Episode 188 – Requested Replay: Putting An End to Patient Frustration

“When patients have to keep coming back because the ceramic shade isn’t right it’s very frustrating for you, but more so for your patients…this is why it’s so important for patients to know their risks.” ~Dr. Bruce B. Baird

As I keep repeating, your patient’s risk factors are not your problem but your patients don’t know that unless you tell them.

All they have are their own ideas of how long their dental work should take and when it takes longer they get frustrated and angry and blame you.

I don’t know if you’ve ever had a patient with high aesthetic risk have to come in three or four times to get their ceramic matched. Of course, it’s frustrating for you but think about what your patient is feeling. What are they thinking when you’re trying their crown for the 3rd or 4th time? They think you don’t know what you’re doing, that you’re a terrible dentist.

That is absolutely not the case. So how do you alleviate this problem?

The answer is simple: you have to In this podcast episode I’m going to share a few methods I learned over the years to set myself and my team up for success:

  • How to help patients understand their risks
  • What to say when you share your treatment plan
  • Using patient education as a practice-building tool

Never miss an episode! Subscribe on iTunes & Spotify. Visit us at http://www.productivedentistpodcast.com


Hello, this is Dr. Bruce Baird, of The Productive Dentist Podcast today we’re going to talk about the fourth risk factor, which is an aesthetic risk, and what do we mean by aesthetic risk? Well, when you have a patient that smiles, and they don’t show their teeth at all, that’s what you would call a low aesthetic risk. Somebody who just you could almost have any laboratory do the dentistry for you, you could have them, you know, you can have a crown that’s a different color, you can have crowns that have a metal collar to patients, or other people are never going to see it on that patient. So what’s the highest set of risk patients? Well, that’s when they smile so big, they show their gums, they you know, and as I go in through the risk factors with these patients that are high risk, I truthfully, don’t even talk to them about it if it’s low risk because it’s not, it’s not a big deal but when you have a high aesthetic risk patient, it’s imperative that they understand that they’re high risk and I’ll tell you, I go back 30 years, and I’d have that patient with a big smile come in and I would go they broke their front tooth and they would say, “Can you fix it?” And I would say, “Yeah, you know, we can fix it, it’s gonna be great, you know, I use a great lab and these guys are amazing and they’re going to do a great job,” and as matter of fact, the guy who developed the sunrise crown was my ceramics back years ago with gold with porcelain on it and did beautiful work but what we would do is I would take my shades, and I would prep the tooth, and we would go have the crown made, and it would come back and sometimes it’d be right on but as many of you know, you put it up there and you go, Darn, you know, I didn’t catch the, you know, didn’t get the right Chroma on this.?”

It’s a little too bright, or it’s a little too down and so I would tell the patient, I said, “You know what, let’s let me send it back to the lab. Let me make a change on this,” and I would tell him that and we would get it back and it still wouldn’t be quite right. I don’t know if this has ever happened to you, but so maybe the third time you’re sending them to the lab, and they’re doing a custom stain job right there in the office and Danny was great at doing that but when he passed away at a young age from pancreatic cancer, so I lost my ceramics but the same thing happened I you know, they’d go to another local lab and have them check and it would come back and it just wouldn’t be exactly a perfect match and that is that’s very frustrating for the dentist, but even more so frustrating for the patient because what did they think during that time? What are they thinking, as you’re trying it in for the third or fourth time? They think you don’t have a clue what you’re doing.

They think you are, you know, one of the worst dentists and I mean, it’s just they think you don’t know what you’re doing. Now. So how do you alleviate that problem? Well, I’ll very simply in talking to the patients about risk factors. I explained to them that they’re a high risk and I’ll say something like, “Maggie when you smile. You see everything you see your gums, you can see your teeth, you can see the edges of your teeth. So when we do this dentistry for you, on your front teeth, it has to be perfect. I mean it literally has to be perfect. Now I have some patients Maggie when they smile, you can’t even see their teeth, but you’re not one of those,” and so I have options as a dentist at that time. I used to charge one and a half times the cost. So if a crown was 1000, I would charge 1500. If it was 800, I charge 1200 and I tell the patient, “You know, your teeth are gonna be a little more expensive because of that hot, big, big smile, but you have, it’s got to be perfect. My commitment to you is to make sure that it’s perfect. Now, it may take us longer, you know, it may not be an overnight deal, we may have to send you to the lab to have it done, we may have to, it may take three or four appointments.”

