Avijit Banerjee: One of the problems we have in our profession. People will see a patient. They’ll sort of do an [00:00:05] assessment of susceptibility, but many don’t write it down. It’s sort of done in here, done in [00:00:10] your heart sort of thing in your gut. You don’t document it and then [00:00:15] we don’t follow it up. And remember susceptibility changes with time. Mhm. So this [00:00:20] must be longitudinal. So one of the things we talked about in that paper was also [00:00:25] phased care. Phased courses of treatment. You know get the prevention [00:00:30] involved then reassess. See if the oral health is improving. And [00:00:35] if it is then crack on with all your high end prosthodontics implants whatever you want to do. [00:00:40] But if it’s not just like in perio with the perio guidelines, Periodontology guidelines, [00:00:45] you loop back and try again. Because ultimately, if the mouth isn’t [00:00:50] essentially healthy and the patient’s not looking after their mouth, whatever fancy work [00:00:55] you do operatively, it’s going to fail.

[VOICE]: This [00:01:00] is Dental Leaders, the [00:01:05] podcast where you get to go one on one with emerging leaders in [00:01:10] dentistry. Your hosts. [00:01:15] Payman Langroudi and Prav Solanki.

Payman Langroudi: Once [00:01:20] in a while I have a world leader in front of me, and it’s one of the lucky [00:01:25] things about this job that sometimes I sit with some of my heroes and [00:01:30] today is no exception. Today we have Avi Banerjee, one of the world’s leaders on [00:01:35] minimally invasive dentistry. Professor Banerjee is professor of cardiology [00:01:40] and, uh. Operative. Operative dentistry at King’s. [00:01:45] He’s authored over 170 papers. He’s [00:01:50] the author of five books and 12 chapters of books on minimally invasive dentistry, [00:01:55] including what is now the new version of Picard’s manual that [00:02:00] all of us would be aware of in dental school, a book called A Clinical Guide to Advanced Minimum Intervention [00:02:05] Restorative Dentistry published by Elsevier, which will be coming out next month.

Avijit Banerjee: That’s [00:02:10] right.

Payman Langroudi: Absolutely amazing. I’ve got I’ve got a copy sitting here and actually reminds me of Picard’s and the way it’s written, [00:02:15] but I’m sure the information is very different. Have you, um, Professor Banerjee [00:02:20] also is in private practice one day a week. Um, Prof. [00:02:25] Is this a massive pleasure to have you? And I want to get into all of these different areas, [00:02:30] minimally invasive dentistry teaching. But really the first question I want [00:02:35] to ask is, when did you decide that you want to be an academic? Was it how early on [00:02:40] did you decide that? Wow.

Avijit Banerjee: So I think for me it was at dental school. I was always [00:02:45] quite academic at school, at secondary school, and enjoyed doing projects and little bits [00:02:50] of research and things that students did in those days. Um, came to dental school and I was [00:02:55] inspired by several teachers that I had at the time was Guy’s Dental Hospital. Obviously, that [00:03:00] was taken over by Kings. And one gentleman in particular was Professor Tim [00:03:05] Watson, that I’m sure many of your audience will remember. And he got me into sort of material [00:03:10] science. And I actually did my first research in third year BDS [00:03:15] in the middle of doing my pharmacology and medicine exams. In those days, I used to sit [00:03:20] in his laboratory, and we did some work on coating glass ionomer cements [00:03:25] with resins. And this was back in 1992. [00:03:30] Wow. And I got my first papers as I graduated. And ironically, [00:03:35] uh, nearly 30 years later, what are companies producing [00:03:40] resin coatings for Jyx? So that was my first [00:03:45] delve into research into sort of real, sort of practical lab based research. Loved it. [00:03:50] And then from that moment on.

Payman Langroudi: Orphaned by the.

Avijit Banerjee: Bug. Totally. And and because I was [00:03:55] encouraged by such good people and such important people in my life professionally, they [00:04:00] gave that encouragement and that enablement to fulfil that, that sort of [00:04:05] passion and sort of got my, uh, a grant from the Medical Research [00:04:10] Council, which was, again, quite an achievement in those days, and that did a [00:04:15] masters in a PhD together in three years. Wow. So whilst I was doing [00:04:20] clinical practice, so it was it all sort of dovetailed really nicely together.

Payman Langroudi: And would you say [00:04:25] as far as research goes, what drove you then is the same as what drives you now [00:04:30] is it’s curiosity.

Avijit Banerjee: Yeah, I think so. It’s curiosity. It’s it’s sort of [00:04:35] pushing boundaries. And it also ties into education, which is another big sort of aspect [00:04:40] of my professional life, because not only do you want to, uh, investigate [00:04:45] new discoveries and new concepts and new ideas, but you then want to [00:04:50] apply them. So there’s the clinical application is one thing, but then it’s also impart that [00:04:55] knowledge. And and you mentioned the textbook. Uh, a lot of my research stuff [00:05:00] is in there because it’s relevant, because you take what you find in the laboratory [00:05:05] and you’ll then make that real for real life patients and for clinicians. [00:05:10] And I think that’s the critical thing. It’s all well and good doing, uh, new science, [00:05:15] discovery science. And I love that and I respect that hugely. But if that [00:05:20] stops and it doesn’t move on and translate to patient care, then [00:05:25] you sort of wonder what’s the point? And as I’ve got older in life, that’s something that’s really [00:05:30] evolved from that discovery science, which is really exciting. It’s [00:05:35] now how do we get that into a clinicians hands if it’s a product or [00:05:40] if it’s a philosophy, how do we embed it in care and things like this. So [00:05:45] now I’m doing more sort of clinical trial delivery as part of my research. So that’s [00:05:50] a really exciting and really different way of doing research. Uh, just as complex [00:05:55] but hugely satisfying because as I said, you’re ultimately helping our [00:06:00] colleagues all around the world pick up these new answers and ideas and then obviously for [00:06:05] patient benefit.

Payman Langroudi: So I’m quite interested in the time between a [00:06:10] breakthrough and it being. Care. Yeah. And [00:06:15] I guess it depends on who makes the breakthrough.

Avijit Banerjee: It does. It’s a really [00:06:20] pertinent question. And with what’s happened with the pandemic, you know, in the last four, four [00:06:25] years or so, such a spot on question and people have looked at this and I can give you the figure [00:06:30] 17 years.

Payman Langroudi: 17 years.

Avijit Banerjee: One seven.

Payman Langroudi: That’s okay. You, [00:06:35] professor at King’s makes a breakthrough. Is that 17 or some some general [00:06:40] practitioner in outside Caracas?

Avijit Banerjee: Yeah. Well exactly. They’re even longer. Absolutely. [00:06:45] That situation is really long. So the argument is if you’re in a in a research environment [00:06:50] with everything, if you like, set up for it. Yeah, there is data to show it can take [00:06:55] nearly that long because of not only do you obviously have to validate all your work, [00:07:00] if it is something that’s going to clinical practice, it will have to go through trial data and [00:07:05] regulatory analysis and everything else, and then a whole bunch of legal [00:07:10] frameworks before anything can get into a patient’s mouth or into a patient’s body. All right. [00:07:15] Um, Covid, things changed a bit. And as I’m sure we’re all aware, [00:07:20] listening to the news, you you had the vaccine being developed so quickly and [00:07:25] trials being carried out. And obviously there was a huge debate as to the validity [00:07:30] of some of this work, but ultimately it was done for the right reasons and was done properly. [00:07:35] Um, and it shows that, you know, where there’s a will, there’s a way. [00:07:40] And sometimes I think now a lot of the, uh, research [00:07:45] bodies are now looking at trying to streamline that time frame because it is [00:07:50] a crazy length of time. Yeah, if you think about it. And in that 17 years, when [00:07:55] you’ve had an idea and you’ve developed it, by the time it comes to fruition, it’s gone because something [00:08:00] else has come along. Yeah. And that’s often the case, especially in dentistry. Yeah.

Payman Langroudi: But I had I [00:08:05] had named Nan Wilson here and um, he was, he was saying that, you know, [00:08:10] when he was working in, in Eisai, he was seeing things develop more quickly [00:08:15] than when he was working in Manchester University. And, and so [00:08:20] that’s interesting that if you want to make a big change, there’s a quick you make that [00:08:25] change point there.

Avijit Banerjee: Yeah. Nan Wilson, Prof Wilson, professor sir. Now Nelson [00:08:30] is a dear friend and colleague and mentor of mine. Yeah. Remember when he did that research, [00:08:35] 60s, 70s and 80s. Now, in those days, you [00:08:40] and remember he was basically pioneering the first type of composite [00:08:45] material. Right. So it’s that level. And I think as we [00:08:50] get more and more contemporary, trying to create a brand new [00:08:55] material with brand new, everything has become that much harder because the scientific advancement has happened. [00:09:00] Yeah, right. That doesn’t mean it can’t be done. Of course, I’m not saying that. But when [00:09:05] you look back, the amount of regulation back in the 70s was massively less. [00:09:10] Yeah, okay. You didn’t have all the processes and the bureaucracy that [00:09:15] you have now. Now that will have a contributory part to [00:09:20] speeding up that, that, that 17 year sort of time frame. No, no debate, no debate. [00:09:25] I’m sure if Nan was sitting here and you asked him, could he do the same things then [00:09:30] that he do them now in the laboratory and everything else? Probably the answer would be no, just [00:09:35] for health and safety and all sorts of other regulations. But, you.

Payman Langroudi: Know, I think where there’s [00:09:40] a will to expand a market as an, in a, in a company. So [00:09:45] for instance, if Prof. Banerjee was sitting in three M yeah. Would your ideas [00:09:50] spread faster? Amongst amongst dentists. I mean, obviously not [00:09:55] amongst academics.

Avijit Banerjee: Yeah. And again absolutely. I think this is [00:10:00] the other, the other sort of dilemma being a clinical academic. And [00:10:05] we have this when we get, uh, industry partners, uh, offering us grants [00:10:10] to, to develop products or create products sort of in conjunction with them. And [00:10:15] we’re sitting as clinical academics and I’ll have PhD students or postdoc students and what have you. [00:10:20] And I’ve got to make sure that the academic rigour, the scientific [00:10:25] rigour, the research rigour is there in everything they do because partly [00:10:30] I’m training them, partly educating them and also just because of the role [00:10:35] we have. It’s sort of our duty to make sure that bit is right now in an industry [00:10:40] lab. Don’t misunderstand me. Of course, the rigour is there. I’m not saying that for a second. [00:10:45] However, they are, they are doing a slightly different job. Their aim is to [00:10:50] produce this product and commercialise. Exactly. Now clinical academia [00:10:55] has got better at that. No debate. So over the last 1015 years, commercialisation [00:11:00] of projects that have started out as pure clinical academic projects has [00:11:05] happened. And it’s happening more and more and more. And I’ve worked with something like King’s has a [00:11:10] huge commercialisation unit and as do most big research universities, they [00:11:15] have to honestly, it’s how they get the how they get the funding and how they can get [00:11:20] money into the system.

Payman Langroudi: So. So has there been times where you’ve done a research project and [00:11:25] then taken it to the what do you call that, the incubator at King’s?

Avijit Banerjee: Essentially, yeah. And [00:11:30] a lot of my colleagues have I’ve been in a position more with my research where if [00:11:35] it’s industry linked industry, we’ve already spoken and talked about it. So we work together to [00:11:40] develop the project. I sort of do the science and the research. Usually, [00:11:45] as I said, the doctorate, postdoc students, they will come in with that sort of [00:11:50] arm. So you do a sort of 50/50 split and that works really well because that’s their expertise. [00:11:55] And the trick nowadays in life is to make sure we use people’s expertise [00:12:00] appropriately. We can’t be, you know, Jack of all trades, master of none. I think it’s much better to [00:12:05] be a master of what you do, but then communicate and work with and liaise with other [00:12:10] masters in what they do and be open to that.

Payman Langroudi: It’s such a funny thing. It’s because we get asked [00:12:15] all the time by dentists, as you would expect for studies. Yeah, in our products. [00:12:20] Yeah, yeah. And one thing I mean, maybe it’s a personal bias of mine. I’ve never, [00:12:25] ever wanted to do a study for marketing reasons. Yeah.

Avijit Banerjee: And again, I. [00:12:30]

Payman Langroudi: Want to do studies to find out the answer to particular questions for myself. But [00:12:35] then the weird thing about those studies is that I don’t want to publicise those studies. And, I mean, it [00:12:40] goes kind of against the open information that goes on in academia. Yeah, [00:12:45] but if I find something out, I’d rather keep that to myself, you know, from a [00:12:50] commercial perspective.

Avijit Banerjee: Yeah. Commercially, of course people do. Therefore people sign NDAs. [00:12:55] People know.

