An associate was asking me, me How many practices do you think are actually good practices where you’ve got a supportive environment as an associate to minority?

I would say.

I kind of I couldn’t really pick out a figure that, you know, just somebody was explaining to me about some difficult scenarios when they’ve moved from practice to practice to practice. And I would hope, I suppose the people that we speak to, we hope that, you know, most people are supportive and good principles and try and look after people as much as possible. But invariably there’s always going to be good and bad in any profession.

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 selling cake.

It gives me great pleasure to welcome Imran Nazir onto the podcast. Amy is a dentist, cosmetic and implant dentist who has recently started a practice in Cheltenham with lots of specialists at Cheltenham and Cotswold Dental. He’s also turned his hand to teaching with his brilliant aesthetic prosthetic courses that he does with Manish Patel and recently launched a new implant course, a rich preservation course called 15. See? Brilliant to have you, buddy. Thanks for joining us. Welcome.

Thank you for having me. It’s great to actually finally come on the the podcast after listening to you guys every morning at 5 a.m. most mornings at 5 a.m..

It’s nice to have someone on the show who actually listens. Yeah, yeah, yeah.

That’s when I do my commute. So it’s the best time to listen to all of this.

Here’s a test. What’s your favourite episode of me? Yeah. Nice. Oh.

Favourite episode. That is a test, isn’t it? Can I scroll to? Can I come back to you on that one?

Yeah. Yeah. I’ll tell you what my favourite episode is. Vishal. Vishal Shah. Yeah. Have you heard that one?

When was that one?

Ages ago. Yeah. This was the whistle blower. Hygienist Wasn’t. Wasn’t. Wasn’t disinfecting the instruments.

Oh, maybe. Maybe I did miss that one.

That’s the best. It’s the best. I’m going to have him back on as well, because he’s. He’s done really well since then. Class action lawsuit. All his patients. He was on the news in in China. What’s your favourite episode? That’s a good test. I think it’s still going to be a new right? Yeah, I think. I think it does, because. You know, I was very fond of the guy and and even listening back to that and I haven’t for a while. So many lessons, so many life lessons in them and whatnot. And such an inspirational guy, amazing teacher and a guy that touched many, many, many hearts and people’s education over the years. So, yeah, it’s still still stands strong as my favourite and then possibly my brothers, just because of the amount of swearing we had to come out of it, crying and crying.

If if you know the one the one actually more recently that I quite resonated with that I was telling the delegates on the weekend about was actually George is one a couple of weeks ago and you know the message I was telling delegates on the weekend was, you know, even someone as skilled as him with so much experience where he shared that story about putting the implant through the mandible without checking his implant motor and, you know, his background from his father medicine and now what he’s doing. I just found it a fascinating story, just a fascinating backstory. And he’s obviously, you know, he’s he’s done so well for himself now. And, you know, so many people look up to him in the implant world.

I mean, you know, how we normally start this podcast, but I’m not going to normally start it the way that we know I want. You know, I was looking at you today and I was looking at your you’ve done basically the sort of the funnel of a dentist. You qualify associate M.C. Squat practice specialist practice and now teacher. I want you to give me for each of those roles. One thing that surprised you. One thing you wish you knew before you did that.

For each of those roles.

Yeah. So before you became a dentist? Yeah.

Before I came. A dentist?

Yeah. What do you wish someone had told you before you became a dentist?

I suppose. I wish that before I became a dentist, someone told me that, you know, at the very outset of your career, try and make sure that a really good balance between your family, your friends and your dentistry. And I think now I’ve become much, much better at sort of being more conscious of my time and juggling all sorts of activities. But I think in the infancy of my career when I was an associate, certainly I would say that I was working so many hours in surgery and I probably missed out on things with my children that I absolutely regret. Whereas whereas now, when I yes, I’m busy in the week, but the weekends are solely, solely dedicated to being by the sports pitch, running my children around. And I wish I’d have known that a little bit earlier.

On that point, you were getting your 10,000, 10000 hours in, right? That made you that made you who you are clinically today. That puts you in a position to be able to teach and guide others and to be able to launch the clinic that you wanted to launch and deliver the patient journey that you wanted to do. And had you not done that and you were at the side of the pitch more or doing more, more family stuff, and I don’t think you’d be where you are today. And I think a lot of us go through that period. I definitely went through that when I was doing my 17, 18 hour days and wife and kids just got sidelined. Right? They were they were a secondary thought. And there are moments when I beat myself up about it. Right. But also I know very, very clearly I wouldn’t be the Prav I am today had I not been through that struggle. So knowing that, would you change anything if you went back?

You know, I don’t think I’m lucky. I have the most incredibly supportive wife who is a dentist as well. And you know, I wouldn’t change anything about my journey at all. I feel very privileged and fortunate to where I am now. And, you know, it’s been it’s been a passion of love, really. And I think even to this day, whether it’s writing new courses, whether it’s writing material for the practice, I love every single minute of it. So I don’t resent anything that I’ve done in the past at all.

I mean, what about before you started to practice? What do you wish you knew?

I started the practice in well, I think we completed on the first of 2nd of January 2020. I wish on the 2nd of January 2020, I knew that COVID was coming. That would have been brilliant. So second, 2nd of January 2020, we completed we started building work immediately. And I think I got into my surgery on the 1st of March. So I think we had 21 days before we shut down.

Wow.

Wow. I think I was in a practice for quite a few years, a private practice in Gloucestershire, and I think sort of through that period, it was a really, really good practice. And I think I learnt over that period the things that worked with management of the team and things that perhaps didn’t work. So, you know, for me actually when I look back on that period with COVID, it gave me a real good chance to sort of galvanise my team around me and to look after them as best as possible. So when I reflect on it, actually I think it was a blessing in disguise because now they are just so loyal and they’re such a good bunch that, that actually I think it worked in my favour.

But did you not have cash crisis?

Oh, there was definitely a cash crisis. I mean, we had we didn’t have everybody we couldn’t put on furlough because people weren’t on payroll in time. Yeah. And cash flow is definitely an issue. And if I look back to it, I think when Boris’s announcement suddenly came that we could reopen, I think that we probably had I probably think we had about three more, about three more weeks in us to keep things going well. We went to the banks, we went to the banks and I asked for a holiday on the repayments. And the first thing that they said was, What was my pandemic plan? And I told them I didn’t have one. And the second thing was that they said the money was tied into the market, so we’d have to pay break fees. But the break fees were in the were in the numbers of tens and tens of thousands. So that wasn’t an option. So in the end, actually, without taking out any more finance or anything like that, we managed to make it work.

I guess you weren’t you weren’t even eligible for the coronavirus business interruption.

We weren’t didn’t have any accounts. We didn’t have any accounts or.

Even a bounce back. No, none of it.

Nothing. We could we didn’t have anything available to us. So so I was basically sat in my garden office from about 6 a.m. till about 10:00 at night, head in hands, trying to work out how we do this. And on top of that, I was trying to work out what we needed when we were allowed to open. And you know, you can probably remember at the time that there was about there was a limit to how much PPE we could buy number one per week. And number two, it was sky high in price. So all I was doing every week I was ordering what I thought we were going to need so that at least I had some stuff. And then as soon as we were allowed to open up, we did training with the staff for about three days, four days, and then we just got going. But I had the PPE, luckily.

Was it from the beginning a specialist practice? Was that the idea from from the get go or did it become.

Yeah, I mean, that was always the vision of it. So the background to the practice was that it was an NHS orthodontic practice and quite a well established one in Cheltenham. So beautiful building lots of space and they lost their contract three years ago. So essentially it was coming onto the market and one of my, you know, my business partner at the Practice, we were best friends at university and she was actually a locum orthodontist at the practice. So she ended up ringing me and said, Look, Amy, this is becoming available. What do you think? There was four partners who own the building and the business and I just thought, wonderful location, Cheltenham’s affluent area. My referral base was in the in the region. I thought it was just too good an opportunity to pass. So, you know, we immediately made the move and with a vision of turning it into a fully specialist practice.

Nice. So in terms of you said your referral base was there, so were you confident that you’d have enough patients to be sort of treating and seeing at the practice so that I guess marketing or new patient acquisition, those sort of things were less.

