Ep. 63: Why Patients Delay Dental Care

Part 10:00

This is Beyond the Arches, where full-arch dentistry meets real talk. Let's get into it. Hello and welcome to Beyond the Arches. I'm your host, Dr. Daniel Noorthoek. With me today, I'm joined by Erica. Hello, Erica. Hello. And Robert. Hello, Robert. Howdy. So today is going to be a fun topic. We are discussing why patients delay their care, why they delay getting treatment, not only for full-arch, I guess, you know, also for regular dentistry as well. And what will make today sort of interesting is Robert and his team have conducted an online poll, and the groups that were involved were those that have received treatment and those that have not received treatment and still are coming up on their care.

And so we're going to delve into those answers and sort of the responses that were associated with that to find out a little bit more about that. A little bit more why somebody might delay care. You know, one of these things is, as I'm going to kick this off to you in a second, but as I'm thinking about it, we have a great resource in that we've discussed, you have the procedure, Alex from our phones has the procedure, we're intimately talking and bringing, you know, guests on this podcast all the time.

So we feel, on a day-to-day, we feel like we know why people get care. Sure. And we have a resource of why did you not get it, et cetera. But that doesn't encompass kind of everybody that's out there, the lurkers and the people that haven't gotten it done yet, because, of course, they still haven't gotten it done. Right. And so it's kind of fascinating to peek in through the internet and do an online thing where we can kind of see a little bit more that may not be specifically the reasons why you or somebody else delayed the care.

So, yeah, pretty fascinating little topic. It runs the gamut, for sure. And these are kind of the top answers. Of course, there's a couple outliers here and there, but this is the general consensus of why people may delay care. And some of them are what you'd expect. Yeah. A couple of them kind of caught me off guard, but they're all very legitimate reasons. Yeah, and we have them all written down here. So I'm going to go. I'm just going to list off the different reasons that we're going to discuss that were brought up, and then I'll go back through and touch, open it up for discussion, if you will, but touch it out to you guys.

So the first one we have here is probably the number one or biggest thing, embarrassment or pride getting in the way, not having the time for the disruption of the treatment and recovery, fear of the pain, huge one. Yeah. Fear of the procedure itself, pretty big to begin with, but then usually after they make that first kind of contact, I feel like that fades away a little bit. Yeah, tiny bit. Tiny bit. Feel like they can't afford it right now.

▶That's always scary, especially if you think to buying a car or anything, which this is very much like buying a car, the fear of even just running your credit and just having that happen. It's a whole thing. Mm-hmm. So psychological weight of losing their teeth, and that's what we have here. So some good topics, and Erica, why don't we talk about sort of why don't we kick it off with the embarrassment or the pride getting in the way first?

Yeah, absolutely. I think that we have a lot of patients who it's kind of interesting because at our office, we offer in-person consultations as well as some virtual consultations. So either way, our goal is always to kind of make people feel more comfortable. Going into that, and at least just it's that initial like speaking with us that sometimes we've had patients freak out even before the consultation, and they kind of get anxious that they're even going to be speaking with a doctor about their dental problems at all just because of past experience or whatever it may be.

So we've even had like a couple, I think, of local patients choose to do a virtual consultation to kind of avoid that face-to-face confrontation about their dental. 100%. It's interesting. It's interesting. We have leads that call in and genuinely say like, I'll do a virtual, but do I have to turn the camera on? Right, right. At some point, you're going to have to let us see what you got going on. Right. They're very hesitant to do so.

Right. And it's just years of pent-up embarrassment and, you know. I can fully understand the feeling that they get.

Part 24:57

If I liken it to something, use an example from my life. I like to road bike, and, you know, I've biked my whole life. And the first, when I was young and didn't really know much and didn't really have any money, I can remember going into bike shops where they treated you like dirt because you didn't have an XYZ derailer or why would you put that nice tire on that bike? Like, that is a piece of garbage, right?

Sure. And it takes finding the right bike shop and also sort of being comfortable with yourself because there becomes a moment where you get, you hit so many walls that I would just never go into a bike shop anymore. Yeah, yeah, yeah. It wasn't that I didn't like biking or that I didn't want my tire fixed or whatever it may be, but it was just embarrassing to walk in and have those people judge me for XYZ. And I struggle a little bit with.

Keeping in mind that patients may think that way because we're totally the opposite. I've never once, at the risk of sounding like a jerk, like, I don't really care the state of your teeth. You know, if you can get to my office and can reason with yourself the parting with the money and parting with the teeth, all the things that we're going to talk about here, if you can overcome that, we're going to fix those. So why do we care if those are bad, you know?

This is literally a career. This is literally what you do and see every single day. It's what you've trained for. So there's nothing, I feel like, at this point that shocks, honestly, anyone in the office. It's even less than shock. Like, it doesn't, I've never once thought negative of a person. It's very hard for me to find a strategy in which we can be caring towards that. In that way, because I don't see us, it's very hard for me to relate that somebody might judge, be judging, right?

But that's a, but it's something that we hear about all the time. And it's certainly a thing in the dental world where people feel judged constantly. Sure, I hear it a lot. Which, I guess, I also say that we're sort of in a cheating position because we're after all of that has kind of gone. Where we don't realize. Where we don't really have to care about it. Let's say that we were going to be just crowns and veneers.

Then you have to care about how well that person's taking care of the tooth adjacent or the tooth opposite because it can affect the health. ▶So I always say that we're in a little bit of a cheating position because we're in a position that can be judge free. Because you don't have to really worry about the neighborhood. You can put a new building there. Yeah, it sounds cliche to say, you know, we're a judgment free zone or whatever.

But in actuality, like, it's just really how it is. And I hear so many people that are like, well, you know, I don't think you guys have ever seen a case like mine. You might have seen some bad stuff, but mine are the worst. I'm telling you, there's nothing we haven't seen and nothing to be embarrassed of and no reason to put it off. I have seen a case back in my residency where the person had so much tartar buildup that they couldn't close their mouth.

