Ep. 15: Managing Full-Arch Complications with Skill and Honesty

Part 10:00

This is Podpopuli, podcasts for the people. Hello and welcome to another episode of Beyond the Arches. I'm your host, Dr. Daniel Noorthoek. With me today, talking with us is Robert Odom. Hello. Hello and welcome, Mr. Odom. Thank you for having me. Today we are going to be talking about managing full-arch complications. Nice. And we're going to get into some nitty-gritty, but I think that the best place to start is going to be just talking about variety of complications, things that can happen, things that are unexpected, and realities of doing surgery on the human body, right?

So let's start off with essentially just kind of discussing or naming off things that we can think of that could be considered complications. You might have the advantage here. So I'm going to start off. I'm going to start off with implant failure. That's a great complication. I don't see how I have the advantage here. Implant failure, yes. Implant failure can be several different things. You can have immediate, what's considered immediate implant failure. Where you do not get stability upon placing the implant.

That would be more of like an in-surgery complication. Oh, okay. So when we talk about immediate implant failure, as confusing as it is, we more or less mean in the first three months while it's trying to heal. Oh, gotcha, gotcha. So that would be anything that is related to maybe you have an infection right away. Right. Actually, let's list those things off as we kind of come back, circle through it. But you can have immediate implant failure, so within the first three months.

You can have a delayed implant failure, which would mean that we saw it at three months. It healed fine. Maybe two. Maybe two years later, you have it fail down the road, which can happen as well. Sure. And part of this podcast is to inform people, right? When I started doing this, regardless of the technique and the protocol, it was always sort of considered good salesmanship to not discuss these things, right? And I would end up doing the surgeries, not understanding how misinformed this patient, may or may not be.

Right. And that can really run in, that can be a complication in and of itself. Sure. Right? And so that would be something that wouldn't have been discussed, right? Like these can fail long term. It is a human body. This is an inanimate object going inside you and being implanted. Right. And so there are things that we have to cover to discuss the good, the bad, and the ugly. Sure. Right? ▶So changing that has always been a little bit of a platform.

That I've wanted to advance because that makes my life a lot simpler in the future. So implant failure is a good one. And that can be a variety of different things and for a variety of different reasons. And I guess to some level you could have, you could say, let's say infection, right? You can have an infection. That infection can be as a result of poor implant placement, prior existing infection, things like that. So we have infections.

Yeah. What else can you think of? I have one quickly. Yeah. Mechanical failure. So if the bite is wrong or too off, it can overload and cause implant failure. But a complication would be the bite being off. Malocclusion is what we call it. Right. But the bite being off is a big thing. Yeah. And very underrated. It's hard to get a consensus. It's hard to get a group of dentists to agree on what. What perfect bite looks like.

Right. Acceptable bite. I'm sure we would all pretty much agree on the same thing. But in terms of like how the mechanics, there's a lot of mechanics of the bite that most people only associate with biting down on paper and sliding their teeth around and does it touch. Right. But there's a lot behind the scenes and a lot of people have dedicated their entire career, not just in hybrid dentistry, but regular teeth. Sure. How, how teeth are supposed to slide and where they're supposed to slide and what teeth they're supposed to slide on.

Right. Sure. So, um, but, but the gross mechanics of bite being wrong is a big thing. Sure. We want to know that if you can feel something that we didn't see. Right. Something that's going to cause TMJ issues if you're out of where you should be. Yep. Right. Absolutely. Um, I think nerve damage can be another complication. Nerve damage. So, yes. So, um, sticking with, with surgical complications. So you could, you could have nerve damage, right? The measurements were wrong or the, uh, approximation of what size implant was placed could, could invade into the nerve canal and put pressure, undue pressure on it.

Right. Sometimes you can get a little bit of swelling from the implant and maybe it doesn't invade and create permanent pressure or permanent, um, paresthesia, tingling. Numbness, that kind of thing. Sometimes that, that post-surgical swelling itself can essentially, you know, make, we've all had sat on our leg wrong and had a Lego numb, similar to that, where once that surgical pressure is off, that swelling is off, then, then that can go down and go away. So it doesn't even have to be invading into the nerve.

It just has to be around it or creating pressure. Sure. And while we're on that topic, a random small little one. And this, this podcast, by the way, is more to awaken people to there. These are the things that can happen so that it's a very transparent discussion on this is what we're considering. The likelihood of these happening, these things happening is exceedingly low when done properly. Sure. It's of course a risk going into it, but you know, we could even list death as a, as a complication.

Sure. Something I've never come remotely close with, right? So these, these things can, just like you can die on an airplane as a complication of boarding an airplane. These are the things that we are discussing. It's a, it's a finicky conversation because we don't want to have people overbalance this as being a fearful, scary thing that can happen. Right. But we also want them to be open eyes and understand. And that there's a, there's a part here that can be played by many different factors.

