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Welcome to The Ruddle Show. I’m Lisette, and this is my dad, Cliff Ruddle. How are you doing?

Great.

I always ask him how he’s doing, and now I’m hoping all of you are doing well, too, and enjoying the start of the new fall season. So, recently, the 12th World Endodontic Congress just took place, and that’s organized by IFEA, the International Federation of Endodontic Associations, and the Indian Endodontic Society.

Uh-huh.

And you were asked to submit an interview where you would talk about the secrets to your success. And this interview turned out pretty special because Mom interviewed you, and it’s really neat to see how you two interact. So, as we’re between seasons right now on The Ruddle Show, we wanted to release this as a Ruddle Show Special Report, so we can share the interview with all of you. So, is there anything you want to tell us about how it was doing this interview or maybe give us any insight before we watch it?

Well, it was a – it’s a kind of interview I – well I don’t even do interviews. I think I’ve done one in Season 1, Show 1, and other than that, I don’t do them because it’s about endodontics for me, but I got roped into a little different venue and that was because of Gopi Krishna, my friend, and Phyllis, who sabotaged me, and together they schemed up a plan and that became the show.

Okay, well let’s watch the interview cause it’s actually very good.

On behalf of Phyllis and I, we’re really happy to be here today and have the opportunity to spend a little time with you. But first, I want to thank the International Federation of Endodontic Associations. I’d like to thank the Indian Endodontic Society and for the organizing committee, there must have been hundreds of people that were involved in a program like this, and we can’t even really imagine all the work that went into it. We recall perfectly we were going to be there in 2020 and it was going to be a physical meeting, so I can only imagine the hotels, the airport, the transfers, the venues, the food, incredible planning and all that – well life happens in-between our plans.

And so, we went to a virtual meeting, like today. So, here we are a year later and we’re still virtual. But we’ll try to make the best out of it we can. I also want to make a special acknowledgement to some people that we’ve lost in the last few months. It’s very sad, and I want to send my condolences, we both do, to their families and their good friends and the colleagues.

So, I’m doing a little different kind of a program today. You’re used to seeing me do technical things on clinical endodontics, but today, I got my arm twisted off by you know who, and one of her compatriots in India, and they schemed up a plan behind the scenes where I was going to talk about me, and that is not the focus ever of my education. It’s never about me. But they wanted me to share a little glimpse of our lives together and some of the things that were the ingredients to success. So, please go easy on me.

Maybe. It was Dr. Gopi Krishna that kind of was twisting Cliff’s arm, and he wasn’t going for it, and so there were some Facebook messages behind the scenes, and here we are. I wanted to tell you a story. Cliff and I have similar backgrounds. Both of our dads were preachers, same church, Seventh Day Adventist ministers, so we moved a lot growing up. So, I decided to do a calculation of the places that we had been up until meeting, and we came up with, between us, a total of – by the time we were 19 when we got married, a total of seven different states, 32 different houses we lived in, and when I say “house” I mean dormitory, trailers for me, houses.

Was there a teepee?

No teepee. And we attended 14 different schools by the time we got out of high school. So, it was quite a journey, and we moved a lot and ended up at the same private boarding school our senior year when we were 17, and the rest is history, got married at 19. So, even though we both like very stable environments, we’re very organized, very maybe a little bit stuck in the mud sometimes, the way we like our life to go, we agree that this early adventure definitely helped train us for what lay ahead and all of our travels around the world and our different insights into traveling and foreign countries and, you know, all of the people that we’ve met. So, it definitely laid a good base for where we are today.

For life on the road.

Life on the road, we definitely were life on the road. So, let’s get started. Okay, number one, in setting up your practice, what are some of the essential factors that influence success? The first step, of course, is setting up the physical environment, and then there’s people and culture. Let’s discuss the physical environment first.

Well, the physical environment is something that’s critical. It doesn’t have to be opulent. It just has to reflect who you are. My first office that we set up we were at Boston, we were in Boston, and from long distance we could see that we were going to be going back to California, and so Phyllis actually did the heavy lifting on the physical environment itself. But I think when we walk into a physical environment, no matter whether it’s a store or a boutique or whatever it is, you only have one chance to make a first impression.

So, when you walk in, you want to have an office that, you know, reflects a glimpse of who you are, but it should be organized; it should be clean. There should be people there that are enthusiastic and exciting, they’re happy to see the people that walk in. I think it needs to be a reflection of technology and that we’re doing things here that are special. You want to project “we’re special.”

One little idea I would share with them. This was your idea. But we decided not to have any magazines in our office. So, when you open up a magazine, you know, how about a week in Martinique, let’s get the scoop on Guadalupe, oh, a brand-new car, I’d like to get the Lexus, oh, it’s a Tesla. Well, these are advertisements that are competing with your dollars, so we decided to have books, and books are restful, they’re relaxing, it’s a place where you can heal. This is all part of that physical environment.