Of a problem? Well, obviously, you know, there was obviously an element of risk, no doubt. Yeah, but a lot of the practices that were referring to the practice in Gloucestershire that was previously at they were referring directly to me as opposed to the practice. So, you know, it felt I felt that it was a risk worth taking and it was the right step for me at the time. And from a marketing point of view, my vision with that was that there was still some NHS orthodontic treatment that was being finished at the practice and actually in the lead up I came out of the practice in Gloucestershire about six months prior to concentrate on this, this set up and you know, the previous owners were great. So in reception we were leaving out flyers, we were leaving our information, we were emailing to say about the change of the practice. So I knew that patients like the practice and parents were bringing their kids in for NHS. Also, that we were going to pick up enough enquiries to get us off the floor. So that’s basically where it started from. And even to this day we don’t, you know, we don’t do external marketing. Yes, we have a website, but every I would say on average we get about 100 new patient referrals a month into our specialists and then enquiries a beyond that. So I track it regularly. So and that started pretty immediately and that just continues to grow.

Just, just on a point of curiosity, you know, when, when a referral comes into the practice and I think one of the things when, when I speak to whether it’s a specialist referral practice or a practice that relies heavily on referrals because they’ve got a team of skilled clinicians, is this element of dropping the ball with referrals that have come in and you see a sliding scale of this, all different elements of it and part of it could be a referral comes in, but it came in via WhatsApp, but a referral came in and it came scribbled on a back of a lab note or whatever. A referral came in by email, but it got it went into junk and then let’s say it was the super smooth process and the referral comes in digitally. What’s your I’m going to call it the patient journey, right? But your patient is the dentist and the patient, right? And so what does your journey look like when when when a dentist sends a referral in? What’s your communication like with that? And if you experienced any of those issues that I’ve just outlined.

Yeah. I mean, when you’ve got a high volume of referrals coming in, it is so easy for one to go astray. Especially when you’ve got a big team and you know how, say, for example, my treatment coordinators would handle matters compared to, say, how one of our front of house staff would handle things may be slightly different. So, you know, the standard we have two treatment coordinators and the standard thing I’ve asked them to do, which they do, is as soon as we receive a referral, we will the treatment coordinator will pick up the phone and ring the referring practice and say that we we received it, thank them for sending the referral and then of course, communicate with the patient and go through everything for the appointment, what to expect, what the fees will be, send them a map, etc. etc.. Throughout the process, I mean, one thing I’m massively keen on is I track everything within the practice. So I’m a spreadsheet man. I like to know that everything is logged. I like to know how long it takes for the patient to be seen and actually what the outcome is. So I view that every month and keep an eye that everything’s been been sort of handled. And I think more often than not with my team, I don’t think many slip the net, but we’re human and mistakes can happen. Because like any referral practice, as I say in our in our monthly huddles, a referral practice is all about relations with our referrals, dentists, dentists. You know, it’s just absolutely key. Yes, we have to look after the patients, but we have to look after the dentists as much as possible.

When the dentist sends a referral to is that patient as good as sold? So they’ve got a clear idea of what your fee structure is and all the rest of it. Or do you start chasing that patient in the sense that your dentist is recommended you come in for an assessment for oral surgery or whatever. And our assessment fee is 250 quid we’d like to book you. And with doctors, such and such. Is that a given that they’re going to book in because they’ve been referred, or is it that the dentist has said, hey, this patient might need this, I’m send him across and then your TSOs are doing exactly the same as what you would be doing if that patient came in on a self referral where they’d have to follow them up, remind them, text them email and so on and so forth.

Yeah, I think I think for those that refer to us that they historically referred to us, I think that, you know, I would say 100% at a time, they will come in for the consultation. Usually, you know, 100% of the time they will already regularly communicate with the practices about like even at the end of the year, what our fees have changed to so that it’s accurate for their patient. So only, you know, in January I was sending those messages out to say, look, our consultation costs have gone up, our CBC costs some more are also fees and now this and that way it’s patients aren’t shocked when they turn up to see us. So I think from that point of view, we do we do relatively well. We have two incredible treatment coordinators. One lady who had knowledge base is superb and and actually she has like, you know, Prav, you know, people skills are everything in that position, right? And the patients just love her. Just absolutely love her. She will know about every pet their family member has and she just gets them on the right level and looks after them. And she will try and work out a plan with the clinician. If somebody can’t afford something, she will work out a payment plan for them. She will do whatever she has to to make sure that the patient gets the right treatment. However long the term is.

So in a normal practice where patients are self referring in, CO may see the patient for a consultation and then book the patient in with the the dentist. Right. Or the treating dentist or whatever. What role does the CO have in a specialist practice like yours? Is it similar. Do they meet with the patient before or are they having that rapport building conversation with the patient where they’re essentially selling them the assessment or the US piece of you or one of your colleagues to get them in and then help them along their journey?

Yes. So they will of course, they will initially build up the relationship on the phone. Yeah. And but when they come for their first new patient appointment, they will meet the CO and they will then go through be led through to the surgery by the TSO. And following the appointment they will go and sit in a room and just chat about things and ask questions that maybe they will find less comfortable asking us about.

Sure.

So that’s usually the journey. And then the TSO will follow them up. They’ll get the letter at the end of the day and the TSO will then followed them up probably about a week later to see if there’s any questions that they want answered.

You usually get a letter out within the day or just.

So all the other clinicians usually will get also will go out within the day. My aim is always to make sure my letters are out within the week. If it’s a straightforward letter, not a nine page summary, if it’s a straightforward letter, they can get it within a couple of days. If it’s if it’s a vast treatment plan or I need to look at the CT scans, it might take a little bit longer.

I mean, you seem to me I mean, we don’t know each other that well, but you seem to me like you found your ikigai. You know about that Japanese thing, right? Do you know about it?

No, I don’t.

It’s like. It’s like the concentric circles. You know, that which you are good at? Yes, That which the world needs. That. That which you will get paid for. Basically something that combines your passion, your your, your mission and everything in the middle ikigai. You seem to me like, like one of those cats who’s got that all fixed. And it’s interesting in dentistry, right, because that which the world needs and that which the world will pay for is already ingrained in dentistry. And then it comes down to, you know, what you enjoy doing and what are you good at doing? So with your practice, which bits of it do you hate and hate to hate of anyway? Which, which bits of it is it that you don’t feel in flow when you’re dealing with and which bits of it you really feel like you’re really in flow you really love doing.

So if I could. So what do I love doing? I love driving the team forward and inspiring the other team members to take ownership. You know, we are so, so lucky that we have I mean, the team is now 30 and I can hand on heart, say within every member of that team, there is no one that I would never there is no one that I wouldn’t employ again. Well, and genuinely, you know, they they feel like, you know, we call ourselves a family and, you know, one of my one of my actual greatest worries, which sounds strange, is that I worry that in the future when we do sell, you know, I worry about who’s going to look after these guys. And, you know, so I kind of I love working with the team. I love inspiring them. Hopefully, I know that I push them hopefully in the right way. And I love that. You know, some of my favourite moments is that when we go and socialise together, you know, the most recent two we did, we had a, we had an evening playing darts and food and drinks and that was good. And then we went to, we went to an Indian afternoon tea session and gin tasting and you know, when you can mix the pleasure, you know, genuinely everybody just gets on right here. So that is probably the massive perk of running this practice. Of course.

You haven’t had to fire anyone yet.

I know I haven’t actually, which is which is great. I mean, along the way, there’s probably been people that perhaps I inherited from the previous practice that I realised we’re going to be an obstacle for my vision. But you know, luckily within a few months they realised that things may not work out how they wanted them to work out. And they, you know, they looked elsewhere and that was perfect. That was ideal. So, you know, I would say that we don’t have any bad eggs and there is only, you know, positive energy. That’s one thing I struggle to cope with, that if somebody is continually negative.

True.

That is that is because that just brings you only need one negative person within the team to bring everybody down. Unfortunately, unfortunately, I wouldn’t say we’ve got any of those at the moment, which is great.

So which aspects of it don’t you like?

You know, it’s very easy for me to say that there is nothing within the practice I don’t like. I mean, I think I think we have we have two managers. We have two managers, which now over the last three years have come to grips with how we like to run things. So I would say at the infancy of the practice, too much was coming to us, to Sam and I. But as time is gone, you know, the managers take a lot of load off us. And for me that’s great because I get to get on with my clinical stuff. You know, we do we do a weekly meeting, a weekly managers meeting where for 2 hours we’ll go through all the issues. Anything may have come up and we we manage it immediately and give an answer. And that’s a really good way. So that way the rest of the week, it’s not eating into my mindset or I can get on with the things that I need to do.

And how many days are you clinical?

So at the moment I’m three and a half.

Well, that’s good.

So I’m three and a half and you know, give it probably a year. I’ll probably be down to I’m looking to get to three. So I do.

That’s good.

So three is three is about the optimum for me, the way that I operate. So I think that’s probably the perfect mix to have a date. I do a days admin from home, which is practice related or treatment planning, and then of course a day may be spent teaching and then weekends is about being a taxi for the children.