Yeah. I think that's, that's important. I mean, like we always talk about, we want informed patients, informed patients or happy patients. Yes. Um, I saw, I saw, I saw a post, uh, maybe on Instagram or something. I don't want to say it's a, it was a meme, but it was like text and it was maybe like a chart or something. And it was titled, um, um, expectations from healthcare patients. Right. And it had all these different services listed.

So expectations of a breast implant. These are the complications. This is how long it can last. Uh, cochlear implant. These are the complications, the side effects. These are how long it could last and angioplasty and on and on, you know, 10 different. And then it went to dental filling, no complication lasts forever. Dental implant, no complication. And it was a take on like how, how uninformed in general, dental patients are compared to medical paid compared to other types of, uh, medicine.

And, and I think, and I don't know, but it, I mean, we have the sheets that tell everybody, these are the potential side effects. These are the things that can happen, but I feel like it doesn't hurt to go kind of above and beyond just to make sure people. Are making informed decisions. Yes, that's part of it, but there's also the part where in medicine, if you need an angioplasty, yes, there are some elective or a breast augmentation.

There are some obvious, uh, elective portions to it, but there's also some non-elective mo mostly it's going to be non-elective and be part of your medical insurance and somewhere in the ether, your bill. It appears maybe disappears. Maybe you pay a portion of it, right? There's a, there's this who knows kind of float. You just know that you're going to get it and they can be a little bit more raw and realistic with it, right? Because, um, ultimately reimbursement doesn't come from a sales pitch.

Right, right, right. And so dentistry, I think has a massive problem from top to bottom ethical to non-ethical dentists. Having to sit. Into a sales role, right? Sure. I daily have to balance how much I disclose of complications, depending on the patient that's hearing it, because they may hear only complications, right? And that's tough because ultimately I do have a business that has to survive. So there's a, the, the sales definitely gets in the way of the sales and the small business definitely impedes dentistry from being altruistic towards revealing complications in the management.

Of such. Yeah. And the reason the, the, the lucky portion that I've had is that I've always been in a role where the volume is there a little bit regardless. So I can be very straightforward and I can't say that I don't care about the sale, but I very much want that person to make a very informed decision and understand. The risks that we're headed down because ultimately my lifestyle is better by not having to worry about going into a room.

Sure. When I used to work for other offices where I didn't manage that message, it was always like, who's going to tell them an implant fails and all of theirs failed or whatever it may be. Right. And that, that, that could have been a self created problem because if you don't tell a patient that an implant fails, you're not going to tell them that they need to go to the doctor and they need to be on a soft diet because why would they need to be on a soft diet if you're not going to tell them it's going to fail.

Right. Right. Totally. And so if you're going to hide that just to make the sale, now you've created a huge downstream problem. Absolutely. For a little old me. Yeah. Right. And it's not anybody's fault necessarily other than the system that we're stuck in. And so ultimately that was the biggest thing that I hated about my life was having to inform somebody of all the complications. That just happened to them and why it would happen even though they didn't know it could.

So that's, and I, and to kind of circle back, the advantage of a nice part that I've always had is that even though ultimately it's still a sale and I'm trying to sell them on coming to see me and my team and everybody that's involved, we don't want to ever have that downstream problem. And so we've tried our best to mitigate and manage that all the way down. Yeah. So on one hand, you have kind of the con of, well, if I'm honest and transparent with this person and just preparing them for the what ifs, not, not the likely to happen or anything like that, but these are things that can happen.

Cause this is, as you say, the human body, they could go down the road and talk to another dentist that says, well, never had a problem ever in my life. That's, I've never heard of that. Everything's going to be fine. Promise them the world. But I think the benefit of being. Being honest and transparent is like you said, um, letting them know what's at stake. This is why we need you to take this medication. This is why we need you to take this steroid or this antibiotic.

This is why we need you on a soft food diet. This is why we need you wearing this night guard because you're kind of leaving it up to them. If you want this to work, if you want the best chance at success, here are the things you need to follow. Cause here are the repercussions if you don't. Right. If you take a sports analogy, we're going to call wins and losses being sales and person found in a loss would be somebody goes somewhere else.

Right. The nice part about being in the position that we are today is that we're more like a baseball team. So the wins that we get are more, you know, higher in number so we can manage the end game specifics and the losses matter less. Right. Right. Losses again, not being with complications. Like we're not saying we flippantly look at complications. Sure. What I'm saying is the loss of a patient, not selling that patient, that patient going and believing somebody else that says they have no complications.

Right. And so it's an unfair advantage because we're a little bit playing like the MLB. Sure. And so we want our wins to be true wins and a loss is just, it racks up and by the end of the season, we're in the playoff independent race or whatnot. Right. Absolutely. Now, if you look at that and you just compare that to maybe you have less exposure and you don't do this for a living and this isn't your main focus, you're more like a football, right?

