Episode #430: Rethinking Endodontics – A Systematic Approach, 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.” (5:41—5:44)
• “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.’” (6:54—7:19)
• “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.” (7:20—8:00)
• “[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.” (9:22—9:44)
• “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.” (12:39—13:12)
• “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.” (14:32—14:44)
• “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 on tooth number three that's been accessed and perfed right through the furcation — with no warning to me, whatsoever. So, how do you manage something like that? Well, very gently. We communicate with the patient what's going on. We don't tell the patient, ‘Oh, your dentist put a big hole in your tooth,’ because that's going to damage relationships. We say, ‘Hey, there was some damage that occurred during some of the treatment. Don't worry, we repaired it for you,’ and we frame it in a way to try to make everybody look good in the end.” (14:47—15:21)
• “There's no secret to doing great root canals, by the way. It’s just practice, repetition, and volume. Just sit there and learn how to use the instruments. You can't play Beethoven on the piano by just reading a book. You've got to practice. Endo is a technical skill that needs to be learned.” (17:32—17:47)
• “You can separate endodontics into two categories: the science and the mechanics. I've taught my 13-year-old daughter and my wife to do a root canal. They have no training in the science, whatsoever. But then again, on the flip side, you can know the science backwards and forwards and hate doing root canals. So, we have to look at that dichotomy here with what we have. So, if you want to get better at doing root canals, practice on extracted teeth. If you want to get better at understanding the science, read the literature.” (17:48—18:14)
• “What I've noticed over the last couple of decades is the type of patients that we see are generally the type of personality from the referring dentists that refer them to me. And it’s a very, very strange thing. So, I'll try to understand or read a patient, if you will, and say, ‘Well, I think you'd be a good match for Dr. X. Or maybe you'd be a good match for Dr. Y.’ And the reversal referral system works really, really well for us too.” (19:46—20:12)
• “When people move to a new community, across the state, across the world, I always tell them, ‘Call your local endodontic clinic and ask for a referral to a general dentist, because we know who to send you to and who not.’” (21:00—21:11)
• “Becoming a healthcare provider, a doctor, dentist, physician, whatever you want to call it, it’s a calling in itself. You have to be wanting to help. You're a healer. Within dentistry, the niche of endodontics is a much deeper calling. You've got to really, really love it — to really, really want to do it. And that's what's given me my satisfaction and validation over the years, the fact that I just really, really love it. I live, I eat, I breathe this stuff.” (21:46—22:13)
• “Are specialties dead? No. I think they're just beginning. I don't think that they're dying, whatsoever. The pendulum always swings in both ways. We look back 10 years ago, 15 years ago, when I was just new to endodontics, everybody was telling me that endo was dead, and implants were going to take over. But hey, we’re still here. And so are implants. So, I don't think it’s dead. I think that you really have to love something wholeheartedly to want to do it all the time. And that's the secret to becoming a specialist, is really put your heart and soul into it and be the best you can at it.” (22:39—23:12)
• “The patient is one of the biggest variables in our long-term success which often gets overlooked.” (28:43—28:48)
• “Understanding is my biggest message. And unfortunately, endodontics is drastically misunderstood because we don't get enough training in dental school, because training in anything is based on understanding the domain knowledge over time. And that's what I'm trying to do with my second half of my career, is helping people really systemize the domain knowledge to help fill in those gaps that dental school didn't teach us.” (29:10—29:35)

Snippets:

• 0:00 Introduction.
• 1:50 Dr. Nudera’s background.
• 5:07 Why he teaches his secrets.
• 6:17 Communicate well to manage your patients.
• 8:02 Doing it for the better good of the community.
• 9:44 Dr. Nudera’s biggest aha moments.
• 13:12 Communicate expectations with patients and specialists.
• 16:18 Practice, repetition, and volume to get better.
• 18:17 Work with people whose value systems line up.
• 21:13 Advice for younger dentists.
• 23:30 The future of endo.
• 25:30 Marketing for endo.
• 27:55 Last thoughts.
• 29:39 About Dr. Nudera’s book.

Reach Out to Dr. Nudera:

Dr. Nudera’s Facebook: https://www.facebook.com/NuderaEndodontics

Dr. Nudera’s social media: @nudera_endodontics

Resources:

NuEndo by Dr. Nudera: https://www.edrapublishing.com/home/552/nuendo-rethinking-endodontics.html

Dr. William Nudera Bio:

Dr. Nudera was born and raised in Aurora, Illinois, and is a graduate of Marmion Military Academy. He attended Augustana College in Rock Island, Illinois, majoring in the Biological Sciences. Dr. Nudera attended the University of Illinois at Chicago College of Dentistry where he received a Bachelor of Science in Dentistry in 1997 and a DDS in 1999.

Dr. Nudera is a veteran of the United States Air Force, where he served as a Captain in the Dental Corps for three years. During his time in service, he completed an Advanced Education in General Dentistry (AEGD) Residency at Wright-Patterson Air Force Base in Ohio. In 2001, Dr. Nudera was named the Air Force Material Command’s Company Grade Dental Officer of the Year for his dedication and commitment to his profession. In 2002, he was awarded the National Defense Service Medal.

Following his service, Dr. Nudera returned home to Chicago. He once again attended the University of Illinois at Chicago where he completed his advanced specialty training in Endodontics and obtained a Master of Science in the Oral Sciences.

Dr. Nudera has been appointed as an Endodontic Advocate and Key Opinion Leader for Dentsply Tulsa Dental Specialties (the leading company in endodontic product development). This appointment allows Dr. Nudera to speak both nationally and internationally on a variety of endodontic-related topics.

Dr. Nudera is a Diplomate of the American Board of Endodontics, as well as an active member of the American Dental Association, Chicago Dental Society, Illinois Dental Society, and the American Association of Endodontists.