So, we went to a used bookstore and we got a shopping cart and we started going down the rows of these musty bunkers of this bookstore, and we started tossing in books and we took books that we like, books that are about us and travel, adventure. And so, we put these in our office, and it was funny how people loved them. And we had a lot of picture books, as I’ve lectured, we did 5 million miles by the end of 2019, and everywhere you go give a lecture, what do they do, they give you a book of Argentina, a book of Peru.

That’s a huge book.

So, you get these books and you put them in your library and you see people out there, oh wow, look at that, you know, look at Bariloche. So, anyway, the books are a reflection of you. It’s peaceful, it’s calming, and there’s not all the stuff in society that’s going on day-to-day that they get confronted with that keeps our nerves, you know, really up there. So, really think about your environment and how to have it organized, clean and a little reflection of you.

And high energy.

Oh yes.

Definitely high energy.

To see the office is to see you.

Yeah. And what are some of the factors you recommend to the staff portion of people?

Well, when I say you want to hire smart people, I’ll just explain, because Phyllis devised this test, and it would still be relevant today even with computers. You’d have to have a pen though and that would require that you write a little bit. But she did a little test that everybody got, and it was called Vocabulary. And then we had to have something on –

Arithmetic.

Yeah, you had a little section on Arithmetic.

Very basic.

And then there was typing, and then there was – I think there was spelling.

Spelling, yeah.

And she wanted it to be written because, you know, you can go online and Google this, you can tell so much about people through their handwriting. They start to give you a glimpse of their inner soul and how they’re wired. So, that was one thing. For me, I was looking for enthusiasm. I was looking for trainable, because I didn’t want people that knew it all. I mean yeah, I really did, but you want them to work within the context of a team. So, energy, good integrity, willing to be coachable and trainable, and what else do I have here on the list?

Honesty.

Well, you want them to be honest and, you know, remember, the people that you’re bringing in the organization, they want to work for a leader, they’re dying to work with somebody they respect and that can help grow them. They’re looking to learn, and they’re looking to improve their skills. And most people I’ve worked with, they want to be part of something that’s actually bigger than themselves.

And also you mentioned hire to your greatest weakness, for instance, the organization behind the scenes. That was something I was very good at, and keeping all of the supplies in stock, that sort of thing.

Hire to your greatest weakness. Okay, so I was okay in endodontics, clinical endodontics, but I was horrible in technology. You were a computer programmer in the city, San Francisco.

Didn’t really need it when we started the office, but it grew.

But hire to your greatest weakness. Get somebody that’s IT oriented and you have that handled. Another example, if you’re a very quiet doctor, you’re kind of introverted, that’s okay, and you’re a man of few words, then maybe get somebody that’s very expressive, they can talk, they can do the chit-chat and start to relax people. If you must speak, ask questions, questions are the answers. How are you doing today, you know, things like that.

Yep, a chatty – chatty person. We had a few of those.

Yep.

Great. And finally, the culture, what do you mean by that?

Well culture is a really – everything has a culture, whether you think it does or not, and most cultures are by default, but I’m talking about – we’re talking about creating an intentional culture. We always tried to and whether people knew it or not, that’s what we were working for. Jay Geier, Practice Management Consultant, he says that culture is defined by what your – what the people in your very own organization say about you when you’re not there.

So, remember when people walk into your environment, they feel the culture, they feel the vibes, the energy. You want to be almost electric, and I’ve walked into offices that take your joy and your energy and there’s no acknowledgement that anybody walked in. And then there’s others that it’s like you’re the only one on this earth that exists. So, everybody wants to be part of something that’s fun, that’s exciting, you know, I don’t know what’s going on around here, but I want to be part of it.

Well, culture is then intentional, and what you need to do is think about having office goals, having objectives that are committed to and the people could all, you know, they must sign their name to be part of something, and it should be patient-centric. The most important thing in your culture is it’s about the person, stupid, because you wouldn’t even exist if the door didn’t open and somebody didn’t come in. So, it’s always about the patient, patient-centric.

And then, of course, you want to hire people that are willing to train, and you have incessant training. G.V. Black, the Father of North American Dentistry, said, “No professional had any right other than to be a professional student for life.” So, we want trainable staff because that – when you start to do things you’ve never done before, it creates confidence, it removes doubt, and when you remove doubt, confidence shows up. So, if you get people that are really enthusiastic to learn, that’s good. And then finally, the practice must be growth oriented. It needs to be absolutely committed to be successful.

Yes. Okay, now that we have –

Well, I should say trust.

Trust.

You know –

Patient trust?

I’m talking about the culture inside the office.

Okay.