Right. That one loss. Yes. That one patient that decides to go and believe somebody else is a huge factor to your overall management and your bottom line and your sales technique, et cetera. And so you're more motivated on a lower game basis, lower amounts of game. And so you're more motivated on a lower game basis to get that however you can. And sometimes that means obscuring or hiding the real facts. Sugarcoating it. And that's unfortunately one of the values of high volume marketing practice is that the losses mean less.

Sure. The loss of a patient to somebody else that wants to believe there's no complications, no problem. I didn't want that win anyway. Yeah. Right. Totally. Whereas if a game means more to you and it means whether or not you're going to be able to pay your staff at all, then you're going to obscure the facts maybe or just not reveal them. Totally. And I consider that to be unfair, right? Because we should be on an even playing field where it's by merit and by value and I believe and I trust this person 100%.

Right. Um, okay. So circling back, uh, complications. So we talked about nerve. There's one that's, that's very underrated that I have seen occasionally and it's been more, more or less to do with like soft tissue grafting, like gum grafting than I've ever, I've never experienced it with a full arch, but you can actually, where the nerve comes out of your jaw, your lower jaw and provides lower lip sensation that actually can get sort of disrupted. Yeah. Yeah.

Or hurt or stretched during the middle of surgery because you're, you are able to see it. I see it all the time, almost weekly. I hear about it. And, uh, if that gets pulled or yanked in a certain way, just like the swelling, you can get some tingling or numbness associated with that. And that's generally temporary. It's not a permanent type damage, but that's something that could be a complication just from the art of doing surgery. Sure.

Regardless of where the implant ends up. Right. It's just from doing the surgery. Yeah. That's reminiscent. And sorry, I don't mean to cut you off, but when I did have this bicep surgery, my arm afterwards was completely numb and I let my surgeon know. And he's like, that's part of it. It got stretched in the surgery. I said, well, will it come back? Maybe, maybe not. Um, and it did. I'm a hundred percent again. That's amazing. It took about a year, but, uh, I was nervous, but it takes a long time to regenerate and repair.

And it's one of the lowest amounts of turnover in our body. So you cut your skin, those cells replace very quickly. Right, right. So healing happens quickly. You hit the nerves, nerves don't turn over as quickly. And so it takes a long time to repair. So that's, that's pretty normal. Yeah. When I was at the six month mark, I'm like, well, if it's not coming back, if I'm still numb after six months. I remember you were concerned about it.

But a hundred percent. The, in the art of managing nerve situations is also, that's also a practitioner. Um, practitioner specific mindset, right there. When, if you've never had an issue with a nerve, okay. I have had two or three in my life. Okay. Enough that I can recognize, or, or I think I can recognize, or I'm at least prepared enough and experienced enough where I can raise the hand and say, whoa, this is serious. Like go right now.

See somebody that can fix it. Cause that's a big deal. Right. Um, luckily that has only happened one time, a long, long time ago. Um, versus, um, oh, that's transient. Don't worry about that. Right. Right. Because if you're on record saying, don't worry about that. And it was serious. Right. Now you're in big trouble with the patient and with the state, et cetera, et cetera. Right. And it's hard to communicate, but it's, it's a fine balance of trying to.

Reveal that this might be an issue, having that conversation with a patient and then managing it correct and successfully. Right. Every patient wants to know that everything's fine. So let's just go down the road and say that, that, that a person is not experienced or they're scared to tell the patient. Right. Which can happen. Sure. But they have serious nerve damage. We'll say in this world. Well, if that practitioner is not, um, think so. Well, yeah. You know, if I just ignore it, it'll go away.

Right. And that patient's like, oh, well, he's not too worried about it. I'll just ignore it. Yeah. That's where things blow up into being huge issues. Yeah. And if, and if you're in practice long enough, you start to see those things in around you or case studies in the, in the records, et cetera, that's where you kind of get this sort of flow chart where you kind of can think through it, but it's, it's very common to sort of hope that the worst case scenario.

Isn't what's for you, the patient, we all would do that. That same thing, right? Like, oh, it's just transient nerve damage. Okay, great. I don't have to talk to a specialist. Right. Right. Right. Um, but the, the, the practitioner also wants that to go away. So identifying when it's serious to refer and when it's not serious to sort of dissipate through comforting them. And, and these are the actions that we're going to get to, to monitor and make sure it goes quickly.

That's, that's a bad thing. It's a balance that really only comes with gray and lost hairs and experience over time, but it's something that has to be learned. And again, as a consumer, it's really difficult to go out there and say, okay, which one of you is going to be straightforward with me? Right. It's tough. Sure. I'm glad I don't have to make the choice. Actually, if I had to make the choice, I have no idea who I'd go to.

And that keeps me up at night. I think about that a lot, not to get too into the other side of it, but that's a conversation I will never have to have. In my life. So I, I feel like as a surgeon, not only do you need to juggle this kind of expertise and know this kind of stuff, whatever, but you got to be able to have those hard conversations with patients when, when they're necessary. You have to.

