Dr Hatem Algraffee has gone from being a confessed lazy student to one of the busiest clinicians in the profession.

After completing two master’s degrees as one of the UK’s first periodontal specialists, Hatem took on 13 jobs simultaneously—and then things got even busier!

He discusses some of the niche and specialist skills needed to get ahead in perio, reveals why you don’t need to specialise in 2022, and predicts a bright holistic future for the discipline.  

In This Episode

01.32 – Being busy

02.44 – Backstory and dental school

10.47 – Why periodontics?

22.33 – Specialist and niche skills

39.45 – New periodontal grading

44.30 – Periodontics and physical health

50.57 – Grafting and predictability

54.53 – Regulation and the future of perio

01.00.50 – Blackbox thinking

01.06.08 – Practice, training and family life

01.14.44 – If I had $1BN

01.19.29 – Fantasy dinner party

01.22.22 – Last days and legacy


About Hatem Algraffee

Hatem Algraffee graduated from the Royal London Hospital in 1996 and went on to specialist training at Guy’s Hospital and King’s College, where he completed two master’s degrees.

In 2004, Hatem founded the Perio Academy centre for periodontal training. He now divides his time between specialist practice and training. 

[00:00:00] There must be a whole a whole lot of skills that to be a good person to refer to.

[00:00:05] I think to be a specialist, that those days are gone. You don’t need to be a specialist. I think you need to have the respect of your colleagues because they have faith and trust in what you’re doing. I think that’s the most important thing. You know, whoever you are, whether your dentist hygiene especially, it doesn’t really matter. And I think it’s communicating to that person. I’m here to look after your patients. This is what I can offer you. These are the parameters in which we can hopefully work together.

[00:00:38] So being available.

[00:00:39] Yeah.

[00:00:44] This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman, Langroudi and Prav Solanki.

[00:01:02] It’s my great pleasure to welcome Hatem al Graphy to the podcast, the third periodontist we’ve had on. And this time I want to make sure I answer the period questions that I have in my head because I do get a bit stuck in life and times. Of course I do want to go through life and times with you. It was a massive pleasure to have you. How are you, man?

[00:01:20] Thank you. Be great. I’ve been listening to your podcast well before the invitation, so it’s it’s strange to be on it.

[00:01:32] From the outside looking in. You seem to me like one of the busiest guys I’ve seen in dentistry. I mean, the I was. I was doing research for this. I was I was on your premiere Academy site. And the number of courses that you guys do, you do a diploma, a certificate de courses in Ireland, here, there. And then on top of that, you’re a proper full on periodontist in three locations. Busy man. Busy.

[00:01:58] Energetic man.

[00:02:01] I enjoy it. I’m quite lucky. I think a lot of people think I just do courses. No, I do four days clinical work and I enjoy it. I’m one of those. I have a wet finger. I don’t wanna be one of those people. Sort of. You know what I use like me that I’m sort of, you know, I enjoy what we do. I love the clinical aspect, I hate the paperwork, and the courses are additional thing which we do Fridays. We do some Thursdays in between clinics, but we stop the weekend courses near enough. Did you.

[00:02:44] Yeah. Did you? Did you? I’m away. I’m away every other weekend. My situation? I think so. Where did you grow up, buddy?

[00:02:53] So. Oh God, my parents are from the Yemen. So that’s. That’s my heritage. We moved to the UK when I was, I think four or five.

[00:03:04] Do you remember moving?

[00:03:06] I remember certain bits of moving or exciting moving to new apartment. Don’t remember any upheaval as such. It was. It was just fun, you know? I had a great childhood. Went to the local school.

[00:03:22] Whereabout. Whereabouts did you move to?

[00:03:24] From the. We were. We. We recently moved to, I think, for the first year, as you ever did. In those days, you had martial arts. That was. That was the. And we moved. I think they just shipped you from the aeroplane to your marble arch and then find a place to stay. So we were there, I think, for the first year or so. Then we moved to Lancaster Gate. My plans to live in the same place. It’s a great, great, great child and just played play park. It was literally.

[00:04:03] So where did you go to school?

[00:04:05] I went to the local school. I didn’t know this. It was a Church of England or Catholic. I honestly can’t remember.

[00:04:14] You would have remembered if it was Catholic.

[00:04:19] Yeah.

[00:04:20] Probably I wasn’t. That was church.

[00:04:24] For whom?

[00:04:25] Because I went to Catholic school. That’s what I’m saying.

[00:04:28] Not at all. It was. It was great. It was a good mix of kids did that at the age of 11, went to international school after that for a few years.

[00:04:42] And Camden, That one.

[00:04:43] Camden. Yeah.

[00:04:45] Oh, really?

[00:04:47] More and more.

[00:04:48] Yeah, I. No more ever.

[00:04:50] Of course. Yeah, The late.

[00:04:52] Great guy. Were you with him?

[00:04:55] Well, we became friends, but we were not friends at school. We didn’t know we went to the same school until. I’ll tell you the story later. But a lovely guy. Lovely. Lovely. Always is in love. It’s a sad story. We lost him, unfortunately, just over a year ago. But I went into national school. Then we transferred to. What was that? Some American school. I did my international Baccalaureate again. Didn’t do much work. I was a lazy, so I literally just did enough to pass whatever I could just, you know, just had a lot of fun. Sports watch, a lot of TV. Then you had the usual decision. It was a family decision. You become a doctor, the usual thing. You have to become a doctor. My brother was a medic.

[00:05:50] What did your dad do?

[00:05:51] That was diplomat. That was a diplomat.

[00:05:54] Oh, really?

[00:05:55] Yeah. And then less than me. You know, he sort of. His career was based on travelling, but with us once, because the education aspect was so good. We’re lucky in that point of view. And he just kept on renewing his extended position here, which became a bit difficult for me. And, and then my brother said, Don’t do medicine. So the nearest thing was dentistry didn’t get my grades. I was close, but not close enough. And they went through clearing, went through clearing.

[00:06:26] To London Hospital.

[00:06:27] Yeah. Yeah. I think yeah, I think Jason’s a few of us. Jason was here above. He had me a year ahead of me.

[00:06:34] Jason Smithson.

[00:06:35] Yeah, yeah, yeah. But me and my principal at that time, I didn’t know what he did. I think he picked up the phone, literally picked up the phone to admissions and said, look, you’ve got to, you’ve got to get this guy. And he was amazing. And I literally got food, fire, literally got in after me, and I just got into dental school, which is good. It was it really was probably the most amazing training we had in those days. It was 50 of us.

[00:07:10] It was it was a very good school. It still is a very good school. But I remember back then it was a very, very good school. They had a great reputation. Did you have Ed Lynch teaching? Teaching you then.

[00:07:19] Eddie? Oh, yeah. Eddie Lynch. He didn’t teach me, but I was one of his clinics. I’ll never forget this. I contradicted him once like that. So he basically. He basically like you go sit down here, read this book. And then I my teacher at that time, I think was Agent Liam. She’s amazing. And she sort of stuck up and he said, no. Then I we would have some. But no, we had, we had the old surgeon, also the orthopaedic, also orthodontic paediatric, every single department was just amazing, really was.

[00:07:58] How were you as a dental student? Were you scraping through as a dental student as well, or did you become serious?

[00:08:04] The first year I failed, I failed, I think, to at for exams. And I thought, God, I can’t. I can’t, I can’t I can’t make any more doing the bare minimum. So that was the biggest kick up the backside. I mean, I think because I think it was the year of the Olympic Games somewhere in the Madrid or Barcelona. I remember now. I just love sport and I failed two exams. I thought, gosh, after that, another for an exam ever. And after that taught me lesson. I sort of knuckled down, got myself together, really put a lot of effort in, and then after that it was just literally a nerd. I was literally a clinical clinical nerd.

[00:08:49] All.

[00:08:50] Afternoon. Wednesday afternoons was off. I was always on clinic doing everything in the summer. I was always there doing extra sessions. I did a lot, probably bit too much. So did that. Yeah, Got off a day. I had Adrian on again. She was amazing. She said, Look, do do has a job with me. So no, I wanted to leave. So I sort of had enough of five years. So did that did beat, did community beat because I was thinking I enjoyed, I enjoyed, I enjoyed surgery, I enjoyed paediatric, I enjoyed ortho. So I thought, hang on, let’s go and do paediatric community has amazing trainer is now I can’t remember that lovely lady she she she she said Look I love working with you but I’m just bored. I don’t think that dentures for me did the job to kill me in Southend and that was on call every other night. And I think one and two, one and three and weekends Max. Yeah. Did that That was a killer. Really was a killer doing things that I had no idea what to do, you know. Yeah.

[00:10:05] And back then there was, there was no, like working European working Directive thing. Was it used to work? If someone was on holiday, you’d be like one one in two.

[00:10:14] Yeah.

[00:10:16] She was. You’d be up to 1:00, 2:00. And I just, I remember just these people who sort of hover around those hovers on the floor, hovering, polishing the floors.

[00:10:29] Cleaning the floor.

[00:10:31] To glass, or gosh, I sort of envy that job in a sense. Bless them, because, you know, I was just reading things are doing catheters, doing bizarre things, but great, great experience when I look back. So did that.