And in that moment, it's not so much what's going on, but it's we're here to get you out of this. We're here to heal it and figure out the solution together. Yeah, so that's a big one. So the take home is don't worry about feeling judged. It's not even a factor. Yeah, literally not even. I know it's hard to hear that and accept that, but that's just the way it is. It's just not even a thing. And it's hard for me to think that even any of our competitors or people that are in the same space.

You hear it all the time, man. You hear it all the time. Yeah. I wonder if like other, you know, other not Dr. Dan, but maybe like whoever else is out there. What caused a patient like poor experience? Maybe they're just so they they're it's normalized. It's normalized. So they just like say how it is. And sometimes that doesn't come off appropriately either. Yeah. I think that that could be a lot of it. Yeah. And then it only takes one time to kind of be vulnerable and expose yourself and have somebody, you know, go off on you with things you don't want to hear to like, I'm never going back to a dentist.

Right. That's the tough part is the past is what hurts. Yeah. In this type of type of category. Nobody wants to feel like that. So to go back to the bike example, you know, I have bought a new bike and I had an old bike when I went in to go buy a new bike. They didn't care the status of my old one. Right. You know, so we're very much like new bike sales. Sure. Yeah. We understand that you've ridden and that may do with bad ones.

And maybe you've been judged for the maintenance of your old one, but you get a new start and we're going to fit you for the perfect right bike. Absolutely. Okay. So let's go on to the next one.

Part 310:39

So not having the time or the disruption of the treatment and recovery to the schedule. That's huge. Huge. That is massive. I hear it from the consultations from the get go. How long do I need to be in town? Some people prefer to do the travel package, at least if they're coming to Boca. That way they can do the more Monday through Friday. You have a timeline. But we do our process in a week and a day.

So you do typically want to be here for that time. And then after that, it's a 90 day healing period. So it's a big chunk of life. Yeah. And people are pretty shocked by, in general, how little the pain sort of lasts. I think. I think too. Many people, if you're doing a desk job or your work from home and you, don't do a lot of interaction with clients, et cetera, you can be back to work pretty quickly.

I mean, we've had people back to work two, two days, three days later. I think it more so comes from like sometimes patients when they're, they're through our process, by the time they're getting their finals, they don't look like they just had surgery. They look perfect. Their teeth look perfect. Their face looks perfect. All the swelling's gone down, bruising's gone down, but then it's still kind of like getting over that. I still have a 90 day period of soft food diet.

It's a, it sounds like a huge commitment, you know, three months is three months, but usually it kind of flies by. Well, if you think about it, it's crazy expensive. It's a very big purchase. It's probably in the top five of most of these people's lives for purchases. It's a really big intimate thing because it's right next to your head. You know, it is your head. So it's very close. It's very close. And you, it's what people see, can't hide it, can't sit in it.

You know, if you have knee surgery, you can at least sit in the chair on zoom calls. Right. Um, so that seems huge for a lot of our patients. They're traveling. So there's taking time out of their schedule and to go back to the prior trauma, if you, if you will, from traditional work, they're probably used to things not lining up. Oh, we have to send it to a lab. Or they, maybe they work with a coworker or they know a friend that has had this done where it didn't fit properly and they had to kind of do a back and forth quite frequently, which that's just changed in the industry in general with the advent of really good scanning equipment.

Yeah. This, our multiple process, our multiple prototype process isn't to make it fit correctly, which is what it used to be. Used to be like, man, teeth are on the side. Hopefully those match up. But like, wow, if this could just fit right, we're going to be in really good shape. Now we know it's going to fit from the scan all the way through. So, um, there's a lot more confidence on our side. Um, but that doesn't necessarily translate to what the patient hears or understands because they know what their friends and their family and their past experiences might've been.

Right. Um, a problem now is generally healing or, um, patient not following a diet or a complication with, you know, maybe some sort of medical factor that, that got in the way of the healing of an implant. So it can be a little bit of a pain in the butt to go through that and get it redone and travel back and whatnot. I always say we all live in a human body, but there, the, the, that's a story.

It's a small thing in comparison to, oh man, it didn't fit. We have to send it to the lab. Now you have to deal without teeth for two more days till I can get ahold of my lab. It's a totally different landscape than it was 13 years ago. Absolutely. Um, and that is something that really helps all of us sleep. Absolutely. I remember working with office managers and treatment coordinators that would genuinely be scared because maybe they're not going to be able to sleep.

I remember working with office managers and treatment coordinators that would genuinely be scared because maybe they're not going to sleep. Maybe the lab, maybe the lab work didn't fit, or maybe there was an issue with the processing or somebody dropped it. And that was like a genuine fear back in the day. Now, if somebody breaks it on the way from the lab, it's 38 minutes and you're going to get a new one. Right. Uh, which is totally different game.

Totally. Anything else with, uh, avoiding the time and the recovery? Um, you know, I, I just, I would say, and this is kind of the common theme running through all these is. What may seem like disruptive now is something that you can plan for, predict and schedule around. Whereas if you avoid it, that's, that's, that's when the disruptions become unplanned. And now you've got a toothache or an abscess tooth or something, and you're calling into work and everything kind of just gets thrown into disarray.

So sometimes the easier route is planning something out, you know, making that sacrifice, getting it over with. So you don't have to worry about it in the future. I don't mean to put you on the spot, but as you were saying that, I, I, I'm going to put you on the spot. Um, I think I remember you telling me there was a time you had, um, the nano ceramic on top of a bar initially, right? I think when we were first working together, you had a fracture or something with one of the sets of teeth.