Payman Langroudi: But what I’m saying, what I’m saying is a lot of a lot of research has done for marketing purposes. [00:13:00]

Avijit Banerjee: Oh yeah.

Payman Langroudi: Sure, sure, sure. I’d say the majority of of product based research is [00:13:05] done for marketing. Of course. Absolutely. And so when a dentist asks me what studies do you have on this published? [00:13:10] And I say none, he sees that as it’s not being researched. Yeah. But [00:13:15] actually, yeah, we’ve done three studies that we’ve never put out because [00:13:20] I don’t want my competitors to have that information. No. And it’s interesting.

Avijit Banerjee: But this is the that’s the [00:13:25] commercial aspect to it, isn’t it. You see. So for me, scientifically, absolutely, we [00:13:30] should be open. And if we’ve done research even now to the point that we publish [00:13:35] methodology before we’ve actually done it. So, [00:13:40] you know, which is an intriguing one. So you work up a study and you actually get [00:13:45] that published, the argument being that if you don’t get funded with the grant to do it, somebody [00:13:50] else could, because it’s meant to be an open, you know, world where we actually allow [00:13:55] people, you don’t just keep all your information to yourself. And that’s correct, because that’s how advances are [00:14:00] made. Or somebody might be able to tweak that methodology or something like that. And it’s interesting because I [00:14:05] hear it all the time. Obviously, I lecture very widely and talk about materials and products and this and that, [00:14:10] and you have to evidence base it, this phrase, lovely phrase, evidence base it, [00:14:15] which usually means what studies are there. And if you think about materials especially, there [00:14:20] will be studies. 99% of them are done in laboratory in [00:14:25] totally artificial conditions. And again, I am not criticising the research.

Avijit Banerjee: I’m not criticising [00:14:30] the researchers. So don’t don’t misunderstand me, but that to lift that information [00:14:35] and translate it into somebody’s mouth and say that the data you found in a test tube is [00:14:40] going to be the same as in somebody’s mouth, frankly, is ridiculous. So then you have to do clinical trials [00:14:45] if you want data and studies. And as you well know, they’re frighteningly expensive [00:14:50] to do properly. So most companies can’t. It’s just impossible. [00:14:55] I mean, you’re talking six seven figure numbers to do proper clinical trials. [00:15:00] So you can only do sort of feasibility trials, a little bit of audit, [00:15:05] a bit of like you say, commercial research, give your product to ten practices, get [00:15:10] feedback on how it feels, what the patients think that has value. And that [00:15:15] has commercial value, as you rightly say. Yeah. Does it have scientific value? Probably [00:15:20] not really, quite clearly. But they’re two different things. And it’s really important [00:15:25] that people appreciate that. And and I think we live in a world where people just say studies. Yeah. Yeah. And just [00:15:30] exactly. And there has to be there really has to be.

Payman Langroudi: And so, [00:15:35] look, a massive part of your life must be fundraising for studies. Yeah. Where do you go [00:15:40] for that.

Avijit Banerjee: So again, I’m I’m fortunate I’ve got good relationships [00:15:45] with industry. So I will often talk to industry. And I’m very open and transparent [00:15:50] and obviously with NDAs and everything else so we can get ideas. And sometimes [00:15:55] I’m lucky enough they may fund a PhD for three years, they may fund a project [00:16:00] grant for a couple of years, and so on and so forth. The other area we go to often in [00:16:05] clinical academia is government money. So there are there are there are pots of money. [00:16:10] So there is the National Institute of Health and Science Research, NIH Health [00:16:15] and Clinical Research, sorry, near which is the research division of the National Health Service, [00:16:20] if you like. Okay. That has a significant budget for doing [00:16:25] health care research, of which obviously oral and dental health is part of it. We don’t [00:16:30] tend to apply very much. And our grants compared to general [00:16:35] medical research, you can imagine a relatively small. But they’re there. And again, [00:16:40] you know, my PhD was funded with the Medical Research Council fellowship. Um, and [00:16:45] there’s lots of money there, but they’re incredibly competitive. You have to write these grants [00:16:50] proposals and they get scrutinised usually 2 or 3 times. [00:16:55] If you’re lucky, you go through the process and at the end they can still say no. So for every [00:17:00] probably a good hit rate, every ten grants you write, you might get 1 or 2. Wow. And [00:17:05] that’s actually part of the job plan. That’s part of my work at King’s is getting [00:17:10] ideas, putting them together. You then have to cost them. So you have to do accountancy [00:17:15] degree, sort of cost it all out.

Avijit Banerjee: It’s all very complex, but [00:17:20] you learn a lot. You talk to lots of people and and you realise what’s genuinely feasible [00:17:25] and what’s not. And I think that goes back to what I said earlier when I’m a bit when I was younger and greener, [00:17:30] you think, oh, this is exciting, I want to I want to chase this, you know, and then as you get older and a bit [00:17:35] greyer and you start to realise, you know, you’ve got to channel your efforts where you’ve got [00:17:40] the best opportunities and where the clinical need is. That’s the other big point. You [00:17:45] know, discovery science is so, so, so, so important. Of course it is. But [00:17:50] we live in a world where, as I said earlier, we need to implement. So there are areas [00:17:55] where you can look at the burning clinical questions. And they’re not always that. There’s [00:18:00] not always rocket science. People often think especially people in my position you think, oh, we’ve got to do something [00:18:05] very, very complex. Doesn’t have to be, you know, there’s lots of research into behavioural psychology [00:18:10] and how we change behaviours in healthcare, especially in oral health care, preventable diseases. Absolutely. [00:18:15] The key thing is exactly, dental care is my area is probably [00:18:20] the most preventable disease, yet it’s the most prevalent disease on the planet. Unbelievable. [00:18:25] You know, you know, 40 odd percent of the population of the whole planet [00:18:30] suffer from untreated dental caries today, which is a frightening statistic [00:18:35] when basically if you brush your teeth well, you check your diet and [00:18:40] you use some decent toothpaste and things like that, you can basically prevent it.

Payman Langroudi: And [00:18:45] I saw you in your paper that just came out in the BJ. There was a big piece on susceptibility. [00:18:50] Yeah.

Avijit Banerjee: Absolutely.

Payman Langroudi: Talk me through that.

Avijit Banerjee: Right. So thank you. Thank you for bringing [00:18:55] that up. So we published a quite an important paper, I think in the British Dental Journal in March, [00:19:00] March the 8th, it came out and this was work that was done with the office of the Chief Dental Officer [00:19:05] of England and also National Health Service England. So NHS so it’s all, you know. [00:19:10] And it was looking at essentially making prevention pay [00:19:15] because one of the issues we’ve had in our profession, it’s basically a fee per item service. [00:19:20] The more you do, the more you operate the more you get paid. Yeah. And that’s been a system for many, [00:19:25] many, many years. And it has some advantages, but it has many disadvantages, as we all know, because [00:19:30] it encourages people to overtreat perhaps prevention. I think [00:19:35] everybody in our profession understands the importance of prevention, but implementing [00:19:40] it is the challenge. Yeah. And our systems don’t always allow that. So [00:19:45] we worked for a couple of years looking at a pathway to see how [00:19:50] with best clinical care, with best clinical practice, all of this is in the textbook you [00:19:55] mentioned, and how we can map out some payment system [00:20:00] within the current framework of Udas, which I know is not not the most favourite, [00:20:05] you know, abbreviation on the planet at the moment.

Avijit Banerjee: But it’s what we have and there are ways [00:20:10] we can start to claim appropriately for it. So that is also [00:20:15] part of that system, is the work has to be tailored to [00:20:20] the patients who most need it. You can’t just blanket cover everybody with this [00:20:25] and it wouldn’t be appropriate to do so. Yeah. And it’s easy for us to forget clinicians, [00:20:30] to forget that if you’re in practice and you’re seeing X number of patients, 90% [00:20:35] of them are fit, well, healthy looking after themselves. And we always forget [00:20:40] that because it’s human nature to always think of the worst case scenarios, the most difficult [00:20:45] patients. Yeah. But a lot of that care needs to be channelled [00:20:50] to that 5 or 10% that you’ll have in your practice. And that’s where it’s about risk [00:20:55] related or susceptibility related patients in terms of targeting this preventive [00:21:00] care, where we can do lots of clever things with technology and materials [00:21:05] and everything else, and behavioural science to start getting patients to realise they’re [00:21:10] in control of their oral health, and we’ve got to fit it into their lifestyles. [00:21:15]

Payman Langroudi: But how can we tell the susceptibility of someone to care? So I mean, again.

Avijit Banerjee: Complex [00:21:20] the the the risk susceptibility assessment for dental caries. I wrote a [00:21:25] chapter in a textbook on risk assessment that came out about four years ago, [00:21:30] and I did the cardiology chapter with a with a good colleague of mine. Which book is it? Um, it’s [00:21:35] it’s risk assessment in oral health. Um, it’s edited by Ian Chappell [00:21:40] and I. The chapter I wrote was with Svante Swetman, who’s a cardiologist [00:21:45] in Denmark. Really, really, really bright guy. Done [00:21:50] a lot of work on this, and we looked at all the ways that we could assess risk susceptibility. [00:21:55] And there’s nearly 150 questions you could ask a patient if you really wanted [00:22:00] to, to try to knuckle down into this. Obviously you wouldn’t do that. You tailor [00:22:05] the questions depending on the person sitting in the chair. But the point I’m making is it’s not a [00:22:10] pure science.

Payman Langroudi: It’s not like a saliva test. You can.

Avijit Banerjee: Do it. There are there are adjunctive [00:22:15] tests. Absolutely, that will help build the picture like saliva, [00:22:20] like any other investigation. Exactly. But one thing on its own. No, there isn’t anything. [00:22:25] You have to take all that data. You have to pull it together. And actually, the clinician and the team, the [00:22:30] oral health care team, need to work together with the patient. It’s not an absolute [00:22:35] you know, it’s not a black and white yes and no answer. And and it’s a really [00:22:40] interesting point because something I wrote, I’ve written papers on this and and in the textbook we [00:22:45] talk about risk assessments susceptibility assessment as the red amber green you know the traffic light system. [00:22:50] Yeah. Yeah. And that’s all well and good. Actually in clinical practice, I [00:22:55] just want clinicians and teams to look at red and green. I’m not too worried about amber because [00:23:00] you treat amber patients as red in real life, okay. However, [00:23:05] if you’re looking at patient motivation and behaviour change, if somebody is high risk [00:23:10] or low risk, how do you move them? It’s slightly arbitrary. You take all these factors, you pull [00:23:15] it together and you make a decision. We live in a world now where people are hyper [00:23:20] competitive. They want to see progress. They want to see change. Otherwise they get bored. [00:23:25] Right? So one of the things I’ve always said is, why don’t we have ten or [00:23:30] 20 or 100 levels of risk for the patient? But for us, [00:23:35] ultimately it’s high and low and then the clinical team can calibrate. And [00:23:40] you can start moving people up and down like a league table so.

Payman Langroudi: People feel like they’re [00:23:45] improving. Bingo.

Avijit Banerjee: Yeah. And then if you’re treating a family.

Payman Langroudi: Gamifying it.

Avijit Banerjee: Bingo, and [00:23:50] you’ve got a family you can get, you know, brothers and sisters competing against each other and [00:23:55] you can within a practice, you can calibrate a practice. You put, you know, in practice [00:24:00] meetings, you put some cases up, take some clinical pictures, and you quietly let everybody privately [00:24:05] decide what the risk is, see what the variation is, discuss it and you do a few [00:24:10] of these. And all of a sudden your, your, your practice is calibrated. And then you [00:24:15] can start seeing your patients. And the other big thing here is to remember susceptibility [00:24:20] assessment is longitudinal. One of the problems we have in our profession, people will see a patient. [00:24:25] They’ll sort of do an assessment of susceptibility. But many don’t write it [00:24:30] down. It’s sort of done in here and done in your heart sort of thing in your gut. Yeah. [00:24:35] You don’t document it and then we don’t follow it up. And remember susceptibility changes with [00:24:40] time. Mhm. So this must be longitudinal. So one of the things we talked [00:24:45] about in that BJ paper was also phased care phased courses of [00:24:50] treatment. You know get the prevention involved then reassess. See [00:24:55] if the oral health is improving. And if it is then crack on with all your high end prosthodontics [00:25:00] implants whatever you want to do. But if it’s not just like in perio [00:25:05] with the perio guidelines, Periodontology guidelines, you loop back and try again. [00:25:10] Yeah, because ultimately, if the mouth isn’t essentially healthy and the patient’s not looking after [00:25:15] their mouth, whatever fancy work you do operatively, it’s going to fail. [00:25:20] It’s got a finite lifespan. And in a in a slightly more toxic mouth, [00:25:25] it will fail quicker. So it’s so important to get that right because then [00:25:30] you can do all, as I said, all your high end stuff, no problem, because you know it will work. [00:25:35] And then you can you rub a stamp on it. You know, I’m happy with this. And if you use an because [00:25:40] the patient’s there, all hygiene’s good, they’re flossing, they’re tooth brushing, etc. you say look after it [00:25:45] and that’s what we need to. That’s what we need to.