[00:10:47] So when did Perio come onto you? Like why why Perry or how were you thinking Perio at this point or not.

[00:10:53] At this point? I then did NHS Dentistry and Practice. I did it for I think about three six months and I literally was doing composites for taking 45 minutes and just, just taking my time and then realising my paycheque was just literally nothing. I thought, I can’t do this. And then at that time Julian Perry and Graham Barmby were setting up or a dental group was one of the things I remember. I remember I joined them and it was och it was, you know, they were starting off and then I thought, hang on, I’m really bored, you know, so much dentistry by this stage, so much. And I remember I spoke to, I think this doctor at the time he was the dean and I said, Look, I’m bored and what would you like doing? I said, Well, I enjoy surgical aspects. I don’t do PE, don’t do ortho. So I went to go and see when to go and see. Richard Palmer Oh really? Roy London So him went to the Eastman also to check that out, spoke to somebody at Royal London. So by that stage I thought yeah, the one I wanted to go to was those guys, which it sort of had the best of everything to do. So again, luck, I thought I’d enrol on that because I was desperate to get out the NHS private aspect of dentistry. I want something a bit different. So they were fully booked, those spaces. So I said, Please put me in the reserve. Somebody dropped out, got on to the four year program, which is again.

[00:12:34] Part time programme.

[00:12:36] Part with three days a week literally. So we did see two years implement another two years. But in those days, literally I came out doing hundreds, hundreds of surgical, did implants, did a sort of training, did so much and we had this course training, basic training and everything. It was a phenomenal course really. What was it that got my specialist brain?

[00:13:03] So you had pull, pull. Cuomo Was one of your teachers then, I guess.

[00:13:06] Obama That’s awesome. Yeah, yeah, yeah, yeah. For Parma, yeah, we had this strange relationship. I just wanted to get down to do some work. I was literally in that stage, you know, And Paul was is like a lot of fun. And, and I was just literally like, I come to work and make peace and, you know, he was there. Zach. He was there. I was doing that training. It was it was literally the golden years of post graduate training, the care of. Andy Yeah, it was. And maybe there was two of us in condensed, just two of us. So literally, whatever we want to do, we could do so did that best training ever, you know, it’s phenomenal. Really, really couldn’t recommend high enough did that.

[00:14:00] And were you paying were you paying for your life with your other two days a week and paying for the course? How would you how did the finances work in that bit?

[00:14:08] So I actually saw my my apartment because I decided to do because I just I just go a bit extreme. I mean, community. I did community, period because I wanted to try things out. So my training, I did community for about four or five years, I think during my training and the other day was private work. So I wanted to do as much as I could, really, I just literally could. And they let me do what I wanted to try things out and it was just brilliant. And then it came and it came in hand because by the time I finished my training and you had lots of committees, unfortunately they determined whether you could go, whether you could get you access to.

[00:14:52] The specialist list or not.

[00:14:53] Yeah. So we did our exit exam before the content, which lets us do that. We did that and then because of a technicality, I didn’t get my meds on time. You got another six months. Unfortunately, five, six months, which I went just absolutely berserk. So luckily and it goes back to who you know, luckily my consultant community knew the SEC chairman eventual training so I finished on time. So it’s good. And then in those days we were the first one of the first specialist come through, I think with the second third groups come through. And by that stage I think I had about 13 jobs. Literally, I had 13 as a visiting specialist around the whole of the Southeast. Wow. Literally. And again, it’s brilliant, brilliant. I have no complaints. It was just literally every single day I remember working in Oxford, turning up there, and I said, What are you doing? I said, I’ve come to work. You’re not due here till tomorrow. Because my diary was. But now it was, it was quite, quite did that started doing a lot of teaching. Did a lot of teaching for dinner. We started doing our own courses, which is great and enjoyed the clinical aspect. Sort of found out hang on, I needed a bit more. So we started pushing the courses and that sort of kicked off quite nicely. Really meant my wife was also paid on and she said, Look, come on, this is proper structure. You have Protestant to write anything regimental, so come on. So then Academy kicked off, you know, over ten years ago.

[00:16:48] So let’s be one. Does you want a bit Let’s rewind a bit. Right. So you qualified as a periodontist, right. And then you suddenly had loads of work. And so is that situation that there was just not enough periodontist?

[00:17:01] Oh, yeah, there’s hardly any.

[00:17:02] There’s still isn’t enough, right?

[00:17:04] There wasn’t enough. There wasn’t enough. I mean, there’s more than we had in 2004. There were probably dozen, I guess, you know, literally everybody’s like, come on, hats and we’re going to pay for your transport. We paid on the day. Here’s your check. In those days since 2004, Dick Cheney was that we were treated and treated well. So we treated a bit over the top. Days because everyone’s desperate to get periodontist on board to do perio implants. And again, it’s 2000 2004 years ago. Thankfully, there’s a lot more out there now. In those days, there were a lot of specialist practices starting to come in the market as such. And these days there’s a lot of in house. So a lot of people in house, patients don’t want to travel. They want to keep their business. So the numbers have increased significantly really? Well, the universities are producing, you know, 4 to 6 at least per year. So I’m not sure the numbers are, but it must be in the hundreds easily compared to this ago.

[00:18:09] Would you say? I mean, I get the feeling that education generally gets better for everyone. Yeah. So in a way.

[00:18:19] It’s I mean, when we qualified 90, 96, we had no courses literally, I think had one or two courses run by the same people who taught you. And it was pretty backward. Nowadays education it’s it’s you know.

[00:18:35] So, so so my question my question is that the quality of the referral in 2004 compared to the referral you get now, are you getting now much more complex cases because people are taking care of the more basic stuff themselves or not similar? Is that other patients the same?

[00:18:56] Yeah, I think it’s similar. I think the only difference is awareness of the referring colleagues, whereas a dentist, they tend to be quick on the mark and also treating. So you know, what we do is we teach, we, we teach dentists and hygienist so they can do the bulk of the work. That’s how it should be. I think everything should be kept in house. But if you look at when we qualify the specialists I was going to America regularly to do to get educated. Yeah, to get educated. And nowadays I would say nearly everything is nearly there in the UK in terms of how many courses we’ve got. The amount of courses are phenomenal. The only thing I would probably say put my foot in it is probably true in planning and I think people talk about choice and all these other I think they’re good at really good in planning cases. I think here we still probably lack that amazing and perio process, whatever, whatever you want is out there. But I think what’s lacking is, is the full comprehensive, comprehensive planning of how we should do things and what stage. And that’s coming up. There’s one or two people are doing that. I think a few others are doing that quite nicely, but I think that’s lacking. But compared to when I qualified, well, it’s true because.

[00:20:21] I found that when I was a dentist I used to refer to Pete Strand. Yeah. And I used to find the value in that referral was, okay, number one, he was going to take care of the site. But number two, he would sort of reconfirm back to the patient what I was saying. And if I said, I would say to Pete, Look, I want to crown this, this and this, but I’m not sure if that one is going to take the crown or the bridge or whatever it was. And and he would say, Yeah, okay, yeah, you can do that crown or bridge or whatever. But then he would pretty much sell the treatment plan to the patient once. Once the patient had got it from the expert guy, then it was a sold plan. The patient would come back and I’d, number one, do it with confidence because the periodontist said the teeth could take it. But number two, the patient had a new confidence. And that sort of that relationship between the referral and the referral for RE is that that’s.

[00:21:17] I.

[00:21:17] Mean I think you’re right, but I remember when I was doing general dentistry, I was doing my specialist training and I think my time was pretty good in those days. And I do plan to the patient, I need this, that crown, that this and the patient will, I’m not sure. And then the patient actually goes to see our hygienist and I put everything in my nose quite clearly. And the hygienist was phenomenal. She was phenomenal. She would say, Oh, he’s planning this. And the patients always come back and say, Well, I’m ready to go now. Well.

[00:21:57] Because I do this.

[00:21:58] Yeah.

[00:22:00] I just think it’s a reinforcement, isn’t it? I think it doesn’t matter. Is it’s that professional person sort of saying, hang on, I think I agree with this. And I think like everything else, if you sing from the same hymn who works really, really well, I think we always have different plans, There’s no doubt about it. But I think if you’re similar in that reinforcement, but I think when you get a referral, if we get referrals, which can be really detailed and others can be brief. The more detail you put in, the more you can sort of say, Hang on, I think we’re going to engage with the patient better that way.

[00:22:33] So look, if there’s someone listening to this who wants to look at becoming a specialist. Okay. Number. Number one, where to train and all of that that that that I get. But the what are the skills that you’ll need as someone who gets referred patients. I mean that there must be a whole a whole lot of skills that that to be a good person to refer to I guess you know let’s take it from the basics. You don’t steal that patient. You turn that patient.

[00:23:01] Back.

[00:23:03] To a specialist, that those days are gone. You don’t need to be a specialist. You know, I think you need to have the respect of your colleagues because they have faith and trust in what you’re doing. I think that’s the most important thing. You know, whoever you are, whether your therapist, dentist, hygiene, especially, it doesn’t really matter. And I think it’s it’s communicating to that person. I’m here to look after your patients. This is what I can offer you. These are the parameters in which we can hopefully work together.