This is five or six or seven years ago. Hmm. And I, I apologize because you had to make it over for the extra time and whatnot. I feel like you told me we had a conversation and you're like, dude, don't worry about it. This is before you worked with us or anything, right? You're like, dude, don't worry about it. You know what the difference is, is that I'm not in an ER, like the time that I'm giving is not in pain.

It's that I have confidence that I'm going to get them back. Right. Yeah. Tell me like, yeah. So I feel like you were, I remember you telling me that specifically. Yeah. I mean, obviously as someone, and I feel like that's what you were kind of alluding to when as someone who's had this done, when I think of disruptive periods from the treatment I needed for my teeth, dude, I'm talking about days of literally not being able to function.

And I know a lot of people out there can relate. It's, it's very hard to like adequately describe. It's calling into work, but even more so, it's just not wanting to wake up because you know what's coming and, you know, tooth pain is wild because it can go away. And that's why we put it off a lot of times because, well, it hurt yesterday, but it doesn't hurt now. So I'll just hold off until a better time comes.

▶And then it always comes back. It's never going to go away forever. It's always going to come back. And like every time it comes back, it comes back a little longer and a little tougher. Um, so, and that's completely unpredictable. You don't know when that's going to happen. I mean, you can do something that set it off. Like maybe when you're eating, you get a piece of something stuck in there and it's aggravating and it's irritating it.

But for the most part, like once you have a, you know, teeth that are, um, regularly getting infected and you're experiencing this pain, like it just comes in waves, total unpredictable waves. So, um, yeah, that even if you have an issue. Something like this, like the difference between being, having your schedule disrupted of going in for a quick fix and having it looming over your head that when is this next pain attack going to come? That's no way to live for sure.

You know, I was just thinking about, as you were giving that example is I've certainly been sent to collections for a credit card when I was, couldn't afford. I think there was a period of time at, at the end of dental school where I ate every canned item in my pantry and couldn't afford my credit card bills. So when that happens, you want to avoid it so you don't answer the phone calls from who you know is calling.

And just because they don't call you for a couple hours, just because you're in that period where they're not bothering you does not mean that went away. It only got worse because it only went higher. Yeah. And until you face it head on, that's, that's when it finally goes away. Yeah. That's all. That's like randomly what it's like many things in, in life, you know, you're kicking the can down the road. The can just gets bigger and harder to kick.

That's the hardest thing to like overcome. It's understanding. Just face it once. Yeah. Tough. It is tough. How about this one? I think this is the number one thing that really keeps people away. Well, actually I should have kept that to myself. Cause at the end we're gonna decide what you guys think is the number one thing, but, um, fear of pain, so a lot that goes into that, um, prior experience, obviously with dental offices, especially, um, I think that sort of the older generation of dentists were a little bit more work focused and maybe did a lot of ignoring of patients.

Yeah. I also sort of feel like there's this weird thing in dental chairs that, um, I don't know. I always say that, that patients really like to hear, this is gonna sound weird to the listeners, but patients really like to hear that they're the most X, Y, Z. This is the worst infection I've ever seen this. You are the hardest patient I've ever seen to get known. What? These are the hardest teeth I've ever taken out. They love it.

Yeah. They may not think that they love it, but they wear it as sort of a badge. Of pride. Yeah. Of pride. Or maybe like I got my money's worth or something. Mm-hmm . Um, and so they, I think that it can kind of, um, be, um, self validating if you will. So on one side, a dentist just to kind of get out of the scenario. Be like, well, that's the worst infection I've ever seen, you know, or that's the, you're the hardest person I've ever been.

I've ever had to get numb. Maybe the guy just didn't want to numb you up anymore. Right. Um, or didn't want to give you too much for, for the beginning. But I think that that kind of builds because then this person comes in, unfortunately, when they get to an end stage, say like this and they have the paralysis of, I need to get this done. But you know, I'm a really hard person. Mm-hmm . To get numb.

It could be their technique. It could be, et cetera. But I think a lot of it comes through psychologically from what I see with patients is, well, you know, I'm really hard to get numb. Mm-hmm . I've never really seen a person that says that then also is hard to get numb. Mm-hmm . But that will keep them out. We're talking about people, not that haven't gone through my care. We'll say this is, these are people that are withholding treatment because, and I think it's sort of damaging to the profession when they say things like that.

I try very hard to not say things like that, even if I may feel it. Mm-hmm . Because I feel like that just sort of propagates down the line where the next person that they have to interact with is, well, Dr. Noorthoek said that I have the curviest, craziest teeth ever. Right. Right. All I did was just get in that person's way of doing a good job or doing the work that needed to be done. Sure. So it's kind of weird to relate that into there, but I think that that's a big fear of people.

And that goes into the fear of pain because a lot of those things come with pain. Most crazy infection, that always kind of means like the dentist is asking you to deal with the pain of what's there, I can't get you numb. Right. Right. Hardest tooth to get out, the person was struggling to get it out, but that's usually kind of a torturous event, getting through that. Sure. Hardest person to get numb. That means specifically you were feeling it and I just couldn't get the nerve appropriately numbed or whatnot.

And of course there's been updates to different anesthetics that we use now that were just on the scene when I was getting out of dental school in 2010, just 16 years ago. That was, it penetrates through the bone better, it works better, it has a more profound anesthetic event. But all of these things culminate into the psychological warfare that it is to convince a patient that it will be okay. So random tie-in, but. I think there's just a very human proclivity to think about the concept of having your teeth removed.