Payman Langroudi: That’s nice. You know, I think the, the job [00:25:50] of an expert is to take all the big information and then bottle [00:25:55] it up. Yeah. And and you know, some of the craziest stuff equals MC squared is, is [00:26:00] a relatively simple thing. But it took a massive amount of understanding to [00:26:05] get to that. Absolutely, absolutely. In that translation of, of your [00:26:10] research into, you know, practical things, is that the kind of [00:26:15] thing we’re talking about is that, you know, very.

Avijit Banerjee: Much so I, you know, I my initial research [00:26:20] was on looking at the microbiology of caries and, and the [00:26:25] microscopy and fluorescence, and then looking at interfaces between adhesive [00:26:30] materials and all this sort of scientific stuff, which is still ongoing. And as I said before, [00:26:35] should carry it should be investigated. Absolutely. But as I’ve got greyer, [00:26:40] I look at how interested.

Payman Langroudi: In this bit. Yeah.

Avijit Banerjee: Because actually ultimately what [00:26:45] we’ve learned over the years is you have the clinician, you [00:26:50] have the patient, and you have the procedure, if you like, in the middle, whatever it is you’re [00:26:55] doing to the tooth, the patient. Right. Yeah. And what it’s been shown in study [00:27:00] after study, in trial after trial. And when people are looking at long, you know, longevity data and [00:27:05] things like this, what they find out the factors that most affect the quality of the work that’s done in [00:27:10] the mouth, it’s the clinician and their skill, and it’s the patient [00:27:15] using their toothbrush. Those are the biggest factors what type of material you use. [00:27:20] And all of that plays a small part. But it’s a small part. And as [00:27:25] you know, these materials change every few years. They change anyway. Yeah. Whereas [00:27:30] the clinician and their skills don’t change unless they keep up to date and what have you. And the patient [00:27:35] has to be motivated to keep looking after their mouth. And I suppose the patients, it’s so difficult [00:27:40] because, you know, with the advent of smartwatches and people doing their steps [00:27:45] and getting their heart rates and all this sort of stuff, people are aware of their general health more and [00:27:50] they they translate their general health to things that can really go wrong and [00:27:55] they suffer oral health. What’s going to happen. People think they get a bit of toothache. [00:28:00] I’ll go to the clinic, dentist will drill my tooth and I’ll be fixed. The mentality [00:28:05] has to change that. Actually, a patient is in full control of their oral health. We’re [00:28:10] there to help them.

Payman Langroudi: Don’t think that we’re guilty as a profession of not getting [00:28:15] the key message over to the public about frequency. Yeah. Of sugar. [00:28:20]

Avijit Banerjee: And it’s so interesting.

Payman Langroudi: Because it’s mad. It’s one very important point. And as a whole profession, [00:28:25] we haven’t managed to the brushing piece. People know even if they don’t do it, they [00:28:30] know they should. Yeah. But the frequency of sugar piece, we just haven’t been we haven’t gotten that.

Avijit Banerjee: You know, [00:28:35] again, you’re asking such pertinent questions because these are really hot [00:28:40] topics that we’re talking about in a whole bunch of the fora that I’m in at the moment. So [00:28:45] one of the big things now is, and I’m saying it, and several of my senior colleagues are saying [00:28:50] it, there’s an element where we don’t actually need much more research into things. We don’t need more data [00:28:55] to prove anything. We sort of know it works. The key problem is why aren’t people [00:29:00] out there doing it? And it’s very interesting. And this is where working with industry is so, [00:29:05] so key because, you know, you go to the big the big brands. I’m not going to mention names, the big brands [00:29:10] that make toothpaste and toothbrushes and things like this. Okay. They are got a multi-billion [00:29:15] dollar companies. They’re selling globally now. Think when you watch the TV. And [00:29:20] they do an oral health message to promote their toothbrush, toothpaste, [00:29:25] mouthwash, whatever it might be. How do they promote it? They [00:29:30] don’t show pictures with people with grotty mouths and big abscesses and things like [00:29:35] this. They show people being vibrant and enjoying life and the [00:29:40] quality of life thing. And I think one of the problems we’ve had as a profession when we talk to our [00:29:45] patients, that health care message has gone away. It’s become a disease [00:29:50] message. If you don’t brush your teeth, you’re going to get holes in your teeth. You’re going to get. Your [00:29:55] smile will change. It’ll, you know, you’ll have stained teeth. You’ll have bad breath. You’ll everything is negative. [00:30:00]

Avijit Banerjee: Yeah. All right. We never actually really spin the positives. And [00:30:05] so there’s a huge amount of talk in a lot of foreign in the areas I’m working in with [00:30:10] industry on how we can change that message because like you say, the brushing [00:30:15] and everything else, it’s like mantra, you know, I’m sure people are aware of it. Do they do it? No they [00:30:20] don’t. So are there clever ways? So there are manufacturers who are [00:30:25] making high tech toothbrushes, you know, with apps linked to your phone and you [00:30:30] know everything else. And when I first heard this, I thought, this is crazy, why would you do that? But [00:30:35] if it motivates people because there are a group of population who love that [00:30:40] tech and want to use it, just like the smartwatch type. Yeah. And [00:30:45] and I think there’s a huge market for this because I said oral [00:30:50] health we all know is linked to general health. You know, the phrase bringing the mouth back in the body so, [00:30:55] so vital. You know, periodontology have done really well in linking oral disease [00:31:00] to cardiovascular disease and all other aspects. There’s even small links with [00:31:05] caries and things like this, and obviously with diet and then obesity and diabetes [00:31:10] and so on, so forth. So it’s intimately linked. And, you know, [00:31:15] that has been a big change over the last 15, 20 years. There’s no debate, you [00:31:20] know, and we were growing up at dental school. It’s all about doing the mouth. Doing teeth. Yeah. Now it’s [00:31:25] not it’s very much about whole patient care and holistic patient care.

Avijit Banerjee: And I know [00:31:30] people get frustrated with that phrase. It’s always bandied around on social media and no one knows [00:31:35] what it means. But actually what it means is taking into account all the factors that [00:31:40] make a person. Not just how they’re holding the brush and what toothpaste [00:31:45] that’s part of it. But that’s one bit of the equation and you’ve got to build everything. So [00:31:50] it then changes. How it how we educate students. Because [00:31:55] when I was educated, you know, we did procedures our whole, [00:32:00] uh, you know, undergraduate education was based around doing practical procedures. [00:32:05] And we could in those days because regulation was different, patients [00:32:10] were different. Everything was different. Now things have changed. So a lot of the [00:32:15] the undergraduate curriculum, even in the textbook there, of course there’s operative things, [00:32:20] but there’s the behavioural psychology again and how you manage expectations and needs [00:32:25] and how you sort of get inside the patient’s head. And which buttons do you [00:32:30] press and how how do you enable them and facilitate them? And I think those are what. [00:32:35] We used to call soft skills. Yeah, I disagree, they’re not soft skills. They’re incredibly [00:32:40] hard skills because that’s the tough bit. We can learn how to do procedures. [00:32:45] You can go on courses. We’re all capable. You can learn how to do those things. All right. [00:32:50] Can we all tap into somebodies head and know which triggers [00:32:55] to to press, which buttons to flick to make them change behaviours. No we can’t. That’s difficult. [00:33:00] That’s really difficult.

Payman Langroudi: So you’re teaching that a lot more.

Avijit Banerjee: Absolutely. That’s a key [00:33:05] part. All all Dental schools are that’s become a much more key sort of thread. [00:33:10] Obviously we’re still trying to teach all the, you know, traditional operative techniques and [00:33:15] things like that, of course. But, you know.

Payman Langroudi: There is a sort of a thought out there that the [00:33:20] graduates that qualify now don’t have as much operative skill as maybe in our [00:33:25] day. And and it’s fundamentally true. So, so you’re saying that there isn’t the [00:33:30] need for that.

Avijit Banerjee: No no no no no no I think it’s different I think so when I look back to my [00:33:35] undergraduate training 30 odd years ago, okay, regulation was different. Patients [00:33:40] attitudes were different, professional attitudes were different. The whole outlook of dentistry [00:33:45] in those days was, as I said, fee per item. You learn procedures and you could basically [00:33:50] get through a Dental degree. You could count off 40 different procedures and you were trained how [00:33:55] to do them in a laboratory. You then went to a patient and then you had to do X numbers. [00:34:00] So it was all counted by numbers. And then you took a little test and that [00:34:05] validated everything. Okay. Now people have spent the last 1015 [00:34:10] years arguing, but counting numbers isn’t the way to go, because obviously some [00:34:15] people could become masterful in ten procedures, others it might take 100, [00:34:20] and so on, so forth. Point number one. Point number two, the world’s changed. The dynamic [00:34:25] of patients coming into hospitals and dental schools, changed that model of [00:34:30] having a dental school and people coming to it. In London especially. It’s [00:34:35] a very, uh, fluid environment trying to get patients to come back for appointments, [00:34:40] regular appointments, their needs are different. They the complaint [00:34:45] levels go through the roof. When I was a dental student, patients never complained. It was it was unheard of. [00:34:50] Unheard of. Now all the time.

Payman Langroudi: At.

Avijit Banerjee: The hospital, [00:34:55] at the hospital. And I’m not saying they probably have right to. I’m not saying, you know, the systems [00:35:00] are there and they and you’re.

Payman Langroudi: Saying the world’s changed.

Avijit Banerjee: The world has changed. And I would argue it doesn’t necessarily [00:35:05] make a dental undergraduate better or worse. They are different. And there’s no dispute [00:35:10] about that. They are different. They’re a different beast to an eye train. And are they.

Payman Langroudi: Cleverer than us as [00:35:15] well? Because it’s harder to get in.

Avijit Banerjee: Depends how you define cleverer. But but yeah, in the sense [00:35:20] that you mean in terms of grades they’ve got to get and the academic attainment in terms [00:35:25] of the, the numbers. And we talk about a stars or nines or whatever they’re measuring now at a level. [00:35:30] And then coming through the system, one might argue that and I [00:35:35] know certainly when when Covid hit, obviously, you know, dentistry was shut down, we couldn’t [00:35:40] do operative treatment. But many schools invested in [00:35:45] more in the sort of phantom head, what we used to call phantom head units and then virtual reality [00:35:50] simulators. And we pushed really hard the academic content. [00:35:55] Now I fully I know people are going to say, but that’s not what’s important [00:36:00] when you’re a clinician. To a degree, I would accept that. But actually it is quite [00:36:05] important. You need to have that knowledge base. Yeah, absolutely.

Payman Langroudi: But you don’t know where. I mean, one [00:36:10] of these students could end up being the next. Absolutely.

Avijit Banerjee: And our job is also to inspire that. Exactly [00:36:15] right. Absolutely. And I think people sometimes forget they think that a university is there to, [00:36:20] to churn out. And it just it just dentists or therapists or hygienists or whoever. And I [00:36:25] disagree, I disagree. We’re there to try to teach best clinical practice. Now [00:36:30] I fully, fully, fully accept there are systems and processes which [00:36:35] then have to be taught to overlay that, which is the whole point of foundation training. [00:36:40] That was the whole purpose of it in the first place. You can learn so much at a dental school, [00:36:45] and the days of being able to learn all the processes, the admin and the actual [00:36:50] and have the confidence, because that’s the other big thing I think now with the with the gen-zs, [00:36:55] the millennials, you know, certainly the Gen Zs who are teaching, it’s not they’re [00:37:00] not capable. It’s not that they’re not intelligent. It’s not that at all. They are they’re more than capable and they’re more than [00:37:05] intelligent. But what they lack is confidence. And because [00:37:10] we protect them more in a university, in a hospital setting, because of the layers [00:37:15] of process which we have to do and rightly do. So again, I’m not saying it’s [00:37:20] I’m not blaming or saying it’s wrong, but the difficulty then means that when they come out, they’re [00:37:25] quite raw with confidence. So they will have been taught [00:37:30] things, but they don’t sort of believe they have and they don’t feel they’ve done [00:37:35] enough. And that is a dilemma. And it’s a dilemma that every school is facing. Bigger schools [00:37:40] face it more purely because just the numbers and the logistics. But it’s a problem and it’s happening across [00:37:45] the world in our day.

Payman Langroudi: I mean, I remember the first time I cut a veneer, [00:37:50] I cut six veneers in in practice, I really didn’t have much idea [00:37:55] what I was doing. Yeah, I really didn’t. I think there was no internet, no to check. [00:38:00] Absolutely. So I remember I found a book when my boss had a book. [00:38:05] Yeah. And you showed me and I just did it. Yeah.