So having said that, now the patient knows, it may take three or four visits in order to get this done correctly what is the patient think when you get it done the first visit or the second? First of all, they know they’re very difficult, but you know that you’re committed to giving them what they need, which is a beautiful crown that you can’t tell the difference between it and the teeth around it. Now, I’ve been very fortunate I’ve been using CEREC technology now for as most of you know, for four years but I didn’t do a lot of anteriors until probably the last eight years, and the software has gotten so good and I’m able to pick blokes I’ve learned to do custom staining myself and so when I’m sitting there with a CEREC, and I’ve told this patient is going to be extremely difficult, I don’t care if you use me for D or whatever scanning and sending it to a lab. I don’t really care but my advantage over the competition and the other dentists around is, first of all, I can do the crowded one visit but I can also do custom staining and I can do it and I can do it where the patient is watching me and so now they look at and they are like, “Wow. I mean, Dr. Baird and his team, and they really know what they’re doing,” and they go out and when they start talking to other patients, they’re saying, “Oh, you’ve got to go see them because they can do the staining and you know, some people have a big high smile.” They’re actually talking about risk factors to their friends, who they know have had dental issues. So it’s an absolutely amazing practice-building tool to be able to do it right there chairside even more. So it is the opportunity to set yourself apart, you know from other dentists, and I’m not trying to take anyone else’s patients but what I will tell you is I’m going to do the best dentistry that can possibly do. If I’m not good at staining, I’ll go to staining courses, I’ll go learn, I’ll go to Vita, I’ll go to, you know, whoever I need to go to, to learn how to do it and that’s what I’ve done over the years. You know, there are actually some AACD fellows that were lab technicians before they became dentists.

So they’ve learned how to do that anybody can learn it, it just takes take some time. So these are the things that I look at when we are, you know, talking about the highest aesthetic risk patient. The other thing that you have to look at it, what about that patient that’s a high aesthetic risk that is losing their teeth, you know, from a denture standpoint, they’re going to lose their teeth, or what I call terminal dentition, they’re going to lose them. You have to be very, very aware and taking impressions on where you want that smile line to be and so what I’ll do is we’re taking impressions for, say dentures or whether it be immediate, whether it be, gosh, whatever it is a hybrid bridge up top, all of these things come into play whenever you’re doing these, these are more complex type treatment plans. So let’s say first, if it’s a denture, if it’s a denture first, well, you know that they’re going to smile to a certain level. So you’re going to want to have that gingiva starting there, but what about that hybrid bridge case? What if a person smiles with no teeth in and shows that upper ridge? What does that tell you? Well, what it tells me is, we’re going to have to do if I’m going to go with a hybrid that has to have, oh, 13 millimeters of thickness, I’m going to have to take away a bunch of bone. Now does that bother me to do that? I’m not really but I have to know that this patient when they smile, I got to have 13 millimeters above that. So those are things that are critical. It’s a matter of fact when I have a patient that has so much bone in many cases, I’ll do more of a crown and bridge type FP one where I’ll have more crown and bridge, I’ll put the implants in but it will be really no pink there because when they smile, they’re already showing it I would also rather do a little alveolar plasti so that that smile line is right at that level. I hope that makes sense. So it’s extremely critical. In implant prosthetics. What I’ve seen is I’ve seen people and this is something you have to be very, very aware of If you go in and you’re saying, “I’m just learning to do implants, I’m going to pop for implants up top, we’re going to get rid of the roof of the mouth for you,” and so you go in and you pop in the implants, and then you put your snaps on, and all of a sudden you realize good grief when they smile. I mean, I can see all that pain, and it just doesn’t look good. How do I know these things? Well, I’ve done them, you know, and I’ve gone back and said, “You know what, I don’t like the way this looks, let’s make some changes,” but the bad news is, if you’ve already put those implants in that position, you don’t have a lot of places to go, you know, without taking them out and then doing a significant alveolar plasti.

So I’m looking at smiles, and their smile risk very critically, when I’m doing any type of prosthetics that include implants because once those implants are in a certain spot, I’ve got it on patients and taken out all the implants that they’ve had on the upper ridge or even the lower, where I can now place implants at the right position so that if I’m going with snaps, say locators, or whatever type of stuff you have, I’m going to have good aesthetic results, because people don’t want to look like Mr. Ed, you know, with these teeth, you know, big old giant teeth, and that’s when they stand out. How many times have you had that happen often? So, or have you had people say that hopefully you haven’t had teeth that look like way, but it’s critical in implant prosthetics.

