Ep. 6: Full-Arch Psychology, Aesthetics, and Patient Experience

Part 10:00

This is Podpopuli, podcast for the people. Welcome to another episode of Beyond the Arches. I'm the host, Dr. Daniel Noorthoek. With me today, I have Lilia, our treatment coordinator extraordinaire. Welcome, Lilz. Thank you. So today, we're going to be talking about what makes a full-arch result, what goes into making a good, beautiful smile, sort of the stuff behind it, kind of what are the components, components, psychology, all of that stuff. And so we're excited to have you here today so you'll provide good insight on kind of the other aspect, the intangibles, if you will, the stuff that you kind of deal with head-on all the time.

And so from my aspect, what makes a good full-arch is a case that's ethically ready for a full set of teeth removal, patient that we'll say behaves well in surgery. Is of a right mindset, like ready to go, goes smoothly, is safe, you know, all of those typical things. But then there's the other side that you deal with a lot, which is, you know. Everything, yeah. I mean, on my end, obviously, financing and prescriptions and all that stuff, just getting it prepared for you aside.

▶I think for me, it's a lot, like we always, we've talked about in the last episode, the psychology behind it for patients. My main priority is, is the patient happy? Are they, you know, mentally doing well throughout this process? Or, you know, I think I feed off of, I don't even know what that personality type is, but I feed off of that energy and me being one of the, usually the first, you know, team members that they meet during that consult, I pick up quickly, like their personality.

So if they're not that same bubbly person, you know, in that consult or before surgery, and then it's day three, I'm like, okay, immediately go to the team. You know, I'll go to our team. I'll go to the doctors. Hey, you know, let's figure out what's wrong with this patient, you know, and, and it can be as simple as their stomach hurts from, you know, just whatever. It's nothing, you know, at all related to us. But for me, it's making sure that patient is happy from start to finish.

Really? Yeah. So what, what does the profile of the patient, does it vary a lot? From sort of beginning to the middle to the end, do they all sort of follow the same ebb and flow sort of rollercoastery kind of ride or like, are there trends that you see, or are you able to kind of pick up sort of initially how everything is going to go? I, I'd like to think I'm pretty good at like picking it up from the start, you know, and it is an emotional time, so I don't judge anybody on, on that, you know, rollercoaster of emotion, super emotional.

So, um, but yeah, I think I can get a good feeling for the patient. And again, that's, I'm there to make sure that their treatment is, is good from start to finish. And, or at least that's my goal. Um, but I would say it is similar trends, you know, whether it be the day of the surgery, maybe a little bit more emotions, you know, it's normal to have not even in the chair. It's more so the prior to going back some tears or maybe excitement.

It's, it's a very emotional day for them. You know, they are. They're a little orally sedated. So that, that I think helps, but, um, to the next day it's them being like, wow, surgery was way easier than I was expecting. And I don't, don't remember my, you know, the, the positives. And then it's the, again, another, I want to say like loop of the rollercoaster is like trying in the first set of teeth and managing expectations of, Hey, this is our first try and this is our first prototype tomorrow, you know, and 90% of patients are over the moon already with what they, that little preview.

They see what that first day, um, and then it's next day it's again, it's, it goes up and down and then it's the finals and maybe day three, it's the peak of pain. So like it is just managing that rollercoaster and making sure it's nothing that we can tweak on our end to make it smoother for them. The yo-yo of emotions for sure. And I'm an emotional human being as well. So again, it's just making sure that it's, if it's something we can do, we'll do it.

If it's just the healing process, it's where there has a friend for them. Yeah. And I think we all are, um, drawn to have empathy and try to fix anything that needs to be fixed. But there is a sort of mechanical part of it that just, it is what it is. And so you just have to be support rather than, you know, adding to, or trying to, to fix it. Yeah.

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Um, I would say probably as from a psychological standpoint, what makes a good case is in general, as a trend. Patients who come in with a positive attitude. Totally. Generally will end up with a better result. Yes. And that's like, even from like a, from an objective standpoint, right? ▶Like from a way that their surgery goes from a way that their experience in picking the teeth goes to even the final result to even better things happening to them, not having complications.

Yeah. Yeah. Uh, which is a weird thing because that, that shouldn't alter anything. Um, but. Yeah. And, and by positive, I don't mean come in all excited with a, with a banner and streamers and pom poms I'm saying an overall, I know this is what I need. I do not like the dental chair. I don't like the experience. I don't like pain. Those are all fine. That doesn't make a person negative. It's the person that comes in with sort of this optimistic view just as a random intangible thing that may not be able to be discovered.