Avijit Banerjee: But then in.

Payman Langroudi: Those days you can’t. [00:38:10]

Avijit Banerjee: If you do that, if you do, and if you do that now and anything goes slightly wrong. Yeah.

Payman Langroudi: So [00:38:15] that’s so, so what I’m saying is that that lack of confidence kind of makes sense. Yeah.

Avijit Banerjee: Totally. Totally. [00:38:20] And but I think I do think current undergrads, generally [00:38:25] speaking, get a bit of a bad rap because of it. Yeah.

Payman Langroudi: Yeah. That’s true.

Avijit Banerjee: You [00:38:30] know, and you know, as I said, I’m not trying to, you know, plant my flag in one camp [00:38:35] or the other here. I’m, I’m genuinely I yes, I am sitting on the fence a bit, but you know, I [00:38:40] take both I see both sides. I work in practice. I see that I train students, [00:38:45] I see that and I and I train postgraduates and specialists and everything else. So you see everything. [00:38:50] Yeah. And I would say that about specialist training. Right. I have specialists, I have prosthodontic, [00:38:55] you know, trainees on my clinics at the hospital and they’re all brilliant. They’re all great. [00:39:00] But as I say, my mantra to them is to be the best specialist, you have to be the best generalist. [00:39:05] That’s my mantra to them. This idea of, well, I’m going to learn how to put implants in, [00:39:10] or I’m going to learn how to do a procedure really well. That’s all great, but actually the skill comes in picking [00:39:15] the cases.

Payman Langroudi: That’s not true everywhere though, is it. And the US they very much.

Avijit Banerjee: It’s [00:39:20] operative based absolutely.

Payman Langroudi: As and they encourage specialising very quickly.

Avijit Banerjee: They do they [00:39:25] do it’s different systems I think I’ve got very dear friends who are specialists in [00:39:30] all the different disciplines. Okay. And you look and again it’s when you get some grey [00:39:35] hairs and you realise what’s worked and what hasn’t worked, and you’ve seen all of this and you’ve [00:39:40] picked the right cases or not the right cases, and we were all like that. You know, when you’re younger, [00:39:45] I’m not saying gung ho, but you went for things, you know, I can do this, you know, and with [00:39:50] experience become you. You start to know your limitations. And I think that’s [00:39:55] what makes you a really good specialist, because you can give the right advice. And my [00:40:00] argument I’ve always said there is there is a push to, you know, specialise more [00:40:05] quickly. And I know we’ve got the current climate in NHS dentistry and more and more people are going [00:40:10] out into private practice quicker. Yeah. Problem with that is if you don’t [00:40:15] have that general experience as being a good general dentist or clinician, therapist, [00:40:20] hygienist, etc., if you if you’re just going to go and specialise straight away, [00:40:25] you don’t see all the different things, right? You don’t experience [00:40:30] them. And that’s going to affect the type of referrals you make and how you accept [00:40:35] them. Because remember, you might be specialist endodontist and you may be the best root canal filler [00:40:40] on the planet, but that’s not specialist endodontics. Specialist endodontics is keeping the pulp alive. [00:40:45] Right. So this is my point. You know, you and [00:40:50] you work with the primary care team. And that’s what a specialist should be doing. [00:40:55] Of course they’ll do their. They’ll do their specialist operative work. I’m not denying [00:41:00] that. But the real skill comes in knowing when to say yes and when to say no. That’s [00:41:05] in my belief. And I’ve watched over the years, you know, um, how does.

Payman Langroudi: It make you feel [00:41:10] when, when you talk to undergrads and they tell you, you know, I want to do a lime bleach blonde. [00:41:15] Does that does that bother you?

Avijit Banerjee: You know exactly how I feel about that. And that’s such a [00:41:20] loaded question. Um, but, um, yeah, it disappoints [00:41:25] me. It does disappoint me. And I know why. Because that’s what they see. They see on social media [00:41:30] and they, they see this is, dare I say it, as a straightforward way of making good [00:41:35] money and having a good life and everything else. And I get that I’m not dumb, I get that. But, [00:41:40] you know, you go into dental school hopefully wanting to look after [00:41:45] people. It’s the sort of Hippocratic Oath type thing. And I have obviously have no issue [00:41:50] with people wanting to specialise in different things, obviously. But my argument is go out [00:41:55] into the big wide world and actually experience the big wide world and work out what it [00:42:00] is that fires your rockets. What makes you passionate, what is it? Which aspect do you really want [00:42:05] to go into? All right. And you know, if you do that for three, four, five years [00:42:10] and maybe get some other qualification, you know, get some general practice qualifications because [00:42:15] that’s only going to put you in good stead. It cannot be negative. It can’t.

Payman Langroudi: That’s [00:42:20] not the advice I give youngsters. I know that’s the advice a lot of people give youngsters but that’s I for [00:42:25] me three years in, in the NHS is a de-skilling. Yeah, [00:42:30] yeah. You get exposed to a bunch of stuff but I don’t know. The advice I give [00:42:35] is pick something and run. Yeah I it’s not, it’s not necessarily it’s, it’s not [00:42:40] popular advice. No, no.

Avijit Banerjee: But but it’s interesting. You see the de-skilling bit. I’m not sure because [00:42:45] as we just said, you know, they’re coming out with pretty raw skills. True. Um, [00:42:50] and I think what we need is a better system that, you know, I’m not suggesting [00:42:55] NHS practice in its current shape or form is an ideal, you [00:43:00] know, learning ground, a place. I fully accept that. Of course, there are very good practice [00:43:05] NHS practices. Let’s not forget, I know we’re living in a world at the moment where all we’re hearing is doom and gloom and [00:43:10] understandably. But let’s not forget there are a significant number of practices that are working their [00:43:15] backsides off and doing good stuff and actually looking after young.

Payman Langroudi: The problem is, if you do [00:43:20] that, you can’t make a living. That’s that’s the the.

Avijit Banerjee: Issue and this is it. And [00:43:25] this is where the systems do have to change clearly. And, and whichever government [00:43:30] is in charge. I said I don’t want to get political about it now, but whichever government’s in [00:43:35] charge, they have to take the bull by the horns and not be frightened to, to to shake this up a bit. [00:43:40] And most governments are not that interested because it’s a tiny fraction of the NHS budget [00:43:45] is not important. 2% even. Yeah, pretty much. Yeah, 1.7%. 2%. [00:43:50] And I’ve said this in front of Chief dental officers, you’ve always got to remember, [00:43:55] you know, if if the NHS budget, let’s say, is £200 billion a [00:44:00] year, give or take, okay. And roughly 2.53 billion [00:44:05] is, is oral health care right. How much is spent [00:44:10] on patient complaints every year dealing with patient complaints do you think in the NHS overall the [00:44:15] whole NHS, the whole whole NHS.

Payman Langroudi: 100 million. Not quite. [00:44:20]

Avijit Banerjee: Not not 50%, but it’s around 15 to 20%. So 15 to 20 billion, [00:44:25] right? How much is spent on patient wastage, i.e. medicines [00:44:30] that aren’t taken, crutches that are thrown into the skip, wheelchairs that [00:44:35] aren’t given back loads pretty much the same amount again. Wow. So you potentially got £30 [00:44:40] billion on legal cases and wastage out of 200,000,000,002.7 [00:44:45] billion is spent on oral health.

Payman Langroudi: Wow.

Avijit Banerjee: I rest my case [00:44:50] and I’ve quoted this in front of chief dental officers asked to be corrected and [00:44:55] I haven’t been well. And that doesn’t matter whether there’s a green [00:45:00] flag, a blue flag, a red flag or whatever colour flag over number ten Downing [00:45:05] Street doesn’t make any difference.

Payman Langroudi: It’s interesting. You know, um, I think it’s a testament to Thatcher that, [00:45:10] that when I talk to academics, a lot of what they say is about costs and [00:45:15] money and, and so forth. And it never was that way. So, so, so and we’ve had to [00:45:20] be that way. And because of this 15 billion or 20 billion that goes into wastage that you’re talking about. [00:45:25] But you know, the question of. Teaching [00:45:30] someone who’s basically a child when they when you get them right, [00:45:35] and then taking them through to whichever dentist they [00:45:40] want to become. Yeah, it’s a real responsibility. It’s a massive responsibility.

Avijit Banerjee: It’s [00:45:45] massive.

Payman Langroudi: One guy could want to become a, you know, two days a week [00:45:50] lifestyle. Yeah. Dentist who wants to do correct a very limited amount of things. And [00:45:55] the other guy could want to be the next. Absolutely.

Avijit Banerjee: And again, that’s what’s different. When [00:46:00] we were students basically we went into dentistry. Yeah.

Payman Langroudi: Right. But do you do you must [00:46:05] have seen them come through totally. And were there people that you saw this this guy’s [00:46:10] going to go far. And he really did.

Avijit Banerjee: And always, always you’ll see that. And that’s the whole privilege [00:46:15] of doing my job because, you know, over the crikey, [00:46:20] since 1997 I’ve been teaching. So what’s that 30, 35, 36 years, [00:46:25] something like that. And you look at that, sorry, 25, 26 years. Can’t [00:46:30] do maths. Yeah. Um, and you look at that and you think of that number of students [00:46:35] that, you know, and we have, we have nearly seven, 800 students a year. So you can you can multiply [00:46:40] this up. And of course, people stick, people stick out and you can [00:46:45] see and in my day and our day, we went into dental school, you came out as a dentist and you did [00:46:50] dentistry. Basically. There weren’t that many pathways. Yeah. Now, as you rightly say, [00:46:55] you’ve got social media pathways. Business people are running 100 practices. [00:47:00]

Payman Langroudi: Yeah.

Avijit Banerjee: Very, very quickly. Yeah. Um, you’ve got the aligned bleach and bond type [00:47:05] style thing. You know, you’ve got everything in between. All right. I’ve had students [00:47:10] who are now running very successful, um, manufacturing companies and product [00:47:15] companies and things like this. Others have gone into research and are deans of dental schools. [00:47:20] All right. Others are scientific researchers for industry, [00:47:25] you know, and there’s, of course, others who’ve given it up and then gone and done something amazing, something [00:47:30] else amazing. You know, my point being is just such a range. And [00:47:35] I suppose that’s what’s made it harder to, if you like, stimulate [00:47:40] people because you’ve got so many different viewpoints, different angles. People are coming at. Yeah, [00:47:45] my day and when I first started teaching back in the late 90s, it was relatively [00:47:50] in that sense, it was relatively straightforward. It was now it’s it’s more of a challenge. And I [00:47:55] don’t mean that in a negative way necessarily, because it keeps us on our toes. The way we teach has to change. You [00:48:00] know, you know, the attention spans, the way people learn. It’s so, so, so, so different, [00:48:05] so different.

Payman Langroudi: As as an international lecturer, you’re in touch with people at the [00:48:10] top of the field. I don’t know, in the US and Japan, in Scandinavia, how do we rank when [00:48:15] it comes to research, teaching, general practice, high [00:48:20] rank high.

Avijit Banerjee: Let’s not underestimate this. We do rank up. This [00:48:25] country is very good at self-flagellation. We love whipping ourselves and telling us, telling all the time [00:48:30] we’re negative, we’re all rubbish. And we’re not. We’re not actually. There’s always room for improvement. [00:48:35] We can always be better. Obviously, I’m not disputing that, but it’s very easy to say, oh, we’re all rubbish, [00:48:40] you know. Kings is now in the top five, uh Dental schools in the world. [00:48:45] Okay. And that’s a qs’s ranking. So it’s a relatively respected ranking. Okay. And yes, people [00:48:50] can argue. What do these rankings mean? I know, but that’s what we’ve got to go on. Okay. A [00:48:55] lot of the British universities not just talking about dentistry now, but the British universities [00:49:00] are in the top ten in the, in the world. Yeah. All right. But there’s a reason for that. [00:49:05] Okay. Industry wants to pump in research money into the UK. And we have an incredible [00:49:10] research network. As I mentioned the niHr. And in oral and dental we have the research delivery [00:49:15] network which is a really important organisation. And I was [00:49:20] talking to about 8 or 9 industry partners just at the BDA showcase just in March, [00:49:25] and we were trying to work out what the blockages were, why international companies don’t want [00:49:30] to come and put money into the UK, because it’s not because of the quality of the research or the quality [00:49:35] of the researchers or the or the labs or things like that. It’s a bit of bureaucracy [00:49:40] in red tape and being brutally honest. I’m not a politician. Brexit and [00:49:45] things like that didn’t really help and it just makes life more and more complicated, not impossible, but more complicated. [00:49:50] And all these things are there. And so we’ve got more and more hurdles. And [00:49:55] of course, there are areas that have declined a little bit. You can argue I’m not disputing [00:50:00] that, but you’re talking to me about oral and dental health and research and those sorts of things. Education. [00:50:05] We are still right up there. Let’s not forget that.