[00:23:37] So being available, yeah.

[00:23:39] I mean, all our work is basically right. This is who I am. As soon as I see the patient, I’ll communicate how that communication is Writing would be. In writing, you need to whatsapp your phone. You and we and especially the last few weeks, we’ve had two colleagues who unfortunately had something’s gone wrong. Unfortunately, I need some help and it’s fine. We just said, Look, don’t tell me, tell me the story, and then we’ll put the patient in as soon as we see them, will communicate what we found and do that way. Really, I think it’s the trust A not poaching for you to do what’s best for the patient and then communicate back to everybody. Really? Did we get it right? No, we don’t. You know, it’s a similar scenario a few weeks ago where I said the patient, I’m sorry, I can’t fulfil what you want me to do. I don’t think I’m the best person for you. You know, he’s a refund. And and we do that about once a year, twice a year where we talk. No, I don’t think it’s a communication back to the dentist or hygienist saying, look, I don’t think I can help this patient for whatever reason.

[00:24:52] Really.

[00:24:54] It comes down to trust competency, really. And again, it comes with experience Again, I’ve been doing this for ten, 20 years now, so I’m way ahead in terms of.

[00:25:06] So you get a sixth sense for the type of patient that’s going to be a problem.

[00:25:10] I do Now. I get a sense now I’m sorry, I can’t do what you want me to do or can’t write what you want to do. I don’t think I can fulfil your expectations. And it’s the best way to say, Look, I’m sorry. I think you learn that from experience because everyone should be the hero. We want to be here. We will learn from our mistakes. Oh, I can do this. I can get this person off twice and hang on. This is this is not going to work out for any of us. I think the best way to learn as you get older and wiser with no sort of say no, sorry, there is nothing to be embarrassed about. It’s best way. I think we tried to. We tried to please. That’s what we try to do. We’re carrying fresh and we want to please people. But sometimes you want to be able to go to sleep at night.

[00:26:08] All right, let’s get into some period, man. Let’s let’s let’s start with this question, right? You know, your wife, Zainab, is a periodontist as well within Perio. What’s your chosen sort of field that you I mean, tell me tell me, both of you, what? So what’s her area and what’s your area? And and is that a thing? Is that a thing that in perio one guy’s like super into pre implant itis and the other guy must be right into some sort of grafting or whatever.

[00:26:39] I, I don’t think yes some people are better than others in some things. I mean, I love surgery. Know probably when we first qualified I think we were doing too many surgical. To be fun, to be honest. And we again, we change our protocols significantly. What do I love? I love this generation. I love. I love doing the grafting session and also regenerating defects. So sad. So that’s why I. That’s what I enjoy, I think.

[00:27:13] So go and talk us through. Talk us through that. Talk us through that. The sort of the end again.

[00:27:17] The. The outlook. Okay.

[00:27:19] So is that what regeneration is? Is that what you mean?

[00:27:22] Yeah. So we’ve been using and again God since, since we were staring God 2002 in 2001. 2002. Been using it so we were using a lot of colleagues just saying, Oh come on man, this is not going to work. This is rubbish. Doesn’t work in my hands. And it’s that it’s that mentality. If it’s not going to, as you say, it’s not going to work. It’s not going to work. If you’ve got the mentality, we’re going to try this. Let’s see if we can get this right. So it took us years and years and years. So we’ve got the protocol pretty good in terms of. Right. We’ve got any defect. We know it’s going to be very simple to break down. If you don’t do it, it’s going to potentially become a daunting problem, the ability to become that. So over the years, we we’ve been known now to be able to regenerate cases that some colleagues don’t want to do or can’t do, whatever the case may be.

[00:28:17] But what it what’s the process? What do you.

[00:28:18] Do? So the process is changed a lot now because it used to be put on just surgery. So so we’ve now gone to flappers, so empty, been a surgical procedure. So, you know, you open the site, you clean it out, you put the MD again, you may put a filler in whether bovine. And you know, we’ve been teaching. So I’ve got my academy colleagues in general, dentists not doing cases, sending us cases, and we put them on Facebook, we put them on social media saying these what these guys can do. So it’s not a specialist, you know, treatment without anymore.

[00:28:51] Your students do it as well.

[00:28:53] Well, they don’t use their dentist. Yeah.

[00:28:55] No, but your students like Perry Academy students.

[00:28:57] Yeah.

[00:28:58] Your delegates.

[00:28:59] Yeah.

[00:29:00] They do the regeneration work as well.

[00:29:02] They do all the he said they do everything we do. We teach which is non surgical, which is surgical recession grafting and we’ve got no value for them. Forgive us on your podcast isn’t it. Really. Yeah. Yeah. It’s phenomenal glance. It’s been a few, we’ve just, Wow, I can do this when I first qualified and did So.

[00:29:34] How long does it take for how long does it take for regeneration, for bone bony infill and all that? How does that take?

[00:29:39] Nine months.

[00:29:41] Nine months?

[00:29:43] So it’s nine months surgical procedure. We’re now moving on to non surgical, so we’re now using Flight-plus. And again, we haven’t got that right yet. So we’re the same situation. When we started off in 2002, 2001 where we like playing around with them to get this does not work. So the first course went correct and we’re now changing the protocols for the flat plus to get it right because it’s an issue of getting it dry, bloodless, etc., etc.. So we’re now teaching dentists and hygienists, but have we got the protocols 100% correct? No, we haven’t. So I suspect we’ll get it right in the next year or so because it came out just before COVID and COVID cocktail bar data. Now we’re using. Yes, that’s what I enjoy. Pam Titus, I did a lot of cases. We’ve got our own protocols. Are they good enough? No, they’re not. Brian Titus. So we’re struggling with getting that correct. Really, The surgical blood testing, we’ve got that correct. So again, I’m lucky enough I started this years ago. So everything we do, we teach. It’s all protocol. So this is what you do. It’s what you have to do, like the aeroplane pilot pencil, all these buttons, do all this. And even before this podcast, one of the guys from the Irish group had I’m doing this recession defect.

[00:31:06] These steps are going to do. So again, it’s it’s in your manual search of what we’ve taught. So that’s how we do it. And I think I wish I although I had phenomenal training, phenomenal training, we sometimes went man houses, which wasn’t a bad thing. This whole point of training, you try everything, see what works in your hands is so we know we have anything between 6 to 10 days to teach our colleagues to get this right. And, you know, some of them come back and say, Oh, I know this rubbish, this B.S. teaching, it probably works. So that’s why we teach it. So it’s it’s getting that. And I think I heard one of your podcasts where you got for your own courses, you get good numbers. And some of them some of them do the cases, some of them don’t. Yeah. So we’re slightly different from you because we have a WhatsApp group all our courses. So for courses we have a WhatsApp group and we physically push everybody come on, do the cases. And on a daily basis we’ve got cases being shown highlighted. Again, we’ve got about 30 over 30 groups now as a WhatsApp. Can you share your cases, any difficulties, what went wrong? And we learn, so do we get everybody?

[00:32:29] We’ve got we’ve got a we’ve got a Facebook group. But but it’s just what I’m saying. Not every one participates, you know, not everyone does. I mean, maybe with yours it’s more I don’t know, maybe, maybe, maybe you’re better at getting people to go ahead and implement what we saw. But I’m super interested in why some do in some way. Some don’t.

[00:32:45] I. I think you did a mistake. It has to be within that group. So each group trust each other, knows each other because they they and even now and again, I’ll get I’ll get in once a month and say, do I need to ask these questions? So why are you asking me separately in WhatsApp? You need to be asking me in the group. I’m a bit.

[00:33:05] Yeah, that happens a lot.

[00:33:08] You change it. So we change it to each group, which is more of a more of a pain for us because it’s more groups, but we get to realise more people are actually engaging a lot better than having in one whole.

[00:33:23] Group, one massive group. You’re right, you’re right. Because our Facebook group is one and a half thousand people now.

[00:33:29] Yeah.

[00:33:29] And it seems like a big audience, isn’t it?

[00:33:32] And we changed it. So the WhatsApp group is we’ve got certain rules, you know, few years ago stopped it, you know, Friday night, Saturday night, Sunday night. No messages, please, because we’re getting to 9:00.

[00:33:46] That’s a.

[00:33:47] Strange bunch.

[00:33:49] That’s it. So I’ve got I’ve got a mini spa makeover coming this weekend. I’m going to do a WhatsApp group with them and see what happens.

[00:33:54] Yeah, do what? And, you know, we sort of say, look, come on, you know, do we get with our group such a small age group, anything between 8 to 10, usually you’ll do 12, no more. And again, whatever you put in, you get out. And each time we do a course, we start the course. We shared not all cases. We share them all the cases, we share the finishes. Douglas Whatever it was, we share all these people who they might know because they’re well known, who’ve done our course and say, This is what they did. They’re no different to you.

[00:34:29] That’s a good idea, too. That’s a good idea to know.