Let's go with a, let's, let's, I'm going to parlay that into another thing that I see more frequently. That's a little bit more of a ostrich in the sand. That's a, not a bigger deal. It's a way smaller deal. But occasionally. I'll see cases from other practitioners happens. Sometimes there's, let's say this, this is a complication. A tooth can fracture the root, right? Sometimes people don't understand the way that a tooth is. So you have the tooth, the tooth that we all see and can brush, and there's essentially an interface or a sleeve of gum tissue around it, right?

That needs to be kept healthy. That's why you need to floss. That's why you need a brush below that. What's held into the bone is the root. That's the base. That's, that is the tooth. Okay. Inside of the tooth are blood vessels and different, uh, nourishment devices, if you will. That's what can get an infection inside of it. If a cavity goes too deep or it breaks off requires a root canal, right? You have to remove the bad and replace it.

So, and a lot of people don't really understand that, but roots can be very, we'll call it spindly. They can be, uh, resistant to fracture, but they can fracture. Fracture off when you're removing the tooth. Sure. ▶The best of the best tooth removers, exodontious can have that happen. The worst ones can have it off happen often more often than not. But, um, sometimes that is identified right away and sometimes it's not okay inside the surgery. Sometimes it seems like your whole tooth is out.

It may not be able to translate, but sometimes you can take the whole tooth out and then see on the x-ray that there was a piece left behind. And sometimes that doesn't get recognized. Recognized and permanent gets put on top of it. Okay. And I saw a case from another practitioner that came in, um, a couple of weeks ago and there's a root tip underneath where the implant is. Okay. So I can see where the root of the tooth is.

I can see the implant was placed like essentially over top. Right. And in order to get to that, I got to take, if I'm going to be 100% transparent and honest and straightforward with the patient, I then have to take that practitioner. Um, and throw them right under the bus, take that whole thing apart, charge for my time, all of that stuff that's entailed, right? It's just a waterfall effect. Right. And the point isn't that I'm the greatest.

I saw it and I'm going to replace it. That's not the point of this part of the conversation. The point of this conversation is me as dental Dan, seeing some random guy's work that I don't know from, we'll call it Indiana. Okay. It was not Indiana. But we're going to call it from Indiana. We're in a competition here. Okay. Cause we already talked about how sales is a motivating factor for those that are playing football games and need the wins and losses.

Right. And sort of for the most part, there's a lot of dentists really ready to jump on. Well, I wouldn't go to that guy. He puts root tips in there and you put your implant on top. And so it becomes this very like. Slandering sloshing sort of world when in reality, it's a human mistake. It's a bad thing that happened to, we'll say a good person, right? Like these things happen to the best of the best, right?

And maybe a practitioner is out there and saying that they, that, that never happened to them. Well, whoever you are listening to this, you are a liar, a big fat liar because things happen, right? This is wild west of surgery and things happen, right? Yeah. Yeah. Managing it and managing it with a patient can be very difficult because of the situations we kind of end up getting put in because of the way that the world works. Sure.

And that's tough because I want to tell that patient, Hey, it's not a big deal. Don't blame him. I'm not trying to throw him under the bus. Even if I don't see them as competition. Right. No matter what I say, the problem is there is a tooth root there. Right. Right. So ethically, what am I? What am I supposed to say? And also not throw him under the bus because I don't want to be thrown under the bus either.

And so this is one of those like postulates, like, what do you do? Right. Like kid, kid is on the train tracks and the, and the dogs, you know, whatever, you know, like those little like ethical exercises. What decision do you make? And those are things that we daily have to navigate and, and you don't want to obscure information from your patient either. And so it can be a very difficult world to sort of navigate in. Yeah.

Yeah. Yeah. And so what I've found is just saying, you know, Hey, there's an issue with this implant. I don't know for sure why it happened. Cause I don't, right. I see some bone loss over here, which may be from the tooth root, but obscuring it just enough so that they understand it needs to be addressed. They can go back to that patient and, or that practitioner and get it done, or I can do it. And this is what it would entail.

So letting them know that there's a problem and not throwing the fellow practitioner of the bus. There's like an art to it because you, you really want to stay ethical and straightforward with them as well. So complications are tough. This, this is a very deep, broad, philosophical conversation. This doesn't go deeper than just infection, right? The other thing is, um, well, so let's go back to surgical complications. So you can have bleeding, right?

Part 226:23

You can expose a blood vessel or something intended or not. That doesn't clot. It doesn't clot on its own or, or it could be like producing enough blood that you can't really see how to manage it. And that can get in your way. Now you can always calm it down with the type of, and the level of surgery that we're dealing with, but there's also factors that go into that. That can be as random as the patient's bone is a little bit more filled with blood and they have more blood flowing through.