Extra. And also having them extracted from your jaw, having screws drilled into your bone. That seems like such a scarier concept than a tooth infection. Right? Because we all have infections and we get colds and we get sinus infections and ear infections. And it's like, it's part of life, you get infections. But I would say this all the time, a tooth infection, an abscess tooth is more painful than a tooth infection. any part of this procedure probably any dental procedure i say that there's probably dental procedures i don't even know about that might be brutal but there's something about an abscess tooth and i hear people say i hear women say that this is worse than when i gave birth i've heard it all i've heard it all it is a very i don't know if it's proximity to your brain i don't really know what it is but dude it is speaking from experience is the most painful thing i've ever experienced and i've had a broken toe and that's pretty bad you're speaking of an infected tooth yes yes and uh and i hear it from everybody else i know it's not just me being a weakling yeah it's a it's a very very painful thing so you know going back to kind of the you know the alternative of putting things off you're putting off this thing that seems scary and because it's not i don't it's you just think of it differently you think of it in different terms so it seems scary and it seems like it's painful but in actuality avoiding that thing is what gets you to a place of even more pain which is wild to think about and when you're at home and you have a tooth infection you don't there's no anesthetic there's no doctor making sure that you're comfortable it's just you and you're trying in the arms of the chair so maybe a pair of pliers because you're desperate like whatever the case may be um but you know it's it's a lot more controlled environment when you're going to have a dental procedure done you know we have we have local anesthetic so shots that get you all numbed up and nobody likes having shots but after that you're good you don't feel you can do anything you could take a you could do anything oral surgery you're not feeling anything um so it's just a from a personal experience to somebody who's been on both sides of the it's just a much scarier concept of going untreated and letting the cards fall where there may and seeing what pops up is much scarier to me than being in a controlled environment with a professional that knows specifically how to adjust these things for sure um and that's it's hard for patients to overcome that it's and it's and i get it there's lots of things you know i had plenty of shoulder surgery done and the first time i had it scheduled uh i went home and i googled it and was like oh hell no not a chance you watch video of the actual i didn't get to that was before then you know before there was really like video of things like this but i immediately canceled and it took me probably another year to can't to to work up the nerve i very much understand how scary it can be because the unknown and the horror stories that you read and um that's what's nice about having a platform that's very transparent and you know the facebook group is very much untouched by us because it's nice i i would think that it would be nice as a to be able to refer to that and say well this did happen to this person but everyone or these two or three people but they're all saying that it was okay and then you know it was fixed um because you need it's very easy for the the dark the dark to creep in yeah scary and when you go online and look at stuff like that you know there's such a wide variety of of outcomes that it's very hard to pin down what to expect for each individual right it's case by case we have some people that come in the next day and they're crying or you know hurting that's what i was gonna say i feel like i'm gonna go a little bit rogue from where you guys were headed in but i just feel like it's a surgical procedure you'd be crazy to think that you're gonna come out of this a hundred percent zero pain however yeah we're still talking five to seven out of ten pain for sure for sure but post-op we manage it right we do things to manage it and like robert was saying earlier what you're gonna go through in the next healing phase of your life after this and even through this it's still going to be so beneficial from what you are coming from initially with getting out of the the infections and stuff like that but it's it is uncomfortable it is there is absolutely discomfort that comes with it however everybody is different in how they handle it too like you were just saying some patients do come back and they're like i feel great i'm so glad because i psyched myself out to where yes i thought that i was going to be rocking back and forth in bed and i wasn't i feel like i can go on a run right now and we're like okay well don't do that take it easy but i feel like we see that end of things but we do also see the other end where sometimes patients lay low during that week and they're laying in bed and resting and just focusing on their recovery which is important but it's of course it's going to be a little bit uncomfortable it's a surgical procedure of course but we can do you we can do as much as we can do on our end to kind of prepare you for that and let you know what to expect and honestly sometimes when people psych themselves out so much so before the procedure where they come back the next day and they're like wow that was actually great so often we see that so often so often so i think it's kind of i like it when it happens that way as weird as that sounds obviously i don't want to see anybody uncomfortable or in pain but i think we do such a good job at preparing people for what to expect that we over prepare yeah i think it's fine to admit that you like it when that happens because it's it's one of the biggest sources of evidence that we've done what we needed to do properly it's one of our biggest indicators of success as a person it says i had all these fears everyone everyone that submitted in online of this is why i'm not getting it done i had all these and you beat them all right sure that's um huge because the actual getting the work done is one thing and we've proven time and time again that's a no-brainer more or less for us um it's this that's the biggest thing right you know if we could we could offer this procedure for free we could bring in world-leading you know sleep medicine experts anesthesiologists etc and guarantee that until you wake up you don't feel any pain and it's free there's still stuff on this list that's going to be there's still going to be a group of people that don't get this done still isn't that crazy to think about like we could literally offer it for free and pain-free guarantee and there's still going to be people that have some kind of hold back yeah i think the number one comment that i hear when i'm doing my pre-op phone calls you know the week before somebody's coming in for a surgical procedure they're like they would be always almost always end the phone call and they're like you know thank you for your help thank you for your information i'm nervous but i'm excited and that's always like the barrier like they kind of just go hand in hand like let's do both let's be excited but let's be nervous you know for sure yeah yeah it's very easy to go online and it's very easy to go online and it's very easy to go online and it's very easy to go online and say hey anybody who's had this done how much pain am i going to be in no one can answer that question it's very personal it's personal case by case the only thing that can be guaranteed is we're going to manage it and you're going to get through it that's all you that's all you need to know you know and then look for you know consensus you know it's it's always going to be outliers and everybody's going to give their opinion but you look for a consensus and the consensus i always see is wow that was nothing like i was expecting it's always going to like you said we we always build it up in our minds to be way worse than it ever turns out being it's human it's human it's very difficult to avoid that doing that the will to it feels like it's um psychologically it's the will to survive it's the way to avoid this is going to hurt you know going in to that area has snakes and i'm going to get bit so let's avoid that it's very primal it's very it is from the base so the will to survive it's the way to avoid it's the way to avoid it's the way to survive and avoid pain yeah and our office is fully equipped for having a comfortable calm procedure go successfully as well this is not the 19 whatever is where you're like got your knee on the chair trying to yank this tooth with no anesthesia no nothing the patient's feeling everything like absolutely not yeah we are we are at the the best point in history ever to have this or so many other things done it has never been better than it is right now for sure today this is the best time to take part in this this uh kind of stuff yeah you're fixed up i like it um another big one fear of the procedure itself um i think that kind of goes in hand with the fear of pain um but i will add something so fear of the procedure itself when and this will tie in a little bit to what i was saying with um the profession itself sort of saying you're the or a person having this sort of torturous experience um the the procedure of removing teeth and replacing them with implants uh is wildly um calm if you let's do it a different way so think about just an individual tooth okay think about how it has a root that's in the bone and then the part that sticks out of it and then the part that's in the bone that's in the bone that's in the bone of the bone and then think about say a root canal what is a root canal well there's a nerve and blood vessels that go through the end of your tooth the root of your tooth into sort of the top where we call the pulp and where where that innervates think about anything that happens to a tooth so a cavity gets into the nerve that's when you need a root canal or a cavity is just in the surface of the tooth anything that's or a crown you need to get a crown cut what's happening when dentistry is being performed there is a burr on a drill that is going really fast and creating heat etc vibration etc directly next to or into a nerve right so traditional dental procedures can be extraordinarily painful you if the anesthesia isn't 100 on point right there's a lot more aggravation that is being caused to the nerve on a day-to-day thing even just for a regular cavity being filled so the the anesthesia that you require doing those procedures really needs to be profound precise nailed right on the head right it seems crazier to take a tooth out but you're actually not really aggravating or or making that nerve angry because you're not generally drilling next to that nerve at all so i find that the anesthesia needs to be in sorts less profound than it does in a regular procedure meaning i can probably do a full arch procedure with less anesthetic and less um technique sensitive injections then mm hmm say a person doing then my friend kevin i hope we get to be have on this podcast at some point he's a root canal specialist but um he probably has to be better and more profound and more precise and risk missing and creating pain for that patient than even i do um even though it seems in your head i just logically it makes sense that that's way crazier to do a full set but i wanted to mention that because i don't think i've ever mentioned that on the podcast before so you know if you think about the big injections one of the biggest ones is the one that's on the bottom right they take a 18 inch needle seems like and they shove it to the back of your throat well i don't even ever ever have to do that right because it's taken care of by where i end up doing the anesthesia right so um and we don't have any needles that are 18 inches long no they're actually all of our needles are it's a problem when we do need to do it because we need to find the longer ones um but at any rate you know just the the procedure itself has a lot of these sort of shortcuts or not shortcuts but these sort of little cheats that make it that psychologically i understand how overwhelming it seems but in reality and in actual practice it's much simpler than it may seem yeah that again cheating for us yeah that kind of leads into i know i keep harping on it but you know kind of the what happens if you don't have this done right so um you could start off with needing your teeth removed and good old regular implants right and if you put that off and you wait too long then you may have to pivot to another treatment and those could be you know zygomatic implants and then you know if that's not an option i remember you telling me for my first time about subperiosteal and i've since seen x-rays of that and i'm like and it's getting a surge back yeah bravo to the to the doctors who are doing that but like that can't be fun for the patient so like if you think that this procedure is intimidating watch what happens if you put it off and put it off because the procedure ends up needing to be more extreme and the solution gets more complex and complicated and expensive and everything so it's just another example of you know the things that you're kind of i don't want to say afraid of though could very well be afraid of but the things that you're putting off end up requiring um bigger solutions the longer that you you put it off yeah and And to parlay on that in terms of the procedure itself, if you see us sooner and we're able to then keep you more numb, then be able to be a little bit more conservative because the teeth are easier to remove, then I don't have to be as traumatic to the gum tissue when I'm doing the surgery, which means that the night of you're going to heal better.