So, if we’re talking about putting together the culture and we got the environment, we got the people, and now we got the culture, we need transparency. We need execution. We need trust, and if I say, “Could you put that last suture in or could you write that record up,” I know I can trust them because they’ve been trained to do it, and I just need to initial it that it’s okay. So, trust is the fuel that drives the dental engine. It allows you to execute on all your ideas and plans.

And one thing I noticed, because I did help assist you for awhile, patients pick up on good communication between the staff and the doctor. You might ask for the wrong thing, but the assistant knows to give you the right thing, things like that, you know, and that comes with training and time. It took me a little – it took me a month.

Yep.

Okay, well now that we have the clinic done and the people hired, what are some of the traits that have led to your success?

Well, I took a class, as you know, decades ago, it was in more in my formative years, and I knew I needed to get better, and I didn’t get it in dental school certainly and I didn’t get it in post-grad school. But I went to a class by Mark B. Cooper, and it was eight days, but it was two days across four weekends of a year. And each course was about a single topic. So, I’ll just say them, and then I’ll talk about them.

But the first one is owner. Dentist as puts on the hats. You’re going to wear four hats. Put on you’re an owner, and then you hope you have a hat – where is that – a leader, I’m a leader now. You take off your owner hat and put on your leader hat. And then you need a managing hat, a manager. Now you might have people to do this. And then finally, you need to have a marketing awareness or marketing hat. So, owner, leader, marketer, manager.

Now let me talk a little bit about each one, and you might be a young dentist and they might just be an associate or they might be in a DSO or they might be in some kind of a deal like that where they say, “I’m not an owner.” Okay, but you should be thinking about this, because you should be able to interact with ownership. You should have ownership if you’re a DSO communicate to you how it’s going to work. They should be a future for you where you can grow. Of course, they’re all about growth, but are you going to be able to grow proportionally or commensurate with what they’re growing?

So, owner. Owners look from the outside in. Owners are the shot callers. Owners can hire. Owners can fire. Owners can expand the business. They can shrink the business. They can relocate the practice. They can shrink the practice. They can sell the practice. So, owners – they have a vision, and it’s their job to guide it towards what they have as goals for the organization. So, that’s kind of what an owner does. So, owners don’t even have to be onsite, you know, but they could be.

Well, leader. No matter where you are in these four things, we all have to have the hat that says leader, cause people are always looking and begging to be led into action. Most people are happy to follow if they have trust. If they know there’s a leader, people are willing to let’s make it happen. So, leaders – leaders think from in perspective of communicating the language, articulating, if you will, the view, the vision, and then to mobilize people and get them into action and get them committed to action. So, that’s what leaders do. You can’t – I can’t overemphasize how important leadership is.

And lead by example.

Lead by example because if you, you know, rules for thee and not for me, that doesn’t work in a dental office.

What do managers do? Managers are looking from the inside-out. Their job is to get work done through people and then develop people through work, okay? So, that’s what managers do. And they’re day-to-day. I mean they’re looking at today. Their job is to hit numbers. Their job is to keep the books – the schedule full, to have the operatories humming along. So, that’s kind of what a manager does.

And then there’s marketing. And you know, try to have some kind of an intentional marketing plan versus a default marketing plan. Here’s default. Let’s get the office together and sit down and we’re going to create a little ad, and then we’ll put it on our website. That’s very ineffective. It’s nice. Okay. Let’s do a radio spot. Nice. But no cigar. And they might do things like, you know, have the Yellow Pages, you might take on a radio spot. That’s called passive marketing, everybody does it, you know, come to our office, cash this spot, this ad, this little quirk of thing on the website.

I want you to do something different. I want you to close with your patients. I want you to get into active marketing. Active marketing is using your own patients to spread the good news. So, I learned this years ago. You know, when people come into the office and they have a good experience and stuff that you can see them smiling, they’re happy, there were some hugs sometimes, handshakes, stuff like that. But they haven’t effectively been coached on how to get it from inside their mind out to the neighbor across the street, to a colleague at work, in the marketplace, and all their interactions with other people.

And think of how each patient interacts with so many people. Those are all opportunities. So, we were trained from an early age on to basically pull that out of them. And here’s how it might work. So, if Phyllis was my patient I might say, “Well Phyllis, how did it go today?”

It went great. I liked your assistants.

Well, were we on time? Did we treat you okay? Was it painless? See, ask her a lot of those questions and she’s never thought about it cause she’s just so happy and went, phew, it’s all over, it’s done. But if you just say a few little things, were we on time, did the staff treat you really good, how did you think about the procedure, all of a sudden, they’re rehearsing. You’re helping them to rehearse what they’re actually going to say extemporaneously out in the marketplace.

And if they say something that is not 100 percent positive, that’s a learning experience also.

Oh, absolutely.

You want to get that feedback. You tend to get in your rut and, you know, you expect everybody to say, “Oh, you’re so wonderful,” but you know, there might be a hiccup.