So. So I’m going to ask same question before you embarked on your teaching. What do you wish you knew or what surprised you about teaching?

And teaching was? A Yeah, teaching was quite a jump because, you know, even on the even on the weekend, just gone when we launched 15, see you kind of there are times where you still feel, you know, it’s that whole inferiority complex and you think, should I be stood here in front of these people? And there are times when I’m lecturing, when I think I’m talking about something so basic that I’m probably not giving value to the delegates. But I was amazed the first time that I taught that actually you can’t take anything for granted and you know, you need to the most keeping things simple is actually the best way to educate others and not to go to Complex. And I learnt that the first time very, very quickly.

What was the first time? Can you cast your mind back to the first time you got up in front of a bunch of people and said, Right, I’m going to teach these dudes some some stuff just how you felt, the whole impostor syndrome complex and nerves maybe. I don’t mean mean. Payman just spoke about this incredible length. We actually went through the journey together. But take us through your journey. I mean, what was that like the first time you stepped into or started thinking about teaching?

Well, I think I mean, it was just the most incredible buzz because during COVID we did I did a few webinars, and the webinars were fun. But, you know, interacting live with a with a group was just was just such an experience. And even even on Friday, you know, it’s a long day. You’re on your feet the whole day. You’re helping everyone. Everyone wants a piece of you. Lots of questions. And the day after you are so, so drained. But it’s just the most rewarding thing when you can see 22 people produced the level of surgery on a pig’s head that you would be proud of and you think, Do you know what? I’ve actually made a huge difference here to 22 people, and that that is just a feeling that you can’t really replicate. You know, we go we after the course we go for, usually I’m there showing clinical paces till we’re thrown out. And on them literally on Friday they were like, You’ve gone past your contracted time. We have you have to go. And I was still up there showing clinical cases. People wanted more. They want to see some soft tissue grafting. So I just started showing a bit of that and we go to the bar afterwards. I ordered the pizzas in and you’re just chatting. You’re just chatting about life, people’s practices, and you just don’t want that moment to end, you know, the course. Or we were just sat there till about 3 a.m. and, you know, and in the end you had to, you had to go to bed. And actually I was so gutted that we had to go to sleep.

Is there a one day course?

It was a one day course, yeah. You know, the second night you would just finished.

So how do you market the courses in me?

So we do it solely on, solely on our Instagram accounts. So, you know, with messages following and the followers that I have, we’ve just slowly, slowly drip fed it onto there. And we’ve been fortunate enough that it’s sort of attraction and people have been really interested in them.

I mean, it’s nice for you, I guess Menashe is a real. Of courses, right. So he could sort of tell you what to expect. And, you know, I remember when we first started doing courses, it was it was a nightmare. The first few times I found it so hard with hands on making sure every little thing was there. Just just just little operational issues like that. Do you not find those hard?

Yeah. So, I mean, his experience from running Focus is has been has been so helpful. And, you know, even when I put some slides together, just his gist his Yeah. Experience from that background has helped us helped us know and I think I think the jump for him has been going from doing photography to something that is different. Say for example, doing live hands on with pigs heads is is a completely different, completely different area. But no doubt from a from a website design, you know like our websites manage puts together from our marketing branding for our book that we put together for the boxes, the packaging, we already has the contact. So it’s made things so much easier. So with AP took us with aesthetic prosthetic, probably put us 12 months, took us 12 months to put it together with 15 C You know, we have the blueprint how we want to do things, we have the venue. And I think within four months we put it together.

What does it stand for?

15 C So 15 C is based on my favourite surgical blade.

So.

So that’s, that’s kind of where we say the logo is, got the blade underneath it.

Okay, that’s funny. What I was trying to think to myself. 15. Yeah, I was saying the mix man because I thought was something dental that you guys probably know about.

So because you haven’t, I mean you haven’t picked up a surgical blade in many years, right?

No, 12 years.

Yeah, 12.

Years. And even then, I didn’t used to like blood at all. I mean, as soon as it was anything to do with blood, I would refer it even a not so difficult wisdom tooth. I just refer it. I just refer.

And that’s fine, isn’t it? Because if that’s if that’s not what, you know, your niche then it’s not your niche.

Yeah. I think what it was, I took a break from dentistry for five years, then I went back. When I went back, I was just like, This isn’t my main career anymore. I’m only going to do the bits I’m either really good at or really like. And that just left bleaching and bonding really was I was referring everything else, completely referring everything else out. And it’s a funny thing. Yeah. But knowing what you’re good at and what you should keep doing because if you ask the question I was asking myself this, it was a bit of a silly question really. Is there anyone who can do it better than me? And if you asked that question, you literally left with nothing because there’s always someone, right? You can do it better than you.

But the but the beating but the bleaching and bonding has taken you down this road, which is, you know.

Was already down the street when, when, when I was saying that. So. Yeah, yeah, yeah. All right, let’s, let’s, let’s get back to your back story, buddy. When was the first time that you had. I’m going to study dentistry in your head. Like, when did that first coming to endure radar, Do you remember?

So that was literally only the day before I handed in my A-level choices. There was there was. There was. I knew that science was always my strongpoint, Always, always. And so I knew that I wanted to do chemistry, biology, physics for my A-levels. But I think it must have been around that time. And when we were handing in the applications for university that I was marrying up medicine, optometry or dentistry, and I came to the conclusion that medicine wasn’t for me and I thought I would give dentistry a go with no reason. There was no family members that were dentists. And I always actually think back to that day and think how lucky I was that I actually chose something that I fell in love with. Yeah, it could have gone so wrong. It could have gone so wrong. So there was no reason why I chose dentistry, hadn’t really done me work experience in it. And I just got lucky.

And you were living in London? Yeah.

Yeah, I was. So family homes in sort of Purley I was at school in Dulwich and.

The school itself.

That one little college. Yeah. And that business was in Balam. So Dad used to drop me on the way to school and then head up the South Circular to Balam.

What does your dad do?

So he retired now. He would call himself a businessman. He is a man with fingers in many pies, but his main business. His main business. He had a Mott mott station in car garage. So, so, so sort of that that moved over to England when he was 16 and started doing engineering and an apprenticeship. And then he was working I think he was working in a petrol station, but at Night-Time he started a business. Mobile repairs through the night and then managed to save enough money to then set up his own garage. And, you know, we’re very it’s served me and my sister well and just, you know, he worked incredibly, incredibly hard to give us what we have today.

So reflecting on that Prav thing that he was saying about, you know, you not seeing your kids when you were putting in those hours. You didn’t see your dad very much, right?

I literally I did not see Dad at all.

Yeah.

The only mom used to do all of the stuff with us. Really? And Dad was. Dad was so busy with the business and working every hour possible that that. Yeah, we didn’t spend much time together, but, you know, through no fault of his own, I mean, everything that he earns or everything that he worked for was solely for us. I mean, I think back to a story that my mom sort of sums up what my dad is like, and my mom is the eldest of six siblings, and I remember he met my mom. They must have been about 16 and he wanted to take my mom out. And my mom was like, well, you’re going you’re going to have to go and ask Nana about it. As in my granddad. So, Dad.

Is this back in Uganda?

This was back in in England. And this is when they met in England. And about this was probably about six months after they came over from Uganda. And he went to ask my granddad whether he can take my mom to the cinema. My granddad said, Yeah, that’s fine, but you do realise to take her out on a date, you’re going to have to marry her first.

So.

You know, so they got married and incredibly, you know, they’re in love, They’re still together. They make a great pair. But before he could take her to the cinema, he. They got married and Dad would work all week for enough money to go to the cinema. But he felt bad that all of Mom’s younger siblings couldn’t go, so he would save all of his money to take all six of them to the cinema together. So his first date with Mom was with five other younger siblings.

Oh, wow.

And even to this, to this day, he spends, you know, he really looks after my mom’s side of the family. His side of the family are in like Canada, America. And he has very few family in the UK that’s originally from Tanzania. So from Tanzania, they they went, they went America Canada way. But Mum’s family from Uganda being born there from Uganda, they all came here pretty much.

Say my dad was from Tanzania as well.

Oh. Whereabouts?

To borrow.

Right. So so we have similar heritages. We look the same background.

Colour, the same hairstyle.

I know, I know.

So listen to me. It sounds to me like you learned from your dad the sort of discipline, working hard, doing things for your kids, that sort of stuff. And I reflect on what I’ve said and, you know, the osmosis of that came through to you. Whether or not he spent the hours at the side of the football pitch or whatever. What did you learn from your mom? What kind of person was she?

