’ve given you everything and he said, If you do it if you follow my recommendations, that’s what you’re going to find. You’re going to stay healthy. If you don’t, then shame on you. Because I’ve given you all the info. Well, that’s strictly between the eyes, I’ll tell you straight up, you know when somebody says you follow my recommendations, and I believe in Brad, and I believe in anything and what they’re doing. So it’s easy for me to say, wow, you know, you hit me in the eyes, I look at the patients and I say something similar.

I said, you know, Mary, what God gave you has broken down in 3030 years. What I do won’t last any time. Unless we figure out what’s causing it. I think dentists as dentists, we’ve learned, oh, insurance pays every five years, that’s okay when I put a crown on my expectation is that crown is going to be in for the rest of their life. That’s my expectation, not that it’s going to last six years, and I’m going to remake it. I mean, that’s frustrating. That’s not what we want to do as dentists is be.

You know, I don’t know, being an auto repair guy. What I want is to help people live a healthy life and today we know now the oral-systemic connection, I was just talking about brand naming, if you want to find out about that, you know, talk to you know, talk to them, talk to Michelle, you know, our hygienist and one of our PDA coaches. I mean, she teaches this stuff and it’s important. So when I’m looking at patients, and I’m, I’m figuring out, these are all the things that you’re doing? Well, that’s it almost seems threatening, but you don’t present it in a threatening way I’ll go into each one of the risk factors and how I talk to them in future episodes but overall, I’m going to be honest with them, because as you know, they came to me for my opinion, I’m going to give them my honest evaluation, I’m going to say this is what I would do if it was me.

This is, you know, as long as we continue doing this, what I will promise you is I will always do dentistry at the highest level I can possibly do it at and I’m going to look at those margins. I’m going to do pre segmentation X rays, I’m going to do everything I can do to make sure that your Dentistry has the best materials, the best margins, I’m going to do everything within my power to make sure you have the best dentistry that you can possibly have done but it will fail if we don’t follow up with all the other things that we’re talking about. So I hope this makes sense.

I think it does. It does to me, certainly and I do believe that if we talk to our patients about their risk factors and about what things are causing their problems. They will love you forever. That can you know you can have a crown fail you can have something happen and they will believe in you because you have given them kind of a ticket or directions on how can they stop spending money every three to five years. How can they stop spending this money?

You know dentistry is expensive when you don’t know what’s going on. It gets really really expensive. I mean, I tell people all the time it doesn’t take that many cavities that many big cavities to get four or five $6,000 with dentistry yet the average crown has done one at a time in the US. You know 95 out of 100 crowns are done. One at a time even though the patient may need more. So those were all conversations that we’ll have in future episodes but I hope this was of interest to you. I look forward to sharing some more information with you in the future. You know, lux not by chance, and you know, these are my opinions.

Could be wrong, but I’ve been doing it now for 36 years and I know it works. So 36 years in private practice, so I do know it works. So hope you guys have a great day and look forward to talking to you again in the next podcast. Thank you for joining me for this episode of the Productive Dentists Podcast. If you found this episode helpful, make sure you subscribe and pass it along to a friend. Give us a like on iTunes and Spotify or drop me an email at podcast@productivedentist.com don’t forget to check out other podcasts from the productive dentist Academy on productivedentistpodcast.com Join me again next week for another episode of the Productive Dentists Podcast