The Dentist Doesn’t Have to Carry It All (E.256)

“It’s not your fault if they don’t brush, don’t wear their guard, or don’t come in for recare. It is your fault if you never told them.” – Dr. Bruce Baird

Brief Overview

For years, Dr. Bruce Baird carried every failure on his shoulders. If a crown broke, if a patient developed gum disease, if restorations didn’t last, he felt it was his burden. Everything changed when he discovered the power of identifying risk factors and communicating them clearly to patients. In this episode of the Productive Dentist Podcast, Dr. Baird shares how dentists can let go of guilt, empower patients, and create a culture of responsibility that transforms both patient outcomes and professional satisfaction.

What This Episode Reveals

• Why dentists mistakenly own every failure in patient care
• How to identify and explain risk factors in plain language
• The patient exam that leaves people saying, “That’s the best exam I’ve ever had.”
• Why being a consultant, not just a clinician, creates trust and referrals

What You’ll Learn

✔ How to shift responsibility from dentist to patient without losing trust
✔ Practical scripts for explaining periodontal risk, dry mouth, occlusal forces, and decay
✔ Why patients need to understand why problems happen, not just hear “you need this”
✔ How to enjoy dentistry more by letting go of the stress you don’t own

If This Sounds Familiar

• You feel weighed down by patient failures that were not your fault
• Patients get frustrated because they don’t understand why problems keep happening
• You want patients to take ownership of their health, but don’t know how to communicate it

Next Steps

Stop carrying it all yourself. When patients understand risk and responsibility, they value your expertise more, and stress decreases for everyone. Subscribe to the Productive Dentist Podcast and explore Clinical Calibration Institute to align your entire team.

TRANSCRIPT

[00:00:00] Dr. Bruce Baird: This is Dr. Bruce Baird with the Productive Dentist Podcast, and I’m pretty excited about today’s topic, and the reason I’m so excited about it is because it was one of the things that changed my, my entire career and changed my life actually, um, and it, it has to do with taking responsibility for failures. We talked a little bit about that in our last, uh, podcast, and you know, the cool part is when I went and heard John Kois years ago, he was talking about, um, risk factors and the risk factors, as I was listening to it, I go, wow, that makes total sense. You know, if a patient doesn’t brush their teeth, they’re gonna get gum disease. If a patient does not wear their occlusal guard, their dentistry’s gonna fail. If a patient doesn’t show up for their recare, they’re not gonna get the same results, and what I did in the first 15 years of my career is I always took it as it was my fault. You know, dentistry, it’s one of those things at dental school, they tell you the mesial buckle has to be at a 90 degree angle to the, to, you know, to the exterior surface, and if it’s not, it’s gonna fail, and you make a B well, a B, it must fail faster than if you make a C. It’s just, you’re told things have to be perfect, and now trust me, I’ve, I’ve, uh, used materials that were probably not well vetted early on in my career that, you know, um, one of the, um, you know, u using a new composite resin that I thought was the best because some doc told me it was, and turned out it wasn’t, wasn’t the best.

[00:02:03] Dr. Bruce Baird: I’m gonna take responsibilities for those kind of failures. Those are easy, those are easy to take responsibility for, um, the arc glass crowns that I did, 500 and some out of those arc glass crowns, well, the arc glass material sucked, but there were big lecturers out there in the country telling everybody, “Oh, this is the best thing since sliced spread. You ought to do it.” Well, I redid all those and I redid ’em because I knew, um, it was a materials fault. It wasn’t the patient’s fault, but that’s, that’s where I draw the line because what’s gonna give you the freedom to practice the kind of dentistry that you really wanna practice? And we talked last time about telling patients about difficulties, telling them how, you know, a front tooth is the hardest thing in dentistry to do, but what we, what we have to do now is we have to tell the patient that for sure, you know, you have periodontal disease. We go through it with them. We, we talk to ’em. Do, does your mom and dad, did they lose their teeth? Oh yeah, they lost their teeth when they were in their thirties, um, do you know if they had gum disease? You know, I’m, I’m noticing that you have some bone loss and you have some other areas where you’re losing bone around your teeth. Now that doesn’t mean you’re gonna lose all your teeth, but you’re gonna have to do some things different genetics have kind of dealt the hand for you and now you’re gonna have to do things different if you wanna keep your teeth. Does that make sense? And the patients, I never had a patient say, no, that doesn’t make sense.