Why that happens, but that's, those are the people that generally, you know, we've talked about that a lot, just in the office to you and I think in the past years of the difference between that, that experience with somebody that is open-minded, um, and who trusts us and has full faith in us throughout the process, it's night and day, and it's not to judge anybody that maybe can't see things from that point of view, but the power of like a positive mental state.

Yeah. Yeah. It really does. It really does. It really does. Just thinking to like golf, you know, when you make it, when you, when you hit a pot and the ball's rolling towards the hole, sometimes somebody will say something like, oh, that's in good job, you know, and, and they don't go in nine times out of 10 when that happens, it's considered bad luck to say it. And it's almost like that when a person will mention something like, oh man, this and this, I know this person that got an infection, this person that got an infection, it's almost like they forced the ball out of the hole.

Yeah. And it becomes every little thing can be nitpicked. And I think that's where it kind of spirals downhill. But again, a good team will help that patient and like, you know, show them the positives and show them, you know, how far they've came to at least get to wherever part of the process they're in. So them being open to, again, it's normal to have like that fear, that anxiety, but if they get into that more negative mindset, being accepting to our team, you know, our advice and our suggestions.

Putting up the walls can really like barricade us out and not let us fix things as well as we want, which is why we're so like intentional about our communication is mostly so that we don't get locked out so that we can address and fix anything that might be an issue. For sure. So we've got the psychology and the, and the way that those things roll that goes into a good result and a good case. And then you have aesthetics, right?

So then the prototyping that starts with my initial records, I've got to kind of get it somewhere. We're in the, in the right ballpark when I'm doing the surgery and then we pass that onto the prototype. And so what are the things that you see that go into overall kind of like how the aesthetics play out with Dr. Lax's role and the restorative dentist? I don't mean to just say Dr. Lax with Tampa as well. But what are the things that you see, you know, do you see a lot of people making a lot of changes?

Like what, what goes into making a good result aesthetic, right? So there's some, let's just kind of speak in generalities. There's the 87 year old that doesn't care that we still have to tweak in, um, that, that we have to convince needs to be tweaked and then there's the 35 year old who, um, wants the female that wants 97 more visits. Like what, what does, what makes that a good result? Start to finish. I think the patient just being open.

Open to what their goals are. I think some, some patients it's harder to express like what needs to be changed because as you know, like in the restorative team knows on either office, like there's a lot of changes we can do to get them to their goal or smile goal, I guess I could smile design goal, but it's them just being open about maybe I don't like this design or maybe it, you know, I think some, not everybody, but some patients that are harder to get to that point, maybe hold that in or don't know how to express that.

Um, so I think patients being open, you know, we're, we're not here to get upset if, you know, they don't like the first PTI or whatever it might be. So, um, just conversation with, with the restorative team. Yes. There's always two ways. It's a patient that comes in that we're, like you said, we're fighting to make their bite, you know, better and forcing them to have another try. And not forcing, but, you know, suggesting and them just happy with the first set.

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And then there's the other side of it where a patient who may be a little younger, who may be a little bit more vulnerable position of like, you know, wanting it to be perfections and we can cater to all of them. It's just that that's something that goes into the experience and the result and how everyone's situations flow. And again, we kind of end up on openness, right. Yeah. And not putting up a wall and communication, um, probably part of that too, is sometimes when they come in with the pictures, not again, not that we dissuade people from coming in with pictures, uh, pictures can be great as an ideal, but sometimes you'll have a patient come in with something from when they were 17 right now they're 67 and they don't look like their picture and they'll want that exact face back.

Well, I can get you the smile, but I can't get you the face. Yeah. I don't have that power. So being open to saying like, to seeing like, yes, those are the shape of my teeth. My lips don't really fall the same way or something like that. Exactly. I think that's all stuff that like a good restorative team will, and they will, they'll, they'll guide you. And a lot of patients actually come in and they're like, Hey, you guys are the professionals, you know what you're doing, you know what you're looking for.

Um, you know, on our end and you know, the restorative team will come in here and speak more on that side of it. ▶But I always hear them say like, functionality is number one. We want to make sure that you can function in these tooth and then teeth and then number two, we want to obviously make sure that you might come in functioning on a tooth functioning on teeth. Thanks for the safe. Um, but we want to make, you know, functionality.

Number one, number two, aesthetics, of course, like we're, we're you, we want you to love your teeth and to be crying and head over heels and love and, and I would say 99.9% of patients always are. Um, so yeah, I'd say the two, another thing that goes to openness as well is you're getting as close to your real natural teeth as you can get, but they're still not your real natural teeth. They still are something prosthetic, you know, they're not going to have the exact same feeling.