[00:34:31] Different to any of us haven’t got super hands. They just got on with it. And there is a difference. I think the youngsters are amazing. The youngsters tend to what? I’m going to go for it. Take it easy, and then I think you’d be too educated. Mature. You tend to swear. You tend to overanalyze things when you know. And some of the youngsters, the cases they’ve done, just like, wow, again, this is and again.

[00:35:02] Is that is that what drives you? Is that what drives you in the teaching that that moment when the somewhat one of the delegates ends up doing something amazing?

[00:35:10] Yeah, that’s right. Because it’s good fun. It’s good fun. I love it and I love people coming back to and this is and also I get to see what they do and where they practice and we mentor them and quite a few become our friends. Literally, some of you become close friends. Now you just follow their path. And we’ve had to do suspicious training to want to do special training to just about, oh yeah, too bad to start. A few have gone to do. I think this two have gone on to do their own implant course and I do that there’s Yeah. So it’s you know I did Douglas. Douglas what.

[00:35:53] Yeah. Good great good.

[00:35:55] Yeah he did of course. And now he’s teaching me the digital flow. So we’ve worked at the district level, so I.

[00:36:04] Have a stent.

[00:36:05] Now. It’s more than that. Yeah, it’s the same. So we’re trying to do it. So a CBC led. So the future.

[00:36:10] Oh, I.

[00:36:10] See. The future is going to be sort of chronic. It’s going to be, you know, close. No surgical approach is just going to be like this. We need some institution to take away. It’s going to take away like a guided implant surgery, short or flap, whatever you want.

[00:36:25] To take me through that because I want people to get value as well. I want people to learn something from this rather than just about you. I’ve been I’ve been guilty of that before. Yeah, I’ve been guilty of that before. So take me through that. Just the basics of of crown lengthening. What amount of, of, of gum can I just shorten with a laser or with a, with a electro surge without impinging on the biological width.

[00:36:52] So there’s two ways to look it. So we teach it as you have to do it as an aesthetic. So if it’s aesthetic is a non aesthetic functional case. So if it’s a cosmetic as you’re talking about, you need to work out what the bullet for that case is. So the first thing to look at and the difficulty that we have is knowing not just how much tissue you take away is how much tissue do you have. So it goes back to the boring thing of have I got enough nice tissue? So we go we go little to the basics and it is difficult to sort of say, why is the freedom an issue? Is it freedom in the way? Have you got inflamed tissue? Have you got crowns in place? Have you got veneers in place? If you have, it changes things completely. So when we teach this, it literally is what do you have in terms of soft tissue, hard tissue? Are you planning to veneer these cases? So if you’re going to try and veneer these cases, you need to try and finish them onto tooth, not onto root. That means. So it sounds easy, but it’s not. And then you need to look at, have you got thin tissue, have you got thick tissue? If you’ve got thin tissue, it’s going to recede more. If you’ve got thick tissue new to it, you’re going to get inflamed tissue. Then you go look at is it high smile line? If it’s a high small line case, you’re going to have to leave it 3 to 6 months with temporaries in there.

[00:38:17] So it’s again, I think we’ve nailed it in terms of saying, right, this is the crib sheet that you use. This is what you have to look at. It is based on that. How much tissue are you going to take away and it all based on your diagnostic setup, etc., etc.. So it’s the DSD in terms of trying to work out hang on based on this, how much tissue do I take away? But it’s not that straightforward in terms of I want to just take away two millimetres of tissue. It depends what you do, how you temporise it. So again, some of the cases, some of the colleagues do are just phenomenal because they follow the protocol of Temporising it’s leaving it longer. And then even that you have to look at your papillae. We teach papillae preservation, so some of the Americans will literally have few horror stories where they’ll just chop chop things off and then restorative they do for martinis or crowns because you’re going to try and create the papillae. We don’t teach that hours. It tends to be quite simple. Follow these steps. That way you won’t lose anything for me, so you won’t make any mistakes from that point of view. So it’s a question which is a huge one. Sorry, if I’m going round.

[00:39:39] That’s more nuanced than it’s more nuanced than. What does he believe.

[00:39:43] He’s.

[00:39:44] Actually.

[00:39:45] Like? Like everything else. Right. What about this new classification, man? Because to me, it feels like they’ve made it more complicated. Or my mind is not paying attention because you’ve got now you’ve got staging and you’ve got grading. Is that right?

[00:40:00] Yeah, there’s lots of things they’ve changed. There’s there’s staging, there’s grading, there’s classification and when to treat, you know, certain things when not to. So it’s a huge problem because I think as soon as as soon as that came out, everybody’s like, I need to take Radiographs. Well, why are you taking away the gloves? Because I’ve got to do classification. So we teach or say we teach, we’re doing this affect system to group of patients and cepstrum where there’s a difference between classification diagnosis, every obsessive classification. And we tend to say, what is classification? Does it affect your diagnosis? No, it doesn’t. It’s two different entities. And it’s that it’s that confusion where we teach it to different entities. Diagnosis is what’s going to affect your treatment. It’s what you’re going to get in trouble medically, legally, if you don’t record classification. So a diagnosis because that’s going to affect the patient. But if you’re going to tell the patient in the letter, you’ve got staging and grading, it means absolutely nothing to the patient. And that’s what it means in the day is what the patient’s understood. Have you just done it just to satisfy some ivory tower person who’s saying to you, you’ve got to do staging grading based on, you know, cancer? Because that’s what it’s based on. It’s based on that. For me, it doesn’t change that. It’s basically you’re going to get a diagnosis. Say, is the patient susceptible? What are the risk factors that we’ve been doing teaching it for decades. So do I.

[00:41:32] Do it.

[00:41:34] In the.

[00:41:34] World of period? For instance, did you feel like the old system was was lacking and so you needed a new system?

[00:41:42] I don’t think we need a new system. I just think, you know, when we were taught period, it was phenomenal. We had phenomenal undergraduate and postgraduate. We had amazing and depending on which type of UK and I can identify which dental schools. Really. Yeah I mean it’s there’s just for my experience tends to be you know the Glasgow you know Dundee the New Castle graduates are just are different level in terms of really clinically knowledge and skill wise and you sort of know after a while based on their pay is not really taught that well in this place or that place. And it’s going back to basics to all these people. So we spend the whole day literally on the courses just going back to basics, not not the anatomy. We do the basic clinical anatomy or we sort of say, What are you looking for? What do these numbers mean? What are the centimetre pocket? Still people don’t know, unfortunately, what eight millimetres seven millimetres pocket model advance. So it’s getting back to basics and it’s sort of like, Oh wow, I didn’t know that. So it’s hard to judge. We just need to sort of say, Look, come on guys, this is what you should be doing. Please do it for your own sake, for patients sake, and you don’t get it. It’s going back to the basics. And again, I was taught we do well. So we do in a simple, basic way. Day one, just on that. Now, before we move on to the.

[00:43:17] It’s interesting, it’s interesting you say that because we even see it with composite. Yeah, there’s a couple of dental schools that they stand out as very good at teaching composition. I haven’t really paid attention to the ones that are really bad, but but I have paid attention to a couple for for me. Birmingham Yeah, I think Louis McKenzie had a lot to do with that because you put the students into hands on composite courses in, in undergrad and I think Peninsula’s being very goth and Jason might have had something to do with, with that, I don’t know. I’m not sure. I see some really good work.

[00:43:50] Hope we see. Good, good from there. Good, good number from there. But we get a few. Unfortunately, again, we sort of say, look, you know, we have some people who do our courses at the beginning sort of say, I’ve got a I’m a bit embarrassed to ask this or have some what do you think I should do? I so don’t worry. You know, we have different stands where people are just amazing, really good one level and others do a bit more, which is fine. It doesn’t, you know, I struggled education wise in certain aspects. So we just said, look that, well, you’ll get there. You could go down a bit more, pay attention a bit more because you are really.

[00:44:30] So noticed in your research interests. There was there was the connection between perio and cardiovascular disease.

[00:44:40] Yeah. Yeah.

[00:44:40] And and it’s such an exciting time, isn’t it, now that, you know, we’ve got this link between P gingivalis and Alzheimer’s, that it’s become a hot, hot topic, right? And diabetes and cardiovascular disease. Do you get that feeling? I get the feeling now that, you know, it could be that suddenly the oral microbiome or whatever is is is super important, or because it’s becoming super important, our understanding of its effect on systemic disease. And, you know, Perrier would be at the forefront of that. Right. And I notice you get all your your delegates to do blood testing.

[00:45:22] Yeah, yeah, yeah.

[00:45:23] Your Perrier patients.

[00:45:25] We do trouble that. That’s not quite that Not quite you know.

[00:45:29] Yeah we.

[00:45:34] Know. Yeah. If you have. So again we go back to we, we do risk factors with donkeys. So if you risk factors one of them is in medical. So if you’ve got generalised advanced severe disease and you haven’t got the level factors of plaque and anything else. Yeah. One of the things we’ve been doing for 15 years, so I did my M.S., I had mercy on the cardiovascular and impair disease.

[00:46:00] I mean, so you mean if the disease is aggressive, but the oral hygiene seems okay, that’s when you do it.