[00:03:32] Dr. Bruce Baird: Um, they go, “Sure, yeah, that makes sense,” and I said, “So what we do, what I recommend, you know, what I would do if I was in your situation, you’re gonna have to come in on regular basis.” You know, the average person comes in once every six months for a cleaning and you know, the average person is gonna do fine. Their, their teeth are gonna be in their mouth for their lifetime, but you happen to be one of those that already are showing signs, whether you’re 20, 30, 40, 50, you’re showing signs of losing the foundation around your teeth, and that’s a significant problem because that’s the number one reason why teeth are taken out, is because of gum disease. Does that make sense? As says, what we would need to do is get you in on an every three-month basis. What we’re doing is we’re taking care of what we call the biofilm. It’s the bacteria that get around the teeth and you know, these bacteria have been shown to increase the chance of, of heart attack, stroke. It’s been associated with Alzheimer’s. So we know so much more now about the bacteria and we wanna make sure we take care of that for you. Does that make sense? Yes. So when we start talking the periodontal realm, it’s very easy now. If, um, if that patient leaves and, and comes in for their first six, three-month visits and then finally don’t come in again, what would you expect to happen to their gum disease? It’s gonna get worse. Um, what about decay? What about erosion? What about acidity in the mouth? Um, you know, you see somebody that’s got this issue with acidity. First thing I always ask ’em is what about, uh. What about soft drinks? Are you a soft drink drinker or I’ll say, do you take a lot of medications? Because you’ll see these people, they walk in, they got a bottle of water with them and they’re sipping on it. I go, “Wow, your mouth is super dry, isn’t it?” “Oh gosh, yes, it’s been dry.” “Do you take any medications?” “Oh yeah. Well, I take blood pressure meds. I take this med, I take that med.” “Well, almost every one of those cause a dry mouth and you know, Bob.”

[00:05:40] Dr. Bruce Baird: “Um, saliva is a natural cavity protector, and, and you’re not getting that now. So we really need to work to get you on fluoride appliances or, uh, we’re doing topical fluorides when you come in for your cleanings, um, do you drink soft drinks?” I go, “Yeah, I might have one Coke, one or two Cokes a day, which that actually means five or six a day, uh, in case you didn’t know, but, um, yeah, one or two Cokes,” and, and I go, “Well, that’s great, but you’re gonna have to quit doing that because that’s what’s starting to cause this decay. You see the decay here and you see that, that that’s what’s doing it.” It soft drinks really. I had one patient that had been coming in every single year at Christmas, um, he came in, he was in his early eighties, and I saw him probably for 12, 15 years, and he would come in at Christmas. He had no cavities. He had no plaque. He had, I mean, he just came in once a year for a claiming, and the guy, it was, it was amazing to look at. He had had no restorations, no crowns, no inlays, no fillings, no nothing, and then the next year he came in and all of a sudden he goes, or my, my, uh, hygienist comes to me. She goes, “Dr. B, you gotta come see this,” and I was like, “Oh, okay.” So I go in and there, there he was, and, and I looked at his X-rays. He had decay on 80% of his teeth. I mean significant decay, like blowout decay, and I was like, “Wow, Bob, what’s, you know, what’s going on?” You know? He said, “Well, last year I had a, uh, I had a heart attack. After, after I saw you guys, I had some heart problems, and so they put me on these medications.” I said, “Do you notice a dry mouth?” He goes, “Yeah, I do. I get a dry mouth.” I said, “So, what are you, what are you trying to do to, to help that?” He goes, “Well, I carry water around. I drink that all the time, and I’m using a couple things I saw over the counter to help,” he says, “but the best thing I’m doing is, you know, I just kind of, I’ve been sucking on these mints, these candy mints where there’s candies.” I said, “Man, I love those.” He says, “I keep ’em in my pocket.” He reached in his pocket, pulled out about five of them, and he goes, “I just suck on ’em all day long and it really helps with my saliva.” I go, “Bob, you know, that’s what’s causing me decay. That’s what’s causing all your teeth to break down.” What God gave you for 82 years was perfect, but one thing changed and now all of a sudden we’ve got this, we’re faced with this problem and, um, unfortunately passed a few months later.

[00:08:09] Dr. Bruce Baird: But that just goes to show you there is a cause and effect in dentistry, you know? If you know, and when I start talking to people about their bite and how strong their jaws are, real easy to, you know, to tell them for me it is because I said I got tested back in the, in the late seventies and they noticed that my bite was a thousand pounds per square inch. You know, the average person 125 pounds to 150 pounds per square inches is normal. I was at a thousand. That’s why I break stuff in my mouth. Does that make sense, Bob? He goes, yeah. I said, “Well, I don’t think you’re at a thousand pounds per square inch, but you could easily be at 5, 6, 700, and that’s why when I look in your mouth, I notice this crown broken, porcelain broken off of here. There’s an edge off of this tooth. There’s wear on the teeth, you’ve got wear that is so significant, and it’s because of what you’re doing at nighttime when you’re sound asleep, and that’s what I’m gonna recommend, and there’s a lot of different types and a lot of different philosophies about it, but I’m gonna recommend an occlusal guard for you, and what that occlusal guard’s gonna do. It’s gonna let you kind of park the car at night so you’re not grinding your teeth away during the night, or you’re not clenching and building these muscles,” and people say, well, I bought one of those things at the, um, at at Walmart, and I said, is it soft? He goes, yeah, you can just put it in there, and it’s kinda like a football mouthpiece. I said, well, the problem with that, Bob, is you’re gonna chew that all night long. Well, what’s that like? Well, that’s like I’m, I’m building my bicep all night long, so you’re making these muscles stronger and stronger and stronger, so we have to do something different. Does that make sense? Oh, well, yeah, that makes total sense, doc.” So, and one of the things that patients say. Inevitably is, this is the best exam I’ve ever had. I haven’t even gone in and started looking tooth by tooth, but what I’ve done is I’ve, I’ve, I’ve made the patient realize that they have issues, they have problems.