We all love praise, but really what I always – I kind of start to glaze over on the praise. I mean that’s what I thought I was supposed to be doing.

Right.

I really latched on, like a lecture, mistakes, not being clear, being confusing. If it’s constructive from a patient, oh, it’s a wonderful opportunity to get better. And close out really well because again, by closing out, they’re rehearsing that this was brought up, but look at how they reacted to that, and man, that’s a great office, I’m going to go back again. And I’m going to yell from the top of my lungs tonight, “Go see Ruddle!”

Okay, so be an active marketer, and you do that very inexpensively by taking care of people. Let’s not – let’s back up. You do that because you are – your whole team is training. You’re committed to a centric practice of patients. There’s actually people behind those teeth, and you know that, and you’re making their lives better.

Right. Personality traits.

You can help me out on some of these. I mean obviously – she asked the question, what does a dentist need to be? Well, I would hope that you aspire to very high standards, you know, big ethics, they come to mind. I’ve said this so many times on The Ruddle Show which I’d like you to join, cause we talk about a lot of this stuff on The Ruddle Show, which is a weekly show, and next week we’re shooting Show 50, so you have a lot of homework to do, 50 hours; they’re about an hour each. But we’ve talked about standards and we’ve talked about training, and the right people, enthusiastic people, kind people.

This is about you as the clinician.

Yes, but we have to have that environment, and so it’s the dentist’s job as leader to create an environment where there’s integrity, there’s professionalism, you’re really committed to forever learning and training.

Imagination?

You know, imagination, listening, are you a good listener? You know, sometimes we come in there and it says “Cliff and blah, blah, blah,” you know, stop sometimes and maybe just get into a little conversation, just a little humanness to connect. And we’ll talk about that in just a few minutes. So, passion, be all for your staff and protect them and be transparent, be honest, be an open book, sit down, have meetings, talk to people. I’m talking about in your office, so you can project this excellence and it’s not an act, it’s in your heart.

Yeah. And I think you need to be passionate about what you’re doing. That’s been a big plus for you, whether you’re teaching –

So, can you tell them how to be passionate? That’s a great thing you just brought up. That’s terrific. How does a dentist become passionate with what he’s doing?

Well, I think number one, you have to be interested in dentistry, which is – was beyond me until we got into it. I had never been to a dentist actually, so it’s very interesting.

Change your friends.

Yeah, once you get in there, it really is every tooth is different, and you start to look at it a little bit differently when you realize that. So, every one is a puzzle, and I know that kept you going.

We’ll talk about that in a moment. That’s very good, but one thing when I was putting the pressure on her on passion, is passion is an inside job.

True.

I mean if you’re – look, so many people sit on a piano bench – I just made that up, and they practice for 50 years on the same piano bench, and they don’t like it, they get through each day with, “It’s 3:00 now, gosh, when is it 5:00? Oh, it’s 4:30? I wonder if we can get out of here by a quarter to 5:00,” and then everybody like breaks the door jamb trying to get out of the door simultaneously. That’s like exit. So, passion comes from learning new things and developing your skills and starting to feel good about yourself. So, I think you can develop your passion.

Great. This next question kind of goes with what we were just talking about. What coaching do you have for dentists to be the best they can be?

Well, I’m going to have to read his name, but his name is – he was a professor, Atul Gawande. He was an Associate Professor of Surgery at Harvard School of Medicine, and he was giving the address to the graduating class of not only Harvard School of Medicine, but Harvard School of Dental Medicine. So, both sides were there, the dentist and the physicians, the young dentists and the young soon to be physicians.

And so he said, “You know, life’s pretty difficult,” and he said, “You don’t realize this, but you wake up every morning and you jump into your car or onto your bike or you walk, but you’re a little tiny cog in a massive machine called dentistry. It’s a 36, 37 billion dollar a year industry. And you’re just this little cog and you have your scrubs on and you walk in every day and you plow through your day, and you’re one of one million dentists in this big machine.” And he said to the young kids, “How do you make yourself relevant?” “You make yourself relevant by making yourself matter.”

And so, he talked about four things in the New York Times. This as an op piece, and it was really nice to read in 2005 for me. He said, “First of all, you meet people from all walks of life. There are astronauts – I’ve treated astronauts. I’ve treated all kinds of people, farmers, workers, street sweepers, but what we all have in common, we’re human beings. So, we usually come in and we have this problem and we’re going to do this and that and do you have any questions? Why don’t we meet our patients and ask an unscripted question?” He was in Boston, so he would say something like, “I see you’re from Boston. Do you follow the Boston Red Sox?”

No.

Okay. Well then he might say, “Do you like the opera?” And if you say, “Well, we have one of the best philharmonic operas right here in Boston, you know. It’s unbelievable the people we have here.” So, anyway, ask a little question. Questions make little connections in life. They show human traits and little personality things that kind of ease us into talking about making the sick person well. So, ask an unscripted question.