Payman Langroudi: Yeah, but when you talk to your peers, for instance, [00:50:10] what’s the difference in character of of a Scandinavian teacher in a school [00:50:15] in Sweden, as in what are they? Is it teaching different? Number one.

Avijit Banerjee: Interesting [00:50:20] question. I’ve been external examiner to in a lot of dental schools around the world really. And, [00:50:25] and, and it’s a really interesting point because you look at the courses, you look at the curriculum, you look at the people delivering [00:50:30] it and how they deliver it. I would argue, you know, a genuinely good [00:50:35] teacher. It’s good whatever country you’re in, because the innate skills are [00:50:40] the same. Because you’ve got to like the passion. You’ve got to like the fire in your students. [00:50:45] It’s not about how polished your PowerPoint slide is or which [00:50:50] font you use, or which colour scheme. All of that’s irrelevant. You need to be [00:50:55] able to light the fire. You need to flip that switch. And whether you’re [00:51:00] in Scandinavia, in the Far East, in the States, in South America where I’m coming.

Payman Langroudi: From, I understand that, of [00:51:05] course, but where I’m coming from is, look, this last bit of research you did was funded by [00:51:10] the government, was it? It was a bunch of it was about funding [00:51:15] of the NHS. Yeah. So so the fact that you come [00:51:20] from the UK pushes you into a particular way of thinking. Very true things. Yeah. [00:51:25]

Avijit Banerjee: Very true.

Payman Langroudi: Whereas if a guy sitting in Japan and there isn’t something like very.

Avijit Banerjee: True, the different system.

Payman Langroudi: They go in a [00:51:30] different direction.

Avijit Banerjee: Agreed, agreed.

Payman Langroudi: But you notice that when you when you do.

Avijit Banerjee: But but you got to remember, fundamental [00:51:35] undergraduate teaching doesn’t change because we’re not trying to teach for a system. And that’s [00:51:40] where there’s always that difficulty. We’re just saying that line when a student graduates and then goes into [00:51:45] NHS or whichever system. Yeah, our job actually isn’t to train. As [00:51:50] you’ve said earlier, we’re not there to train NHS dentists. We’re there to train dentists or dental therapists or dental [00:51:55] hygienists or dental nurses. They can then, in theory, need to learn the [00:52:00] system they’re going to work in. But the clinical work, I would argue, shouldn’t [00:52:05] really change. Now, of course, as you get more experience, you get better at doing things and then you might [00:52:10] go on specialist courses. That’s different. Yeah, that’s later. But I would argue every dental [00:52:15] school around the world, the ambition should be the same. Now, you know, I [00:52:20] know I’m seeing the world through rose tinted spectacles here. I know life isn’t that simple. And of course you’re going to have different [00:52:25] countries with different pressures, societal pressures, government pressures, you [00:52:30] name it, system pressures. And of course, you’ll find courses that will therefore [00:52:35] be tailored towards that. But I would still argue when you when you peel [00:52:40] that layer off because that’s all it is. It’s a layer.

Payman Langroudi: Yeah, the heart.

Avijit Banerjee: Beneath [00:52:45] it is still doing the right thing for your patients. You know, whether it’s operative, [00:52:50] whether it’s behavioural science and behaviour change and all these sorts of [00:52:55] things. That’s actually the crux. And, you know, yes, of course [00:53:00] there’s different ways of delivering things.

Payman Langroudi: And as an example, I’m from Iran, so my [00:53:05] uncle’s a dentist in Iran. I went and spent one day in university. He taught [00:53:10] at the university there. And in that one day he said to me, look, you’re going to learn extractions today. [00:53:15] And I was in the third year of dental school that one day I think I took out 20 teeth and there was a [00:53:20] queue of people. Absolutely. And so if you become a dentist in Iran, [00:53:25] you’ll learn extractions pretty damn well. Yeah, yeah. That’s just a feature of Iran is each [00:53:30] country’s got annoyances. Of course. Absolutely.

Avijit Banerjee: And, you know, and I think, as I [00:53:35] said, in the good old days, the good old days, you know, when when we were a dental students, it [00:53:40] was not quite like that, but we had plenty of patients. We could do work. Yeah. It’s not [00:53:45] a dissimilar point. You know, there were patients who do amalgams on and composites on and jyx [00:53:50] and endo and everything else. Now the world has changed. My first [00:53:55] clinical patient I treated in year two, second [00:54:00] year BDS was a first upper molar endo first [00:54:05] page, first patient ever. Right. And I didn’t sleep the night before [00:54:10] I studied everything. I went over all my, you know, uh, sat down [00:54:15] and basically our tutors were there. And of course they helped and suggesting we were just left [00:54:20] alone. Of course not. But we did it. Essentially we did it. And you [00:54:25] had a sleepless night the next night because you had the stress was still there and, you know, in your body and, you know, it [00:54:30] was so funny. I tell this story because I remember doing it. I remember the patient, [00:54:35] lovely patient, a lovely lady, nearly something like 17 [00:54:40] years later. I was the professor on clinic, and the student comes [00:54:45] up to me and says, there’s a patient who wants to say hello. He came to my office. That was the patient came [00:54:50] out and it was that lady. She actually got out of the chair, gave me a hug because she remembered me, [00:54:55] and I actually did. She lived in Hong Kong or had family in Hong Kong and actually did my elective [00:55:00] in Hong Kong, and she helped. So that’s why there was a little bit of a relationship there. And the first [00:55:05] thing I said to her and went. Is that is that a root canal? Done? And she laughed [00:55:10] and went, absolutely. Look at the x rays are.

Payman Langroudi: Amazing.

Avijit Banerjee: Isn’t it just. No. All right. Beginner’s [00:55:15] luck. I’m not denying it. Beginner’s luck. But my point I’m making is that that’s how we did things, and [00:55:20] now we wouldn’t be allowed to do that. We wouldn’t be allowed to put a student in that position. [00:55:25] Yeah, and that’s where things have changed. And you can people can argue [00:55:30] either way whether that’s right or wrong, good or bad. And there’s arguments for both sides. Of course there is. [00:55:35] But that’s where it’s changed.

Payman Langroudi: Let’s get into me a bit.

Avijit Banerjee: Yes.

Payman Langroudi: I [00:55:40] mean, number one from when we studied to today. [00:55:45] What’s the main difference?

Avijit Banerjee: Right.

Payman Langroudi: First of all, we were taught to fully remove.

Avijit Banerjee: Yeah yeah yeah yeah. Right. [00:55:50]

Payman Langroudi: So is it.

Avijit Banerjee: Right now now, now now into my hot topic. Now, now now you’re not going to [00:55:55] struggle to shut me up now. So two miss first of all and this is this is really important. Really [00:56:00] really important because people use that term interchangeably. There’s minimum intervention. [00:56:05] Yep. And we used to people call it minimum intervention [00:56:10] dentistry or mid. I don’t like that because that’s also [00:56:15] the same as minimally invasive dentistry. Mid. So it causes confusion. So [00:56:20] what we’re calling it now is minimum intervention oral care. So [00:56:25] it just subtly different. And if you think of it, this is that holistic approach of [00:56:30] looking after your patient. Right? So it’s delivered by the team, not just [00:56:35] a dentist but by the whole oral health care team. It’s prevention based, it’s susceptibility [00:56:40] related. All the things we’ve discussed. Yeah. And it’s person focussed. So [00:56:45] it’s tailored to the individual. And you have four clinical domains. It’s [00:56:50] really obvious I know it sounds complex but it’s so obvious. You need to examine your patient [00:56:55] and identify what’s wrong with them. So do your detection, your diagnosis, your special investigations, [00:57:00] your susceptibility assessments, all of that sort of thing. From [00:57:05] that you develop a personalised care plan, not a treatment plan. All [00:57:10] terminology. It’s incorrect. Treatment plan is just a list of things that people do. [00:57:15]

Avijit Banerjee: A personalised care plan is linked to them and it’s what you do. And then [00:57:20] why. And people forget the why. Okay. And that’s really important. So [00:57:25] if you’ve chosen not to do something why. Really, [00:57:30] really, really important. And medicine has dropped treatment planning and all this sort of old [00:57:35] terminology. They call it care planning. Why aren’t we. So it’s a personalised care plan. [00:57:40] That’s going to involve prevention and control. So prevention of [00:57:45] lesions control of disease. That’s the second domain. That’s where your behavioural psychology comes [00:57:50] in. That’s where you’ve got to motivate your patient goal setting. Yeah. Capability opportunity [00:57:55] motivation. It’s the behavioural psychology model. That’s what’s being taught difficult [00:58:00] flicking the switches. Right. And your interventions there could [00:58:05] be non-operative. So diet control remineralization [00:58:10] fluoride. Exactly. You know and and brushing oral hygiene. Yeah. Or there could be [00:58:15] micro invasive which is sealants and infiltration [00:58:20] resin infiltration things like that okay. There. You can keep people nice and healthy and [00:58:25] keep them ticking over really well. Our third domain is minimally [00:58:30] invasive dentistry. So it’s the other me. So remember we’ve got minimum intervention [00:58:35] oral care as the umbrella. And the third domain is minimally invasive. [00:58:40] So now your patients are coming with holes in their teeth. So you got to do something.

Payman Langroudi: So and then is [00:58:45] that it. Or is there a fourth.

Avijit Banerjee: There’s a fourth. And so and I’ll come back to minimally invasive [00:58:50] because that was your original question. But the fourth and arguably the most important domain is [00:58:55] the recall reassessment, which we again call a check-up. Yeah, [00:59:00] which is a terrible throw away term. Negative connotations. What [00:59:05] it is, is actually a consultation. And there’s a brilliant term I learned from our American [00:59:10] colleagues. I was on a Kerry summit for paediatric dentistry in Rome [00:59:15] a couple of years ago, and there were a lot of American paediatric dentists, really bright people [00:59:20] around the table, and they came up with a fabulous term, which I’m using all the time. It’s in the book. It’s [00:59:25] active surveillance. We were taught the term monitoring. We monitor things. [00:59:30] Monitoring, if you think about it, is a passive action. Right? Yeah. That’s not what [00:59:35] we’re doing. Active surveillance. I joke about it in lectures is you imagine FBI agents, you know, [00:59:40] black suit and dark glasses and earpieces, and they’re coming in and they’re tapping your phone. They’re checking what you’re doing. [00:59:45] Well, that’s sort of what we should be doing. So our patients, are they actually brushing properly? Are [00:59:50] they listening to the advice? Are they taking the advice? Are they modifying their diet? What are they doing? Can we get in [00:59:55] there and do that? What? The pandemic was terrible on so many levels. One [01:00:00] of the things we did learn was how to use technology to stay in touch and all the online communication. [01:00:05] Yeah. Why can’t we do some of that now to keep in touch, [01:00:10] to do this active surveillance. Why does a patient have to get in a car or get in a bus and come to [01:00:15] come to your practice? We’re talking about sustainability environmental sustainability. This all fits. [01:00:20] Yeah. So that domain suddenly becomes so so so important. Yeah. So [01:00:25] you’ve got the identify domain prevention and control minimally invasive [01:00:30] operative. And then that recall that’s minimum intervention oral care okay.

Payman Langroudi: But [01:00:35] is there another is there non minimally invasive.

Avijit Banerjee: I would argue there [01:00:40] isn’t. And I’ll explain why. Minimally invasive is a term that’s been been around for 4050 [01:00:45] years. It’s not a new term probably even longer 60 years right. Not new. And if you think [01:00:50] about general surgery now forget about dentistry for a minute. Think about just general surgery. You [01:00:55] know, in the 20, 30, 40 years ago, if you had a heart operation, you’d be in hospital [01:01:00] for a month. You’d have a massive incision, you’d have big invasive surgery. Right. And [01:01:05] all these things, now everything is done. Keyhole. Yep. That’s minimally invasive, right? Yeah. Do [01:01:10] general surgeons, orthopaedic surgeons, brain surgeons, heart surgeons, any surgeon [01:01:15] talk about minimally invasive anymore? No. The term’s gone because take all correct. [01:01:20]

Payman Langroudi: As minimally invasive as possibly can be.