It's not as strong and solid. It's more, we'll call it mushy. More like styrofoamy and full of sort of blood vessels. And these are complications that have to be managed and can't be seen, foreseen ahead of time. Um, so bleeding is an issue or can be an issue for the most part. It's very, pretty easily prevented by getting a good medical history, by understanding what their, their history has been like before. Right. And also sort of having a good flow chart in terms of how you're going to handle it and, and not freaking the patient out.

You're using a lot of drugs, right? You can have, um, drug issues like we'll just, one minor thing would be prescribing the right medication at the right dosage, et cetera, can be a little bit difficult, right? By the textbook, it makes total sense, but in the real world, it's one of those things that doesn't necessarily apply perfectly. Sure. So something like, um, a patient doesn't really tell you that they have diabetes. They are, we're giving them a surgery.

It's a steroid. It's a short acting steroid, but they can go in what's called adrenal shock from not having, by having a reaction to it with the way that, uh, diabetics work. And so you can have these complications that develop just unintended, right? Right. Um, there's different infections. There's infections that can develop on the inside of the bone. There's infections that can just be surface, maybe from residual, uh, tooth left. It can be from residual inflamed. Infected tissue being left behind.

It can be surgical technique. Most, most of these complications can include at least one category or part of this category could always be, um, self-inflicted by the practitioner. Sure. You know, uh, an infection can be sloppy surgical technique. It can be unannounced or unknown to the surgeon if they don't have enough protocols dialed in, in terms of their aseptic technique. Okay. Okay. And maybe they, uh, cut a corner on getting their sterilizer maintained and it's just not quite doing the right job.

And those are things that you can't even figure out, right? It's very hard to figure that out. Right. Um, and so there's a lot of complications, right? Especially in the surgical side. And we try to our best to list it out and inform consent and make sure everybody has access and understanding to it. Right. Um, but the way in which you handle those complications is, is the important part. And I don't want to get into that. Like I'd prefer that sort of be the wrap up of this conversation because there's other parts of, of complications or, or failures, if you will, that aren't even related to just implant and surgery stitches and allergic reactions and things like that.

You can have an aesthetic failure, right? You can have a prosthetic failure. Prosthesis could be. Made of the wrong material, not wrong material. It could be made of a material that's inferior for that particular person's bite or habits or whatnot. It could be a production failure, right? We're going to, uh, in the next episode, we're going to be talking about materials to make teeth out of prosthetics, right? Of specifically at hybrids. That'll be you and I. Okay.

And, um, we're actually going to spend the week kind of researching that and, and we're going to really go through and kind of give some numbers. And, and really vet out why we use what we use and why the industry is there. But those, those are things that can happen just specifically off the cuff. ▶When you're putting your zirconia into the oven, there can be micro fractures in there that exist from the manufacturer. Right. And when you cook it, it just makes the crack a little bit worse that you can't even see their micro fractures.

And so you can have a person have a prosthetic failure that is. No control of yours. It doesn't even have to do necessarily with the quality of the price point either. Right. And so there's a lot of things in here that go to how, how, what are the problems, right? Not, not only what are the problems, but who's going to be managing this? Right. Who's going to be the parent in the room? Right. Where's our referee? You know, who's going to keep me calm?

Right. Um, and that's, that's. That's kind of the bulk of what we wanted this conversation to be more or less than the specifics. Let's think of, um, you could have engine failure and not make it to the appointment. Sure. That's a complication. Sure. Happens every now and again. Um, there's a lot. What's a, what's another, can you think of anything off the top of your head? That's what I said.

Part 331:53

I think you have the advantage here because some of these, I wasn't even hadn't even, had not been considered considered And that's, you know, from, and, and you're one of the more informed people out there, right? Right. So the average person, you know, and, and I see that a lot out, out in the community is, you know, you were kind of touching on the blame game and, and I think it's human nature to want to hold someone accountable and, and make it someone's fault.

And it's kind of a tough pill to swallow that sometimes it's no one's fault. It's just, it is the way it was and we're going to move forward whatever we have to do to to correct this issue whoever's fault it was was in the past so yeah and that goes in so let's transition over into we've got we kind of covered some specifics right and let's kind of merge over into what matters isn't whether or not a complication happens what matters more is how that complication is managed right and so i've just speaking from personal experience because that's what i can go on and we'll say even i've observed other colleagues succeeded the same thing it's always being straightforward and upfront about what happened but also instead of it being this is your problem and your random thing that happened more sort of accepting it as our problem and the thing that we're going to manage right and that it doesn't even have to be self-caused from us right let's let's just say a patient went to mexico and they have an emergency some sort of like long-term failure or pain or something like that we we see that occasionally or local whatever wherever they got their teeth and they come into us there's no pointing a finger at that we're just like what's the point of this okay we're just gonna stop if we don't stop it's gonna be just one day we're gonna go to the hospital and we'll ask the doctor okay how long is that and my doctor and i imagine the doctor's going to say a week and a half uh and they're going to i mean these are the things that happened but in reality we need to think about what's the point of this right and we have our patients and we're trying to end on these two terms right so when it comes to it's when it comes to what happened to them in the past what happened after they got so many what the answer is to all the things that i've been saying right now and i don't think they have beneath the implant.

