Rethinking Endodontics – A Systematic Approach

Episode #430 with Dr. William Nudera

No dentist can do everything. There are times when you have to refer. And to make that process easier and more organized, Kirk Behrendt brings in Dr. William Nudera to talk about his book, NuEndo: ReThinking Endodontics. It contains a flowchart roadmap that will guide general dentists and endodontists to have predictability and efficiency with diagnosis and prognosis. Having this book is like having an expert in your office! To learn more about this great resource that will improve your clinical decisions, listen to Episode 430 of the Best Practices Show!

Main Takeaways:

Understanding what you're doing and why is critical.

Communicating with patients and other specialists is key.

Your “crazy” patients aren't crazy, they're just frustrated.

Be clear with patients to make their decision-making easier.

The secret to endo is practice, repetition, and volume.

Quotes:

“Nobody can do everything. Even super dentists run into problems once in a while.” (5:15—5:18)

“It comes down to communication. People, when they come in and they're labelled as “crazy,” they just haven't been communicated to as well enough as they need to be to understand expectations moving forward. So, yes, we get more challenging people — people that need a little more TLC — challenging cases, but our treatment begins the moment I start talking about what we can do, realistically. We lay it down for them in black and white and say, ‘Here are your possibilities.’” (6:29—6:54)

“By the time somebody comes to my treatment room, they have three options: either they do nothing, they make an attempt to save the tooth, or they remove the tooth. And that's it. And when we lay it out like that, they have to choose which risks they want to take, because everything comes with risks. And when we really communicate with [patients] and get to the bottom of why they're frustrated, it’s because no one’s ever told them this before. So, yes, we do get those outliers that some people just don't like to deal with. But when we can manage them, they become putty in our hands and expectations are all in line with what we can do. And not everything we do works. But people really understand that we’re trying and communicating really well with them. So, that's what it comes down to, is communication.” (6:54—7:35)

“[Some dentists] are doing endo for purely monetary reasons. Well, we’ve got to think about this. I mean, what are we really doing here? We’re doctors, right? We’re here to help. So, yes, endo is lucrative. Implants are lucrative. That's why everybody likes to do them. However, we have to have our mind in the right place in order to really render quality care, regardless of which modality we use.” (8:56—9:18)

“Our definition of success is much different than the patients’ definition of success. So, when we talk about endo, we want to think that the tooth’s going to survive for a lifetime. Unlikely. It’s how long can we get this tooth to survive. Because some people are okay with just a few years, apparently. But we want our stuff to work a lifetime. And sometimes, that's just not reasonable. So, again, it all goes back to those communication points, how long can we expect things to last, how much can we control of the treatment, because we’re all at the mercy of biology and our patients.” (12:14—12:46)

“The dentists that I work most frequently with, we always have those open lines of communication. There's never really any question about what we need to do. We’re always on the same page because of a cultivation of two decades of learning each other’s philosophies.” (14:06—14:18)

“Let's take it back to the brand-new practice when I was just starting, when I'd get those referrals, such as complete root canal treatment