So mom is a really unique, selfless person. I think one of the things I learnt from Mum is that well, I sort of learnt it in a in a roundabout way is that most of her life. She never used to say no to anyone about anything. And I’d say in the last couple of years she’s learnt the art of saying no. If it goes, you know, if it’s to a complete detriment herself. So Mum’s always been a giver. She’s been a feeder. You know, my sister lives around the corner from her in London, and I bet you every time my sister steps out the door, there will be fruit bowls and parcels for all of her children where Mum, Mum can’t go to the shops without buying groceries for her sisters, for her mum, for my sister. Recently we wanted to change mum’s car and she’s got a mercedes saloon and mum’s rationality that she couldn’t possibly change the car. Was that her Mercedes with the saloon? She could fit multiple boxes into the back of it, that she could deliver food parcels to the rest of the community. So, you know Mum. Mum has been. Mum has been the sounding board the whole way through. You know, I still ring mum and dad every day as much as I possibly can, you know, for, for advice or just to listen to things and just get their opinion of things. But you know, they’ve been, they’ve been a great support. Always. Always.

So did you not feel like coming back to London after you studied in Bristol, Right. Yeah. You’ve pretty much stayed on that side of the country.

Yeah, I think I think I’m quite I wouldn’t say say I’m the black sheep of the family, but we have we have so much family in London that actually I find it so claustrophobic that when I’m back, it’s like, you must go and see this and you must go and see this person. If you don’t go here, this person is going to get offended. And I just I just literally there’s too much going on in life that I can’t cope with that.

Yeah. Yeah.

So I think for me, moving out of London was was great for me. It just allowed me to grow up. And Bristol is a phenomenal place and we’re lucky. My wife’s my wife’s family’s in Bristol, so we have that support nearby. And, you know, it’s only, as I say to mum and dad, it’s only 2 hours to London. And now that they’re now that Dad’s retired, they can, they can come up at their leisure. But again, you know, from Mum’s point of view he has so many people that she must look after in London. So it’s difficult for them to free up their time as well.

So you still live in Bristol?

So I still live in Bristol. So the children are at school in Bristol. We’re happy and settled there. They’re settled in school, so I don’t see myself moving towards Cheltenham.

So I have like a city.

Yeah. I mean, Bristol is just we have so many friends that have stayed on from uni, so, you know, I can’t see anything changing for the in the near future.

My, my, one of my favourite restaurants in the country is in Bristol. Which was it. Pacos.

Yeah. Pacos is good. You must have gone with Alfonso. He must have taken you.

No, Richard took me. Richard Field. Richard.

Yeah, yeah.

Yeah, yeah. But what a restaurant, man. What a great, great restaurant. And perhaps the best thing on the menu. The best thing on the menu. Go on. Brendan Olive oil. Yeah, but you wouldn’t believe it. It’s like a michelin star place or something. Yeah, and bread and olive oil. It’s like they barbecue the bread and then they’ve got some amazing oil they put on my water. I just. I just started watching something on Netflix where the I can’t remember what it is. And the guy walks around with a bottle of olive oil that his mum’s pressed and he just walks around eating this bread and olive oil and they pass it around and apparently it’s the best thing ever. So yeah, I’ll have to, I’ll have to get Alfonso to take me there the next time I’m in Bristol. He just.

I mean, the restaurants, we’ve got some I mean, there’s Michelin starred restaurants. There are Michelin starred restaurants that are so reasonably priced in Bristol as well. We’re actually the bill comes. And you think they’ve miscalculated? Actually, you know, I think the last time I went to one actually said to them, I said, you’re actually under charging here. I feel uncomfortable paying this bill. And it was like it was a it was and the service was just so good and it was like a nine course tasting menu. And it’s in cotton. I forget the name of it, and it’s not flashy at all. It’s got wooden chairs that you think that you just see in a cafe. But just the food was just incredible.

What will you like as a dental student? I mean.

I think I was a party animal. Yes, I was. I was diligent. What I needed to do my work. I did my work. I did well. I did well at dental school, but I was massively involved as well in the sports scene. So I played I played hockey at university, I played cricket at university. So with that came a lot of socialising, a lot of nights out. So I would say probably, you know, there would be events probably for four out of five nights in the week.

Nice. Did you meet your wife at dental school?

No. So we didn’t. So we met at. We met in VTE in Bristol. So she graduated from Cardiff.

All right.

And then we were on the Bristol scheme together.

Nice. Yes. So she’s a better dentist than you, then?

She is definitely the better dentist than me. He’s definitely the better dentist in me.

Because you work in the practice also.

No, she doesn’t. So I’m very what’s really important to me is that my. It sounds strange, but I don’t want my family life and my work life mixing together. So, you know, Kristina works a couple of days a week. She she unfortunately got meningitis ten years ago. So she’s been she’s suffered a lot of health issues. So she stopped working for about 9 to 10 years. So she she only went back probably about school probably about six months ago. And she does a couple of days a week at the at the practice where she did her vet. So a lovely practice down in Cheddar North Somerset. And she’s happy. She works in general practice and she’s a really, really good solid dentist, really solid dentist. So. So yeah, so but no, there’s no aspirations to work together. I mean, recently I asked her if we could go on a course together and she was looking at some courses, but she refuses to go on any courses with me because she said she finds that it would be too much pressure if I was looking at her work.

So, Amy, when you look at this business of yours now. And I mean to you. It must feel like it’s you’ve gone through so many different stages already. But to me, you know, when Prav, I’m sure from the outside you’re just at the very, very beginning of it. I mean, it’s very, very early days. What’s your aspiration? Do you feel like you’re going to repeat this model? Do you want this perfect one site where you’re just going to keep on perfecting it and keep on perfecting that one site? Are you thinking anything about the future, long term future? Do you want to sell it and do another one like you said, sell?

Yeah. You know, there are times where I. I think I think this one would stay as a hub for sure. And, you know, this is the baby. This is this is where it sort of started from. And, you know, Sam and I are so Sam and I Sam, being the business partner and one of my best friends from university. You know this. We will always keep going. I think my one worry is that if there was any expansion, I think that, you know, there’s an element where you have to start letting go of certain things a lot more. And I think either you can I think it’s very difficult to be a teacher, clinician style individual and to have multiple practices potentially. And I feel that for me, I think that I would struggle to cope with multiple practices. I think there is that whole thing where, you know, only about three or four months ago I said to Dad, I said, You know what, I would love to potentially start a school in Bristol and go again. That doesn’t mean getting rid of getting rid of this one. That just means trying to learn something else. And, you know, one dad’s advice always to me is that, you know, slow and steady, you don’t have to do everything at 200 miles an hour.

But I think that’s where dad, in my opinion, slightly deferred, because I’m always thinking I’m always thinking about exit and trying to, you know, not exit, always thinking that I don’t want to be working, you know, at this level of dentistry. I don’t think I can be doing it at the age of 60. So I kind of need to have a strategy in place for the age of 50, you know, something, something along those lines. And then there’s this burning desire of what a challenge of what a new practice would bring. But I think there’s nothing on the horizon. I think I’m fully, fully content. I am fully content with this one. There is room for expansion. There is room for further growth. You know, we’re just starting a sedation service. We’re starting inhalation sedation. There’s a few other angles that we’re working on as well. So I think really that this is this is just what we’re going to focus on for now. On the other side of it, you know, with 15 C, there are lots of exciting ideas that we have coming with that that we’re already working on other projects around the 15 C sort of brand and between the practice and that, I think that’s enough for me to chew on at the moment.

Go on, Amy. Tell us what you mean by that.

Well, I think, you know, I think when I think back to my MSC training and implant ology and what I think to the questions I often get asked, I think within implant dentistry varies. That could be an improvement to the training programs that have been there in the past. So, you know, with this within this umbrella, you know, we’ve been working on. Yes, we’ve brought rich preservation to it. But, you know, I firmly believe that it would be nice to have one day courses for each discipline within implant dentistry where, you know, with a hands on element. And that way people can pick and choose what part they want to dip in or dip out at, you know, and that might be rich preservation, that might be soft tissue grafting, that might be hard tissue grafting, that might be immediate, that might be sinus lifting. You know, So all these things are going on behind the scenes to hopefully put together a program that if people want to do the whole program, that’s great. If people want to do one bit, then that’s also fine. But it’s taking time to develop it because I want to we want to make sure that it’s absolutely perfect before before it comes out.