[00:46:06] Yeah. And again, we pick up head of a lot. We pick up, you know, thyroid anaemia, diabetes, the whole shebang. And patients come back and come back. Wow. Thank you so much. You know, others come back with tablets. Look, look, I’m on now so much, okay? And yeah, we when we’re with them, we tell them, look, you may lose a bit of time, bit of blood, but I need to make sure you know, we’re not going to waste your time starting treatment knowing. Hang on. And again, we started this with implants years ago. And I think our colleagues in the you know, when I see lots of implants, we were doing that. And why did we get failure? Is this due to something, you know, prediabetic, etc., etc.? So we did that. So I remember seeing that. So I was I was I was like, Wow, this is really fascinating. So I got into that again years ago for many years to be We’ve got to be careful. It’s an association. Yeah, it isn’t.

[00:47:09] Yeah. Yeah. But I’m really excited about this idea. Of course we What I say, of course, is if this is even new, right, isn’t it that, that you can, you can, you can help someone’s gum disease if, if, if their diabetes is sorted. Right. That’s one thing. But the other way round is what’s exciting. The idea that you could help their diabetes with their gum disease fixing their their gum problems. Yeah, that that’s such a crazy notion.

[00:47:35] Lots of I mean there’s lots of k you know, if you read that there’s lots of cases of, you know, women not being pregnant because their thyroid, you know, is the easiest little mini things. You know, they don’t seem a big thing, but they are all because they’ve got why somebody’s not healing, why are getting pregnant, why you know, this is not happening. It tends to be underlying systemic issue. And the good thing about it is a hygienist, dentist therapist are going to know about it. And so our patients so I’ve got patients who turn up in sitting, as I say, I’m planning to have a baby I’ve heard about I may because I’ve got gum problems, I may have premature know. And that was that’s.

[00:48:17] That’s what they’ve just read that on the Internet somewhere.

[00:48:19] Yeah it’s they now they read about it And that’s that’s actually good in a sense because it’s amazing. Yeah. You’re getting it’s the social media people thank God you need to look after your gums because your health is set to smoking, etc. So the awareness is brilliant and it’s coming up thankfully. Are we pushing it enough? I don’t I don’t think we are. Do we have.

[00:48:43] This link, this link with Alzheimer’s? You must be aware of that, right? The Do you know about Zuckerberg’s dad? Did you hear about this?

[00:48:51] Yeah. I mean, my father in law’s got my father in law. Bless him. He’s got Alzheimer’s.

[00:48:57] And has he?

[00:48:59] It’s. I think we’ve got to be slightly careful where we are. I know they found bugs and bacteria and brains and etc., etc., but I think it is important. Are we there in terms of identifying this as the cause? No, we’re definitely not there. We know there’s a relationship, but you see lots of patients who who hyper who over the years have developed cancer and all of a sudden their their mouth does deteriorate but. Mick thing is, it’s a huge it’s every single pathway you can think of and it’s exciting. Yes. But we’ve known this again, this has been going for 20 years, but we haven’t, I think, publicised enough. We haven’t.

[00:49:43] Yeah.

[00:49:43] Because for, for a long time period to the to the outsider like me would seem like well right, you know, you’re kind of cleaning away and once in a while it’s going to be a surgical going to refer that and you know, that’s the first. It felt like it wasn’t getting anywhere. You know, now, though. Yeah. I mean, maybe I’m looking into it more. I don’t know.

[00:50:07] Honestly, if we go back to our first thing, first thing I say to to anybody who does our cause is I say thank you. Thank you. Because it’s not a sexy it’s not like you’re a composite. It’s not, you know, it’s.

[00:50:20] Who.

[00:50:21] Are. I just always say thank you because it’s not a sexy subject. It’s something I don’t think was talked well to a lot of people, unfortunately. And we’re trying to change that. But it’s like, thank you so much because people just think, as you said, it’s just going to be, you know, gum gardening, cleaning a bit here, doing that. It’s not. And there’s so much in it. So whether it’s crowning thing, whether it’s recession, whether you’re grafting, you know, implant implants, really. And again, it’s it’s so much more now and again, it’s how.

[00:50:57] Predictable is grafting.

[00:50:59] Well, a good question. Got again the case is pick your cases. So since alignment you know since the alignment kicked off the massive recession beginnings Huge, massive, massive could be thankful for that too. But again, the cases, the cases that we’re doing in the upper anterior, they tend to be stable in the lower. We’ve changed it now. So we’re now doing a lot of CBC. So again, where we’re doing CBCs is we’re seeing a lot of cases where there’s no buccal bone left, there’s no buckle bone and teeth are out because.

[00:51:39] Of because the aligners is pushed the tooth too far.

[00:51:42] Yeah. And I think if you look at I think it’s coming up, if you look at most entire onion, most in the he’s a big aligner guy and he’s now I think one of the first people to do CBC and alignment. So you actually looking at where the teeth are where you want to put in the bone. Yeah. And in the bone which said we’ve been saying that for quite some time now, know sort of saying, hang on, you need to be looking at this. And one of the issues that we have is going to put my foot in it now is some groups, let’s just put this way. So some groups sort of saying, well, no, you should not be doing it. The gold standard for is is a panel, which I think those days are gone. You know, if you look at Indian context, they’re pushing CBC implant dentistry perio was still not there and trying to fight that and also it hasn’t got there either. And those kind of cases are going to tell you so much before you even start aligning them. And it’s those cases where sort of saying, hang on, if the tooth is out of neutral zone, are you going to have orthodontic treatment aligned or have you had it? If you have and there’s no buccal bone? I personally think stability in our case is not there. Then you sort of say, hang on, should I be doing connective tissue grafting? No, I probably should be doing epithelium grafting because I think a tissue. So we’re tending to do a lot more of those in the in the lower end. So if the teeth are out of the neutral zone and again, making it super interesting.

[00:53:14] Yeah, super interesting.

[00:53:16] And when we show our cases, we show our cases to colleagues and say, Oh, hang on, sugar. I didn’t look at it. I didn’t think of that.

[00:53:24] And that’s so so the groups, the groups that say that, are they basing it on the x ray dose of a CBC? Is that what they mean?

[00:53:34] Yes, they are. But those days are going or gone. I mean.

[00:53:38] With the dose isn’t as big as.

[00:53:43] What? What can you see on a lower end? My opinion that this is going to be a small volume and I think the same issue is being said for implant dentistry, same issues being said for endo. So you should not be doing this. But if you if you ask my medical colleagues, I think they laugh. I always speak to my colleagues and say, look, I.

[00:54:03] Think the other thing is a CBC is different to a.

[00:54:06] Ct. Yes.

[00:54:07] And not enough people realise that. Yeah. People people know a CT scan is 100 chest x rays or whatever that is. Yeah. Like a big, big dose. A CBC is a different thing. It’s a different technology. So it’s a much, much lower dose.

[00:54:22] Yeah. Dentistry is.

[00:54:25] Is.

[00:54:27] Phenomenal compared to 20 years ago. It’s bloody exciting. There’s so much going on. But I think we should sort of start pushing the parameters and saying, come on, let’s just do you know the negativity there or you mustn’t do this, you mustn’t do it, has to go. Some of it is due to unfortunately regulation and or we too scared and we mustn’t do this. And the other other other is to do with the ivory tower still having a bit of power.

[00:54:53] But how do you feel? How do you feel about how do you feel about the regulation and the culture of patients? I mean, I think I often think that there’s many things that we did at Enlighten that I’d be too scared to do today, you know, tests, the different gels we were trying and all of that back in the day, back in 2001, 2004, 2006. We’re trying things out that today is a dentist. I’d be like a little bit like so worried about being sued all the time. They are, aren’t they? They’re always worried about what you see. How do you deal with that?

[00:55:27] That’s sad. And we will doing it like it’s really sad. You know, I half my days writing up letters, defensive dentistry and.

[00:55:38] Dentists, but, you know, like you said, you said you said we’re not there yet on on peri implant itis. You know, we’re getting there and we’re not there yet on the flap. Less regeneration. We’re getting there. All of those, you know, every single movement forwards in dentistry happened because someone said, what if.

[00:55:57] Yes. Yeah. So really the days of us, especially from a referral point of view, you know, I would engage patients say, look, can we try this? And patients say, yes, and you know, again, on a regular basis, you know, every month I’m getting a colleague saying, How can you write me reference for I’ve got a I’ve got a case going to GDC case. Did you see. Yeah. Or I’ve got it. And it’s, it’s I had one last week before and it’s a regular thing and it’s not I think a lot of colleagues have COVID gave up or given up or just say, is it worth it? And I think that’s so bloody sad. We’re coming to a stage where, you know, we’re losing colleagues.

[00:56:43] Well, the lawyers are winning.

[00:56:45] Yeah. I mean, I’ve gone as a as a witness, especially expert witness, and I’ve gone to years ago to watch some. And it is scary. It’s not nice, but, you know, at some stage there needs to be change whether that will happen. But we’ve been saying that for good. You know, in.

[00:57:07] 20 years.

