Virtually all dentists are intrigued when endodontic post-treatment radiographs exhibit filled accessory canals. Filling root canal systems represents the culmination and successful fulfillment of a series of procedural steps that comprise start-to-finish endodontics...
Best Sealer & Best Dental Team Kerr Pulp Canal Sealer EWT & Hiring Staff
This show opens with discussing the upcoming Super Bowl LV and how it will be especially unique this year. Next, Ruddle reveals his sealer of choice, its benefits, and why it is the best. Ruddle and Lisette are then joined by Phyllis Ruddle, human resources expert, to talk about hiring the best dental team. To close the show, enjoy some lifestyle footage of Ruddle and his family utilizing the new gym at The Ruddle Show studio.
Show Content & Timecodes00:09 - INTRO: Super Bowl LV 03:49 - SEGMENT 1: The Best Sealer 31:13 - SEGMENT 2: How to Hire the Best Dental Team 50:00 - CLOSE: Lifestyle - Ruddle Gym
Extra content referenced within show:
Extra movie/video content:
Downloadable PDFs & Related Materials
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Phyllis' Aptitude Tests "Answer Key" for Hiring Employees
This transcript is made available by The Ruddle Show in an effort to share opinions and information, and as an added service. Since all show text has been transcribed by a third party, grammatical errors and/or misspellings may occur. As such, we encourage you to listen/watch the show whenever possible and use the transcript for your own general, personal information. Any reproduction of show content (visual, audio or written) is strictly forbidden.
INTRO: Super Bowl LV
Welcome to The Ruddle Show. I’m Lisette and this is my dad, Cliff Ruddle. How are you doing today?
Are you getting excited for the Super Bowl this Sunday?
I am. After all 55 of them, of course I am, and I’m ready to watch the pigskin fly!
Yes, it is Super Bowl 55 and for our international viewers who might not know this, it’s the annual championship for the National Football League, and it’s usually played on the first Sunday in February. And since 1967 when the first game was played, the Super Bowl has pretty much become an American icon and is celebrated with social gatherings, cookouts, and excessive alcohol consumption.
Yes. So, this Super Bowl though is going to be a little bit different. Why don’t you start off by telling us why.
Well, we’ve got the Tampa Bay Buccaneers and we’ve got the Kansas City Chiefs. The Kansas City Chiefs were there last year, and what’s interesting is they have this kid who last year was 24, now he’s 25, and he’s already got a Super Bowl, he’s won one, and he’s going to be playing against Tom Brady who has been in 10 Super Bowls, won six Super Bowls, and he is 43.
Patrick Mahomes is the –
We just call him “the kid.”
Oh yeah, the kid is Patrick Mahomes.
Well, it’s also an unusual Super Bowl because it’s the first time that it’s going to be held in the stadium of one of the competing teams, so it’s going to be in the Tampa Bay Buccaneers home stadium. And the location is generally chosen like well in advance, generally in a warmer climate, but it’s just never been the case that a competing team has had like – that the Super Bowl has been their home game.
Yeah, it’s interesting though. The State of Florida, this will be their 17th Super Bowl hosting because of the warm weather you talked about, the 17th.
Yeah. So, I guess they’re also letting in healthcare workers, right?
Yeah, there’s about 66,000 fans. They’re going to let 22,000 in because of COVID, and then out of those 22,000, 7,500 are getting free admission and they’ve been vaccinated, and that was a gesture from the NFL to people who had gotten vaccinated, and they’re special people, they get to come to the game.
Yeah, I also heard like they’re giving everybody hand sanitizer and KN95 masks and all that.
Hell, I almost went to the game to get vaccinated!
I guess they’re thinking that the ticket sales are going to go way up this week because of the more limited seating, and usually there’s people that try to resell tickets like at the last minute, so they think it’s going to be maybe the most expensive seats ever.
You’re describing a scalper.
I guess. Okay, so we’re excited about it. We usually watch it together, but maybe not this year. Maybe we won’t watch.
Ever since you were born, we’ve watched Super Bowls together, so on Sunday I know we’ll be watching the game.
Okay, well we have an exciting show for you today. We even have a special guest who you will see who it is shortly. So, we’re excited. Let’s get going.
SEGMENT 1: The Best Sealer
You know, today I’m going to talk about something that I rarely talk about. When we talk about obturation, everybody goes do you do this technique, is it vertical, are you using a carrier-based obturator? Is it a single cone, is it a squirt technique? And then we assume and use your sealer. So today, the producer asked me to actually talk about sealer in endodontic obturation, and I’ve actually never made that lecture before on just sealers. So, here we go. This will not be a comprehensive piece. Obviously, there’s a lot of chemistry, physics, and different things we could look at, and all the leakage studies and stuff, but this will be a quick, clinical overview of the importance and the rationale for sealer and endodontics.
And when you look at Paque’s work, Frank did micro CTs and he shared a number of these with me. But when you look at this, it’s obvious our files are going to touch small amounts of the root canal space. It’s obvious that if we use a solid, semi-solid material like gutta percha, it’s going to fit into the shape canal, and it won’t be touching even closely the preponderance of the anatomy that’s inside these teeth. So, we’re going to need to have some sealer, and we all know that, and sealer is actually what affects the seal.