Can you get some feeling? Yes. Can they feel, start to feel like you're a part of you? Yes. Yes. But they're always going to have that hold back of, they aren't that. Yeah. And that's why you want to not do cases. One of the reasons, one of the many, why you don't want to do this work on somebody that doesn't need it. Yeah. Um, but when they do need it, there's a, a hard part is to convey that this is, we want it to sound and feel and be awesome teeth because it's the best alternative we have, but it's still not going to be what you were born with.

Yeah. I think, um, patients. And I, I always say, I don't know. I don't know what other offices for full arch to their consults are like, but ours are, can be an hour, sometimes a little over an hour, sometimes 45 minutes, whatever it might be. But we go into so much depth of like what can happen, the openness, the transparency of like, Hey, these are not, like you said, they're not your real teeth, but I think patients doing their own research is super important of maybe hearing what other patients have to say.

Cause we can't tell them exactly what it feels like, but we've heard of the little things that, you know, again, they're not their natural teeth, but it's,

Part 413:22

A hundred percent next best thing to it and if they need this treatment. Yeah. And then, and then on top of that, when we have function, right. We all want the. Well, some people's main motivating factor is aesthetics and getting the, the bad infections and such out of their mouth or the unknown. There's a lot of different things that go into this decision. Yeah. And so therefore. Yeah. There's a lot of things that go into why a person did it.

There's a lot of things that go into how we address those and what we're going to fix. And one of those being bite, right? Yeah. The comfort and the satisfaction and the enjoyment of food and being able to be comfortable when you're talking, being able to be comfortable when you're biting. And that really, you know, there's a science behind how teeth come together. There's a science behind how tall those teeth need to be. There's a science behind the strength of the material.

You can't go too thin. And even in a weird way, sometimes going too thin, even if the material can hold it, actually plays a role in the way that the patient feels, right? Sometimes making it bulkier makes it feel smaller in a very weird way. And, you know, as much as we want to make it an exact science about how teeth come together, at the end of the day, no matter how many tools and instruments and papers and stuff, ▶I have, I'm never inside there, right?

I'm never living inside the mouth. And so getting that bite dialed in can be a very personal experience. It can be perfect on our aspect of the spectrum, but feel off, right? And there's a management. So what makes a good case is being able to get that result where that patient feels comfortable, but I also feel comfortable with the bite that I'm leaving them with. Yeah, totally. I'm my own. I've had times where I'm like, oh, my bite feels high at my own general dentist and it looks good to me.

And I'm like, oh, okay. And it's one of those things is, yes, like trusting the, you know, providers that we have or our team, but also knowing like we're all human too. Like I know our restorative doctors are so quick to say, hey, come in again. Well, let's take a look at it. Let's check it out. Like we won't push you out. And I think a lot of patients are afraid of not being heard maybe from past experiences.

Um, because again, it's a vulnerable experience. This is not their teeth anymore. So, yeah. As we're, as we're talking, there's another thing that goes into a good case to, um, a good outcome is the patient care after the surgery. Right. I always tell people what I do or what we do is like sending somebody across on a road trip across the country with a Faberge or some, something expensive. That's fine. Fragile across the country. ▶And you're just saying, this is how you need to package it, but you're just trusting that they package it and transport it across the country that way.

Yeah.

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And that's very much, you know, what we have to live with is we give them a special, uh, diet. We give them special instructions. Do they ice afterwards? Are they going to be compliant with meds? You know, just a little anecdotal thing.

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Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm.

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And I consider him to be like an intelligent, good dude.

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So, um, trusting that a patient takes their medications, takes care of the things correctly. Those things all set you up for success and, you know, it can be frustrating when you have a patient that's noncompliant. Yeah, for sure. Cause we're not going to really, we can have inklings of maybe they've been smoking, maybe they didn't ice, you know, but we can't do that. We can't rule them out. Cause what if they did and they're just a unique outlier.

It's really hard to know. But yeah, patients, again, being open to taking your advice and, you know, if they have questions, asking the questions, but yeah, following, reading the instructions, you know, it's not there just for fun. It's there to help you out in the long run, but it's not just like you're going to be offended. It's their investment. ▶So I would say again, I always say 99.9, but it's true. I think majority of our patients. Take that time to, which is a great thing to learn how to properly clean.

I'm sure we'll go over, you'll go over that on another episode. And I know patients have questions on that, but like, how do I maintain this? So patients being willing to ask the right questions and, and know that this isn't just like a quick fix. Like they have to take care of that is important. Yeah. The openness to the education is important. Yes, for sure. And we're, we've been very intentional about making sure that every word on that piece of paper is there for a reason.