It means that you're going to have more profound anesthesia. It means that the restorative appointments when they're putting the teeth in and out, because the gum tissue is not as beat up, it's going to be much more healthy and a lot easier to heal. It just flows much simpler for sure. It's very complex. I don't envy anyone that has to shop this out. One, to make a selection of who they're going to have do it. Two, going through all of these.

As we go through them, it's just, it's actually feels a little bit like if these are all the mental hurdles we have to overcome, how does anyone get this done? Because just one little hang up and you're not going to get it done. It's so much easier just to say, I'll deal with that later. It would have been much easier to go into surfboard fabrication. I always say, I don't know why that's my go-to, but if I ever leave dentistry, I think I'm going to go into like, surfboard fabrication, because who doesn't want a surfboard?

Even people that don't want surfboards still buy them for their beach house or whatnot. At any rate, speaking of expensive things, feeling like they can't afford it right now. This is probably the hardest for us to overcome because it's something that's totally out of our control. We do have, Erica has many avenues. I'll put in my piece and then you can throw yours in. My piece would be, if that's your holdup and you're in that scenario where you're looking to avoid, we've always really kind of focused on getting a patient or working with a patient to that next step.

We have some really cool stuff coming out soon in terms of helping with or assisting with guidance on credit repair, et cetera. We have some really cool stuff coming up. Because that is something. That is something that we want to help people with. But as far as what's in our control, let's say a person has a tooth or two that absolutely need to come out. It's not a huge deal for them to come here and they know they want to come here in the future.

Generally speaking, we want to get that out. We don't want them to avoid all the way until they have the cash for that procedure. So a lot of times what we'll do is we'll take the teeth out for a pretty nominal fee and then say, hey, if you come back here for the final procedure. We'll credit that to your overall procedure or something that isn't doesn't put them any further back. And it doesn't put us shorthanded for getting the procedure done, but also that prevents those horrible, painful nights that might cause them to avoid them in the future.