[00:57:08] Patients will suffer. You know, the patients will pay more. They won’t have the tumour that, you know, we’re not pushing the bands like we used to, but I’ve got the answers to that. It’s just that we’ve got all this amazing technology, facilities, courses, everything. It’s amazing stuff that out there and you sort of say, Well look, can, can we utilise some of this without. No, I haven’t got the answer. It’s good and bad. Unfortunately.

[00:57:41] Well, let’s dream this dream a little This dream let’s all let’s say let’s say that you are the king of the world And you you could make a make a bet on the future of period. Like, like in ten years time. What do you think could happen? Because Zuckerberg’s dad was talking about investing in the company where these little nano robots go into the periodontal pocket and you wear this virtual reality thing and drive the robot into the first nation and.

[00:58:11] He’s.

[00:58:13] Like, He’s investing in that company. Yeah, he’s investing in that company.

[00:58:19] I don’t think the future is going to be more medically related. You think it’s going to be, you know, patients coming in and getting blood tests, getting blood pressure, getting their pulse all done.

[00:58:36] It’s more holistic understanding, holistic understanding of what’s going on.

[00:58:40] Exactly. I think it’s going to be right. We need to make sure you’re physically, mentally, well before we go on to. And I think that’s that’s exciting. I think that would be in terms of I think the implant dentistry is amazing. And I see a big part of my work was to do some implant dentistry. I think people are saving more teeth now, which is great. It’s still a lot of implants and there’s still, but I think a lot more cosmetically driven recession cases, grafting cases bit like what they’re doing in America. Hopefully I think there’ll be a lot more regeneration, which be great, and I think there’ll be a lot more CVC saying, Right, this tooth is saved. We need to be doing this less surgery, I think, because I think regeneration would be stem cell related, I don’t know, be ten years, I think be 20 years. To be honest, I don’t think we’re there yet. Yeah, I think that’ll be about 28, 20 years time. But if you look at CAD cam, if you look at some of the things coming out, implant dentistry, we used to struggle, you know, 15, 20 years when we were doing implants and then it’s totally different now and again those people coming through the new graduates, they’re just, you know, unfortunate because they’ve got so much debt, but they’re fortunate. So in terms of having the facilities and technology that we didn’t have, so I think.

[01:00:10] We didn’t have you said before we didn’t have any courses here. We didn’t have the Internet. The Internet didn’t exist. You know, that’s a massive thing.

[01:00:18] I asked my son, my son, I would be grateful you got one for kids. I know. Of course you had one. You kind of go on different channels. No, no, of course you didn’t have that. We have four channels that exchange, and I think we embrace. There’s some old farts. I call them old farts complaining about this. I think it’s. If you’re coming out of dentistry now, it’s amazing, really.

[01:00:50] So let’s talk about darker times. We like to discuss errors, you know, mistakes that you’ve made, mistakes that maybe someone else can learn from. Can you think of something? Maybe a oh, shit moment, maybe a management management mistake with a patient that lost confidence, something like that. Can you think of something that you did?

[01:01:12] Yeah, I remember. And she still sees me. I remember really, really, really, really hot summer and relining a coat, chrome denture. But there were teeth and she had precision attachments on them. An amazing work done in Germany years and years ago. So I realised it. First time I thought, hang up, I know I don’t get stuck. So first time I took it out, that took that too early. Second time to get to mine. My nurse sent me. Oh, God. And the third time it gets stuck. Literally, I couldn’t get it. I couldn’t get snow danger out. Literally, it got stuck.

[01:02:00] It’s what it went to the undercut or something.

[01:02:02] Completely undercut.

[01:02:05] So what, you had to drill it out?

[01:02:06] No, I gave a local and I you know, the brilliant move was that the tap.

[01:02:13] The one with the juice, with the hammer and the way. Yeah. Yeah. So you took it out like.

[01:02:18] That.

[01:02:21] Section by section. It didn’t break, but she was amazing. I know. She’s in a lot of pain. Even I gave a local. It was a pressure. And she still. So I’ve had. I’ve had that. I’ve had I’ve treated, you know, don’t treat dentists treat. We treat families. Their families don’t treat dentists.

[01:02:40] You must treat a lot of dentists, though.

[01:02:41] No, actually I treat quite a few. And usually. Gosh, and this might help because you might put them off. Now I’ve had yeah, I’ve had bleeds so I’ve treated period before. I don’t take the teeth out of dentists because I love to do that. Not just generally enjoy taking these out. Bled You know, I had some bleeding and scenario of graft go after me. I’ve got black bleeding, my nose bled my face and it never happens.

[01:03:18] Don’t get nosebleeds.

[01:03:20] Doing facial swelling. But when you to pay a dentist. So I’ve had a few of those. I’ve, you know, I’ve clocked up in terms of finances over the years. You know, I always say I always say to colleagues, look, don’t just get mental. You don’t just get a clinical get a damn financial mental. I think business mental. Yeah. Try and get as much as you can. One clinical one for your personal, one for your finances, because you learn the hard way. You make so many mistakes.

[01:03:55] Go on, go on. Tell me. Tell me a business mistake you’ve made, then.

[01:03:58] Business. Oh, God. Few go. We’ve done property, I think during COVID. During COVID. So COVID is great because again, over the years since it took off, it’s just been I had no time to do anything. So COVID was not.

[01:04:15] Nice, time to reflect.

[01:04:17] But also time to go through accounts. We literally went through, dissected all our accounts. We went through what we’re spending on, what were we doing right in terms of this, where the overheads were. You know, we went through everything, which is great and there was five, it was five figures. Mistake. I know that you and then then you speak to colleagues, you speak to you speak to colleagues, and it’s like, wow, yeah, this is you know, it’s you’re bound to get there. I said, I know, but, you know, it’s and I sort of learn now. I go through everything myself. Now I tend to I tend to I’m a bit of a control freak, unfortunately. I tend to find out everything about accounts and this and this and that. So I know I check everything, really. And it’s a bit. Pitt said The.

[01:05:12] Problem with going through everything yourself is it’s not scalable, you know? That’s that’s the problem with it.

[01:05:18] I’m not into the big corporate, you know, Pokémon is great in terms of what we do and we’ve got.

[01:05:26] It’s pretty big, but it’s pretty big, but it’s pretty big whatever, whichever way you want to look at it, it’s pretty big.

[01:05:32] Yeah, I try and stay up and look at everything I physically can to make sure we know we’re covering all the bases. Whether that’s a good management skill, I don’t think it is, but at least it gets us to find out where we’re going wrong, unfortunately. But it’s it’s it’s a learning curve. And I’d say to anybody, look, from a financial point of view, whether it’s property, dentistry or other things, you’re going to make mistakes. But I think try and get a mentor because it will save you a lot of money and bother me.

[01:06:08] So you work four days a week in London and Sire Ancestor and in Orpington, and then on the fifth day teaching every week, is it? No, no. Friday. So was it once, once a month or what is it.

[01:06:23] Twice. Two times a month. So usually on a monday. My schedule is Monday. It’s Mondays are kids. Mondays. Okay, so I do the kids.

[01:06:33] Just Do you sit at home on Monday?

[01:06:35] If I can. Either that or I’ll go and see my parents. So I see my parents if I can take the kids, do paperwork, non dental and dental, pick up the kids, feed the kids, get sleep. So she comes home late on a monday at her. And typical works, finishing late Tuesdays and Wednesdays and Thursdays, usually London working and then Fridays with scientist courses. So the courses are back to twice a month, sometimes three times a month. So this month think we’re doing more. Last month we had so varies. We used in Saturdays are cool We were we were doing courses every Saturday morning. Literally was a lot. And I think one day we were running out courses and I think I was doing about, I think 1 to 25 days non-stop. I think it was 25 or 24 days, literally non-stop clinical, everyday courses.

[01:07:41] Saturday was science. What science is the team who takes care of the academy apart from you and Zainab, is it? How many people is that exactly? Three others or one other. That’s pretty good. That’s. That’s that’s that’s that’s pretty good going, man.

[01:07:57] And then it’s the courses are great. And, you know, it’s a dilemma now because my clinical work I’ve got a waiting list waiting. So two months whenever it’s a bit long in other places. So it’s do we reduce the clinical do we increase the courses? And my kids are too important. So I think my son said to me a few years ago, going in the usual moment, Daddy, can we be a family? Can you be at home? You know, so that was a killer. And I said, No more Saturdays, no more Sundays. But the exception is this month where I’m actually doing two because I had no choice to do two said one Saturday, one Sunday, in fact. Otherwise we stopped the course of the weekend. So it’s just whether we we scale the courses more and there’s demand. We’re lucky. We’ve got waiting lists and we’ve got them here. They’re everywhere. So it’s just whether we do more courses or we cut down the clinical work really. And I enjoy clinical work, I hate the paperwork, but I enjoy clinical work. So it’s.

[01:09:11] And how about ZAYNAB, Does she work in practice now?

[01:09:14] So yes.

[01:09:15] She’s a consultant.

[01:09:15] Yes. As a clinical consultant, teaching three days a week. She’s not doing PhD for two days. So she’s she’s another machine and she does private work about two or three days a month when she can.

[01:09:35] So but where does she teach?