So, with this rationale, let’s get started, but we can also go back and have the same rationale even from the early 1900’s. You’ve seen this book a thousand times, but as I tell everybody, this is the foundation of everything we do in clinical endodontics. So, I do not mind coming back to old material because it is a foundational philosophy that everything builds upon.
So, can you imagine the webs, the anastomosing, the fins, the cul-de-sacs. Okay, lateral canals, how are we going to get those filled? We’re going to need a sealer. You know in 1935, Louis Grossman came up with his own sealer. He made a sealer and worked with a commercial company and made Grossman’s Cement. All right? And out of that he described the characteristics and traits of an ideal sealer. And so, you’ll know everything to this moment in time today we still talk about the ideal requirements of a sealer according to Grossman, because the requirements are just as relevant today as when he wrote them and published them in 1940.
So, we need to have a really tacky material. It needs to adhere and have good adhesion to the walls. It needs to seal the root canal space. It should be radiopaque so we can see it radiographically. It should be well tolerated. We’re going to get extrusion or what Schilder described as surplus after filling. Get the distinction, not surplus and underfilling, but surplus after filling, so we would like to have it tolerated well and not be cytotoxic. Bacteriostatic, it should be a cement that tries to kill bacteria or residual organisms, because I don’t think we get every one of them out; do you? So, if we’re going to have them entombed, wouldn’t it be good to have it be bacteriostatic?
Finally, the material should be stable. It should be biologically inert, and it should not be carried away rapidly through resorption. In the retreatment situation, Grossman recognized even back then that not all endodontics works, and when it doesn’t work, we do oftentimes retreatment, whether it’s non-surgical or surgical, and we should be able to readily remove the cement, unlike the tri-calcium sealers today, okay? There are no real solvents that are miscible in your tri-calcium, which is commonly known around the world as BC sealers.
And then if it is in the tissue, we would like it to be insoluble, which is a little bit of a take off of we wouldn’t really want it to be, you know, tissue tolerant and we don’t want it to be insoluble. So, we want it to be non-cytotoxic and we want it to stay there. Many of you get a puff of cement and you were trained, you know, that was bad. And so, you look at the puff and at six months on the recall, you’re so excited when the cement is gone, but if you really think carefully, if it’s being carried away out of the bone, associated with the portal of exit, maybe it’s starting to wash out of the portal of exit and open up the root canal system to secondary leakage, and that means inviting longitudinal failure.
So, make the connection. Schilder was Grossman’s student. Schilder was in Philadelphia. Schilder was there when Grossman was describing and making all this stuff, and he came along as a student and he worked with the Kerr Company and he worked to invent Kerr Pulp Canal Sealer. Schilder had graduate students and for years and years they did their two-year master thesis and it’s in the BU library, but a number of his students worked on the chemistry so that they could have an optimal sealer. So, they enhanced the sealers that were available in that day. They wanted it to flow better. They wanted it to be more archival and not resorb. They wanted it to be thixotropic. Okay, thixotropic. In other words, I’ll describe that in a little bit.
But this is what Schilder was doing even in 1960. Notice, filling the root canal systems. Notice, filling the root canal system. Schilder used to say, as you get away from the heat source, the gutta percha will move a little bit laterally, but probably the rest of this could be sealer. So, like a car engine where you have a piston and a cylinder block, as you get a piston of guttapercha moving, it will drive sealer in front of it and get the hermetic seal. So, I wanted to acknowledge Schilder because of the Kerr Pulp Canal Sealer, and I wanted you to know he’s Grossman’s student.
So, this is what Schilder did with the Kerr Company. You can get Kerr Pulp Canal Sealer with and without extended working time. You can just get regular Pulp Canal Sealer, or you can get extended working time. Extended working time will set on the bench in 30 minutes, very fast by today’s sealer standards. Regular Kerr Pulp Canal Sealer, it’s about 15 minutes on the bench, thus require the sealer goes inside the body, that’s 37 degrees, there’s humidity, it’s going to set even faster.
Okay, so it’s a rapidly setting cement. Schilder recognized there would be the Schilder puff, and he didn’t want runny cement sitting out on the bone taking hours, if not days to set up. That creates a whole cascade of pathological events called inflammation. So, if we can have our cement rapidly set, it becomes biologically stable and it is going to allow healing to begin. So, it’s a eugenol, you have a eugenol-based liquid and then we have a zinc oxide powder. The powder/liquid ratio, so the powder/liquid ratio manufacturer says is 1:1. Let me make these big so you can see them, 1:1. So, when is it 1:1? Longer systems, narrower systems, and more curved systems, 1:1.
But if you’re in something that is different, it’s shorter, wider, straighter, you can take two shovels of powder, two shovels of powder to one drop of liquid. This is perhaps the only sealer left in the world where you can change the viscosity based on the clinical situation. I like that flexibility. And there are many other advantages. Now I’m going to go through this, not now, but I’m going to have a case or two with each one of those, say a sentence or two, and then you can come back later and re-watch this movie and you can jot these down and you’ll begin to see why Ruddle uses this over the fast people going into that BC sealer world, oh they delve into the pool, it’s like a resilon, a hydron, come on you guys, you know there’s deficiencies. You can’t remove it.