It's a small thing, but it's something that we've always tried to kind of do. Yeah. Not to keep bringing you up, but in a way, we did the same thing where. When I was going to do your case, I couldn't really afford, didn't really have the resources or the equipment behind me to do your case in a full arch. And so we took the stuff that was really in your way out and we both kind of in a way we both work towards this is where we're going to go.

All right. Yeah. Yeah. I was going to say similar to that, too, especially if somebody does, you know, that is in our office at a time that we're running like one of our specials, which we do run. Pretty frequently, honestly, if they want to start with like a upper arch instead of upper and lower, that is something that we're more than happy to work with them about. That way we can at least get something started, something out of the way.

And like you said, a couple of miscellaneous floaters on the bottom that need to come out in the meantime. It's definitely something that we can do. There's kind of by time, either on our end or your end. Same thing goes with like an antibiotic. If a patient knows that they're going to come in for surgery. Like. Maybe like next month or something, but we have their X-ray in front of us and we know that this is going to be beneficial to them.

Go ahead and send it in to kind of buy time there, too. I would say it's probably. One of I would say that the odds of you getting a single. Arch set of teeth and us not taking a tooth out on the lower. Because it's just not good. Is really low. Low and the odds that we even charge you for it is extremely low. The worst case scenario, we charge you and then we credit it to you when you get the second arch done because we want it to be healthy.

We're not here to quibble over a couple hundred dollars here and there. We're not here to quibble over, you know, whether we use bone graph or whatnot. That's why we have a very global fee is we don't want people to feel like we've nickel and dined them. We want them. We want them to feel like we've conquered this list. If we could conquer this list and everyone, then we've done our job. And part of that is let's be human and understand that you may be in the worst dental situation and maybe not a great financial solution or situation.

Can can we help you at least in one area and help assist you to get to the next level? And then once you're there, we also have the lifetime warranty. So, you know.

Part 445:56

That what you just spent a ton of money on is going to be protected. You don't have to worry about working out another whatever grand here, grand there just to have a tooth removed or, you know, God forbid something happens or you just want to X-ray to check on everything and make sure everything's okay. That's something that we can do because it's covered under that. Yeah. And it is an investment, right? We always say it's an investment.

It's a costly procedure. You never pretend that it's not. It's not within. It's not within everybody's budget, unfortunately. But it is definitely an investment that pays for itself in magnitudes, right? And it's something that if if it's something that you need done, you definitely want to prioritize it and and and get it done because otherwise you're just being held back until you have it done. And, you know, Erica. It's got lots of ways to make monthly payments and that kind of stuff.

And you just you just make it a priority, maybe instead of the new car, you have this done. And if you don't going back to that's when things, believe it or not, can get even more expensive than this than having the procedure done, you know, dragging it out and having everything kind of piecemeal and paying full price for a single tooth implant or crowning bridge work or. Root canals or whatever that don't last and you have to have them redone.

Like if you add it all up at the end of the day, at the end of your lifetime. It's it's it can get expensive, right? We all we've all talked to the patients who've already got one hundred grand in my teeth and now I'm having to have this done. Oh, yeah. That's that's kind of it's kind of part of it. So, you know, if you're at a point where you need this done and it makes sense and your dentist has recommended it and it's something that you've accepted.

It if you just figure out how to make it work, you will be saving yourself money in the long run. We talk about how expensive it is to have this done. Sometimes it's more expensive to not have it done. Yeah, my philosophy. I always tell patients that. I'm not by any means saying that this is a cheap procedure. It's still the cost of a Chevy brand new Chevy. Chevy's are getting up there. Yeah, true, true. Yeah, that's very true.

It's the cost of a brand new slate Amazon electric truck. Right. But, you know, part of the missions, part of the goal of done in one is the belief that the less expensive that we can make this, the better we can all feel about our careers and what we do. Because the volume will, you know, obviously. So we have to make money, but the volume will make up for that. And then the service that we provide to those masses of people will then generate more work.

And so I've always been a little bit of a dental outsider because I don't in any way, shape or form take any pride in the number that's attached to my fee schedule. You know, I would imagine that with the team that we have. The facility that we have, the equipment that we have and the experience that I have that we could command a hundred grand an arch. But, you know, who do you want to go to? The guy that's done a bazillion and has an amazing team or, you know, but that how would that make us feel?

I would hate to even if even at a hundred grand for a double. I don't want a person to spend that much on something. I don't think it's worth that much. I want to see more people. Come in and see more people's lives be improved. And so the push here is where I'm getting to is the push is to make it as affordable as we can while still providing an amazing profit product that we can still put a lifetime warranty behind and allow it to be an attainable and achievable goal that doesn't encumber a person's life.

And I can understand that that sounds sort of out of touch. For somebody that's struggling to make ends meet and pay their bills. But we've tried to eliminate every barrier that we can along the way to make it as affordable as we can. Whether it be working something out with someone or, like we said, taking that tooth out and saying, hey, just come back to us when you do get the money. That's sort of been like a big drive and focus.

Because I look at it myself. I wouldn't want to afford it. It's tough. It's expensive. But, like anything, sometimes avoiding that isn't going to improve it. So maybe you do have to pick up an Uber job on the side or something to make it a priority. It's tough. We all kind of have to make those choices. It's a tough, tough thing. But I will say, again, I know it sounds cliche, but all of our patients. All of our patients are happy they spent the money.

You know, I've seen literally one patient that's like, I can't believe I dropped this money and all I have to show for it is this perfect smile. Like, everybody is like, this changed my life. I should have done it so long ago. It's just, it's hard to think of too many things in life that are like worthy investments. And you don't have buyer's remorse on. And you look back and you say, that was worth every penny I spent on it.