Avijit Banerjee: Because you’ve got to respect biology. You’ve got to respect tissues. It’s [01:01:25] as simple as that. It’s as simple as that in dentistry. You are right. You were saying earlier that [01:01:30] often, you know, years ago we were taught, you know, dental caries is gangrene. And we got to cut it away [01:01:35] and make the cavity clean and hard and everything else. And even if you expose a little bit, well, hell doesn’t [01:01:40] matter. We’ll put Dikul on there and everything will be all right. No, it’s not, it’s not all right. All the clinical evidence [01:01:45] shows it’s not all right. And our job is to preserve tooth structure and keep the pulp [01:01:50] alive and keep the tooth vital and working. All right. And I always ask [01:01:55] again, the best clinician, we’d said the best specialist was also the best generalist. The [01:02:00] best clinician always asks why before they do anything, [01:02:05] anything, including active surveillance. Why am I doing it? Yeah, always ask [01:02:10] why. I say to my students. I say to Post-grads. I say, let everybody ask why. So [01:02:15] if you’re excavating lots, why are you doing it? If you’re excavating a little amount, why [01:02:20] are you doing it? And it becomes obvious. So think about it. You’ve got deep caries [01:02:25] in a tooth.

Avijit Banerjee: I’m getting specific now, right? Yeah. Got deep caries, occlusal caries and a lower molar. [01:02:30] You’ve got the rad. You can see it’s getting close to the pole. You know, within the inner third [01:02:35] of dentine radiographically. Okay. Patients got a few symptoms, but it’s reversible. Pulpitis [01:02:40] reversible. So you don’t want to kill the pulp. Give the pulp a chance. It’s [01:02:45] the most powerful tissue that we have in terms of regeneration. So give it a chance. [01:02:50] So in that situation you would practice minimally invasive [01:02:55] selective caries removal. You would remove the infected [01:03:00] contaminated dentine, the soft wet necrotic tissue which you could take a spoon [01:03:05] excavator to really simply. Yeah. And you’d excavate carefully down to [01:03:10] the leathery tissue which is the affected dentine. It still is probably stained. [01:03:15] And to many of us it will look carious, but actually [01:03:20] it’s a leathery. It’s not so soft anymore. Um, and it’s at the base overlying the [01:03:25] pulp. We’re allowing the dentine pulp complex now to work [01:03:30] and do its job, do its magic. And it will, it will. You’re [01:03:35] a deep cavity. So by by excavating, you’ve got a really nice volume in that cavity. Now [01:03:40] you’ve got a space.

Avijit Banerjee: Yeah. It’s important around the periphery, around the edge, [01:03:45] around the enamel dentine junction that we clear that. And we keep the enamel and dentine as clean as [01:03:50] possible. So you try to get to sound enamel and dentine if you can. Now on a [01:03:55] proximal box or something like that, it becomes difficult because it can go subgingival. So you’ve got to balance. Yeah. But [01:04:00] in principle you try to keep the periphery clean. Yeah. So periphery is clean pulpal [01:04:05] floor less important. And this is in a deep lesion. You’ve got [01:04:10] a nice big volume. You put your plastic restoration in your GRC, your composite, your amalgam, [01:04:15] whatever you wish. And we all know in dense materials our [01:04:20] plastic materials. When I say plastic, I mean malleable. I don’t mean plastic is in plastic [01:04:25] as in, as in, you know, I mean malleable or malleable. Direct materials work best [01:04:30] in bulk. They need to be in bulk, not in thin section, but in a deep cavity. You’ve [01:04:35] got bulk. So your priority in a deep cavity is keep the pulp alive. Don’t [01:04:40] go near it. Let it do its job. Assuming your clinical judgement is that the pulp [01:04:45] is still vital right now, take another scenario.

Payman Langroudi: What’s on [01:04:50] that is is there anything new that we can put on top of it to make it?

Avijit Banerjee: There are materials [01:04:55] and I can I can I come back to that. It is important. But if you take [01:05:00] the, the, the now shallower lesion that’s not so deep, maybe halfway through [01:05:05] dentine or a third of the way through dentine. It’s cavitated because that’s a key indicator. It’s cavitated [01:05:10] clinically. And you’ve decided I’m going to drill this out and put a filling in there for, for the [01:05:15] reasons you’ve decided, which you’ll have written down in your care plan. Yeah, fine. Now, [01:05:20] if you do selective caries removal and you leave this affected [01:05:25] leathery dentine and you clear the periphery, your volume of your cavity is now going to be [01:05:30] tiny. Your material is now going to be weak because it’s in thin section. When the patient bites [01:05:35] on it, it’ll break. So there you can start to be a little [01:05:40] bit more invasive and you can remove a bit more tissue, because now you need the volume [01:05:45] because your restorative material becomes important. Right. Does that make sense? Yeah. So [01:05:50] deep. It’s the pulp. Shallow. It’s the material. But periphery [01:05:55] should always be clear. The rest, you’ve got to work it out. Which is why you need to understand your histology. [01:06:00] You need to know how to use your instruments and bears and hand instruments and everything [01:06:05] else, and get isolation into all the clinical bit. And then coming to your point, the restorative material. [01:06:10] You need to know your material science. Now, when we were growing up it was easy. You learnt amalgam. [01:06:15] We learnt a bit about composite, a little bit about glass ionomer and that was it, a bit about Dicul? Yeah. All [01:06:20] right. We had about 4 or 5 materials. We had to learn nothing else. Now the poor students have got a myriad of different [01:06:25] materials, and they’re all subtly different because the manufacturers are getting cleverer and cleverer and cleverer. [01:06:30]

Avijit Banerjee: And we’ve got therapeutic materials now. Um, like what? Like, [01:06:35] for example, we’re going to mention names, but something like bio dentine, a tricalcium silicate. [01:06:40] Um, a lot of the modern glass ionomer cements are also carrying different ions. Now that [01:06:45] can be transferred into the tooth. And what these materials are doing, not only are they sealing [01:06:50] around the periphery, because that’s the key point. We want that peripheral seal. But [01:06:55] they’re also, if you like, transmitting really good ions, ions [01:07:00] right into the tooth and helping the dentine pop complex, [01:07:05] either to remineralize or to be antibacterial or whatever they’re doing. And [01:07:10] these materials have been around for quite a long time. The manufacturers are so clever. They’re tweaking them, they’re adjusting [01:07:15] them, modifying them. And it does. I’ll be honest, it winds me up when I hear clinicians [01:07:20] complaining about materials nowadays. Nowadays, because there isn’t [01:07:25] any reputable company on the planet who is producing a poor quality material. It [01:07:30] doesn’t happen because they wouldn’t survive. Yeah, they’re producing decent materials. What’s happening? [01:07:35] Remember I said right at the beginning, it’s the operator, the patient. And [01:07:40] actually in the middle the materials a little bit less important because it’s the operator not necessarily handling the material [01:07:45] properly, not giving it the best chance, you know, not linking it to the right histology, [01:07:50] you know, all these things. That’s where often the problems lie. [01:07:55] Not always, but often. So I am much more reticent when I give [01:08:00] lectures and people put their hands up saying, oh, but I’ve tried this material and I get post-op sensitivity, [01:08:05] or I get this or I get that. I always take them aside later and go [01:08:10] through with them, specifically their protocols. What exactly are they doing? I [01:08:15] mean, that’s.

Payman Langroudi: A number of dentists who read the instructions on [01:08:20] materials.

Avijit Banerjee: Count the fingers of one hand.

Payman Langroudi: It’s tiny.

Avijit Banerjee: Yeah, absolutely. Yeah, absolutely. And [01:08:25] it’s important. It’s very.

Payman Langroudi: Very difficult from our perspective on the manufacturing side.

Avijit Banerjee: Absolutely. And [01:08:30] what I try to explain to clinicians is that when you I’ve been privileged to go to research [01:08:35] labs for a lot of these companies. Right. Very privileged. And it is a privilege. And you go in and you [01:08:40] think, wow, these are these are scientists. Really high end scientists [01:08:45] are in big laboratories. They’ve got everything there. This isn’t Mickey Mouse. And, [01:08:50] you know, I remember I’m pretty sure Septuagint told me when they first brought bio dentine out in 2010. [01:08:55] Yeah, they’d spent nearly 12, €13 million [01:09:00] just developing that product. Yeah, that’s 15 years ago. [01:09:05] Yeah. And actually more because it took them five, probably ten years to develop the material. So it’s probably [01:09:10] 20 years ago, €13 million.

Payman Langroudi: Runway the runway to get a return on that.

Avijit Banerjee: Is [01:09:15] horrendous.

Payman Langroudi: It’s still not it’s still not a mass of material. No.

Avijit Banerjee: But it’s picking up now because [01:09:20] people are realising its value. And guess what? They’ve got clinical trial data and they’re starting to [01:09:25] show that it actually works. And I’m not here to to advertise one material. You [01:09:30] ask the question so I’m giving you an example. There’s also glass ionomers that, you know, in a similar vein. You [01:09:35] know, they can be really, really effective and all the other materials are effective, but [01:09:40] it goes down. It boils down to the clinician knowing about the science of the material. [01:09:45]

Payman Langroudi: It’s important.

Avijit Banerjee: It’s important. And you can’t get away from that.

Payman Langroudi: You know, for me, what stands out [01:09:50] is the dentists who do read the instructions are few and far between, as you said. Yeah, but guess what? [01:09:55]

Avijit Banerjee: The materials work in their hands.

Payman Langroudi: It’s well, it’s important because, look, we all know about etching [01:10:00] enamel and saliva not getting on there. Yeah, that seems very obvious to me. We’ve all learned that. But if [01:10:05] that was a new concept, you know, it’s critical thing. And [01:10:10] if you expect manufacturers to improve stuff, you’ve got to you’ve got to follow the instructions. And [01:10:15] it’s such a basic.

Avijit Banerjee: And it’s such a, you know.

Payman Langroudi: We weren’t taught properly in dental [01:10:20] school I wasn’t. Yeah. To thoroughly read the instructions on materials.

Avijit Banerjee: Oh no who [01:10:25] does and I agree. And plus they’re they’re in like something that looks like the Dead Sea Scrolls and. Yeah [01:10:30] because size for font and people are my age. No chance.

Payman Langroudi: The regulatory side is so ridiculous [01:10:35] as well.

Avijit Banerjee: And there you go.

Payman Langroudi: Write it in 14 different.

Avijit Banerjee: Languages and you have to put every last bit [01:10:40] of and this is the problem. So I’ve been working with some industry partners now [01:10:45] to, to dare I say produce. I don’t want to say simplify because it’s not simplified produce [01:10:50] correct step by step protocols. Yeah. You know that you could laminate you know you could you could [01:10:55] literally just have a PDF and laminate it or you have it on your screen in the, you know, if you wanted to. [01:11:00] Yeah. Because there’s no harm in that. But but I mean correct. Not just not not a, not a crib sheet but I mean [01:11:05] properly this is what you do and. I’m I’m for [01:11:10] those sorts of things. But at the same time, there’s part of me that not [01:11:15] I don’t want to say dumb it down is wrong because it’s not dumbing it down. But what I don’t want is people [01:11:20] to just rely on tables and flowcharts, because then they switch this off because [01:11:25] the other skill, if you understand the histology, you understand the chemistry and you [01:11:30] understand the clinical handling of the material. Those three things, Golden triangle, I call it in the book, [01:11:35] right. If you get that, what you can start to do is adapt. Because [01:11:40] your histology will never be optimal. You’ll be compromising, as I just mentioned, [01:11:45] proximal box base of a proximal box. How are you going to get moisture control? Do you chase [01:11:50] the caries and go three millimetres subgingival and then you can’t restore it? What do you do. So you [01:11:55] understand your histology. Now if you’ve got that situation, do you really understand the chemistry [01:12:00] behind what’s in that bonding agent? Or how you use that asset, or [01:12:05] how you use that particular resin composite or whatever material it is. Because if [01:12:10] you know the understand the chemistry, I’m not talking about learning formulae. I’m talking about understanding [01:12:15] what each component does. So by knowing that you can start to, you know, [01:12:20] bespoke.

Payman Langroudi: What you do to.

Avijit Banerjee: That. So you might extra bit longer on a particular tooth. You might, you [01:12:25] might, you might air dry something a bit. Whatever subtle changes in your clinical because [01:12:30] you’ve understood those two things and you’re allowed to do that and write it in [01:12:35] your notes. Simples.

Payman Langroudi: What about, uh, radiographic [01:12:40] signs of, you know, things that we would have gone in and drilled for? Yeah, [01:12:45] that we no longer do.

Avijit Banerjee: Yeah.

Payman Langroudi: Again, where are we at?