So, why don’t we use a sealer that has what? 60 years of research, how about that, not five years, 60 years. I know you don’t like watching it mix, but I thought you’d like the gloved hand of the assistant. It’s quite nice, right, with the gloves and the nails. You see the nails? Nice nail care on that. Anyway, in this case, you want to have your powder out, and then you put some drops in, maybe 1:1. Some of these we’ll put a little liquid over on the side in case we need to incorporate a little bit more.
There is research and scientific papers that show even how you spatulate it, using a very firm, vigorous motion, use a big part of the pad and feather it out, and you’ll make it set even more rapidly, which means less resorbable, more archival. And it’s just better. There’s even a lot of ideas even in the mixing. You want to mix it so when you pull it up, it suspends about an inch or two and doesn’t go rapidly crashing back down to the pad. That would be too runny and too loose. So, you want good body, good viscosity. Oh, that’s a thing of beauty. See, we got this great verticality here, yes, we’re going up maybe a couple inches, yes, very nice.
So, how do we deliver it? Okay, if you’re using a carrier-based obturation method, all you need to do is pick up a bead on a straight explorer and streak it around the orifice, that’s it. Just like a window washer uses a squeegee to dry the window, this warm gutta percha is going to squeegee and capture that sealer and drive it into the complexities known as the root canal system. Intricacies, webs, fins, lateral canals, bifidities, it’s the hydraulics. The carrier has the internal plugger, so the carrier is a plugger with gutta percha and you can do it in seven to eight seconds.
So, everybody can do three-dimensional obturation. I did my research on this at Harvard back in the 70’s, not CBOs, but just the adaptation of warm gutta percha to walls. You can break off the carrier. You can see that you’re going to have that gutta percha wall to wall and you’re going to have a sealer interface of about six, seven or eight microns. So, it would be like reading a newspaper. You could read through the sealer and read the print on the other side, very thin.
So, one way we can deliver the sealer is with a straight explorer streaking the orifice. If I’m going to fit a cone and I’m not using CBO, then I’m going to sputter coat the walls with the endo-activator. So, I can use the endo-activator and a tip like this one, and I can just pick up a bead like you would on an explorer on the endo-activator tip and just sputter-coat the walls, a very efficient way to distribute lightly a thin coat of sealer below the orifice.
So, if you look at the actual clinical footage, not the animation, you bring it out of the oven and two, three, four, you count to seven, you got it home. If you’ve got swing space, you could break the handle off, and we can go around the horn and get the rest of the system. If you already have sealer in these two, these two oftentimes have communication back and forth, anastomosing, webbing and stuff like that, and then we can go ahead and just cut to the recall. That’s carrier-based obturation. Furcal canals, multiple portals of exit with all the roots.
So, sealer, we’re talking about the rationale for sealer, and it’s just not any sealer, it’s a sealer that was made specifically for warm gutta percha. Most of the sealers aren’t. Try taking a hot instrument and plunging it into bio-ceramic sealers. It bubbles. Try doing it in resin sealers. It bubbles. Calcium hydroxide, forget about it. I just gave you three of the four family of sealers. Resins, calcium hydroxides, okay, tri-calcium silicates, that’s the, you know, the rage, that’s the big rage today, and of course, zinc oxide eugenol.
So, and another way to deliver sealer, we’re talking sealer, deliver sealer, is you have a wet canal, you dry the canal per usual, you butter the cone, you butter the cone in the sealer, just lightly, and cement the cone. You’ll see similarities that maybe you’re a little devoid, but as you start packing down with the heat and you put a little pressure with the selected pluggers that you’re using, you can load this material laterally and vertically and you can get sealer driven into all this anatomy down here.
So, if we just pick up the last wave of condensation, how do you deliver sealer, what sealer are you going to use? You’re going to come in with heat, you’re going to get a heat wave all the way to the end of the root. Now when you come in with the plugger, step, step, step, step, circumferentially around the canal, make a platform and press. The five-second press loads the material and drives it into all aspects of the anatomy that’s been actually cleaned out. Oh, cleaned out.
Okay, now this is pretty interesting. Some of you go well Ruddle’s been doing this for almost 50 years, you know, we see a lot of the same cases, so this time you’re going to see a lot of new cases that we put in. Sometimes we show new cases. Sometimes I like old cases, because I can show you 10-year, 20-year, 30-year, almost 40-year recalls. That lets us know about the sealer, okay? So, when you look at that, that’s like a capillary bed. What kind of hydraulics would do that? What kind of loads? You got anatomy in here, multiple portals of exit, but that looks like a labyrinth.
So, in one slide we can look at nine apical one-thirds, but what you see everywhere is thin, little shapes because of thin roots, multiple portals of exit, and highly curved systems, a labyrinth. Who even knows what’s going on? Loops, bore heads, multiple lateral canals, mid-mesials, lateral canals, lateral canals, bifidities, this is the world you live in. And so, if you start using something like the endo-activator, you can clean it out. If you start using a good sealer and a low load, you can pack in about 10, 15 minutes. You can pack a four-canal molar, and you can start seeing the thrill of the fill.