[01:09:38] She’s a guy, She, she’s, she’s dating so she, she, they’re training at guys. So she did her training. All right guys with the usual perio mafia. We’re talking about session. And she stayed and she loves it. She loves the the hospital environment. So. Yeah.

[01:09:57] And what about what about if let’s say, let’s say Zainab and the kids went off to see someone in Paris or whatever and you had a weekend to yourself, what would, what would fun be like for you? Like, what would you do with you? So.

[01:10:11] I.

[01:10:13] I’ve got that feeling. Yeah.

[01:10:20] I’ve got a you know, I started gardening, so I said to you earlier.

[01:10:23] I.

[01:10:24] Just Beaconsfield.

[01:10:27] I bought a lawnmower. What is it called? Electric lawnmower. So summer, I started the gardening. Bloody desert.

[01:10:42] It’s not here.

[01:10:44] I’ve started gardening, so I enjoy that and that. But I’m one of those people. Unfortunately, I don’t switch off when I used to. I think before the kids were born, I would read a lot. I would read a lot. A lot of politics. That’s my obsession because of Dad and everything else. So literally when we got married, my bookshelf was literally Middle Eastern politics. Everywhere I put it, I bought a few cook cookery books, which we used just just to sort of, you know, just think, Oh my God, he’s a hardcore, you know, Middle Eastern politician or such.

[01:11:23] So how do you feel how do you feel when you look at Yemen now?

[01:11:27] Oh, God, this is tragic. I mean, the such.

[01:11:31] A tragedy.

[01:11:32] Yeah. The Middle Eastern thing is wherever you go, God, it’s in other countries, you know that It’s.

[01:11:38] Yeah, I mean, right now in Iran, we’ve got everything going on in Iran. Right?

[01:11:42] Right.

[01:11:43] I mean, most countries tend to tend to progress. But yeah.

[01:11:48] It’s not not Middle East.

[01:11:52] It’s yeah, it’s, it’s it’s tragic. It’s it’s always it’s always the children. It’s always it always innocent ones that suffer. It’s not the politicians always have the money, always have their kids sent abroad. And so it’s it’s your basic personal to live. So you know, I would love to love to go there I’m British but I can’t my British I’m British Middle Eastern. But I’d love to go do some charity work events in the future. Do do some of that. I mean, I’d love to go back and do some more reading, but do I get any free time? Not much. And if I do, is is it Dental? Is it non Dental business? Is it the courses? It’s just trying to juggle, juggle everything and then the kids. The kids now take priority and everything. So the kids are, you know, before, before this I said to you before taking them and you know, how do we where we’re going? So the kids are taking part in that because they’re young, they’re under ten. How old are they? Seven. Three. So a bit too young. And so I’ve got a few more years to go. Yeah. Before they become teenagers. And it’s fun. The good thing is you have a lousy day at work or whatever. You get stuck in the train traffic, you go home, all the kid wants you. They just want, you know, affection, entertainment, food and time. That’s what they want. And that’s the great thing, you know? So it’s it’s there’s also guilt. It’s always like if you do extra work or you’ve got to travel for a day to Scotland or whatever it is, you miss the kids and it’s that guilt. And I find.

[01:13:34] Yeah, I feel I’m on a mission of, of taking guilt out of it, man. I mean, I don’t know. I’ve had this conversation so many times with my guests. Yeah, but. But take guilt out of it, man. I mean, if you’re guilty, you’re at work one day less than if you really guilty. Yeah, Yeah.

[01:13:49] But there’s always work that you’re not guilty. Yeah, I know, but.

[01:13:53] Double your price. Triple your price and work one day. You know what I mean? If you really guilty. Yeah. Yes, of course you could. But what I’m saying that’d be guilty. To be guilty was guilt. Yeah. Like, was your dad guilty that he was diplomatic around what you learnt a lot by looking at that guy.

[01:14:08] I know, but, I mean, I look at my childhood. I had a great childhood and my responsibility as a parent to sort of say, well, look, I will do everything I can for my kids, you know, And it’s not. And I don’t mean that in a financial point. I don’t mean it does everything. Yeah. It’s just being there. And I actually enjoy it. I love being with the kids and they’re great fun. And if you ask me, although I love my clinical work and I love teaching, you know, the other in the family life is the most important bit. At the end of the day, it’s what counts, really.

[01:14:44] I’ve got a question. Do you? Imagine if I gave you $1,000,000,000. What would you do every day? Would you do?

[01:14:52] What I do. I, I, I take, take, take, take family. Probably go to this and charity work and just get get other people to do bits and pieces for me so I can just, you know.

[01:15:08] See even charity. Where I was, I was discussing this. I was discussing this with Sandra. I don’t know if you heard the the podcast with Sandra Garcia Marti, but we were talking about charity work here. And she does this thing. She goes away and and and helps it drills in in this really poor place in the Caribbean where they haven’t even got electricity and all of this. Yeah. And, and I was saying, you know, that there’s an element of charity work here that is self is for you if not for the not. Yeah.

[01:15:38] Yeah. So it’s giving something back. I mean you know.

[01:15:42] It is, it is, is but, but I’m giving you, I’ve given you a billion. Right. So you could, you could take that billion and give it to charity if you really want it you could, you could give half of it away to charity. You know what I mean? The actual doing of the work itself is what would you do with yourself? You know what I mean? What would you do every day?

[01:15:58] I’m quite cynical because that charity one, I want to see where it’s going.

[01:16:03] Sure, sure. You’d set up a whole charity, right? I like that. I like that you’d give back something, though, but. Okay, let’s say you’ve done that. And you know, I never asked this question. Everyone says charity, and they say I’ll go on holiday. Yeah, see, you’ve done that. And you you’ve been on the holidays as well.

[01:16:17] The holiday? I can’t see that you. I’m one of those. I can’t sit down. I’m always answer my pants, as they call it. I’ve got the with the kidney thing.

[01:16:24] Okay. But you could go on holiday to the North Pole and you know, whatever, climb the mountain. But. But what I’m saying is, okay, after you’ve done the holidays and you’ve done the charity, what would you do? It’s an important question to answer. I don’t mean you need you have to answer it right now. Yeah, but it’s an important question to know the answer to because you know why? Because it could be that the thing you could just do tomorrow. That thing you don’t need $1,000,000,000 to like. And if it’s I’ll spend one day with my kids a week, you could do it.

[01:16:57] You know, it’s a beautiful thing. I know.

[01:17:00] But I mean, from a selfish point of view, I would do things for my family. My kids is no doubt about if you ask for something dental, you probably open a dental school or dental clinic and do this. I want to do, you know, sort of pioneer things, if I could. But other than that.

[01:17:18] That would be cool. That would be cool. That would be cool, wouldn’t it pioneer some some something in in interior like some some inkling that you had you could put money behind it and put like these PhD’s on it.

[01:17:30] Like making sure that money was used. Well other than I’m like, I’ve wasted all this money as such.

[01:17:36] True, true.

[01:17:37] I never I never I’m one of those who doesn’t have regrets. I tend to sort of say, well, look, if I can do something, I’ll do it. If I haven’t done it, I don’t think it’s my priority list as such if I’m getting the answer to that question. So but I mean, I do know I really don’t know. I’d probably give it to Zainab to do. She comes up with it with the best ideas. I do. She’s one of, you know, Right. Let’s do this. Let’s do that. Typical to know who can can.

[01:18:16] That.

[01:18:17] Kind of analyse things, get a cookbook and say, let’s do that. And they tend to be right. It’s a it’s a we say between us is a verse is it prefers crystal ball. Some people have and I’m not one of those people she does she sees that person, not me.

[01:18:34] Because you got an Iranian woman. Iranian women are hard. They rule, they rule the roost. So that’s why I married a Lebanese.

[01:18:48] But that’s it, isn’t it? Is that the.

[01:18:53] That’s the Lisa that’s the Lisa connection. Yeah.

[01:18:56] I actually watch the watch side thing. I watch the what’s the the Nissan Vino chap, Lebanese guy who made it run up.

[01:19:05] Yeah. Yeah, yeah. Got Rosner.

[01:19:07] Yeah. Yeah. That was a really good Netflix program about that.

[01:19:12] I was there was it called.

[01:19:14] It just came out last week it’s about him look like.

[01:19:17] It just look up his name. Yeah yeah I well, I’m really interested in him.

[01:19:21] Fascinating, interesting character. But anyway that’s, that’s another political thing is that I guess.

[01:19:29] It’s been a massive pleasure talking to you, but we’ve kind of come to the end of the time, so we always end this with the same two questions. So it’s kind of I know perhaps not here, but it’s perhaps in my mind is fantasy dinner party. Three guests. Dead or alive. How would you. Who would you. Who would you.

[01:19:51] Have? One is Muhammad Ali. Amazing. I think if you go through what you went through the struggle and he’s also bloody witty, sarcastic, witty sarcasm, that’s that’s why I love that.

[01:20:07] But if you if you go down the if you go down a YouTube rabbit hole of Muhammad Ali, you just see so much at one. I did do that one.

[01:20:15] That is marvellous. If you take away the boxing, you know, he’s a phenomenal, fascinating, fascinating.