The second thing he talked about is, “Don’t whine!” It’s dispiriting. Okay. You have a lot to whine about, don’t you? You know, you got people, like when you have one staff member, nobody has one, but if you have one, it’s just you and that one, so you have two personalities, but then you get one more person and now you got a mesh. I didn’t say it was a little bit harder by 33 percent. I said it’s exponentially harder. And then you get somebody else and somebody else and all of a sudden, you’ve got an army of people in the office.

And it’s easy to whine about, you know, all the world things they bring in, you know, “I didn’t sleep last night,” and, “Oh, yeah, Johnny, you know, got in a car accident.” “Harry fell off his bike.” You know, there’s a lot of stuff, and you got to leave it outside the office. When you walk in, you’re ready to go. Well, you have staff issues, you have a lot of pressure on fees. Your costs are always going up. There’s regulatory, there’s insurance, you’re getting crushed by paper. It’s easy to whine. Don’t whine. It’s very dispiriting.

And especially, don’t whine to your staff. And don’t whine to your wife and maybe whine to yourself, but don’t listen. Okay, but then about the whining, if you see things that are really challenging you, hire to your greatest weakness. Maybe you need somebody to help do that little thing and it would take a lot of negatives off your plate and maybe you’d be more free to focus on, in my case, endodontics. So, don’t whine. Unscripted question, don’t whine.

Okay, you’re a dentist, right, you went through dental school, but to get through dental school you had to go through college, probably took some chemistry, some math and whatever you took, biology a lot, physiology, you’re a scientist. So, by the time you got out, you were a scientist. Well, what do scientists do? They count. So, we were saying how do you get passion? Well count something that you’re interested in. So, count the number of teeth you lost during that year. How about that one? Was it a small, single-digit number? Or was it some massive number, you go like, “Whoa!” Okay, how about mid-mesials? How about resorptions? How about MB2s? How about radix paramolaris?

Okay, count something that you like that you’re interested in. Dark teeth that need bleaching. When you count something, you immediately, like a stamp collector or gold coins, there’s passion, you start to get energy. Write something, that was number four. Write something. So, now you’ve been counting something, so now you that you’ve counted something, it’s kind of easy to write down a little observation, right?

When I say write, I didn’t say write a thesis. I didn’t say write something for a professional journal. You can just write a single page and you can share it with your patients, you could put it on your website. As an endodontist, I would share it with my referrals. You know, some little observation, very simple, preoperative film, couple photographs, post-op, maybe you have healing, and just share that little case, that little glimpse of something that meant something to you with them. A lot of people get a kick out of that.

Maybe a newsletter type thing.

Maybe a newsletter. So, that was the fourth thing, write something. It can be very, very modest or it could be in a textbook. And finally, be an early adopter. You know, you’re not passionate, you’re just sitting there, I’m talking to all you out there. You might be young, you might be middle-age. You might be as old as me. My God, you might be older than me. But when you go to meetings, isn’t it something that Ruddle finds somebody that’s 10 years older than me and they’re at the meeting. I’m going, “Why are you here? You’re 83.” “I love dentistry and you’re in town today.” So, you can make yourself matter a lot by being an early adopter.

And if you’re an early adopter, cause there’s three kinds, there’s the people that buy something when it comes out, they just have to have the latest and greatest. Well don’t buy recklessly; buy prudently. But buy things that are going to make you better or have more fun or that allow you to do a new kind of a case that you’ve never done before. And so, then there’s the ones that will wait several years to adopt, and then there’s the ones, I hate to say it, we will not be adopting anything. We can do just fine on the piano bench of life, and we can do just fine with this 1951 K file, and I can carve great shapes and I have my irrigation cannula, and everything is good. Well, they’re probably not that happy either, are they?

No.

So, anyway, I thought that the Professor of Microsurgery at Harvard gave a wonderful speech. It touched my heart and from that, I started thinking about those five things, and I started to work those subtlely into every patient I met, every day in my practice, just these little things you start thinking about them, and you start to integrate them as you feel comfortable. Don’t do something that’s awkward. It will really show up as a bomb.

So, do things in the stripe – share it with your staff. They’ll probably help and encourage you to do it. In fact, you’ll see your staff, cause I always cross-train them, I want them to think like I was thinking. I want to think like they’re thinking, cause we all together, you know, Napoleon Bonaparte, there is someone smarter than any of us, and that is all of us. So, they have ideas too, and it’s funny how energy breeds enthusiasm.

And sometimes just saying something out loud. In your head, it may sound crazy, but if you say it out loud it may sound crazier, but it may also spawn more ideas.

Yeah.

And that sort of thing, yeah. Conversation is good.

Most things I say sound crazy.