So now let’s go through that big list very quickly. You might want to have variable viscosity, because sometimes we have really long systems. Sometimes big, long, sweeping curves. So, you make your access, you fill a furcal canal and look at that distal root. That distal root has one, two, three, four, five, six portals of exit, seven, eight. Okay, so mix the cement based on length, diameter, and curvatures and re-curvatures.
Next, flow. We need a sealer. Schilder made the sealer with the Kerr Company to reduce the flow so he could get it into the micro anatomy. When you start packing down on these mandibular bicuspids, it’s the anterior abutment of the bridge; it’s a significantly strategic tooth, and look at all the anatomy. I don’t even know how many are there. And we won’t take time to count. But you need to have flow. You need to be able to load the material, either with an internal plugger, CBO, or with an external plugger, vertical condensation, and you can deliver your sealer into the anatomy.
Heat activated. This is that property called thixotropic. What that means is when you load a material, when you heat a material, it gets decreased viscosity. That means it can flow better. This is one of the only sealers that is thixotropic. You’re going to love it! Try it and see it because sometimes, like this is the bone in here, I’m subcrustal, there’s the orifice, I’m subcrustal, and this thing takes off and goes for millimeters and in the more mesial view, it has its own separate apical portal of exit, so you can drive sealer millimeters and millimeters because it’s thixotropic. Try saying that several times. Sets fast.
You know, this is bigger. This portal of exit right here, it’s bigger than where I instrumented to. It’s a lateral canal that’s probably resorbed and blown out. It’s massive! And when I pack it, there’s a sealer trail up to the sulcus because it probed pre-treatment, but it was a necrotic tooth. We’ll get into the show and we’ll talk about Endo-Perio and their interrelationships. But right now, you want it to set fast because there’s saliva, and this is a two-way street, and you don’t want to end up with an infrabony pocket, so you need to set fast, because healing begins two hours after cleaning and shaping and packing, two hours, two hours.
And if you have this patient back it’s thrilling. I hope I can get you excited. I mean just filling the anatomy is so much fun, and then when you see the bone, when you see the bone rise up to the surface, and when you see it kind of level out here, actually, it’s right in here, but when we see it kind of level out and you see what we had here is a big vertical defect, a three-wall osseous defect, then, of course, endodontics makes a difference. And you want it to set fast, because you don’t want saliva and then the pocket remains.
Non-cytotoxic. I like to show this to scare the Hell out of you. You know, when I used to show these cases in the late 70’s, people go oh, that’s too big, it’s just too big, you can’t have this kind of surplus. That’s surplus. Yep. You know what it is? It’s surplus after filling. Down here you see barely a little puff. We can control our apical puffs. We cannot control our lateral puffs. That’s why we mix the cement more viscous sometimes on shorter, straighter, and less curved canals, so you can mix it.
But you can see in any event, notice the bone repair. Recall, as I keep stressing, endodonics is a regenerating procedure. We actually grow bone and properly performed endodontics is the cornerstone of restorative and reconstructive dentistry. So the sealers make all the difference. Keep going through that big list.
Blocks pain. You’re going to like this. When you mix zinc oxide with eugenol, it forms zinc eugenolates. Those eugenolates, what they do is they block prostaglandin and prostaglandin is well known in the pain cycle by causing mast cells to light, which releases histamine. You can block the pain pathway by just knowing the right sealer. How about that? So, you’re going to get sometimes some pretty big splashes. You want to be well tolerated, so let’s use a sealer that the body can heal. Sets in about 15-30 minutes, EWT [30 minutes] vs. regular Pulp Canal Sealer [15 minutes].
Well, non-resorbable. Now you’ve seen this case before, maybe, but the DB and the MB roots have been amputated 25 or 30 years earlier. This is the lone palatal root. Notice the bifidity known as the loop, but notice the lateral canal to the base of the pocket. Endodontics has to seal the root canal system, not just the mother canal, not just where you put your files.
We got to also treat the un-instrumental portions of root canal systems. Well, when you put six units, a six-unit splint, canine, bi, second bi is gone, palatal root, first molar, second molar, third molar, when you do all this kind of work, your endodontics has to be successful, because the foundation is the endodontic abutment, and then all the restoratives are built on top of that, so we really have to have an eye towards good work, solid work, archival work.
Adhesion dentistry. Some people say well, you know, you can’t use a eugenol clip and have any expectations that you’re going to be able to bond. And we’re in a day and age of like what are we on, like fifth, sixth generation adhesion dentistry products? Well after you pack a case, we’re not going to talk about the treatment, I’m going to suggest squirting with your gun, your gutta percha gun, squirting, you know, with a canula. You can squirt gutta percha in warm, thermal softened gutta percha. Now when you cut the cone off, and now when you commence with your down-pack, with your plugger, guess what, you’ll get hydraulics.
You can see the down-pack if you look really careful. I’ll erase it. But you can even see a little impression right here for my plugger sunk into that big thermal mass, and I’m driving that material laterally, vertically, and I’m filling the root canal system, but how do we manage this space? We’re going to do bonding. So, take Xylol or chloroform, either one is a solvent in gutta percha sealers. They’re miscible in the solvent. And you can take Xylol on a cotton pellet and flush out, clean the internal aspects of the pulp chamber and even down below the orifice if you are going to post, okay?