[01:20:25] Political guy, too. Yeah.

[01:20:28] Very, very, very smart. You think he’s just a boxer? He’s not. This is a very intelligent, intelligent chap. Robert Fisk.

[01:20:40] Oh, really?

[01:20:42] Yeah. I went to listen to him years ago. He’s so brilliant. He lived in your wife’s father. He, you know, British. Irish lived in. And he’s. He’s knowledge of Middle Eastern politics is just. Yeah, brilliant, unfortunately. And it’s.

[01:21:00] Something. I didn’t know that.

[01:21:02] Yeah, he died year two years ago. Phenomenal. Literally suck his brain out in terms of because he’s witnessed everything he witnessed the Afghanistan war we know to what’s been happening recently. So I went to listen to him Fascinating. Offered these books and these books. And then he’s the greatest. I think if you listen to me, much more books are the I’ve read them but I can’t read enjoy them. It’s yeah I think somebody can write well I put my foot in there so. Yeah. Fascinating. Really, really sad. Oh, really shock. He died, unfortunately. And then Nelson. Nelson Mandela.

[01:21:46] Another one. You’re not the first.

[01:21:48] Yeah, he’s. He’s a lady’s book to pick. And again, just to go through what you know, and to forgive, forgive and forget. My God. Yeah. Yeah. Extraordinary. I think you need to forgive and forget. I can’t forget that person. To do what he was able to do is phenomenal. And with a smile on his face. Yeah, it’s. Yeah.

[01:22:22] And the final question then. On your deathbed. So all your friends and family around you. Your nearest and dearest around you?

[01:22:32] Yeah.

[01:22:33] Three pieces of advice. It. Give them.

[01:22:37] A fun. Have fun. We have fun. And I teach my kids, if you have fun, if you come into work or whatever you do, you’re smiling. It’s half the battle, you know? Come with a positive attitude and enjoy what you do. I always think if you enjoy what you do, you’ll excel at it. You do better to engage with people, not better. It’s having that positive attitude. I can do this. You know, this is great, you know? And if you don’t, I start to change. I always. Oh, my God, I’m not happy. I’ll need to change something about it. So have fun.

[01:23:16] It’s a theme. It’s a theme that’s run through everything you’ve said. You said. You said you enjoy work. You said you enjoy teaching. You said you enjoy your kids. I think I can see.

[01:23:26] That whenever I’ve enjoyed working. I’ve got to go. Sorry. I need to leave. And that’s you know, I’ve had that before, either the Monday morning or choose whatever it is. Oh, God. I’ve got to get to this place. That’s the time you’ve got to say so. Have fun. Enjoy what you do. Life. Life’s gone too fast. I turned 50 this year. You know, it’s. Yeah, me too. Yeah. But look. Both. You can’t see them both bald. I got more.

[01:23:59] Have you still got your eyesight? I’m blind, but soon.

[01:24:07] I’m not joking by that point of view. Can I just say, look, let’s have fun. Don’t ignore what people say. You’ve got mentors, but you know, you’ve got haters. People tell you, don’t do this. Can’t do this. You mustn’t do this. Go out and prove them wrong. You know, listen to your instincts. If you think what I know, I can do this. I’m going to do this. I need to do this. Just go out and do it. So have fun. And then really, from the point of view, don’t look back to regret. Don’t regret. You never make mistakes. Everybody makes mistakes. That’s all part of learning. As long as you know, that’s politics and history, isn’t it? Really? People don’t learn from from mistakes. They repeat the same cycle. So learn the mistakes. You’re going to make mistakes we all do to that point of view. I think one of the podcasts I think I listened to you guys was the amazing book. God, who’s that table tennis player? You read that.

[01:25:15] Book? Yes. Say it. Yeah.

[01:25:17] Yeah. Let’s think outside the box.

[01:25:21] Black box.

[01:25:22] Thinking. Yeah. Yeah. That’s amazing. So, look, you kind of make mistakes. You know, we shouldn’t be condemned to it. We all make mistakes. Just learn from it. So learn from the mistakes. Don’t be ashamed by it and just move forward. Don’t have any regrets. And I think that’s the most important thing, right? Those are my three items.

[01:25:47] That was only two. That was only two. Have fun. Don’t look back. What was the third one?

[01:25:51] Regrets?

[01:25:52] It’s the same.

[01:25:53] One. Same thing. He wasn’t there.

[01:25:58] 1111111. One moment.

[01:26:04] I don’t know.

[01:26:09] Probably just be patient. You know? Be patient in life. Everything comes. Comes to good. I honestly think. You think. Oh, God, I made it all comes to you. You know, you go round in circles as such, but at the end of the day, things will work out for the best. They always do. I know you got to go through a bit of hell and shit and this kind of thing, and you just got to say, Look, there’s good days. You have more good days and you have more dark days. And I think if you’re having dark days, get some help. We’ve all been there. So truly, just find somebody who will guide you. That’s what we look forward to in Barrows. I think in the UK, it’s the it’s the Scottish thing of saying I’m too vast to have physical mental health. And it’s sad. I think if you look back when we were kids, Smarties was everywhere. If you want help, you’ve got it really quickly. There’s not a lot of peer pressure. I did identify everything I’ve got to achieve. This must do this. If I don’t do this, I’m a failure now. And I think if you look at even our colleagues that we teach, some people just they work in nowhere, but they’re so content and happy. They just, you know, but nice simple life things go well, but I get it. Get up, get on with it. That’s why.

[01:27:37] It’s.

[01:27:39] Have you have you heard anything by that Mo Gaudet?

[01:27:43] No.

[01:27:45] He was we used to work in, in Google or something and then his his son passed away and then he was talking about is he going to be sad forever or is he going to try and be happy? And he looked into the science or whatever of happiness and he talks about it’s a bit sad today. Truth is a bit sad, but it works. Yeah, it’s still like kind of lower your expectations on stuff, you know? But it just works because it’s very easy to sort of raise your expectations. Oh, this, this, this event, this course, this whatever this this thing is going to be amazing. And then you can only get disappointed from that point.

[01:28:28] You know, don’t have too much expectations really because.

[01:28:31] Yeah, yeah, yeah, yeah.

[01:28:32] You won’t be disappointed if that makes sense.

[01:28:35] Yeah, it plenty works slowly. Your expectations a little bit really does work, man. It’s sad that it works, but it does work. But I’m going to throw in one more question. This might become a regular. What’s your favourite book?

[01:28:46] What’s my favourite book?

[01:28:48] Got some of them.

[01:28:50] Political or just, you know, any book?

[01:28:53] Sure, sure, sure. Yeah. I’m interested in politics, but. But whatever. Whichever. What’s your favourite period?

[01:28:59] But no.

[01:29:01] Don’t answer that.

[01:29:03] I read the book 22 books, one of it by Edward Said, Because I’m fascinated, because he again so political and he was going about the Middle East process and you know, he, he again, he, he died to leukaemia and I read his book, one of his books and it’s just like, you know, too much war, too many things going on and for no apparent reason, comedy. So one particular book, I said, wow, to us, what.

[01:29:36] Was what was that book called This Side one?

[01:29:38] I don’t know. To be honest. It’s I love him to death. But one of the things that she did was to put a lot of my political, political books away, because I tend to be obsessive by reading a lot of them. And then you sort of you sort of you don’t get depressed. You just you just think, hang on. You feel like kicking somebody and saying, come on, change the politics in there. He wrote several books.

[01:30:05] Orientalism.

[01:30:07] Yes.

[01:30:08] I’m looking it up as. I didn’t know that. I just looked.

[01:30:11] Up.

[01:30:12] I should have pretended to have known that.

[01:30:16] I thought you’re looking out for us. Yeah. I can’t really say this one particular book, I i Perrineau. I mean, it’s. I think as soon as you read the book, it becomes old. If that makes sense.

[01:30:36] Yeah, of.

[01:30:36] Course. Yeah. You know, I. If I have any free time, it will tend to be more political books that I, I like to read than anything else. Really?

[01:30:49] That’s amazing. I’ve really, really enjoyed this conversation. Thank you so much for taking the time. I know you’re such a busy guy. And today, busy with Halloween. I thought. I thought my kids were over it, but it turned out they were. My my daughter still wasn’t. So that’s why I was.

[01:31:08] Thankful it’s not raining at 6:00 because I think. Yeah, yeah, yeah, yeah, yeah. Science is still just bucketing with with like, oh God. So we went out with my kids and then some neighbours. It was just, it was great, it was brilliant and thank you so much.

[01:31:26] It’s been a real pleasure. Thanks so much for taking the time.

[01:31:28] Hotel Nice.

[01:31:29] Lovely to have you.

[01:31:32] This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts. Payman, Langroudi and Prav. Solanki.

[01:31:48] Thanks for listening, guys. If you got this file, you must have listened to the whole thing. And just a huge thank you both from me and pay for actually sticking through and listening to what we had to say and what our guest has had to say, because I’m assuming you got some value out of it. If you did get some value out of it, think about subscribing and if you would share this with a friend who you think might get some value out of it too. Thank you so, so, so much for listening. Thanks. Don’t forget our six star rating.

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