I wouldn’t wait till anything is absolutely perfect, though, you know, because you’ll never get it. It’s one of those things it can get better on the job. Yeah. But I think, I don’t know, with implant training, there seems to be quite a lot of implant training around, lots of different sort of people teaching. But I still think it’s underserved. You know, one, one thing you don’t realise when you’re in it is that the whole market is growing. You know, when when we started bleaching, there was literally two of us right at the beginning, and then it became three of us. And then now there might be, I don’t know. 23 bleaching systems on the market. It doesn’t mean that now we’ve got 1/23 of that market. The whole market grows at the same time. And when I’m calling, I’m not calling it a market. I don’t mean market as in business opportunity market, but dentists, we need to get trained on implants. Now, talking to others, it seems to me and by the way, we have this problem in composite two people who come on the course and don’t implement. Have you got any sort of ideas on that? You know, there’s I mean, of course some people come on the course realise it’s not right for them. Others will come on the course. Think I’ll just restore implants? I won’t place them. But around that issue of implementation, can you think, you know, why were you the kind of cat who learnt it when on the MSC comes out, treats loads of patients now wants to teach it and then they other people who sit through long courses and not implement? And why are you doing anything about that?

Yeah, I think you’re absolutely right. There is with implants. There is definitely you see a lot of that. You see people that have done the MSC and they have not placed an implant in like five years. And I find it really hard to understand why people don’t just get going with it. I think nowadays there is good access to mentors, and I think that’s crucial. Finding a good mentor that can assist you, that you can take patients to them and under supervision, you know, you can build some confidence. But I think really, I think if an individual is that way inclined, I think you need your own individual get though, to to push yourself to take that leap of faith. I think whether people are scared about litigation may be a part of it. Or also I think sometimes people are so people are caught in a rat race where somebody within an NHS practice may have gone and done an implant course and their diary is just so, so full of check ups and things like that that they can’t work out. How do I make time in my diary to just do implant work? And sometimes it takes a leap of faith or vision to think, Do you know what? Even if for the first month there is, I’m empty in that implant clinic on Friday morning that I’m going to go, It’s okay because eventually I’ll fill it and allocate.

The space anyway.

Just allocate the space to it. So I think, number one, that’s the barrier. And I think number two, I think it’s start up cost potentially to people. So if they’re an associate and they’re worried about the equipment that they have to buy. So I think I think within that remit, whether actually implant companies could help to get people going and to give them some implants or I don’t know how they would recoup it in time. But I think if you could take the the barrier away of having to buy everything initially, then people will just get going with it. And in the end, for those companies, if the if the clinician is using their implants, they’re going to do well out of it anyway.

It’s a very good point. I mean, there’s loads more barriers in implants than in other sorts of practice because like you say, you’ve got it’s one of those disciplines. You’ve got to kind of go all in on, isn’t it. You do, you can’t dabble.

You can’t dabble. And you know, you also have to be careful because you can’t do you can’t take on procedures unless you know how to deal with the complications. So, you know, and how many implant sites do you deal with where everything is pristine with lots of bone? I mean, it’s just not the case because you’re dealing with failed teeth. So, you know, I think if you’ve got a supportive principal that can that can help you, that obviously makes a huge difference. But not everybody has that. I mean, what would you say, pay in private? I mean, within the I was having this discussion on on Friday. And, you know, as a percentage in the UK, an associate was asking me in me how many how many practices do you think are actually good practices where you’ve got a supportive environment as an associate.

The minority?

I kind of I couldn’t really pick out a figure that, you know, just somebody was explaining to me about some difficult scenarios when they moved from practice to practice to practice. And I would hope, I suppose the people that we speak to, we hope that, you know, most people are supportive and good principles and try and look after people as much as possible. But invariably there’s always going to be good, bad in any profession.

You know, although when I say minority, I don’t mean I don’t mean that most people are bad. I mean most people are too busy just in the rat race of of running the business. You know, you seem to have this sort of very calm situation where you love your staff, you love your job, you’re running a very successful business from the get go. And I guess you had 16 years of training before you set up your practice, right? You didn’t jump into it on day two. So so but I think most most practices when when Prav visits them, I visit them. And you’re right, these are self-selecting group of like enlightened user is going to be a different type of dentist or the type of practice that’s that’s employing Prav is going to be a higher end kind of practice. And yet we see. I see. I don’t know about you. Tell us now. I see quite a lot of dentists and practice owners who are just running, running and not stopping. I mean, this idea of he’s working in me, he’s working three and one half. At the beginning. It’s rare to see. Yeah. Look, I see a whole mix. Those who want pay. Same, right? The guys who are. Who are just head down in the sand, just getting on with. Just trying to keep their head above the water, shall we say. Then you’ve got those who want to take all the juicy stuff for themselves, right. And so they don’t give the associates the support or the cases or whatever. I’ll take all the juicy implants. I’ll give you the more troublesome cases or whatever. Right. There’s that piece. And this is the whole thing.

The question that you asked earlier in me, which is when we get back to implementation, what do we need to do? You need volume, right? You need to get you need to get your miles in. And if I go on an implant course and the opportunity for me to place an implant is a month apart each time, I’m not going to have the muscle memory, the time, the the repetition and getting those reps in to be able to get better at placing implants. Right. Same with when we’re teaching the orthodontic courses, right? The first thing we say is before you come on the course, have three patients lined up. You know, your mom, your sister, your best friend who’s got crooked tooth nurse, whatever, right? So you’ve got your cases lined up and then start identifying those patients straight away. Make sure you’re in a supportive environment. So it’s really hard to answer that question. What percentage is supportive? I mean, we’re seeing in the high end practices we deal with combination of what case saying. But what I’m saying is that the greedy principle, right? Not necessarily the greedy principle. The principle is thinking, look, I’ve got to get the money in for the business rather than for the associate so we can pay the bills. Yeah. And Amy, what I’m seeing with you is definitely not the mindset of somebody who’s been running a business for three years. Yet, to me, if we were to summarise the conversation we’ve had at the moment, you just floating through life. Yeah. And I mean that with the greatest respect. I’m not saying it’s been handed to you, you just floating through life, right? Like you’ve put, you’ve put the miles in but weekend with your kids.

Right. Three and one half days clinical doing a bit of teaching. Yeah. If you came to me for advice and said practice number two, I’d be like, life’s beautiful right now. Yeah, life is beautiful right now. Scale what you’ve got right now. Yeah. In that location where you can be more regularly. Yeah. Grow the teaching side of things and put an exit strategy together. What does that look like? Forget about volume of practices. What’s the magic number? Yeah, what’s the magic number? That you need to walk away from it all and say, You know what? I’m done, guys. I’m out of bag of material, right? And figure out what that is and then just work backwards from there and you’ll have your answer right as to do. I do practice number two, practice number three. Or maybe you’ve got those ambitions right. But it seems like you’ve got your shit together. Make it really, really does. And I really admire that for somebody who’s three years into business such a short period of time, very calm in terms of not have to fire anyone. Everything. All those members of staff, you’d hire them. Again, there’s not many practice principals that can say that, I promise you, because it’s a daily conversation. How are we going to get such and such out of the business? We’re dragging them along. We’re doing this, we’re doing that. There’s problems and stuff. The systems, processes that you’ve put together, the follow up that you’ve got for your inquiries, just the way you’re talking about that is super, super mature. And it’s that’s your next course, mate.

Well, you know what I think of when I think of that sort of the team and what what makes them so good. I mean, even my interview process, most of my practice, the so recently when we’re been looking for another front of house stuff or the front of our staff said that they were just too busy dealing with all the inquiries and they didn’t have enough time. So I said, okay, so what’s the solution? And they said that they wanted another team member to help in the afternoon with answering the telephone and dealing with the Invisalign lab work, etc. So I said, okay, fine. So we advertised for another position and part of the interview process, yes, the managers will look at the applications. I, Sam, and I won’t get too involved at that stage, but actually we then bring in we might shortlist to six or seven applicants and they will come in and spend time with reception with the other team members and then the other team members will give us feedback and decide who moves through to the next stage. And then of course at the end of the line they will meet Sam and I and we will do the final interviews. But by then, you know, the staff have kind of already made their decision and, you know, and if there was a disagreement, we would have to decide whether we want to go a different way or if we’re going to follow the staff. But actually, more often than not, we all come to the same conclusion. And I think. I think I think that’s the main thing with bringing people in. I’ve just been very conscious that I think anybody is you can teach people some skills, but actually personality, you can’t change somebody so you know more. All I want is a good person in the practice. The rest I’m not so worried about because we can work on it.

That’s lovely. Really, it is. And and you know that the the first time you see that that person, once the staff have whittled it down to two or three.

Yeah. I don’t see them until, until the very end.

And who looks at the CVS in that is you is that still.