Knowing that not everyone's going to follow it, right. That we know not everyone's going to do everything we want them to do. And that's okay within reason, but we're very, if anything, we over-prepare our patients for what to do and how to handle things because we want that to be, if the average is 50% and it still works, we want them to be 85% and it works that much better. Yeah. Yeah. I think we say the same.

I know myself. I, same pre-op. I know my instructions and, and I even tell patients like, Hey, I'm sorry. I think I'm annoying. I feel like I'm annoying, but I want to make sure that you are prepared and you have everything you need prior. I don't want you scrambling the day of surgery. I want you comfortable because again, that's going to make their experience that much easier. Right. So I think it all goes back to just patients being open to asking questions or, you know, listening to, you know, again, you've done it.

How many years? Like, you know, all the tips and tricks. What will keep them comfortable? Yeah. And, and we also, from doing a lot of cases, know the sort of pain points and when to like re-hammer that in. Yeah. And sometimes you get this, you know, let's say, I don't know, once a week, once every

Part 619:32

two or three weeks, whatever it is, you'll get a console that's, I know everything about this. I want it done and I want it done now. Yeah. So I'm ready to go. I have the cash. Where do I send it? And I'll be there tomorrow. That's fine. You can still come in tomorrow. You can still sit on your couch, but you're going to sit here and you're going to listen to everything. Not because I'm a jerk, but because I want you to know everything.

Right. If, if it's like buying a car, if I'm going to sell you a used car that has a funny little part that you need to worry about with the power windows and you got to kick the trunk a couple of times to get it open, I don't want you to be sold on it and just buy it and then not know how to open the window or how to kick to open the trunk. I want to be able to sit down and tell you like, this is how you got to do that.

So there is a point too, where the perfect case that comes in and falls out of the sky that says I'm ready to go, they still have to sit there and listen to it. And that can be frustrating or it can be difficult for them and us. Yeah. I've had that a good fit. And I think it's because maybe hopefully you would hope that it's because they've done the research on us, but there's so many ways of doing it out there that it's an extra level of like mental protection for me knowing, Hey, I've told this patient everything I've done.

I need to tell them they have everything they need. And now I can feel good about them. And at the end of the day, if hopefully they listen, but like, and they, I think majority do, but yes, there's so many ways out there. So I don't want them to take something from the last call, their last office consult and kind of merge it together with what we do when you and other, you know, done in one doctors go through the step.

Like it's an extra reassurance on my end as a treatment coordinator. Hey, that patient knows everything. I'll come in and finish it up on, on my end. But I know that they are prepared to drop out of the sky that they didn't know. Yeah. They know about the soft diet. They know what they're getting themselves into. Like they're ready. So the, the face that I, the faces that we used to make when there were times back in the day, you know, I always make fun of like, um, other offices and stuff that I've done, you know, they get a post-op sheet and it's been photocopied over time.

I mean, something I'm very, very, I'm not particular about a lot. Something, as you know, that I'm very particular about is that every, uh, version of post-op is on a color sheet that was printed right away specifically because there's so many offices out there where, that I used to work at that the post-op sheet would become skewed over time. It was just a Xerox, you know, somebody had written in pen over it, wiped it out and was just a copy and the message doesn't come in clear.

Yeah. ▶And you never know what you're going to get. Like, Hey, you know, your implants all failed. Um, any idea why we're eating the soft diet? And they look at you like soft diet. What is that? I know I've been eating jerky and I've been, I've been eating good, clean diet, all, all paleo jerky. Uh, and that comes from being very particular about certain things, like the way that we present our message and such. So that goes definitely into the good outcome and with a patient responsibility.

Um, you know, of course, like you said, having the finances sort of dialed in first and that can be a tricky one. Sometimes, sometimes it can be even last minute, but having that come in kind of makes things smooth. Um, having the reps at, at bat, you know, especially with us having so many patients come from out of state, having a sort of ecosystem where they can come sort of without a lot of preparation for their travel and, and all of that.

Yeah. Yeah. Yeah. Yeah. But there's like a, the other side for us is that we know where that patient's going to be. We know where they're going to be staying. We know where to pick them up. And so for us, it gives us a peace of mind that their outcome will be smooth and easy because we also, I don't want to say control. It's not like we're sitting there outside of their hotel room. But when, when we started this, it became where things flowed much better, not only for their experience.