But they’ve kind of evolved. So, how did you get involved in teaching and lecturing?

Well, it was an accident. Maybe you should tell the audience yourself how maybe it got kindled even in college.

Cliff didn’t do too well in school up until college. He wasn’t there to learn anything. He was there for the social and the sports, period. Grade school, middle school, high school, I don’t think he learned anything. So, all of a sudden we got –

I learned how to dribble.

Cliff was a good dribbler in basketball! But then we get married, and it’s like, uh-oh, what’s he going to do? So he became extremely serious about college, not really knowing what he wanted to do yet, but an idea something in the sciences. So, he was many majors, math, physics, chemistry, probably biology, I don’t even –

No, I didn’t like biology.

Okay, no biology. I lost track. But along the journey, he discovered dentistry. But the first thing I noticed about him going to college, he was – he didn’t sit in a corner and study like many people would do. He had to talk, and he had to draw pictures, and I realized early on, he was a natural teacher, and he started tutoring in college when he would do well in math and somebody else wasn’t doing as well, he would start tutoring, not for money or anything, of course not, not for money, but just because that helped him get better, and it helped the person he was helping. And that was a huge asset that you had that you didn’t even know you had back then.

You remind—

That kind of led into –

You remind me of that old expression the teacher teaches best what he most needs to know.

And that’s very true for you.

Yeah.

Yeah.

So, she’s telling you that – back to the question how did I get involved in this stuff, it wasn’t planned. It was a complete accident, and it probably started because, well back in the late 70s and early 80s, I was doing warm Gutta-percha, and I was like the third or fourth guy in the state of California, literally, at that time. So, we were getting a lot of anatomy. We were getting root canal systems. And I was getting furcal puffs and lateral canals and anastomoses – I mean I thought this was the greatest thing. Santa Barbara is going to go crazy.

Well, Santa Barbara did not go crazy. In fact, they actually did go crazy. They were crazy about what they call overfills. He’s overfilling the teeth, and of course, I was in a town where most of the dentists were from southern California, and anything beyond the root was absolute heresy and you were condemned and probably would be in Hell shortly. So, these referrals, they were seeing lesions healed that hadn’t been healed ever in Santa Barbara before, and they were intrigued and they wanted to know how I did it.

And it took three or four years of them asking before I finally said okay. Earl Ness has passed away, but he was the dentist, went on to become a fabulous prosthodontist. And anyway, he – I said, “If you, Earl, get 15 people, you find the venue, I’ll show up.” And so, I think it probably started for me, and I was using exactly Gawande’s idea of write something, share something. I was just, you know, I had a few slides under my arm, I’d walk in. Well, all of a sudden I went back to my practice and I thought, you know, I need some photographs, and then all of a sudden, we’re getting more cameras and Phyllis says, “You could use video.”

So, it all just sort of naturally unfolded for this little study club. The study club grew, and then it became a California study club, and then it became and international study club. But teaching, it can happen like that. For you out there, you young ones, or even the older ones, if you’re an older one, you have so much to give, so much to give. You could go back to a school and give a half a day or a day if you live in a city that has a dental school, and you’d get a lot of kick out of it, cause role reversal, you’re older, and now you’re with these young kids, and these ladies and gentlemen, you know, they’re doing interesting research, they have fascinating questions, they’re state of the art in their literature reviews, and so you can learn from them and they can learn from you.

And if you’re young, going back to a dental school, like she said, it reinforces what you most need to know. So, you’re just practicing – but see, I practiced chairside consultations. I was giving little mini-lectures, but they were very informal. They were very, very simple. And I learned to speak simply to people, because people don’t understand your big words. So, talk like you’re talking almost to a 14, 15, 16-year-old, cause they’re really smart, but you don’t need to overwhelm them with words. They’re probably smarter than you are.

So, I learned with teaching my staff, teaching my patients, teaching my referral base, and then it kind of prepared me for teaching a few dentists. So, that’s kind of how I started.

One thing I noticed, some young dentists get out and the first thing they want to know is how do I get on the podium, and I – it always puzzled me, because we never went that direction. People came and asked you because of what comes first, the chicken or the egg? But that is one way you can get into teaching is just keep calling people and asking to be on a meeting. It does work.

I’ll say something about that, though. I have seen – I won’t mention any names, but you know them well, they’re from Santa Barbara, they’re an endodontist. And I was a little older than them, and they wanted, you know, the big room, you know, the 800 people at the California Dental Association. And I’m telling you, I didn’t get that big room on year one or year eight. It took many years. And so, it’s that crawl, walk, run. All this little discipline you’re doing with your staff training, you’re training your patients, you’re teaching the referrals the little things, on the phone, through a treatment report, sharing a little observation with them.