It doesn't matter how it happened. And I'll say, too, sometimes that tooth can be obscured, that fracture in the root can be obscured for a lot of different reasons, just visibility from bleeding, maybe poor anesthetic technique. There's a lot of things that go into it, but it could also be patient-based. Patient behavior could also be listed as a failure or a complication. And sometimes you have wild patients and you're just happy to get it done. You're done. You'll deal with the rest later.

So you never know. I've learned to not speak ill on somebody else's work because you don't know what that story is. That person could have been wildly uncomfortable from an immediate infection or have bad trauma and not be sedated properly or wherever it may be. Who cares? ▶And so walking a patient through complication is a fact of life and it happens, but it's done together. Without. Placing blame on necessarily where it came from. Right. Because it could be patient-based.

It could be from out of thin air and it could be from another doctor. It could be from me. It could be from a lot of different things. But at the end of the day, other than does it change the way that we treat it?

Part 435:40

Other than that, the focus is really only on like how we're going to fix it. And so going again back to the root tip that was left behind, the conversation was very much like, this is what I see. Don't really care. Don't really care about the backstory or who did it or, you know, I'm not talking bad on them. This is how we're going to fix it. If you would like this part of your mouth fixed, right?

This is how I would do it. This is how I would do it. If you were my family member, my friends and family circle, et cetera. And that is where you become the most successful. Another complication to that, a hard part about that is that sometimes a patient doesn't hear you, right? Sometimes the patient does not interpret what is coming out of your mouth. Correctly, and that happens frequently, right? Just like, um, I can't think of, uh, something off the top of my head, but, um, you know, thinking to, to let's say a car and we'll, let's go to tires.

▶I don't know why we always talk about tires, you and I, but let's talk about a tire. You get a nail and you think, oh man, that's from the construction site right next to my house. I know. I hit that, right? Well, it could actually be from 30 miles down the road or right out this door, you know, and they could pull it out and say, no, this is a roofing nail. And what you're telling me is the guy was building, um, a work bench out back.

This is not a work bench type nail. They're doing roofing right there. Right. You could say all that in this person that's blown their tire and they still, because in their head that that has been seated, that that's what it is. Yeah. They're still going around telling people that they caught. They caught it right by their house. Right. Right. And that's not talking bad on patients. It's just something that we have to overcome. We have to know that that that's a potential.

Yeah. So again, hammering and educating is of the utmost importance to make sure that they understand what you say and what, what you are talking about is for real. Cause, cause there's also other things that maybe there isn't a problem with an implant. Maybe there is no fruit to through. They may hear me say something that sounds like. That other guy did it in Indiana. Right. And they may go to that guy and say, this guy thinks you're a scumbag and you screwed it all up.

And it may not have said that. Right. Right. Those are other things that you have to worry about that, that you have to over educate towards because you don't want that to be what's what's out there in the world. Sure. Um, so management of complications, um, can be pretty well taken care of by making sure, um, that everyone is on the same page, that you are working together or you will work with the other people or your team, um, is there by their side.

And that's sort of the way that I approach complications in general. I don't want to be flippant about complications, but it's a reality that you have to watch on, um, on the message boards or, or see other people, right. You've sent me cases before. Um, and so it's, it's a reality. It's part. It's part of doing surgery as part of the mechanics of the art, the art portion, not

Part 539:02

just the science. Right. And, um, knowing the scientific way to fix it can sometimes be different than the emotional intangible way to present it. Right. And so you kind of have two things that you really have to navigate, but a good experienced clinician kind of will already have that developed, right? This isn't something ground shattering or earth breaking or whatever. This is something that you see in the good guys, right? They know how to handle it. They know to jump on that right away, right.

You know? But I'm sure that's something you learn in the field. Like you don't come out of dental school knowing how to properly manage those kinds of complications, especially the emotional aspect of it. Like I feel like that's something you learn as you go. I would liken it to becoming an adult and getting your first apartment. You know, there's bills, you don't know how to contact them, right? And you kind of figure it out and now you just pay the electric bill or you pay your rent or you pay your mortgage.

When you're first starting out, it's a little clunky. It's not as good. You're not as good today or you're not as good back then at paying your rent and your mortgage for many different factors. But we're not as good right away out of our parents' household, paying rent, et cetera, as we are now. Sure. And that's... It's not that that person can't pay rent. It's more just the understanding the mechanics. And you're trying to also establish what your eating habits are going to be.

And when you go to the grocery store, you're trying to establish 60 new adult things at the same time of trying to manage your rent. Sure. Right? Whereas we already kind of know, I always get apples. I always get... These are my bases. This is the card I put this on. This is how I track this. And so as you gain experience... You become more efficient and better at things. Sure. I feel like you don't get good at having those tough conversations until you've had some of those tough conversations.