So, the first thing is Xylol. And you do that with a cotton pellet that’s saturated. Maybe do two cotton pellets. When that’s pretty clear, in other words, it’s not pink or grey like Kerr Pulp Canal Sealer, then use 70 percent isopropyl alcohol, OH for alcohol, and that will remove the precipitates of chloral-percha if it’s chloroform or with a Xylol, and it will remove those precipitates, and many textbooks have shown the resin tags in dentinal tubule, so you can definitely do adhesion dentistry. So, don’t give up a world class sealer because somebody told you in a lecture, that was a restoring dentist no doubt, well we’ve moved now over here to our resin cements like AH Plus or we moved over here now to BC sealer because, you know, we can now bond.
Well, there’s the world that is and there’s the world we see, and they’re not always the same, are they, especially when there’s too much misinformation. So, you can see we can do great adhesion dentistry.
And I’m just about done, but we want a sealer that is reversible. I have said this for decades, but 90 percent of my practice for years and years and years was redoing other people’s work. That means I had to do a lot of disassembly, and when you do disassembly, you got to get those old materials out, whether it’s a silverpoint, a carrier or gutta percha, not pace fillers. Those require a solvent. So, when we see all the BC noise and we hear all the euphoria, they just haven’t gotten to their cycle of retreatment, and they like to show a little straight plastic block that you can get it all out cause you can get out the gutta percha. Come on! If they’re even thinking about anatomy, they’re not round little tubes, are they? They’re systems. Say systems.
So, you get out the silverpoint, the gutta percha, the old Grossman type sealer that was placed, down-pack, get that way the rubber going right up in there and dry that material laterally and compress that sealer up against those walls and get that 6, 7, 8, 9 microns and backpack and watch the bone work over many, many years. So, it’s a reversible procedure.
Okay, I hope you’ve learned a little bit about sealer. I’ll let you go to the web and punch in the Kerr Pulp Canal Sealer and start learning more about the chemistry. There’s some really great articles that should be very encouraging to you. I would say the only negative is you have to mix it. You have to mix it. And you have to have a lot of spatula pressure, and you’ve got to have an assistant, you know, that has Nautilus arms so she can really crush that, get a thin layer, nice and smooth and creamy, put it inside your canals and start watching the anatomy pop if you give that material a little load during the cooling cycle. I hope this has helped you fill root canal systems.
SEGMENT 2: How to Hire the Best Dental Team
Okay, so today we wanted to talk about hiring staff for your dental office, and so things to consider to maximize your dental team. Because to be an excellent clinician, you need to surround yourself with an excellent staff. So today we are joined by my mom, Phyllis Ruddle, who is going to help us with our discussion today because of the large role she played over the years in hiring staff in my dad’s office. So, welcome to the show, Mom.
So, I understand if I was looking to work in Dad’s office, that you would be my first person that I talk to. So, what would I do? Just drop off a resume?
If you have a resume or come in and fill out an application, and we always maintain a current legal application that I would get at the local office supply place, because it would incorporate all of the California laws.
So, say you thought I was worthy enough from how I filled out the application to possibly work in the office, then what?
Then set up an interview time to come in and take my tests.
Now I understand that – could you tell us a little bit more about these tests?
Well, let me go back to the beginning. Somebody thinks everyone is wonderful and nobody lies, so it became obvious after one fairly disastrous hire that –
– they’re not all wonderful, and he needed somebody to kind of weed out the good ones and the shaky ones. So, that’s when I came up with my little routine of my tests and just ways to find out about people and kind of put a picture together before he got to meet them.
Well, let me show you some examples of these tests that she has. Here we have a spelling and a vocabulary test. Then there’s an arithmetic test. And this I – oh, this is a typing test and here we have a writing test. So, we’ll have these in our show notes, and we’ll also have the answer keys too, so you can check your work if you want to do that.
See how smart you are, see if we would hire you.
So, did anyone ever refuse to test?
I had one lady who came in with her resume. She had been in the business for many years, was well trained as a front person, receptionist, insurance, she had all of the qualifications, and that was fine. And I just said, you know, this is my little routine, it’s just a very simple – takes you 10 minutes. I want you to take the test like everybody, and she said, “Absolutely not! I’ve been in town forty years and no, no test.” I said, “Well it’s been nice seeing you.” And she left.
So, it’s not –
Was it bye-bye?
So, it’s also willingness to take the test was part of the test. So, I guess we would maybe now have a little different test, you know, for the modern-day dental office.
Maybe like testing computer skills or computer knowledge, maybe a proofreading test instead of a typing test cause everyone types now, but I do see a lot of errors in emails and stuff.
It isn’t as important as it used to be.
So, what would be – what would you say when you were interviewing somebody? What would you say would be your priorities?
Priorities would be willingness to work with a team, and we had a lot of systems and structures that a lot went into that to make things run smoothly and efficiently, and I needed somebody that was willing to at least listen to how we were doing it and be part of the team before diving in and wanting to change everything. So, that was a high priority. And we actually hired a lot of girls over the years who had no experience, either at the front or assisting, and we’d train them to fill into the positions, or would have other staff members help train. And we had really good success with that. And presentation, obviously, is important. Honestly is probably one of the highest things we required, because if they’re not honest about anything, they’re not a good team player.