And I think this is one of those things. Yeah. You see people that quit smoking just for this. You see people that, you know, make some sacrifices for this because it does hurt. You're right. ▶If it was always free, we would see a lot more complications, a lot more problems because people don't take it seriously. We actually do that. We used to do, we do a ton of pro bono cases, but I'm pretty selective on the ones that are totally free because we've seen a lot more.

We've seen a lot more complications in the patients that get it just totally free and maybe didn't necessarily seek it out. So, you know, sort of the solution to that is give them a payment plan that makes it hurt them just a little bit relative to their finances. Right. Because then they sort of take it seriously. So, I am grateful that it does cost money, honestly. Yeah. Yeah, you see a good bit of talk among, like, professionals.

A lot of professionals of, you know, do we want to do implants for this person? They didn't take care of their natural teeth, so what makes us think they're going to take care of these? Sometimes I think it's that investment that makes them take care of it. And to be clear, not everyone gets in this situation by not taking care of their teeth. There are a million other reasons why they may need this. But I agree. Again, you see the people stop smoking.

I paid so much money for this. Better safe than sorry. They lower their A1C. They're doing all these things that are kind of building blocks of a better future and a healthier, you know, life. So, it's an investment, but it's one that, again, pays for itself. I think if somebody, some crazy billionaire came to us and said, this is our focus now, and we're going to double the income that you have, and you're going to take the same staff, and they're all going to be boned.

And we're going to do a totally, everyone that walks in the door is free for life for as long as you want to go. ▶I think I would think about it for a day and then reject it because the amount of complications that you would see would not be worth the life. It wouldn't be worth it. Psychological weight of losing their teeth. I know we discussed this a little bit before we sat down. This one is tough to, it's easy to understand.

Nobody wants to lose anything that's them. But for me, it's hard to understand, and probably for you guys too, because we see the results from it every day. So, you're kind of like, why do you want to keep this car when you can get a brand new one? So, I think that one's, this one's sort of the toughest for us to understand, I think. It's a tough one, but I see it so often. Yeah, we do hear it.

So often. At least once every other week, I would say maybe. Yeah. That the patients actually physically want to keep their teeth after the, even after the surgical procedure. They're like, can I take my teeth home? What do you, where do you think that comes from? I don't know. I don't know. I've heard it from, I feel like I've heard different reasons for it. I had somebody tell me it was like a religious thing. I've heard somebody just say that it's like a piece of them.

It's, you know, it's theirs. ▶It's like your favorite pair of shoes that you've worn every day for the last 20 years, and you're finally giving them up. I don't, I don't know. Do you think that deep down that a little bit of it is the, isn't necessarily like the psychology of losing their teeth, but the fear of not liking the new ones as much? I think that plays a part as well. Yeah. But I've even seen people that are over the moon happy and not even just coming to us, but just across the board that still don't recognize their teeth.

Yeah. If that makes sense. Like, even though their smile is perfect and everything, everything's great and they wouldn't change a thing, they're still like struggling to connect with who they see in the mirror.

Part 556:04

And I think it's just some ingrained psychological thing that, that is hard to adjust to, you know? Mm-hmm. But I do see so many people saying, you know, we don't talk about this enough. We talk about the price and we talk about the pain and we talk about this and that, but like no one talks about the psychological. The psychological aspect of this loss that you're, you know, going through. And I don't know, personally, I can't relate to that.

So I'm empathetic if someone is going through that. But in my case, I had no attachment. It was quite the opposite. I was like, these things are killing me. They're literally killing me. I want them out. Mm-hmm. I want to save myself from these things. ▶I had no emotional attachment to my teeth. They had always given me problems. I never liked the way they look. Just a headache. Get rid of them. But there are some people that are completely opposite and they want to do everything they can because it's, like you said, it's just a piece of them.

Yeah. I mean, I've seen, I also can't really, I understand and I empathize, but I can't relate to wanting to keep something like that, especially if it's something that has given you so much trouble in the past. Mm-hmm. And more so just kind of like looking forward to the future, I guess, is where my perspective on that would be. But I have seen patients ask for their natural smile with the zirconia. You know, they send us their before photos and they want to get as close to their natural smile as they possibly can.

That I totally understand. Yeah. We've had a patient in the past, we've done, we've done a gap between like the front two teeth because that's what the patient had. They've had that their whole entire life and they wanted a space and we created them a space. So I feel like we do our best to still portray that of them, still portray that the most natural smile. That's the most natural version of themselves that we can possibly do.

But. Yeah. It's easy to be sort of flippant because it's not our teeth about like, well, they're going to look better. And I don't mean to be flippant. Right. But it's easy to be that way. And for anybody, it's like, okay, but it's like a better house. Why wouldn't you move there? Yeah. This is the house I grew up in. Yeah. Nostalgia. Yeah. And it's, it's easy to become flippant when it's not your, your natural smile. Decision.

▶Um, so I, and I understand cause it's also one of the first things we said is teeth are the, like to put it in Reggie's words back Reggie's days, teeth are the, well, you know, the smile is the welcome mat to the soul. So you're changing that up. Yeah. It can change that person's feeling on themselves. Yeah. Um, I also wonder if part of this isn't necessarily just the psychological. Weight of losing the teeth, but maybe losing the effort that it was to go through with those teeth.

It was a journey and a story with them. And, you know, uh, I think too, the lady had every single tooth was crowned basically,

Part 659:10

but they all had cavities and such. It felt like, um, she was on, uh, a lot of medications and had like xerostomia, a lot of dry mouth. And it just, that just causes rampant carries, but it genuinely, until that happened, she had fought the fight. She had been in a dental chair. So I bet that is a big anchor for people and it can be too, especially if they went down the traditional multiple implant path, you know, you go to any, and I can speak for ours as well.

You go to any perio office and pull records, you're going to see people that have put significant investment in. Five or six implants. And now you're pitching them on removing that effort, that work, that pain. So there's, I bet that there's some of that buried into that, like psychological weight of losing teeth and prior dental work, prior effort, prior money, prior everything, everything that we've discussed is packaged into that for sure as a tail. Yeah. So it's probably a really big one as we always have said.