Correct. And that first tough conversation has got to be pretty tough, but it's the only way you're going to get better at it. Yeah. I mean, I can think of one time maybe, I don't know, let's say within a year of being out, I was pushed in one of those conversations where the patient wasn't told that anything was wrong. That nothing could fail. And it was back when I was doing six implants per. Might have been the reason, but we won't get into that tonight.

But it was back when I was doing that and I had to... I was the one elected slash shoved into the room that had to tell them that all of them failed. ▶And I will never forget the heat and anger that came out of that patient's mouth and brain. Right? And to their... This is not speaking down on them. That is their right. Because they were unprepared. Yeah. I'm sure it's magnitude worse. Totally. Totally. If you buy a car...

Again, let's get away from cars. If you buy the new soda and it explodes when you open it, and it doesn't say that on the can and it explodes. Yeah. It's not my fault as a consumer that I bought a can that exploded in my face. It's your fault for not putting that warning on it. Yeah.

Part 642:17

You know? I always say, if people are prepared for something... It'll go a lot smoother... Every time. ...if it does go right. So that's our job. Like you said, we don't want to scare people, but we want to make them aware that these are the things that can happen. We don't want them to happen. We're going to do everything in our power to avoid them. But sometimes things are beyond our control. But if they happen, we're going to take care of it.

We're going to hold your hand through it. We're going to make sure you get to the other side. That's... As a patient and as a consumer, if you shoot me straight and just tell me, like, hey, this could happen. You don't need to worry about it. But if it does, we're going to take care of it. Don't worry. That's it. That's all I can ask for. I can't ask for a better guarantee than that. Yeah. I'm dealing with a significant other.

You know, if you are up front and say, listen, I didn't buy this ticket and I didn't do this and I didn't book this hotel, they might be mad at you in the very beginning. Yeah. But they're at least going to know. You're not going to have some unwieldy, unhinged person on your hands when you get there and you hadn't told them the whole way through. So managing expectations, unfortunately, is just one of those adult skills that you have to have as a dental professional or no matter what you do.

Right? Absolutely. And informing patients and informing them that everything will be fine is a big deal. Yep. These big things that we talk about. That gets people scared are so off the radar, regardless of who treats them, that it might as well be the message is it doesn't ever happen. Right. Right? It does. But that's how little these things will happen almost in anybody's hands. Right. The more common stuff that you're going to see is we're going to go back to aesthetic failure, patient not liking the way that the teeth look.

Right. Just today I was talking to a patient of mine. One of ours. And she was telling me that she has a good friend, a good personal friend, who went to a different place. I don't have any idea where it was. And she didn't like the way the teeth look. Right? Well, let us take a look for a fair and reasonable fee. We can put teeth on top of it and make sure that the implants are okay, et cetera.

But that happens. And sometimes you just can't get it across the finish line. So that's the complication that's going to happen. It's going to happen more often. Right. It was fine, but it was more pain than I expected. ▶It was fine, but I didn't like the way that my teeth looked. These big surgical like bleed to death and nerve pain and sinus invasion, those are the things that need to be on your message board or on your radar.

Yeah. Can happen. Has happened. Will happen again in the future. But the likelihood that it'll happen to you, it's very similar to we all get on planes. We all know we could crash and die in a plane. And we still do it. Sure. Because that's how low of a chance it is. Sure. So talking about complications is complicated. As it should be, I'm sure. I wish I could take that back. Suck those words back in my mouth.

No. So that's a big part is having the right team to manage it and having the right message to patients and communicating that is a big deal. Yeah. There was some other things that we were going to discuss. The last thing we'll talk about is mistakes that patients can make. And they're pretty simple. And again, it goes to the message and the education to start with. Right. Diet is a big one. Right. And you hear a lot of people in consults, done thousands of them, that say, well, you know, I don't need to worry about that because I'm a really fast healer.

You know, I may be 50, but my pediatrician said I was the best healer they've ever seen. Right. And they just kind of discounted in their head. Right. You can have presented the right thing. Hey, if you read the wrong stuff, you're in trouble. This is why. ▶This is how an implant heals, no matter who, brand, et cetera. And they can still not hear it because their pediatrician, back when they were 10, said they were the best healer ever.

Right. And so patients can cause these issues as well. Sure.

Part 746:56

And the other side of it, well, on my side, I always tell people, tell friends that the tough part about our job is that we essentially take what amounts to a Fabergé egg in the healings. And we give that to a patient and we say, hey, go on a road trip for three months and I want you to deliver it to this address in Washington. I'm not going to pack. You were going to do fine packaging. Just know that it has to be safe.

Right. And when you're out the other, trusting that they're going to make it to Washington without any oversight. You know, if you get to admit a patient to the hospital until they're through enough healing that they're through the woods. Right. That's amazing. Right. And you watch them as they're handling this Fabergé egg. Right. But in dentistry, we kind of have to perform and hope. Yeah. And that can be tough. And that further, not to beat an absolute dead horse, but that further solidifies why we have to spend.