You know I just actually read something about Elon Musk that the one interview question that he asks everybody to test their honesty, and I guess he asks them to talk about some problem they were confronted with and then go into detail about how they solved that problem, and he could tell right away, like if you don’t go into much detail, then probably you’re making it up and lying. Like he could tell by the amount of detail that they gave.
Yeah, that is.
What about you, Dad? Cause I know you interviewed assistants a lot that were going to work back with you, what would you say your priority was?
I would say the most important thing was enthusiasm, willingness to learn, well I’m a male, but appearance was very important to me. I want to be around people that took care of themselves and had good energy and they were outgoing and if they were willing to learn, then everybody is coachable, and you can make an all-star. So, that experience was fine, but what’s your line about experience?
Bad experience is worse than no experience.
Yeah, so a lot of times you get somebody that’s been out there seven or eight years and they’ve even been saying an endo office.
Hard to reach.
But a lot of times, their endodontist did things so different than me that I was untraining, breaking their game apart to reassemble a new game, to have the right person. So, we used to hand out cards around town, on the airplane, airports and just say we meet some incredible person, if you’re looking for work, here’s my card.
Now I know that both you, if I would ask you both, and I’m going to, but if I would ask you both what deal breakers are, both of you would say know-it-alls. And I know that when I started working for you, Dad, you told me to just do the work for six months, learn everything, don’t ask a lot of – don’t come with me – don’t come to me with suggestions on how we can start changing everything, to wait six months first, that’s kind of the policy you guys had, right?
Well yeah, you’d hire somebody and about the third day, “Dr. Ruddle,” and, you know, “What’s going on?” “I have an idea. I have an idea, a way to do it that would be better.” So, the rule was no damn suggestions for six months. Watch, observe, be respectful, because she probably set up a system and structure that has a lot of thinking behind it. After six months, spill your guts. Tell me everything I’m doing wrong or I could do better, cause I, too, can learn.
Right. So, what would you say are other dealbreakers for you?
If somebody isn’t honest, if they lie about something, and it’s pretty easy to figure that out. I’m never clear why people go that direction, because I’m going to find out, and a number one thing that we had to work on since we were married, people come into the office with a pre-assumption that I’m the wife, I’m going to be a problem.
You were a problem.
And that’s actually common. A lot of dental offices, the wife is the manager in a lot of dental offices.
Yeah, and it varies with, you know, hygienists assisting, running the front, just doing the books. You know, sometimes they’re just sneaking in the back door, but I was always fully involved as a team member, and so we had to always have that conversation with anybody we were hiring that it’s okay, we’re a team, and if it’s a technical thing about patients or all of that part of the business, you talk to him. If there’s anything else, you talk to me. And if they would sneak behind my back and talk to him, I always found out, and we had to have a little conversation the next day about the right direction to go when you had a problem.
Which is actually just bizarre for me to even think about, because if I thought – think back too when I was a kid if I did anything wrong, I’d always go to you first and not go to dad. I mean unless I wanted to get really in trouble. You know, I’d go to the buffer first. So, you know, I’ve heard you guys say a couple times, “team,” the word “team”, and I know that your staff was pretty much like a team and that even if you weren’t – like for me, I’m not good at everything, but there’s a lot of areas, like customer service maybe isn’t my strongpoint, you know, so but you guys are really good at finding what a person is good at and putting them more into that area and –
– you know, maximizing their potential there, instead of having someone in a position where they’re going to struggle all the time. So, I think that’s kind of how you guys ran your office.
Well, I always go to sports, as you know, growing up, but in sports, you can have terrific players like by themselves in and of themselves, but when you put five people together in basketball, can people give up the ball a little bit more, can you sacrifice for the better good of the team? So, staff has to come in and realize it’s a functioning office, and that was a good point you made, cause you always want to hire to your greatest weakness because then you’ll get the right people.
And then you put a lot of effort into these people and cross-training is huge, because at some point there’s not the luxury of having people standing in the sidelines ready to come in, in the sports analogy, to come in because Patrick Mahomes broke his leg. I shouldn’t have said that, bad luck. Anyway, you want people that can assist and can fill in at the front desk and you want no egos. They need to be able to do different jobs, bathrooms, floors, everything.
Right. I do remember that, like when I started working for you guys, that it was like we all are going to participate in cleaning the office, we’re all going to be janitors, we’re all going to answer the phones, we’re all going to just do all the various jobs.
No primadonnas. That was the number one rule in front and back, no primadonnas.
The number one rule is just win, baby.
Okay, so besides just basic skills, is there anything that a new employee could bring to the table that you would look at as wow, this is just excellent that they know how to do this? What about you, dad? Or mom, you want to start?
I’ll start. An important thing I discovered when I got more involved every single day in the office, not everyone is good at technical stuff, and that’s fine, but there’s usually one person on the team that can talk to the repair guy who comes by.
Oh, very good.
To fix the handpiece that broke or the air or whatever. A lot of them will just say, yeah, he came. And you’re going, “And?” “Well, I don’t know; he’s gone now.”
Lisette, the answer is you want to hear, “And they fixed the O-ring.” And then you’re going, “Oh, okay.”