The business manager will look at that and that’s Sam. So Sam and I cover different parts of the practice of Sam will usually have been looking at the CVS when they come in on indeed or what have you. And then between her and the business manager, they’ll whittle it down to six or seven guys. And then. And then. Yeah, I’ll come in. I’ll come in on the final three.

I mean, you’ve listened to this podcast before. We like to dwell on errors. Tell me about clinical errors you’ve made that someone else can learn from.

And. I once did a. An extract. This was an ortho extraction. And there was absolutely no issue whatsoever. Tooth came out straightforwardly. It was the right tooth as well. And I went to just irrigate the socket slightly. And as I irrigated, the face completely blew up.

Well.

So my finger must have just touched the air at the same time as touching the irrigation. So, you know, immediately we had an emphysema. And. You know, reflecting back on that.

Did you know what it was when it happened? You understood?

Yeah, I understood what happened. You know, I immediately sort of I immediately pressed on the patient’s cheek, expressed as much air as I possibly could. And I’d done my couple of years of Max. Max right back after beat. So I expressed the air, obviously explained to the patient what happened and talk through the management process, ran the hospital, discussed it with them, discuss whether they wanted to see the patient or not, and and just so innocuous is so innocuous, an intact extraction socket. There should have been no chance of the surgical emphysema there because I hadn’t even separated the gingiva from the bone. So my take home message for everybody is be aware of those scenarios. All I can think was possibly happening was that at the apex of the tooth, it must have just been communicating outside the buccal plate. And then just that tiny bit of air must have gone up through the tissue plane and just blown the face up.

A pre molar. Did that.

It was a pre molar.

Wow.

Yes. So innocuous.

Wow.

And you know, I remember looking at my nurse’s face and obviously, if you’ve never seen that for the first time, it is so worrying. The patient’s eyes closed. The patient thinks they’re going to die tomorrow.

I’ve never seen it. What does it look like? Like a swelling.

Yeah, it’s literally like it’s literally out here within within seconds. It’s just blowing off, you know? And the risk the risk with something like that is that there’s an infected process that goes to the brain. So you expel the air as much as you can, but you won’t get rid of all of it. And then you’ve got to put the patient on prophylactic antibiotics with close monitoring and review that they don’t get any sort of pyrexia systemic issues that you could then be worried that it’s going north.

So this was an adult, not a child, right?

This was on a this was on a probably 29 year old that was happening. Simple extractions for ortho.

And so was the patient.

Calm the patient. I think the patient was calm because because.

I was calm.

I knew I knew what was going on. Right. And actually, I thrive on things like that because I love when something happens like that. It’s just another experience or something to document, something to share with somebody. So I don’t really I just look at it as an opportunity, really.

I think I think when you’ve done max facts, it’s hard to get fazed by that sort of thing. But tell me about one time you did get fazed. You know, it doesn’t have to be that sort of thing. It could be a patient who lost confidence, whatever, like something something that really affected you.

And I would say, oh, I reckon about two years post qualifying, I was doing a root canal and quite a difficult, difficult patient who I would say definitely litigious in nature. And I think there had been a history of stuff in the past and everything was fine. The rubber dam was on and I decided to I was irrigating the tooth and of course she started getting burning sensation in her cheek. Commonly hypochlorite. Hypochlorite had gone straight through the apex.

I realised.

Yeah, I did realise that the mistake was that my my gauge of my needle was way too close to the orifice of the opening of the canal. And yeah, I must have just been irrigating to vigorously and it just went straight through.

Through the situation. Really.

Pardon. Yes. And actually I’d say in clinical dentistry that is the only time I’ve been worried.

Why? Because your relationship with the patient wasn’t great.

Well we had a good relationship. We had a good relationship. But she is just unpleasant in nature. And probably now I would handle her differently. I suppose with experience and knowledge and controlled confidence, you talk to patients in a completely different way. But at that stage, you know, I was really worried afterwards because obviously I knew what happened. I didn’t know what was going to happen was the tissues gone and the crows on top of it. Fortunately, everything healed absolutely fine. There was no ramifications. I saw her every couple of days to check it. I did everything that I should have done, but God, I shat myself at the time.

So when you say litigious, you thought she would be the type?

Yeah.

So what you mean?

Yeah, absolutely. You know the mess.

With your mind, can it?

Yeah. The sort of lady she had, I think she’d had. She was just. She’d had two divorces. She’d had two divorces to two very, very wealthy men. And there was a lot of resentment to life in general because I think the things were she was finding things tough financially. And, you know, of course, in the back of my head, I was thinking, well, actually there’s probably there could be a claim here.

Yeah. Then hopefully.

Hopefully she’s not listening to this and and acclaim doesn’t come through my letterbox tomorrow.

It’s funny, isn’t it? As a as a professional, you’re always looking behind your shoulder.

Is there a time frame where they can’t come up, come after you? Or is it just indefinite?

No. There is a time frame after the time that they know there’s a problem, that they find something like that. But this is two years after you qualified. It’s been a while.

This is years after I qualified. Yeah.

Yeah. It’s hard talking. 12 years ago, though, probably I’d have had me.

I literally had so much hair I used to use. I used to use hair straighteners. I that much hair, really. I used to have some hair straighteners to do my.

Mohawk when I was when I was at uni. The barber said to me because my hair was so thick. Used to use these scissors to thin it out, to control it a bit more. Right. And he said to me, One problem you’re never going to have. You’re never going to go bald. Hmm. Yeah.

Famous, famous last word.

Famous last words. Yeah. Yeah. You did the messy. Now, if someone wanted to get into implant ology, would you recommend they do a sort of a course like that, an MSC type course, or would you say to do more like your kind of course or both?

What would you say? I think you need to do both. I think what you learn scientifically from you get you get pretty much no, I would say no clinical experience with them. What you do get is a really good foundation of knowledge and the ability to critique papers. And that even to this day when I’m looking at studies and papers, is a skill that I still have. But I think you can’t expect to come out of doing a four year MSC and think you’re the finished article because it’s just the beginning. And then you need to supplement it by clinical experience and then fine tuning on the right courses.

So where did you do your MSC?

I did it in Bristol as well. So it was back. I did it in 2010 to 2014. So it was four years, four years back then.

And how many how many implants did you place? Very few.

In the MSC. I place.

To.

Two two cases. Yes. So the first year was just one case, simple case. The second year you had to do a complex case, which was a block graft, and that was it. And then two years of dissertation.

And what was your research area?

So my research area was all for.

Oh, well, what about?

So I did I read all 970 papers back then on all on four. And you know, it was, it was, it was topical at the time. So I thought, you know what? I want to find out more about this. And it wasn’t as prevalent as it is now. So it was it was a really valuable review that I put together.

Do you do that kind of work a lot?

So I don’t do I don’t do all on four. I think there’s plenty of guys out there that do it all day, every day that are better served doing it. And you know, most of my referral work is I get referred high aesthetic cases mainly. So I just focus on what I do and let the all four guys do the oral four stuff, you know, because these guys, when things go wrong, they’ve got options to sort it out. They can put Zigomanis in, they can put Terry Goines in, you know, and that’s what I advise my patients when people come asking me to do an all on four, I say, Look, there are clinics that just do this. Just go to one of them, you’re going to get looked after and they’ll know exactly what they’re doing.

When you say high aesthetic case from an implant guy does that, we’re talking soft tissue.

Yeah, it’s a mixture. So it might be you know, my common referral is for a single central incisor. So and so most of my every implant case that I do, I would say 95% of my cases get a soft tissue graft.

Oh, really? Wow.

So, so every pretty much any anterior case gets the soft tissue graft. If I do any bone grafting, it gets a soft tissue graft at the same time. So, you know, I firmly believe that when we get volume loss around a ridge, 60% of that is actually bone and 40% of that is soft tissue. So I build the bone bit, I build the soft tissue bit, and my implant goes in.

Well. That’s not normal, is it?

I think it is different.

Yes, different to the to the sort of normal orthodox normal mantra.

Yeah. So I think it is quite different because in my eyes, I want I want at least in height of nice tissue, I’m looking for about five millimetres. So if we think if I’m thinking technical terms for the dentist that are listening, if the biologic width is three millimetres, I want a good good trans mucosal seal there. But then also I want that characterised tissue on the first two millimetres of bone so that we don’t start getting bone loss. So for me that five millimetres is key and there’s not many cases where you have five millimetres there. Hence why I tend to augment at the same time.

What does it mean though? Like surgically a soft tissue graft, right? What does that mean?