[00:10:13] Dr. Bruce Baird: I don’t have problems, um, in other words, it’s not my problem, it’s their problem. Super important for you to, to see this because the patients have to take responsibility. So I, I tell patients, I said, isn’t it frustrating? It seems like every time you’ve come to the dentist in your life, I mean, I look at all these different things that you’ve had done and now you’re coming to see me. Isn’t that frustrating? And go, “Yeah, every time I go to the dentist, I have something new.” I said, “Well, what would it be like if we put a plan together so that. That stopped so that when we did dentistry, that it had a chance to last the rest of your life with having, without having to be redone.” That’s the thought process that I have, any dentistry I do, there’s no reason why it should fail in five years and insurance should pay more for, for a new crown or whatever. I, I just don’t believe that. Now having said that, you also have to understand that they have to follow the right rules. They have to, they have to come in every three months for their cleanings. We do laser pocket disinfection at every visit. We, we try to nuke the bacteria. We give them certain rinses and certain things that they can treat themselves as well. You know, medications, there are all types of saliva substitutes. There’s things that they can do, but they have to be really careful when sugar comes around, you know, and so wearing a night guard that patient’s biting and tearing stuff up, they’ve got to wear the night guard. So in our hygiene department, we literally have the, the risk factors set right there. They’re a high functional risk. They’re a high aesthetic risk, they’re a high, whatever those risk factors are, and my hygienist at every visit go, how you know your gums are looking good. You know, you’re here for your three-month care. We’re gonna use the laser. How’s the occlusal guard doing? Well, you know, and if they say, well, with their eyes squinting, that means they don’t know where it is. My hygienists are so well-trained, they will tell the patient, “Now, do you, have you been wearing it?” “Well, it just doesn’t feel comfortable.” I go, remember what Dr. B said? You know, your bite is extremely strong. You’ve got to wear that thing. I tell you what, bring it in, Dr. Bearer, adjust it. Gay will do it summer. They’ll get it to where it feels totally comfortable because you’ve got to wear that thing.

[00:12:33] Dr. Bruce Baird: Otherwise you’re gonna tear up the dentistry and then you know, you’ll have to have to redo it, and we don’t want to do that. Does that make sense? And that gives patients, in my opinion, it gives patients a totally different thought process as far as. I’m going to the dentist. The dentist told me I needed this. They told me I needed that. They told me I needed this. No, they shared with me why the things that are going on in my mouth, why they’re happening, and when, when patients understand that, then they say, this is the best exam I’ve ever had. Why? Because I understand what the hell’s going on in my mouth now. Somebody finally took the time to do that, and they’ll, they’ll say that this is the best exam I’ve ever had. You know, why has no other dentist ever told me this? And I always say the same thing. Well, you know, every, you know, we’re learning so many new things, and I always wanna stay on the cutting edge because I’m a patient too. I don’t wanna lose my teeth. I don’t want to, to have problems either, and so I become, for those patients, a consultant, not somebody who’s gonna, they come in and go, you need this, you need this, you need this with no explanation. Dentistry is done that way 99% of the time across the country, 99 out of a hundred dentists do it that way. If you do it differently, guess what? You’re gonna have a phenomenal practice. You’re gonna have people telling other people about you and your office. So those are the things to me that are so super exciting, that are so super exciting about being a dentist today. Yeah, you know, you worry about the DSOs, you worry about this, you worry about that. Don’t worry about all that shit. Take care of your patients at the highest level you can with an explanation about why things are happening, and if you do that, your career is gonna be amazing. You’ll also enjoy dentistry because you’re not taking responsibility for other people’s failures. Do you know why? Because it’s not your fault. It’s not your fault. They’re not brushing. It’s not your fault that they’re not coming in for their cleaning. It’s not your fault that they don’t wear an occlusal door. It’s not your fault, but it is your fault if you haven’t told ’em all that. Does that make sense? I know you probably already knew this.

[00:14:47] Dr. Bruce Baird: You know, those are my two sayings that I say all day long, but, um, anyway, I enjoyed today. I, I hope you guys get something out of this and I look forward to the next one. Clinical Calibration Institute, that’s the thing that we’re doing now that can help get your whole team on that same page so that everybody is saying the same things. Everybody’s excited by the chance of helping patients long term, and not just drilling and filling and billing. So anyway, I talk to you guys at our next time, so look forward to it.