Now we started a little booklet, a repair booklet, that they would make notes in, and there was always one person on the team who would was the best at doing that sort of thing. So, I was personally, being in computers and stuff, I was always looking for that kind of a person who could kind of step outside of their role as receptionist or assistant, that they knew they could step into the IT part.
Yeah, I think – we live in Santa Barbara and our community is about 50 of 60 percent Hispanic, so it would be really good if somebody who applied for a job, they could speak another language, as an example, Spanish. That would be very helpful.
And you know, some people are good at working with ordering supplies. They’re detailed. They get the best price, you know, they shop. So, yeah, you hire these kinds of people and then get out of the way and let them flower.
Some love talking on the phone; others were terrified of the phone. I was not a phone person, so I loved the ones who loved talking on the phone. I could have them do all the phone work, because that wasn’t my strong point.
So, I assume you guys checked references?
That’s something that you didn’t just skip over ever?
No, I always called, and I always would listen and kind of read between the lines, because obviously if they’re listed as a reference, they’re going to say good things.
Reading between the lines means simply this. Somebody can work in your office or another office for 25 years and they’re now in your office and they’re applying for work, same town, one mile away. And you call the person up, a dentist, and he or she says, “They were fabulous, they were very gifted, always punctual, good appearance, on time, big enthusiasm.” And you’re going, “Well why did they – what happened?”
So, reading between the lines? Yeah, there’s the things I know and there’s the things I don’t know I don’t know.
Yeah, so we would try to debug those kinds of things.
Yeah, I think that – I once heard something that when you first start interacting with someone, like maybe there’s like three or four sentences that are going to just be like very surface, but if you persist in that conversation, you’ll start to get deeper and deeper and see what’s actually happening. But you just have to devote a little more time to it, a few more questions.
And occasionally we would have somebody that just outright lied about the employee, and you wondered later, what happened, you know, so it does happen, but yeah, we would always check all the references.
Okay. Now I know that a lot of you – a lot of you, both of you, keep in touch with your past staff, and I know that they speak really highly of you, and I even remember as a kid when they came over to the house, people saying how great it was to work for you guys. So, why do you think it’s so great to work for you guys?
I think you have to create the environment. It’s a team environment again. I would be with my staff more hours per day than I was ever with you, or with her, literally, so you better get people you enjoy being with, people that can, if Cliff’s feeling a little flat, I get a lot of energy, I get a lot of energy, all of a sudden, we’re going to do it together. And it really is helpful to have that enthusiasm, that infectious attitude that we can do this, come on, come on, Cliff, we can do this.
We became a family, and we would have, you know, occasional parties and get-togethers, Christmas, and we were always very generous with our pay and the benefits that we did offer. We really wanted to take care of them so they didn’t have to worry about that part of their life, and they could just come in and be family and be team. And that’s how we got the most out of people.
You guys had something called Well Pay, which I think is very motivating. What – describe that.
We had somebody that advised us of that idea many years ago, and it was in a time when the health insurance for the small offices had been a great idea, maybe through the 70’s and early 80’s and all of a sudden, it got so complicated it was almost impossible to keep up with. So, he recommended this Well Pay idea, and if they had absolutely no sick day during the entire month, they got paid an extra day of time on their month-end paycheck. And it worked wonderfully. Nobody ever was sick.
Or that you were aware of.
That we were aware of.
Oh, very good.
Okay, so just really quick, cause we’re running out of time, but was there anything that was just not allowed in the office? Dad?
Well, I hate whispering, you know, whispering, you know, when you hear whispering, why are they whispering? Is it about the patient, is it about Cliff Ruddle, are they having a fight? So, I would rather hear every word and hear very clearly in my ear than to hear whispering. So, if you have to whisper, get out of the office, go to the back room, go to the lounge, go somewhere else.
He needs to see a psychiatrist about this. There’s something in his past about whispering that is a problem.
Okay, it was my grandparents. They used to come to the house, and they’d stay for about three or four days and then they’d always smile and joke. They were like in their 80’s and they’d say, “I heard whispering.” And we’d go, “What?” They’d go, “When we hear whispering, it’s time to go, and today we’re leaving.”
Okay, Mom, so if you could think back to the best employee you guys ever had and I know you can’t name names, because you’re still in touch with most of them, and you can’t say me, but if you could think of the best employee you’ve ever had, what would you say are maybe the qualities in them that made them the best?
Probably my favorite quality are the ones who don’t get flustered. It doesn’t matter what is happening on, you know, you’re talking to somebody about the finances or if they’re in pain or whatever it is, and they just handle it. And we had a couple of staff over the years that I would just marvel at how well they stayed so balanced and just, “Okay, did you want to come in on Monday or Tuesday next week?” And it was just like that just never happened, you know, the whole freaking-out thing, and they would just smooth it over and things would move on, and that was my favorite employee.
That’s funny, because actually, that’s the quality I’ve noticed most about you, like how I always say my mom never gets flustered, she just like keeps a really even keel.
Go with the flow.
Cool, calm, and collected would be the three words that come to mind.
Oh collecting. Collectibles, yes, that was important.
Okay, well thank you to both of you and thanks for coming on the show, Mom, and maybe now if you’re looking to hire some staff you have maybe some ideas of what you’re looking for, so thank you.