So soft tissue graft y. So technically there’s lots of different ways of doing it. If I’m doing it simultaneously with implant placement, it will be harvesting a free gingival graft from the palate and then the epithelial using that outside the mouth and then transferring the connective tissue site to the area. And I’d say predominantly, I use a connective tissue graft. I am doing more and more work with substitute materials. And that’s that’s probably more so from a teaching perspective. So I can give delegate a really good sort of description of how I find things working in my hands, all the various different materials. So if I think I’ve got a banker case, I will I will use a substitute material if I don’t need to harvest from the palate, if I’m really pushing the boundaries, I will always harvest from the palate and use the patient’s own tissue.

So you your personal clinical work, is it all implant based or do you do that?

I still do. I still have a handful of general patients and my standard make up for my day. I do my surgery in the morning and in the afternoon I do my consults a little bit restorative. I might do like my last patient just now, I just did a Crown Prep, so there were some patients that followed me from my previous practice. So those guys I feel that have been so loyal to me, they’re the ones that I keep. And, you know, there’s not hundreds and hundreds of them, but I like to look after those. And actually for me that makes a great mix from the surgery that I’m doing. So the case I’m doing tomorrow morning will be, I think I’m taking out single Central. I’ll be placing the implant bone graft, soft tissue graft, custom provisional, and that will take me most of the morning. But then in the afternoon, I don’t want to do another surgery. So I will just do I will do a composite, I will do this. I will do that just so I can slow down a little bit. So it’s the stage.

That you said you listen to this podcast at 5 a.m.. So is that what’s your day like? I mean, what time are you waking up and what’s your morning routine and all the.

So my morning routine. So I’m up at five. The bags are already packed downstairs. I jump in the car and work on the podcast. And if you guys haven’t released another one, then it’s usually the high Performance podcast with Jake Humphrey or Diary of a CEO. So I rotate between the three of you. And then and then I’ll get to I’ll get up to the gym and Cheltenham about at six. So I will train till seven every day, every day, every weekday. So I train till from 6 to 7 and shower out the gym by 730 into the practice. Four eight first patient, then I’ll chat to everyone 15, 20 minutes, have a little huddle with my nurse for the day and then 830 get going and then usually last patient finishes at five and then usually I’ll hang around for probably hour, hour and a half doing odd jobs, doing a few things. And I’ll usually set off from the practice about 630 and get home at 730.

Long day.

And then then usually usually then 730, there’ll always be there’ll be stuff to catch up with emails. So every day I’ll go through all the emails then so that I’m up to date ready for the next day. So usually I probably switch off about nine 930 as Cristina puts on Love Island and, and then up to bed for about 1030.

And the kids it’s that 730 to 830 piece right.

Payton says. The kids, The kids, the kids in the week, I do not see really a part. Yeah. So they’ve gone to I’ve left before they wake up and I’m back after they’ve gone to bed the only day that I’m there for them. So in the weekdays Thursday is my admin day. So I go to the I go and do my blaze gym class at 6 a.m. I rush back home and it’s my day where I drop them to school and I pick them up and then I do my meetings in between. So Thursdays are a dedicated day to drop off and pick off, which I absolutely love.

Let’s, let’s imagine, let’s let’s dream a little bit. Let’s imagine you’ve got a weekend to yourself. Wife and kids have gone somewhere and it’s just you weekend by yourself. What would you do?

I probably write more coarse material. Probably. I guess I probably do a mixture.

I think this guy’s got yeah.

I would probably do a few practice things. I would definitely write more coarse material.

Yeah, I did that yourself, man.

I know a little bit of that. And then I would message the boys and and make sure that we go out for drinks and a catch up that evening, lads.

The lads.

The lads.

Yeah.

And I’d definitely message the lads there would be a gym session in there somewhere. There would definitely be a gin and tonic in there somewhere. And I’m just, you know, genuinely speaking, just really simple stuff. You know, I’m not.

Just tell me that. Might you go to bed a bit later than ten? Come on. I probably.

I, I probably would. I’d probably be watching some sport or something.

Do you like watching sport?

Yeah, like I am sport mad. So, you know, whether it be whether it be Formula One, whether it be rugby, hockey, cricket, everything, you name it. You know, I am the one, the one thing we commit to every year is that we go to Silverstone to watch the F1 and we take my dad and my middle son who’s Formula One crazy as well. And we get great seats right by pole position. And but this year we’ve held off until we know whether the Mercedes is quick enough to compete because if Max is going to run away with it, we’re not going to go this year.

Like I said, maybe and perhaps they know what you’re talking about. But but, but I went but I did. I went to Silverstone last year, actually. It was raining like hell. And I was like, I was telling my son, who loves it. I was telling him, Come on, man, let’s just get out of here before the crowds. And he was like, Are you crazy? Yeah, our time’s coming out. Coming to an end. Time’s coming to an end. It’s gone quickly, man. Let’s. Let’s. Let’s finish with the usual questions. Let’s start with mine. Fancy dinner party. Three guests, dead or alive? Who would you have?

So. Of course. Of course. Guys, I knew you were going to ask this, so I’ve sort of been thinking about it. I’ve been thinking about it for the last hour before we came on. And the first one that I want to invite to this dinner party is one of my biggest, biggest regrets. And that biggest regret was, well, the person I want to invite first is my maternal grandfather, because he passed away when I was just in my first year at uni. And of course, he set up his whole life in Uganda and he was doing so, so well and he sacrificed everything. He had a lot of siblings, he had lots of children. And, you know, he was going through he kind of went into hiding for six months because the soldiers were trying to get him and kill him and he managed to get the family out of the country. And he eventually got out to Switzerland. And, you know, when we were actually at my nan’s house, as I was growing up, I was never old enough to know about or understand it properly when I was ten, 11. And I never, ever had the discussion with him about it. But the whole story, how he got away, what was going on, what was going on with his neighbours, how we managed to start with nothing and basically now have a generation where all my cousins have really a jobs started from him and I never had the conversation. So I would just I would love to spend the evening knowing more about it because even when I ask my mom, mom doesn’t know it in the detail that he knows it. So he would be number one.

Beautiful.

My second guest is going to be from my childhood. This is a strange one, and I don’t know if anyone’s ever invited this person to the dinner party is that I was a huge WWF fan and I believed for many years that it was real. So I really want to be the rock Dwayne Johnson, because I think he would be phenomenal at a dinner party. And, you know, he’s obviously gone on to do so well and have many different careers. So he’s number two for me.

Nice.

The third one, who is now unfortunately passed away, is someone that I’ve always been inspired by. And being a keen cricketer myself, I thought no one better to invite than Shane Warne, who I think I think he was the one guy that had such a influence on the game of cricket. Length in bowling, the character that he was, he was always in the media. He was probably had the greatest cricket mind, but he was never Australian captain because he was he was a complex character or he wasn’t conforming to the norm. But I just think that he would be he would be great on a night out. So he’s going to be my third guest. Nice.

That’s a nice combination you’re going to have. You’re going to have to explain to the WWF guy what cricket is.

He might have the other two in a headlock.

So how.

About.

That? Well, while you and your grandpa put the curry on.

I know he’ll be he was a chain smoker, so he’ll literally just be smoking. Shane Warne will be smoking and the Rock will be doing press ups in the corner.

Probably the shade won’t smoke. Is that what happened to. Is that did he die of that.

Yeah, I think I think he’s been I think there’s definitely sort of been some incidences of being caught smoking and smoking other things and, and various substances.

So, Amy, it’s your last day on the planet. And you’re surrounded by your loved ones, the kids. And you’ve got to leave them with three pieces of life advice, wisdom. Call it whatever you want. What would they be?

So I think I think my first one to all three of them would be that there is no substitute for hard work. Do not expect anything to come easy. Do not expect anything to fall into your lap. You have to go and grab the opportunities. That would be the first one. The second one would be to be. To be kind to everybody. To treat people how you want to be treated. Because I’m a strong believer in karma. And I think good things happen to good people. So I want them to continue to be good people always. And the third thing I would say to them is to try and sort of give them the confidence to say that it’s okay to make mistakes, but never, ever live with regrets. And that those would probably be some of my final words to them.

Very nice. Nice. I’ve got a question around number one, which is no substitute for hard work. It’s not handed to you on a plate. And, you know, coming from a generation now, who’s sort of, shall we say, we’ve you’ve upgraded your life from the melt station, Right. So so be that, be that. Whatever. Right. So your dad gave you everything he could give you within his means. And now you’re giving your children everything that you can give them within their means. But but there’s a certain amount of graft and hard work and, shall we say, struggle that you’ve fought through to get to where you are. Right? Because I don’t know whether whether you went without or you had less or whatever, but I’m assuming you can give your children more from, let’s say let’s say from a financial point of view than than let’s say your father could give you. Certainly that’s that’s my that’s definitely my situation. And the thing that I battle with quite a lot is how do you strike that balance of holding back and not giving them everything so they can learn the value of things? And with the thing that you always want the best for your children, you want to give them everything right. Do you ever have that conversation with yourself?