Absolutely. We as practitioners have to spend so much time educating our patients because sometimes you have to say to that person, listen, I know your pediatrician said this. These are biological mechanics. Right. ▶But this bad boy takes three months to heal an implant. And I don't care what your implant brochure person told your doctor. Right. But this bad boy takes three months. And we don't like to violate it because who knows in the middle how it's going to heal or what healing path it's going to be on.

Yeah. Whether you're fast or slow, et cetera. And so some of this can be outside of your own control. And, you know, another scenario, we've had patients that come in. Yeah. And they develop something while they're in the middle of their healing, be it, let's say, breast cancer. They find out they have breast cancer and they have to go through treatment. Let's say that they have been diagnosed with dementia after getting this done. And these can be very difficult for dementia patients.

Patient will kind of get obsessive about the feeling of something getting stuck or, you know, something to that nature. And they'll get very obsessive about it. And there is an amount of reasoning that will make it last long term because that's the unfortunate side. Right. And so things can arise in the middle of your treatment as well. Managing it, how you handle it, what your message is, those are all part of it. And, again, to go back to it, the best way to handle it is to not care.

You know, if a patient – I care that a patient follows my diet. I care that a patient understands. But if a patient ultimately was the one that caused the problem, it doesn't change anything. Still got to fix it. Right. And so as long as they know that I'm going to fix it, I'll get mad if they tell me that they did it and I can see that they did it. Right. And they've done it multiple times.

But being able to just look at it and not place blame and not sort of waggle fingers, for me, has always been the better part. It's the best way of managing these bigger issues. Sure. And that's what we all want. Yeah. You know? I think that's applicable in all walks of life. Absolutely. Dwell less on how this came to be and focus more on how we're going to fix it. Mm-hmm. Teamwork. Yeah. Yeah. That's pretty much all I wanted to say, you know, without getting too specific.

Right. You know, I'd like to do a series where we get more specific on – Yeah. What antibiotics are even. You know, a lot of patients – you'd be surprised at how few people understand what antibiotics are, how they work, why they exist. I am one of those people, and I would absolutely listen to that episode. Yeah. I think what's going to be really exciting about this is at a surface level, we've kind of covered a lot of stuff, right?

And maybe in the next 10 episodes, it may feel at the surface level like we've covered everything you can cover. There's a lot of stuff that we can get into the nitty-gritty, why antibiotics exist, why they fail sometimes. And we can do it in very plain, simple language that makes sense, I think. Yeah. I love it. And I'm excited for what grows out of this. You know, I hope that this is one of the more important episodes that people refer to.

Right. I don't care that we have weekly subscribers, but I want people to be able to use this as a reference. Sure. Sure. Whether they're being treated in Idaho or Indiana, New York, here, I don't care. I want them, if we can improve the world, as cliche as it is, but if we can improve somebody's experience and somebody's knowledge going into something as big and serious as this, then I think that we've done our job. And being a reference point forever, I mean, you say it all the time, once it's on the internet, it's there forever.

Yeah. In a good way. Yeah, absolutely. So. That's the goal. So that being said, if anybody has requests, all of our links are down in the description. Highly recommend you join our Facebook group. There's always a ton of good discussion going on there. I have started collecting some listener requests for episodes. I can't wait. The only thing I struggle with is I don't think this is going to be like a quick Q&A. I think each one of these suggestions could be an entire episode.

Absolutely. So I do have a list. We will keep adding to that list. Anybody has any specific questions, requests, please reach out.

Part 852:44

Let's start from the least expected to the most expected when we do that. Okay. Let's start with the, I won't say wildest, because there isn't a wildest question, but the ones that we haven't heard that much. Yeah. Sure. You know, there's of course going to be number of implants and why you do this and that. Yeah. There's going to be a lot more that we have heard of. Yeah. We haven't, but there's still going to, we can pull some interesting ones.

I'd love to start with the one like, can I ride a motorcycle immediately after something off the cuff that we don't hear all the time. We'll make it happen. Yeah. So submit your questions and as always, kind of to wrap everything up, the biggest thing is communication. If you're struggling with your practitioner, hopefully they'll be straightforward with you. Yeah. And hopefully you can find somebody that, you know, we're all human and we're all fallible and complications, good, bad things can happen to good people, but having the team to work through it is, is the important part, selecting that person where you should go for surgery is a person that's going to, at least in the beginning feel, because you can't go beyond that, but like having somebody that has experience with it or, or having somebody that, that feels like they have the team built out to really handle.

And manage you all the way through the good, the bad and the ugly is, is absolutely number one. Absolutely. ▶And, um, as always, thank you, Robert, it's been a pleasure for having me. It's always an engaging conversation and, um, for you, the listener, we appreciate your involvement and your dedication to listening to these and, um, we'll see you next time. See you next time.