You’re welcome. It’s great to be here.
CLOSE: Lifestyle – Ruddle Gym
So, that’s our show for today. We’re going to now leave you with some lifestyle footage of my dad working out with some of the family in the Ruddle Studio gym right over there. So, thank you for watching and we’ll see you next time.
[Begin gym footage]
You know, when I was here for the first day, I grabbed one of those medicine balls, and I—because you know when you like throw it down and you like catch it, I threw it down and I wasn’t expecting it to bounce up so hard and I—I throw it down and it shoots back up and it hits me right in the face.
Is this going in the show?
Okay, here we go.
And you do it without holding any handlebars or are you supposed to hold on to down here?
You can either hold on to here, but if you hold on down here, it measures your heartrate which is interesting.
And then, is this your favorite equipment in here?
This is one of them. I also like using the treadmill and then I do core exercises with like a mat on the floor.
I heard that, I think Lori comes here with Noah and does yoga, do you do that too?
I don’t do that. I do other, just like little stretches like after I play. But I do it in my room.
Is there anything in here you never use?
I feel like I’m bad at this, so I want to get better at it. Like, I got kinda frustrated when I’ve gotten on it before, but I need to keep on working at it.
Maybe Papa can show you how it works.
Do you come over here like every day?
Like, honestly like four to seven days, it kinda ranges per week.
Do you come by yourself or do you come with Noah?
I feel like the times I normally come, I happen to be by myself because I’ll go and he might be at the club or mom’s at work or something.
So, Noah, what is it that you’re doing right now?
I’m doing some of the Tom Brady band exercises.
This is actually like reverse rowing, almost.
Yeah. Yeah, I like to do it both ways. So, sometimes I’ll stretch it and then stretch more.
Yeah, you know what, when we work out with our sensi, we always do like, we’ll do pushing up but then he makes us do, like always like the reverse.
Yeah, yeah, I like to do that as well.
What’s your favorite thing to do in here?
It’s like picking between children, I don’t really know. I like—I love all of it. It’s tough decisions.
Is there anything that you do not ever use?
The treadmill, it’s the only one. I like to run outside.
Yeah, me too. Treadmills are a little bit dangerous too.
Yeah, my mom has gone through it a little bit.
[Laughter] Yes, we do that too when we do our weights.
And do you ever like, hold it together and push it out, like that.
Because we do that sometimes.
That’d be something for me to try.
Oh, that’s a good one. That’s the one I did.
Are there any rules in here?
You gotta wipe down the equipment, that’s one. I sweat a lot, so that’s a must for me.
Okay. Do you—when you work out, do you watch that TV over there, do you listen to music?
I watch a lot of tennis and sports.
Okay. While you’re working out?
I always thought it was kinda hard to hear the TV if I was on the treadmill but you don’t really use that.
Yeah, it’s a little similar with the bike, but tennis, you don’t really need to hear a lot.
Especially when the announcers aren’t really talking about the players.
That’s pretty frequently, unfortunately.
And for my physical therapy, when I tore my ACL, so I had to stand on like something that wobbled a lot on one foot and throw that weighted ball back and forth with them and catch it and still—and it was—I used to think that was such a—I made it such a game.
So, mom, how did you end up choosing all of this equipment, did you ask what people wanted?
I did. I asked the family. I was aware of what they were using up at the club. I had them actually pick the types and the name brands of what they wanted.
Like, who wanted the rowing machine?
That is dad.
He had an old one that he thought was too clunky so he wanted a nice fancy one.
So, when you thought about maybe having a trainer—because I know you’re not going to Jesse anymore, right?
No. We thought about once, you know, everything opens up again and I know the equipment people, they have a whole trainer group that can come out and help you learn how to do everything and also Jesse might, but he starts on his favorite direction. So, yeah, we talked about it.
It would be fun if it could be like a group thing, with you and dad together.
So, are you over here a lot rowing?
I’ve done it about three times since the new gym went in five minutes ago.
Do you watch TV when you are here?
No, I look out over that view.
Yeah, it’s a really nice view.
You can see the city and the harbor and the ocean and the islands.
Yeah, you look out that way and you see the city. Or we can, if you want to see yourself, you look behind you.
Yeah, I have to do this **** to keep strong because these young fast followers, these young endodontists, they’re such a big threat, you know, I gotta go faster and really work. Woah. **** [inaudible] awhile.
Dad, is there anything in here you avoid and never go near?
Are you happy with the layout here?
[playing on treadmill]
I like to use it when it’s not on because you can do high knees better. High knees is easier when it’s not moving.
You’re pretty athletic Pops, can’t lie.
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The content presented in this show is made available in an effort to share opinions and information. Note the opinions expressed by Dr. Cliff Ruddle are his opinions only and are based on over 40 years of endodontic practice and product development, direct personal observation, fellow colleague reports, and/or information gathered from online sources. Any opinions expressed by the hosts and/or guests reflect their opinions and are not necessarily the views of The Ruddle Show. While we have taken every precaution to ensure that the content of this material is both current and accurate, errors can occur. The Ruddle Show, Advanced Endodontics, and its hosts/guests assume no responsibility or liability for any errors or omissions. Any reproduction of show content is strictly forbidden.