The other areas that make a big difference are I’ve seen dentists and I’ve had patients walk in and their teeth are ugly as heck. They said, “Yeah, had implants done, they snap them out,” and now what they’ve done is the dentists previously had put in four implants and made a bar, which they didn’t have enough room for snaps, but now they’ve added another two or three millimeters in a bar with attachments, well, even using breed and attachments on the side where you’re not adding to the occlusion, it still can be a major problem on aesthetics. So if you’re doing a bar, a bar overdenture or snaps, those are great for those patients who’ve lost an enormous amount of vertical but when you’ve just done an immediate taken out teeth on somebody’s got to be aware of those things. It’s absolutely paramount, and it’s critical. So I had a patient years ago come in that had a maxillary sub subperiosteal implant. I don’t do maxillary subs, I’ve done probably 50 mandibular subperiosteal. That’s, that tells you how old I am. So it’s, this maxillary sub that was coming in and the thing had settled into the sinus. The patient came in, I didn’t know it is settled in the sinus at the time, but I had the patient come in and when they smiled, they couldn’t even put their lips together. Guess who they were pissed off at? They weren’t pissed off at the guy who did the subperiosteal they were pissed off at the dentist who did the teeth. So I said, “Okay, I said we’ll take those out for me.” You know, because they had, oh, ring attachments on this up.

I said, “Take them out for me.” She goes, “Oh, I can’t take it out.: I go, “Wait a minute. Yeah, you can take it out.” This lady had not taken the upper sub out, since she had it done for years. So I was like, okay, so we got it out, it was not a pretty picture. That’s when we found out the tissues were just, like, minced up and then, the patient was actually upset with the restorative dentists. When when I took that denture out and she smiled, I can see the framework of the sub. I mean, there’s no way that restorative dentists could be successful with the prosthetics being set up that way. So you know, just be aware of that aesthetic risk. It’s not unusual to have patients who, you know when you’d when I talked to them, and I explained that it’s going to be more costly, because of that they understand.

So I can charge a higher fee, the fact that I do pretty much all my own staining and custom staining, I usually don’t even charge them that extra fee, and I could if I was trying to, you know, nickel and dime if I’m sending the laboratory. I mean, the truth is you can send it to any ceramist in the world and have this work done as long as the patient’s paying for it. You know, I think in the past, I would go oh, I’m going to send him to this ceramics. I’ve never told him as a different cost and then here the bill would be and I’d be going like crap, I didn’t even make any money on this case and that happens a lot in the early stages in implant dentistry. I remember Paul Homily talking about, you know, these big cases are wonderful, but there’s a lot of people that aren’t making money doing and so you have to just really be aware of those things. So anyway, that’s today’s risk factor, which is an aesthetic risk, we’re gonna be talking about physiologic risk and some of the other risk factors that I’ve made up myself that I work with my patients on a day-to-day basis. So I hope you guys have a great day send me questions if you have to bruce@productivedentist.com go to iTunes go to the store and register for the podcast I would really love it if you do that and tell your friends because we’d love to have them get involved. So talk to you next time.

Hello, Regan Robertson here from Productive Dentist Academy. Do you ever have that nagging feeling that you deserve more, more case acceptance more time with your family, and more profit without sacrificing excellent patient care? I have great news for you. You can join your favorite PDA podcast hosts Dr. Chad Johnson, Dr. Bruce B. Baird, Dr. Victoria Peterson, and myself at a PDA productivity workshop in 2023. This is a full emergency where we give you the resources and tools you desire. So you can align your team streamline your systems and consistently produce more without raising your fees and without more time in the chair. This is the nation’s number one dental business course and the best part is this program guarantees your dental practice growth. We have two events in 2023 March 2 to the fourth and September 28. To the 30th fair warning, these events get full quickly. March is already half full as I record this so grab your registration today. If you have to have it right now you can email directly Brent brent@productivedentist.com To save your seat and hurry these events fill fast.

Dr. Bruce Baird
Thank you for joining me for this episode of The Productive Dentist Podcast. If you found this episode helpful, make sure you subscribe, 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  of productivedentist/podcast.com Join me again next week for another episode of the The Productive Dentist Podcast

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