Yeah, I think, you know, luckily, Christina and I sing off the same hymn sheet. And, you know, we firmly believe that as the children are growing up and even when they’re at school, that they will go and do paper rounds and they will do jobs. And, you know, they they very, very carefully at birthdays, they have been collecting money that family members would give them. Sometimes when we’re out shopping or something like that, if they want something, I will say to them, that is absolutely fine and you can pay for it from your piggy bank, you know, on certain instances. And I think that’s our that’s our way of making sure that they understand the value of money and they realise that actually, yes, you don’t want to drum it into them, but how lucky they are at the school that they go to the fact that they get beautiful dinners, the fact that they have every sport possible under the sun given to them at school, you know, and that they’re they’re fortunate in that way. And I would hope that they’re really well grounded children because, say, for example, Christina, she was never afforded the luxuries as a child that I was afforded. So we had quite different lifestyles back then. So Christina wasn’t having many holidays with her family. And we were having holidays just just small things like that. So I think that you’re right, it’s always the forefront of our minds that we want to give them everything. But absolutely, they need to know that that. That there is that money doesn’t come easy and that they have to work hard for it.

Nice. Yeah. So. So is is always an interesting topic of conversation at home for us. My two younger girls get pocket money now. Your four year old? Yes, 70 a week. So we’ve created this. We’ve got this little sheet that goes through doing their homework, playing their instruments, blah, blah, blah. The seven things in the week. Right? And they get $0.10 for each thing.

Okay, that’s good. That’s a good way.

And every Sunday, they’re so excited. We sit there and sit around the dinner table and go, Right, we’re going to do pocket money down. And then if they I mean, if the little one goes batshit crazy at any point during the week, like she loses one of the ten B’s. Right. So we sit down around the table and both of them are really excited because we talk through the week and we say, how many that time you smacked your sister. That wasn’t cool, was it? So on and so forth. And she sits down, maybe she’ll apologise, reflect or whatever. Right. But we, the four of us, sit around the table and we have that conversation with the girls. And you know, my, my youngest is one of them is like, take your plate, pick your plate and put it in the sink after dinner. Now, my youngest is so good at that. She’ll grab hers, she’ll grab mine, she’ll grab her sisters. Right. And it’s so cute to see see this. Right. But, you know, sometimes we sit there and think, are we doing the right thing here? You know what I mean? Because there’s often that thing that, you know, should you have to should anyway. It’s always a conversation that, you know, whichever way you look at it and whatever you do and however you mix it up, you can always see two sides to the story, Right? But the motive is we just want to do our best for them to be grounded and learn about the value.

Absolutely. I mean, we’ve done those charts for exactly the same thing. And at the end of the week, it’s on the inside of the larder cupboard. And, you know, when we started off, their behaviour is so, so good, so, so good. But then as things get busy and things waver, you know, and then, and then they start getting to the age of ten and 11 and they start getting very smart with their answers and you know, their answers are correct. Yeah. Yeah. And the arguments become a little bit challenging to work around.

Sure.

But but you’re right. That’s all we want. That’s all we want for them to grow up, to be good people, to have the value, money. And that question that you asked before about, you know, an exit strategy or or a point where I want to stop, a lot of that revolves around me continually thinking about multiples of three in the sense that if I have to do this for one of them, I have to do this for the other two of them. And, you know, you just always want none of your children to feel that you love that one more and you love this one less. You just want absolute equality the whole time.

Because you think like Prav like you’re so different to Kailash when it comes to money. Yeah, I’m. I’m totally opposite to my brother when it comes to money. We were brought up the same way. Same parents, same same reward system. And I feel like I’ve got the opposite problem to what you’re saying. I feel like my dad gave me more than I’m giving my kids, and that’s a real head fuck. Do you feel like a failure and this sort of thing, But this question of value, of money and so forth, if it was that easy to to fix that, surely you and Kailash would have the same outlook. Yeah. Look me in my head. Look, I don’t even know if I’m approaching it the right way or. Or the right or I’ve got the right answers. Right. What I’m doing is going to end up with my children being totally grounded or not. It’s important to think about you, right? Go ahead. Me. But me and my wife have this conversation a lot of the time, right? You know, even when we’re away on holiday. Right. And you just you know, I think back to when I was a kid, right? We used to go to a place called Pizza Land twice a year. Twice a year. Yeah. And those are the only times we went out for meals. Yeah. Now we meet the wife and the kids, like, a couple of times a week, we’ll go out for dinner or whatever, and. And that’s just for shits and giggles. It’s not a birthday. It’s nothing. It’s. And I’m sure a lot of people do, right? And sometimes you sit back and reflect and think, Do you know what we’re really looking for? For the following reasons, Right? You know what? When we when we go round the supermarket, we never look at the price of anything we put in the trolley.

In fact, now we don’t even go around the bloody supermarket because a van turns up and delivers it through the kitchen window. Yeah. And, and you know what? Last week I spent, I spent a few days in hospital. Right. And I was on a ward surrounded by people. And there’s one guy across the way from me, and he said to the nurse, Can you ring my wife? Because I don’t have enough credit on my phone. Hmm. And you know, those those little moments, right, where you just think, fucking hell, you know what? Sometimes you’ve just got? It’s the little things that you take for granted. You’ve got a bloody pinch yourself, right? And whether it’s through your hard work or it’s been given to you, gifted to you, whatever. Right. It’s just sit back and reflect and appreciate the fact that you know what? I can stick some jammy dodgers in the basket and not look at the price. I can. I can say to my daughter, let’s just go. Let me you let’s just go out for a meal. Nando’s, whatever. Super nice restaurant, whatever. The thought or the cost aspect of it doesn’t even enter into the thought process. Right. And, you know, it was that guy who was in the bed across the way from me in hospital credit. I don’t have enough credit to ring my wife and I’m ill in hospital. That just blew my mind. So I think it’s important to sit back and reflect and appreciate what we’ve all got. Amy, It’s been so lovely to me. If you’ve got if you’ve got something to say on that. Go ahead and say it.

You’re absolutely right. I mean, I’m speechless that something that we are so we are so lucky and. You know, you’re absolutely right. Not genuinely really having to look at. What is the price of food that you’re having or however many starters you want or the main course? And yeah, it’s a very fortunate position to be in. You know, hard work or not, there is a fortune element to it.

Yeah, there is. But that practice of, of, of gratitude that you’re doing there, you’re definitely one of the, one of the cornerstones of happiness, right? Sure. For sure.

How do you do it? Do you do any journaling, Prav?

I do. So I’ve got a it’s called the five minute Journal, right. Say that, too.

So, yeah, I do that, too. It’s on my bedside.

So my young my my six year old also has a kids journal and gratitude journal, and it’s written in a different language. But she’ll sit there and she’ll write in it every single night after she’s done a reading before she goes to bed. And about a week ago, she got a piece of paper and she cut out loads of love hearts from the piece of paper. And she got a flask in all these hot thermos type flasks, right? And she got a piece of paper and she stuck on that piece. You stuck the piece of paper on with Sellotape and on that thing she wrote Gratitude Jar. Write down one thing that you’re grateful for and put it in the jar. And she put all the love hearts on the windowsill around it. So what she asks us to do is write something that we’re grateful for on the love part. Put your name on the back and pop it in the jar just once a day. She wants the whole family to do it. Her own bloody idea. She’s 50 years in front of me, man. Yeah. Her own bloody idea. I was blown away because my wife said, Look at what my hand is doing. Right? And I’m like, What the.

Can I suggest one thing? I think. I think she deserves more than $0.70 a week. Especially especially with current inflation levels. I mean, that.

That is at least 85. I’ll give a $0.10 bonus this week.

That is just that is like ultimate proud dad moment.

Right. Do you know what? I just I couldn’t believe that she came up with the concept herself. So I sat there, quizzed my wife, said, Have you told her about this? How does she even know about gratitude? Yeah, etc.. Except blew my mind. Thank you so, so, so much, Jimi. Thank you. Really, really enjoyed that, buddy. Really enjoyed that. Please stay in touch as well. But it’s so nice to see someone so at peace. Successful, you know, ikigai. I’m going to call this one or your your your copywriter is going to call this one ikigai guy. Thank you so much, man.

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.

Thanks for listening, guys. If you got this far, 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. And don’t forget our six star rating.