They may be going to school and they start helping kids, and now you’re getting more comfortable, because you’re getting a lot of questions now from young dentists. Then faculty start asking you about stuff. Then they say, “Well could you give the afternoon lecture on diagnosis, Cliff?” You’re building up so when you get the big room, you’re ready for the big room.

One time – or maybe I shouldn’t tell this, but I will. It’s one on me. It’s one about humility. So, I’m giving my first lecture in I don’t know, ’78 or ’79, at the California Dental Association, and I had my slides and I used my trolley and I’m feeling really important, you know. I’m Cliff Ruddle, I’m going to save the world in endodontics. And I’m walking by ballrooms that seated 1,200 people, 1,600 people. I mean I’m saying – that’s a big meeting, the third biggest meeting in North America. Ha!

And I’m walking and I’m looking. The ballrooms are on the left, but my address, my room is going to be on the right, and the rights were little shoeboxes. They held like 50 people. And I said, “Phyllis, how do I get to the big room?” And she said, “Practice!”

Right. We’re going to skip the writing part and go to the inventions.

Oh okay, well I already talked a little bit about writing.

Yeah, I think we covered it. You have invented or co-invented at least 12 dental products used internationally. In turn, some of these inventions pioneered new clinical techniques. How did inventions happen?

Well, nothing happens, I’ve learned in life, by accident. I mean you can hit the lottery, okay. You can slip on a banana peel, but most things are success by design. I think a lot of it is how I would say people all over the world cause you’re right with me, in fact, there are more around you than are around me. And they’ll say something to the effect, “Geez, he’s really lucky.” Boy, he’s – “Cliff, you really have a lot of luck. It’s enormous.” And I always think in my mind, I don’t want to embarrass the colleague, but luck is where opportunity and preparation meet. You’ve worked your whole life. You’ve prepared for that moment. So, when an opportunity arises, it’s not like you’re lucky; you’re ready.

So, I would say it reminds me of that book by Malcolm Gladwell called Outliers. And he talks about pretty much if you look back generationally over the last 100 years, the greatest people in any profession, it has to do with the year they were born. How about that for no control? So, this is true of hockey players, baseball players, dentists. There’s a complete link. In my life, being born in ’48, if you extrapolate forward, I just happened to come along at a time where the greatest decade of change occurred in endodontics. From 1985 to 1995 we got the microscope, we got MTA, we got ultrasonics, and we got NiTi, did I say that?

No.

NiTi. So, as an example, in ’85, ’86, I got my first microscope. Well, I just happened to come along at ground zero. I was the first microscope user on the West Coast, and I was about the fifth in the nation. So, obviously, Phyllis got me a lot of textbooks because everything I was using was too big. I could see so well, but I had clumsy, big tools. She got me medical – what do you call them, catalogues.

Catalogues.

And at night, I’d be flipping through the catalogues. Oh, there’s a microblade, oh there’s a cool tool, it’s small. So, I began to think about things that we could do and techniques that could be perfected because we had vision. If you can see it, you can do it, and you only know what you know and only see what you see. So, microscopes was an opportunity, but, you know, if you come along now, they’re mature, you might say well, what has needed to be done has been done. But that was new, so I was there.

Ultrasonics, well hygienists were using ultrasonics in the ‘60s to clean teeth, but I came along at a time where because of vision, we needed tools to go below the orifice, so we started working on refining, staging platforms, which now we’re already past that, and we’re on to something new. But there was a lot of things we could do with ultrasonics and a microscope, and then I coined the word “micro-sonic techniques,” micro instrumentation, very precise.

NiTi ’91, ’92. I was at the ground zero although I didn’t start using NiTi for eight years after their launch. I was not an early adopter, because there were too many horror stories of broken instruments. But I began to look at that and say how could we make a better instrument that would cut efficiently, be flexible? It turned out to be the number one file sold in the world. It has been for 15 years. It’s called ProTaper. So, I think luck again had a lot to play with it. I came along at a good time.

And MTA, my goodness, Mahmoud Torabinejad at Loma Linda University invented it. He used to come up with his students to Santa Barbara. We finally had a repair material where sharpey’s fibers would go 400 microns into the material. We got a biological attachment. It was a thrilling decade and it spawned almost everything that I’m doing today because, you know, if you can shape well, then cleaning was not opening.

But you young dentists, don’t be discouraged. You can look at your birthdate and you can see that we’re going into regeneration. We are going into more biomedical solutions instead of mechanical solutions, all the opportunities are right in front of us all over again. Everything old is new again. All these opportunities.

And technology – who knows where it’s going?

I think be around thought leaders, be around positive people, be around people that have imaginations and creativity. You know, if you’re around a bunch of people and they’re sleeping all the time and snoring, and they wake up and have a beer and go back to sleep, you’re with the wrong group. You want to get with people that have juice in the tank, they’re excited about life, they’re going places, be part of something big. Okay. Enough.

And that’s our list.