Cause we know that they're getting better. They're getting from the, the airport, et cetera, but we're also in a way in control of their schedule enough that they can kind of plug out if you will. And, and just focus on, on healing. Yeah. I think that's a big thing is patients are already overwhelmed with like, oh my gosh, if I am traveling out of state and having this big procedure, the last thing, and I hear, and I heard it in a consult today is like, oh my gosh, thank gosh you have a travel package because I don't want to, so you're telling me I don't have to book my flights.

I'm like, no. Like we'll make sure you're happy with the flight options, but our travel coordinator will take care of it. It's, I don't even think of it as like a control thing. I think they're just relieved to not have to make another decision because that's a, it's already a big enough decision as it is that they're making, you know, that really changed some of the, as we're talking about outcome that really changed part of the game was getting that established for patients that maybe were older and might've been confused to make all the, you know, it can be overwhelming to make all of those arrangements.

To patients that just weren't ever going to have the attention and the focus to do it. So that really kind of changed the game where that came from was I was getting a shoulder surgery in Colorado. Well, it's actually where the travel package came from was multifactorial, but where the actual like establishing where people are going to stay and such that came from, I went to a place, a well-known Institute for my shoulder surgery in Colorado. And I was talking to them about how I'd be traveling.

And they say, yeah, we have lots of people that travel from out of state. We even, you know, help them with arrangements and stuff. And it's a great, wonderful, awesome. Can't wait to see what your recommendations are and how we're going to set it up. And they slid a piece of paper that was photocopied, you know, from the side. You had to plan everything. And it was just like four hotels listed, et cetera. Like I have Google.

I could have found that myself. But giving that the patient that patient.

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It's a mind goes into it. Yeah. There's also the speech, right? Getting the speech correct. And that can be different. You know, your tongue is different than my tongue in my your cheeks fall different than mine. ▶And that changes over time and the healing and such. And so working with the team and getting that done is important as well. But being in a digital world has allowed us the capability of sort of very straightforward saying no problem.

It's going to be fixed. We're not even going to worry about speech. Back in the day when it was dentures, it was very difficult to get the speech. You could get you could get a speech issue that just was very difficult to get out of the patient's head or out of the prosthesis. And now it's much simpler and much more straightforward. I think with all the technology that you have invested in the company and everything, I think it's we can get to a point faster in their try and process, let's say, like second day in by isn't.

Dialed in and now we can focus on the looks of the teeth. Like we said before, you feel something rubbing you here. OK, now we can address that. Like, how can we change it? So at that point, it's just getting things even more comfortable for the patient. Yeah. Put sort of like succinctly and to sort of wrap up the conversation like so this last weekend was Memorial Day. As you heard me, I made potato wedges. Yes. And as simple.

▶As they have seemed for years, like I missed one step and I made it absolutely the worst experience ever. But it is like cooking, right? There's a lot of things that go into it. And one of the we'll say secrets of not secrets, but the way that I I cook when I'm cooking for a group, I don't buy just the off brand cheddar cheese. I buy the one that's that's folded in the paper and I buy like the best ingredients I can.

And the way in which you. Put them together can it can be a an issue. The flavor, you know, you can have, say, two potato wedges, one made with inferior ingredients and one made with better by the same person in the exact same way. And one will taste better. Right. There's the ingredient that goes into it. But there's also who and how they assembled and what that what went on with it and how what oven they did it in.

All of those things play into whether or not it's a good result. Right. And also to parlay it again into mine, mine turned out well. Yeah. But the middle and the frustrating part was so frustrating being able to have at least cooked enough in my world to have fixed it and make it so that it didn't even wasn't even a blip on anyone's radar for. Yeah, I really screwed these up is also important. Having the capability to kind of save it.

So it all comes into all of these different things. Make. A case good or bad. Yeah. But when you finally assemble it, does it taste awesome or not? You know, is it a good potato wedge? Is it a good potato wedge?

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Yeah. I think patients see that, though, too. I think they know. I think they, you know, they see how we do things. They know how to come, you know, what to bring to the office as well. So open, you know, mindset and all that is great. But yeah, they trust everything. Our products and the stuff that we order were very particular. We buy the paper wrapped. We've got. We buy the best cheese. Yeah. ▶Our zirconia comes in a very nice wrapped and styrofoam box, not in a bulk package that jumps around all over the place.

There's a lot that goes into what makes a case a good case. And again, I think we've done all mindset, product, personnel working on it, the ingredients, all of that stuff is absolutely a key. So appreciate your time again, Lilz. Always a pleasure. Always a pleasure. Thank you for listening, watching. But we appreciate you and we appreciate you, everybody out there listening. And look forward to another episode and another follow, like, subscribe. Appreciate it.