Avijit Banerjee: We’ve published some guideline papers. So one [01:12:50] of the other things, again, I’ve put them in the textbook and the references is that it’s not just perio [01:12:55] who has guidelines about right. Caries has guidelines. Now we’ve probably got about ten, 12 [01:13:00] different guidelines papers. They are guidelines. They’re not law. They’re not rules. They’re guidelines. [01:13:05] And one of them has been looking at when do we intervene. Yeah. When do you go in with a drill. And [01:13:10] the radiographic appearance is something people have looked at. Unfortunately in all [01:13:15] the data for the last 50, 60 years, when people have trawled through it, there [01:13:20] is no link, no clear link between the radiographic depth of a lesion and cavitation. [01:13:25] Surprisingly, now, obviously at the extremes there are so obviously if the [01:13:30] if the lesion is radiographically over a third of the way into the tooth, there [01:13:35] is increased likelihood they’ll be cavitation. And note my words I’m using increased likelihood. [01:13:40] I’m not saying it will be cavitated. There’s an increased likelihood. If it’s within enamel [01:13:45] and an edge, then it’s very unlikely to be cavitated. But I’m not saying never, [01:13:50] but unlikely in the middle. It depends. You’ve got to examine. So the problem [01:13:55] we have is radiographs have been there for ages. They’re still an incredibly important, [01:14:00] uh, detection, uh, technology that we need to use. But we need to interpret [01:14:05] them carefully. And there’s all sorts of issues, stuff that we were taught that the [01:14:10] radiographic lesion is sort of behind the real lesion in terms of the radiolucency and demon, [01:14:15] all those classic things. But now.

Payman Langroudi: Is that not the.

Avijit Banerjee: Case? No, it is, but no, but there’s other [01:14:20] things now. There’s other things. So there are some restorative materials that when you place on [01:14:25] a tooth, could potentially accentuate the radiolucency at the base of a cavity [01:14:30] underneath the rest of the restorative material. Yeah. All right. Things like this. So if you don’t know [01:14:35] the chemistry it you wouldn’t know. And therefore you’ll see a radiolucency when you take your out [01:14:40] a year later or two years later and think your secondary carriers are going to drill it. So again, when I teach [01:14:45] I make sure people understand you are not drilling the radiograph. You’re [01:14:50] using that as an example, as one bit of information to make a decision. And [01:14:55] don’t just assume because you see a radiolucency underneath the restoration that it automatically [01:15:00] means it’s pathology. It might be, but there’ll be other clues. And your job is to get the [01:15:05] clues, the.

Payman Langroudi: Significance of the cavitation. Do we not drill if there isn’t cavitation essentially. [01:15:10]

Avijit Banerjee: Basically, yeah. I mean, we’re getting these sorts of guidelines now that if a lesion [01:15:15] is not overtly, clinically cavitated, you won’t necessarily have to drill [01:15:20] into it. You could do a therapeutic sealant. There could be other things you could do, rather than picking up a [01:15:25] handpiece with a rotating bur and cutting in. All right. Now, as with all [01:15:30] these things, we’re never I’m never saying never. You can’t do that. You have to make a clinical judgement [01:15:35] of what’s in front of you. But the automatic, you know, we would I was taught if [01:15:40] there’s a radiolucency into dentine, drill it. Yeah. All right. That is incorrect. Now [01:15:45] it was right at the time. And I’m not criticising what I was taught, but it’s not right now. But [01:15:50] I did some research only five years ago, just before Covid, we looked at a study in London [01:15:55] with around 220 dentists survey about when you would intervene. [01:16:00] And we showed pictures of radiographs of depths of lesion. Yeah. And [01:16:05] we showed clinical pictures from a sound fissure pattern right the way through to a big cavity. [01:16:10] And if I remember rightly from my data, nearly 60% [01:16:15] of clinicians in 2019, in London were [01:16:20] drilling in abnormal spot lesions. White spot lesions, which is not been taught. [01:16:25]

Payman Langroudi: Ever.

Avijit Banerjee: Well, not been taught for many, many, many, many years. So [01:16:30] there is still an implementation disconnect. And that is quite remarkable [01:16:35] I think.

Payman Langroudi: Have you come across these, um, AI driven, um, x [01:16:40] ray diagnosis?

Avijit Banerjee: I’ve, I was asked several years ago to [01:16:45] get involved with some research looking into those, uh, those sort of software packages [01:16:50] and that development. I haven’t directly I am aware of them, and I [01:16:55] know several of my colleagues in Europe have done a lot of work in these areas. And I think they’re, [01:17:00] they’re, they’re developing, I think, getting the database of information, because I [01:17:05] obviously works in big data and has to learn and has to work on big, big data. So they’re getting [01:17:10] clever and clever at picking. But what is interesting, certainly at the moment, and probably [01:17:15] for the I don’t want to put a time frame on it, but for the next immediate future, [01:17:20] if you’re using that technology, I’m not saying don’t use it, but you still got to use the main [01:17:25] bit of technology that we were all given when we were born. Exactly. The stuff between [01:17:30] your ears. That’s really important because however good the AI is, it’s not [01:17:35] perfect and you still it will give you an indication, it will give you a percentage [01:17:40] risk. This is caries or not. You have to be the one who’s picking up the drill. [01:17:45]

Payman Langroudi: It comes down to it serves you. You don’t serve it. Bingo. This is.

Avijit Banerjee: Now. Maybe there’ll come [01:17:50] a day with, you know, with AI robots or whatever. You know, where.

Payman Langroudi: They sit in [01:17:55] front of the robot. Exactly. Absolutely.

Avijit Banerjee: Hopefully I’ll be long retired and long [01:18:00] gone. Um, but at the moment, that tech is there. [01:18:05] I do believe it’s interesting. It’s exciting. I have no issue with people developing it and [01:18:10] learning from it, but we need to be clever about how we use it. And exactly [01:18:15] your point. It helps us, not the other way around.

Payman Langroudi: But but what other tech? I mean, I know [01:18:20] Itero came out with something which was like a camera that they call it a near-field [01:18:25] or something. It’s almost like a scanner that you put in the mouth, but it detects. Yeah. [01:18:30] So again, what are the good stuff?

Avijit Banerjee: I’ve just got a new PhD starting that. I’m working [01:18:35] with a colleague looking at intraoral scanning and demineralisation detection. A [01:18:40] lot of the companies have realised you’ve got intraoral scanners, you know, doing [01:18:45] all this work. And it’s been primarily obviously always been used for essentially replacing impressions and [01:18:50] what have you. But there’s so much more physics you could build into it. And [01:18:55] I’ve said this for many years now. The difficulty my PhD many moons ago was looking at fluorescence [01:19:00] of caries, but using really high end laboratory confocal microscopes and [01:19:05] all sorts of fancy experimental stuff. So I do have a bit [01:19:10] of sort of knowledge of the physics, and it’s complex. And as you’re well aware now, there’s [01:19:15] lots of sort of detection devices that are based on, on light scattering and fluorescence [01:19:20] and things like this. And there’s several bunch of different companies producing cameras and, and what [01:19:25] have you. All of them can be beneficial. It goes back to what you said. If they [01:19:30] are a device that help you make a decision, but don’t make the decision [01:19:35] for you. And I think that’s the important point. If a clinician is [01:19:40] solely relying on the tech to tell them there’s caries or not, or [01:19:45] something’s wrong when there isn’t or whatever, you will make plenty of, you’ll [01:19:50] Overtreat is the bottom line. So you cannot ignore [01:19:55] the stuff between your ears and you have to use that, that detection, [01:20:00] uh, technology as an adjunct to what you’re doing. [01:20:05] And then it can be amazing.

Payman Langroudi: What about the sort of danger [01:20:10] of undertreatment? You must have fallen down that hazard [01:20:15] once in a while, right? When you’re when you’re trying to be less invasive.

Avijit Banerjee: Absolutely. We got [01:20:20] I got brilliant cases and I show them in my lectures. Do. Oh yeah. Yeah. No, no, you’ve got to see. Absolutely. [01:20:25] And there was a classic one of a patient who came in [01:20:30] and there were lesions you could see on the bike wing. And there were sort of shadows, you know, the classic little shadow, but no, [01:20:35] no obvious cavitation or anything like that. And this is quite a long time ago made a judgement call. We’re [01:20:40] not going to operatively intervene. We’re going to non-operatively intervene, like I was mentioning. So [01:20:45] oral hygiene, diet or remineralising agents, all that sort of stuff. We [01:20:50] went really carefully through all the interproximal cleaning and all this sort of stuff. Patient understood [01:20:55] and didn’t come back for reviews. They were given reviews, didn’t come back and [01:21:00] then came back a year or maybe 18 months later. And now you’ve got frank cavities. [01:21:05] Okay, now this was a while back, so I took a deep breath and thought, oh [01:21:10] gosh, now I could be in trouble here because I should, I should I [01:21:15] just drill the teeth? You know, that’s what people are going to accuse me of. The patient admitted they didn’t [01:21:20] come back, you know, and there wasn’t any. Luckily, there wasn’t a big issue, but it made [01:21:25] me think long and hard about who’s liable here. And this is a really important [01:21:30] sort of ethical dilemma and a medical legal dilemma. And as you know, I’ve been talking about [01:21:35] me and Me.ok and mid now for since the mid 90s, late 90s. [01:21:40] All right. And this case I did was actually early naughty. So it was around then. And [01:21:45] I genuinely had a few sleepless nights thinking, what’s going to happen? As I said, luckily [01:21:50] it didn’t go further.

Avijit Banerjee: But the point is, whose actual fault was [01:21:55] it that those lesions had developed? Was it my fault for not drilling the teeth [01:22:00] and putting a filling in? Because I done all the biofilm control. I done all of that really [01:22:05] carefully. And I was calling the patient back. There was evidence that we were trying to call the patient back, you know, [01:22:10] for for active surveillance, for recalls. Patient didn’t come. That’s [01:22:15] not my fault. I’m not the patient’s keeper. Clinicians don’t [01:22:20] have that level of responsibility to our patients. We can’t. That’s physically impossible. So [01:22:25] all we can do is impart the knowledge and understanding and facilitate and enable and encourage, [01:22:30] right and motivate. But we’re also going to do the right thing. And [01:22:35] there’s a in the preface in that book, I’ve said that, you know, that [01:22:40] what heals disease is not the drill and the and the filling. [01:22:45] It’s the toothbrush. That’s what cures disease. All we’re doing when we’re drilling a hole and [01:22:50] putting a filling in is we’re trying to make it easier for the patient to clean that surface of the tooth. Of [01:22:55] course, there’s structure and function and things like, yeah, I get that in aesthetics. But ultimately, from a disease point [01:23:00] of view, it’s biofilm. It’s all about the biofilm. That’s it. That’s what selective caries [01:23:05] removal is about. We’re not bothered about the bugs in the tooth. We’re bothered about the bugs in the biofilm. So [01:23:10] if we’re doing this and pushing this, the onus now becomes back on the patient [01:23:15] because they’re the ones doing biotherm control.

Payman Langroudi: I think we need to have an honest conversation around [01:23:20] the question of progress. Yeah, that there is. When you’re at the [01:23:25] tip of the spear, as you are, there’s going to be times where [01:23:30] you try things. Yeah, yeah. Now. Yeah. Okay. It would be ideal, [01:23:35] correct, for you to tell the patient I’m trying this. Let’s even say for the first time. Absolutely, [01:23:40] absolutely. But at the tip of the spear, that’s that’s where you that’s where you’re, you’re you’re [01:23:45] operating. You’re not you’re not operating in general practice. Yeah. The information comes to you 17 years later. [01:23:50] Yeah. You’re at the tip of the spear. Yeah. At that point, there’s going to be times of experimentation [01:23:55] on patients. Of course, all the time. Of course, if we want progress, of course, and progress [01:24:00] doesn’t go in a straight line, progress goes up and then 100%.

Avijit Banerjee: But it’s an interesting [01:24:05] it’s an interesting point you make because, yeah, I’m privileged in what I do because I do the research. [01:24:10] I work in a, in a, in a academic hospital where, yeah, we, I and [01:24:15] I have the links with industry. So they’re sending me all these. All right. They’re obviously see Mark they’re all legal [01:24:20] to go in the mouth. But they are they haven’t been put on the market yet and they want to try things out. And I help develop [01:24:25] them. And you try them and you obviously let patients know that you’re doing it and and you get consent to do [01:24:30] it and everything else. And actually the vast majority of patients are very keen because they like the idea of being [01:24:35] at the forefront. Yeah. All right. But I also think that role [01:24:40] should happen in primary care to a degree as well, to a degree [01:24:45] because I.

Payman Langroudi: And it is.

Avijit Banerjee: Happening. It is. And but I think I think when.

Payman Langroudi: People say in my [01:24:50] hands is this bingo.

Avijit Banerjee: Right. And it goes back to your question right at the beginning about studies. [01:24:55] You know, if you have a product and people are asking for studies, well, what I say to primary care teams [01:25:00] and I’m, I’m not saying dentists because dental therapists, dental how’s everybody when if you’re clinically working on a [01:25:05] patient and you’re doing a technique or a product or using a technology, whatever. You [01:25:10] need to write down in your notes what you’ve done, why you’ve done it, what you’ve found. [01:25:15] Just like I would like a research thing, right? And there’s ways of writing that. I’m not saying [01:25:20] you have to write a Shakespearean diatribe, but you write it and then you keep doing it, and then you build [01:25:25] up the data set for you. So when a patient then asks you, how many times have you done this, you can say, well, actually, [01:25:30] I’ve done it 50 times. And what’s your success rate? Well, actually my success rate is actually 93% because you can [01:25:35] literally get the data. Yeah, that is infinitely more powerful [01:25:40] than any publication in a journal by some random person [01:25:45] who’s, who’s worked in a, in a, in a, in an environment where it’s all the factors are controlled [01:25:50] and everything else, which is what sort of we have to do with trials. So I and I know [01:25:55] industry are very keen to have more and more of that sort of data. So I would say that that that [01:26:00] tip of the spear happens in primary care as well. You’re right.