Well, I had a story, but –

You can tell the story.

I – is there time for the story?

There’s time for the story.

Maybe the story would kind of summarize everything that we’ve talked about today, because it’s about overcoming adversity and how to succeed in life. And that is the story. So, the story – I’ve told it one time publicly. You can Google it. It’s a nice story, so you might have heard it before. But I’ve told it in Engelberg, Switzerland, to 100 of the opinion leaders. So, they were the key opinion leaders and I told this story at closing, so they might have to hear it a second time. One guy did come up after that lecture and he had tears in his eyes because he said – anyway, okay.

No crying.

Okay, so this is Avery Fisher Hall in New York City, and it’s a story about Itzhak Perlman. Now Itzhak Perlman is a world-famous international violinist. And you might have heard his music, but you maybe have never seen a live performance. But if you were to see a live performance, it’s pretty painful until it gets started, because he was crippled with polio. He had severe polio as a young kid and so he wore leg braces and he had crutches.

So, when he’s doing a symphonic work, the symphony is in the pit and they’re all set, the conductor, the maestro is there. But he has to come across an enormous stage, if you’ve been to Avery Fisher Hall, and he has to get to his lone chair, and it’s painful watching him. But the audience has gotten accustomed to this over the years, and they see him coming out and they can hear the noises of his clasps and his braces and stuff. And he finally gets to his chair, and he lays his crutches down, unclasps his braces, and he lays them over on the other side.

And as customary, he puts one foot forward and one foot back, and he got the bow up and the violin, and he nods at the maestro and the symphony begins. And they only got a few bars into the symphony and he broke a string. And it was like a shot was fired in Avery Fisher Hall. The crowd could hear it like a bullet. And everybody is going, “What’s he going to do?” “What’s he going to do?” They’re thinking, well he might have to get back off stage and how long will that take? And then do they have a second violin? Maybe he can get a restringing job done like my grandkids in tennis.

No, what he did is he looked at the conductor, he hesitated, he needed a moment, and you could see him thinking. And then he nodded, and they picked right up where they left off. So, he starts playing again. The problem is you know, I know, we all know, you can’t play a symphonic work with three strings, but that night, Itzhak Perlman, he never knew. He didn’t have any idea. He said, “I can do this.” Attitude! “I can do this.”

So, he began to play and music came out powerful, pure. It came out like majestic. And people couldn’t even believe it. And he was modulating, he was recomposing, right during the work. And when he was all done, the crowd was completely quiet. People realized they had seen something that they had never, ever saw before. It was like a miracle had happened.

And he finally took his bow and he motioned to the crowd, calm down please, and he said, “You know what, sometimes it’s the artist’s obligation to find out how much music they can play with what they got left.”

So, what I’d like to say today, I really want to thank you, Phyllis, I wasn’t really looking forward to this, so you made the impossible possible.

Thank you.

In fact, if you think about the spelling, impossible, is ‘I-m-possible’.

That’s right.

So, very good. And for all the colleagues out there, I’d like to challenge you. I’d like you to make as much endo music as you can make with what you have left.

Okay, well I really loved that interview. I do think that you and mom have a very special connection and it really does show.

Thanks.

So, one thing that really struck me when I was listening to your answers, was I could see how much The Ruddle Show has influenced you in how your perspective is and in the way you express yourself, in the words you choose to use. Like we’re always telling our viewers that, you know, we want to offer you a fresh perspective, we want to challenge you to think in new ways, and I think in our efforts to do this, it has ended up – we’ve ended up growing ourselves.

So, like when I listen to you talk about the past, and the past is the past, it can’t be changed, but what can change is your understanding of it, and how you choose to incorporate that knowledge into your present and future.

Very good.

And I actually even saw the influence on Mom too, and how she spoke as well. So, I just really loved everything about that interview.

Well, thanks. Maybe I should say this. Well, we’ll probably use this in another show, at another time, about the Steve Jobs and those three things, and we were talking about that earlier, but one of the things he said is connect the dots, but you can’t connect the dots from here looking out at the future; you have to be here and look back and something that happened in your life or a series of things that happened in your life, can now, from this perspective, you can connect the dots and utilize maybe something from the past that didn’t have as much affect on you at that moment, but now with new understanding, maybe even a new vocabulary, how he communicates, how it is, you could express things differently. So, definitely the show has helped me connect the dots.

Yeah, I think for me I just noticed in my life, too, like it’s amazing how much I use the word “culture” now since we did that episode on – or the segment on office culture. And so now I’m just noticing culture all the time.

Culture is everything.

Like in sports organizations, just what culture they have, so yeah, it – definitely The Ruddle Show has had a big impact on my life, and even just in how I communicate things now.

[music playing]

Great.

All right. Well hopefully it’s having some impact on you as well. And hope you like this interview. See you next time on The Ruddle Show.