Yeah. It's probably not like at its face value, just the psychology of losing your teeth, even though it is what we discussed. But there's that weight of, man, I remember when my husband had to go work double extra shifts to get me this bridge and this implant. It's, it's there. It's serious. Yeah. You, you do feel like once you've spent money on something like that thing is fixed, you never have to worry about that thing again, but that's never the way it goes.

You know, when you, we just bought new furniture and we're like, all right, we're good. We've got that covered. We can worry about all the other stuff, but it's not going to last forever. 10 more years. We'll be saying, Oh, we need new furniture, but I get it. And then there's the sunk cost fallacy aspect of it. And no one, that's a tough one to deal with for humans. Like we have a very hard time when we've already put money into something, letting it go.

That's a very difficult one. But I will say like Erica, like you said, with, um, your person that, you know, they want their natural smile, exactly how it used to look. And even if they had a gap, I feel like there's just, there's as many people, they're like, ▶I've had this gap my whole life and I hate it. I want, I want my teeth to look nothing like they did before. I want them to look fake and Hollywood and perfect and whatever.

So just a, uh, personal preference, I guess the human brain is wild. Yeah. The other thing that I'll never really get over is how many people in the consults say, I don't, do you guys do normal color teeth? I don't want them to be perfect. You guys customize it like that, which we do versus the people that if you looked at the incoming statement and then the people that walk out the door with perfect refrigerator ordering on refrigerator, white teeth is very flip flop.

From what wouldn't you say? It's pretty wild to see actually. And that we're talking about something that's very deep because it's the psychology of everything, but that plays into, um, that whole psychological shift and that change is all part of it. That's part of why people don't come in. It's part of why people are happy to have come in that whole journey happens every single time. Yeah. Yeah. So let's recap. So let's go.

Part 762:53

I'd like each of you to tell me what you think, and it can be the same. What's the number one, what you feel like the number one thing is on this list. I think the number one thing on this list is fear of pain in the procedure. In the procedure? Mm-hmm. Like during? Mm-hmm. Like surgery. Like too afraid to go through surgery. Mm-hmm. To have the results that you're wanting. Mm-hmm. I think the pain of that itself holds a lot of people back, probably even more so than the finances.

Mm-hmm. Yeah. I think that's a big barrier, but I think it is a, um, it's a spectrum, right? The further you get along in, in tooth decay and experiencing infections, abscessed tooth, tooth pain, the, the longer you're on that road. The less you care about that. So I, so I think, you know, at the beginning of that journey, that's a big factor. ▶By the time you get down that road a little bit, you're like, I don't care what the pain is.

Nothing could compare to the road I've been on. And then you get into the, the financial aspect of it. So I think the financial aspect is the bigger barrier, depending where you are on that spectrum. Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. So I, I think the, the, of the pain of going through the process. And then the longer you stay on that road, the more it becomes a, uh, don't care so much about the pain, but the financial aspect is what's holding me back.

That's my take on it. That, or the embarrassment of pride getting in the way too, like we said at the initial, just getting that initial phone call and that initial consultation and get your foot in the door to actually learn and understand the process. That's a big one too. They're all, they're all big. They're all huge. Sounds hard to just like, you know? side yeah um i i will say though you know again you know we tend to talk to people before they make it to the console so we kind of have first impressions with them and a lot of times they're very hesitant and we have no shows and we have cancellations and i think a lot of those are from people not able to overcome that hurdle i really do they're just not ready to face the the the facts or open up that can of worms they know it's going to be a whole thing so they just avoid it like we've been talking about um but that is i can hear it in their voice they're they're they're very hesitant to face this this thing head on um so i can i and i get it i can get it it can hold a lot of people back that's a big one for sure what do you think um i'll probably take the cop out answer and probably summarize it as a general statement of fear of the unknown yes or fear of the the devil they do know right and and not feeling comfortable with accepting that there's absolutely nicer devils um and so i'd say fear of the unknown is probably our biggest number one hurdle

Part 866:09

i know that's a total cop out because it's not on there and it covers everything it's true um but the it's such a multifactorial yeah problem but it's it's it's personal and everyone has to go through their own journey and you know not to plug the the podcast necessarily but that's the real reason why we have this here right is the idea that you can do research and you can go as deep in this as you want to go with transparent answers or we try to be transparent about everything the reason why this exists is not to get a thousand ten thousand a million followers it's not to become a celebrity of youtube it's to be able to get out so much content that it would be unreasonable for a person to sort of not be pacified by the amount of content he totally fine to still have fears and holdbacks and doubts and concerns but we want to be at least able to cross off every single thing that you could possibly cross off prior to yeah and do it in the comfort and privacy of your own home you don't have to go to a forum you don't have to raise your hand and ask a question in front of everyone you don't even have to face a dentist to get a lot of these answers that's the the dissemination and the reduction of that fear of the unknown is really the primary intent of this yeah for sure i think that's a really good point of everything i feel like yeah the podcast but but the website and the consultations like that fear of uncertainty is is real so any amount of that we can alleviate is you know that that's that's what we're trying to accomplish here we want more people to receive this that need it than we do necessarily need the likes or the patience in our own chair and we talk all the time one thing that bothers me is we talk all the time and we talk all the time and we talk all the time about our procedure because it's what we know um i feel like this next in this next year we should make a focus to bring in the other types of procedures because the real focus of this is to hopefully be a resource for literally any patient going through any different uh dentists or group dentist protocol whatever it may be it's i genuinely want this to be a resource for people yeah so that being said thanks for joining us guys thank you uh and we will see you next time and uh hopefully have a good topic to discuss just like this one this was a good one okay thanks everybody thanks take care