Payman Langroudi: But but also look in the pre-trial [01:26:05] phase. Yeah. Yeah, yeah. The pre-trial phase doesn’t get talked about at all. Of course not. But the pre-trial [01:26:10] phase that someone, somewhere tried something. Absolutely and absolutely. And it was a [01:26:15] good idea. Absolutely. They took it to a company. The company. And then the company came to you for trials. Absolutely. I mean, I was talking [01:26:20] to Tiff about this and there would be no enlighten. Yeah. In today’s environment. [01:26:25] Yeah. Correct. We tried things. I tried things on myself and my family. Absolutely. [01:26:30] And then and then we tried things.

Avijit Banerjee: And but but this is, this is where [01:26:35] the problem I’ve had being in research now for nearly 30 [01:26:40] years, about 30 years. What upsets me is that we’re getting [01:26:45] more and more tied up with red tape bureaucracy and process. Now, don’t misunderstand [01:26:50] me. We need levels of red tape and process. I’m not saying we get rid of it [01:26:55] all overnight. Of course not. Yeah. However, we were just talking about Professor Nilsson [01:27:00] just a few minutes ago and what he did in the 70s. You’re talking about developing your [01:27:05] your whitening products and how you did it. Okay. You sort of did it in the background [01:27:10] quietly. I tried things out exactly right now. If you did that now and [01:27:15] the regulator worked that out, couldn’t you’d be have a legal case, wouldn’t you? That’s my point. [01:27:20] And that’s then just in the way of progress.

Payman Langroudi: To some extent there is an.

Avijit Banerjee: Argument or it just [01:27:25] makes progress that much harder. And you have to be that more evolved and, you know, have a team of people [01:27:30] and everything else. And it sometimes saddens me because when Covid hit, [01:27:35] what happened? Three laboratories or however many laboratories around the world, key laboratories [01:27:40] got their heads together, went, bam, bam, bam, let’s get these experiments done. Bam. Right, we tried it. Let’s get a [01:27:45] quick trial done, a quick dirty trial. And what was interesting, the way that was reported in the media, because the press [01:27:50] didn’t have a clue what they were reporting about, were commenting about rush, but it [01:27:55] was rushed. But it was still the processes were followed. All right. They were streamlined. Absolutely. But they [01:28:00] were followed. And I remember there was one classic one morning I was coming into work and [01:28:05] radio four was saying how one of the Covid trials had stopped because of an adverse reaction or something. Okay. [01:28:10] And I came into work and people were talking about it and I went. You have adverse reactions [01:28:15] all the time in clinical trials. All that’s happened is this is the first time in history that [01:28:20] journalists are talking about it and sticking it in a news broadcast. You just don’t know this is going on. This happens [01:28:25] all the time. It’s not big deal.

Payman Langroudi: Mhm.

Avijit Banerjee: It’s not like somebody died or something like that. [01:28:30] And even if it has, that happens when you’re doing this sort of level of, of trial. Right. And [01:28:35] I don’t mean that flippantly but it shows the stakes. Okay. But that doesn’t [01:28:40] mean the trial is and the implication was the trial has been done terribly and this is awful. And it’s not [01:28:45] that is part of normal trial process, but no one knows. And I would argue [01:28:50] why should people know it? They don’t need to. They don’t need to. I don’t [01:28:55] know how my car engine works. Yeah, right. Yeah. I don’t need to. [01:29:00] I don’t have the brain capacity to cope with that. Right. And I’m and admiration [01:29:05] and awe of people who do and I need them. And that’s my point. And [01:29:10] because we live in a world where you can just tap into so much information, but the problem is you can tap into [01:29:15] misinformation, you tap into superficial information. And what we actually need is the depth of information [01:29:20] to get the full story. And people don’t do that anymore because.

Payman Langroudi: Yeah, you can you can pull out, you can [01:29:25] pull out any bit of information that serves your yes, you can pre pre-decided of course. [01:29:30]

Avijit Banerjee: You can. Absolutely.

Payman Langroudi: I’ve got questions around fluoride right. And hydroxyapatite [01:29:35] in toothpaste. So we brought out a hydroxyapatite toothpaste in 2009 [01:29:40] okay. Having that with fluoride was a nightmare [01:29:45] a disaster because it was become fluorapatite correct. Yeah. And but [01:29:50] commercially we couldn’t put one out that was fluoride free back then [01:29:55] and try and sell that to dentists. Yeah. Today there’s a bunch of hydroxyapatite [01:30:00] toothpaste that are fluoride free, and there’s a bunch of people who want the best non [01:30:05] fluoride toothpaste that’s available. Yeah. What are your thoughts around fluoride? I’m interested in fluoridated water. [01:30:10] If you if what you think about that. And then what about hydroxyapatite as an alternative to fluoride. [01:30:15]

Avijit Banerjee: So in answering your first question about, you know, fluoride in toothpaste and water, I [01:30:20] have to admit I am in the camp that I’m in favour in terms of having when [01:30:25] you when you realise, as I said to you, 40% of the planet are suffering from dental caries. And this [01:30:30] is something that’s been tried and tested for nearly nearly 50 years in terms [01:30:35] of having fluoride in the water. It’s very, very, very, very low levels, remember, has been shown to have [01:30:40] a beneficial effect. What is interesting, we’ve had some clinical trial data out recently that [01:30:45] didn’t quite hit the news as I thought it would. There have been some reviews and trials to show [01:30:50] that water fluoridation probably now has plateaued in terms of its beneficial [01:30:55] effect. So when we were at dental school, we learned about all the studies and, you know, all the classic [01:31:00] studies of fluoride studies and everything else. Right? And we realised that fluoride and water was great [01:31:05] and it brought the caries rate down. And that was brilliant. Okay. It’s not going to bring the caries rate down [01:31:10] down down down down to zero always. It will take it to a level and basically hold [01:31:15] it there because there are other factors involved. Yeah, yeah that’s the point. And there has been some [01:31:20] data and some studies now that’s come out publicly sort of to say that that [01:31:25] doesn’t mean we shouldn’t have fluoride in the water or fluoride in toothpaste, but [01:31:30] this idea that by keeping on doing it, it’s just going to improve things and improve things and improve [01:31:35] things. I’m also not sure is right. Does that make sense? Of course. Yeah.

Payman Langroudi: In your view, is [01:31:40] the the the idea that fluoride is somehow toxic, is that.

Avijit Banerjee: Not. [01:31:45]

Payman Langroudi: Do you see that as complete bunk? Yeah.

Avijit Banerjee: Yeah. In terms of the amounts [01:31:50] that are being used and everything else. Yeah. Basically, yes. That’s my personal opinion based [01:31:55] on science and research and everything else I appreciate. There are other points of view. And I as [01:32:00] I said, I’m not. I don’t I’m not going to get drawn into who’s right or wrong. That’s your [01:32:05] that’s my position. You talk about hydroxyapatite and other mineralising agents. [01:32:10] I think that’s a really important point. And again, when I, when I teach about fluoride and [01:32:15] remineralization and everything else, I always like simplifying things. I have a very simple mind, [01:32:20] a very simple brain, and I like having really simple analogies in my students. And people will know that. [01:32:25] And the analogy I always use, if you’re building a brick wall, you need bricks [01:32:30] and you need mortar, right? And if you think the bricks are your mineral [01:32:35] hydroxyapatite or calcium phosphate or other, you know, [01:32:40] ions, the fluoride, if you like, is the mortar. So [01:32:45] you can’t just have fluoride on its own because that’s actually not going to happen. It’ll have some beneficial effects, but not [01:32:50] necessarily a reaming effect. It might strengthen some of the mineral because like you said, the fluoride incorporates [01:32:55] into crystals, but it won’t remineralize because you need the [01:33:00] mineral crystals. You need the ions. Right. So if you think of it bricks and mortar, it [01:33:05] makes a bit of sense. And then it gets even better. The analogy, because if you watch a bricklayer, if you look at a house, [01:33:10] bricks are placed in an interlaced pattern, aren’t they? Right. [01:33:15]

Avijit Banerjee: They’re not stacked in columns. Yeah. And there’s a reason for that. Because if you actually built a wall [01:33:20] where the bricks are all on top of each other, stacked in columns, that wall would be inherently weak because its [01:33:25] structure has changed. Yeah. Whereas if you interlace them, you actually get an interlocking structure. [01:33:30] So it actually builds some intrinsic strength with the same number of bricks. So you haven’t increased [01:33:35] the amount of mineral. Yeah. And it’s exactly the same in teeth. So that’s where your hydroxyapatite [01:33:40] and different crystals of octacalcium phosphate [01:33:45] whitlockite and a whole bunch of different crystals can form with different configurations. [01:33:50] And that way that they stack and the way they’re organised will also have an effect. So the whole [01:33:55] issue about Remineralization is a really interesting one. It’s a complex, [01:34:00] complex science, really complex, and people misunderstand [01:34:05] what it means. Enamel clearly cannot remineralize because remineralization is a biological [01:34:10] reaction. You need cells to cause remineralization [01:34:15] enamel can you can have mineral deposition, you can crystallise. [01:34:20] Absolutely. You can precipitate, you can do all those things. But I’m a [01:34:25] bit of a pedant when it comes to terminology. And remineralization to me is something biological. [01:34:30] Okay. So dentine can remineralize because you’ve got you’ve got the odontoblasts [01:34:35] and you’ve got the pulp. They’re working hard. All right. So organic.

Payman Langroudi: Element.

Avijit Banerjee: Yeah exactly. So [01:34:40] there’s a difference subtle difference between ream in remineralization and mineral deposition. [01:34:45] And a lot of our, uh, remineralizing agents that we [01:34:50] have are really topical agents that you put on the tooth, and you’ll get [01:34:55] mineral crystal deposition on the surface. They often don’t penetrate into the porosities [01:35:00] or go further, deeper into the, into the enamel or dentine. And that can have consequences [01:35:05] in itself, which is why they get worn off quicker and all this sort of thing. Again, I’ve had [01:35:10] PhD students and postdocs and people looking at different ways [01:35:15] of trying to get the mineral into a tooth and the difficulty with the toothpaste. [01:35:20] Clearly it’s only on the teeth for, well, for most people, a few seconds. Sure. [01:35:25] And that’s the difficulty is not there long enough for it to have any effect. [01:35:30] But you made a really valid point in a commercial world ten, [01:35:35] even ten years ago, it was nearly impossible to sell a fluoride non fluoride [01:35:40] toothpaste because people go.

Payman Langroudi: Especially to dentists. I’m absolutely convinced.

Avijit Banerjee: Now [01:35:45] there’s the options I. Yeah, and you can. And again, the problem with social media is you get [01:35:50] influencers and people saying use this, use that without any scientific [01:35:55] basis, just because they’re probably getting the product free or getting a, you know, a freebie from [01:36:00] it. And people listen and they watch this. And then the difficulty then becomes when [01:36:05] they start getting disease. You know.

Payman Langroudi: I think in some markets [01:36:10] in Japan, 25% of the population are not using fluoride toothpaste. And in Russia, [01:36:15] 25% of the population not using 30% of population not using fluoride toothpaste. [01:36:20] What’s the.

Avijit Banerjee: Caries? Right.

Payman Langroudi: I don’t know, I’m not aware, but but both both those countries have got real fluoride [01:36:25] issues.

Avijit Banerjee: But you’ve got to.

Payman Langroudi: Remember the public. The public. Yeah. You [01:36:30] know, I don’t know what the case is in Japan, but a Russian guy explained it to me. He said, look, when you’ve been lied [01:36:35] to a lot by your government, you start to question everything. Absolutely. And so the public’s questioning [01:36:40] fluoride now.

Avijit Banerjee: And that’s and that’s a flavour.

Payman Langroudi: Of the month.

Avijit Banerjee: And that’s a totally legitimate argument. This is [01:36:45] this is what I said at the beginning. Remember I said there’s so many layers to the complexity of caries and things [01:36:50] like this. This is exactly it. It’s one of it’s things like this that we don’t even well, I say we don’t even think [01:36:55] about. Maybe we start doing and but with social media just straight in [01:37:00] our faces continuously and and it is let’s be honest, it’s that, [01:37:05] that that’s created the fact that people can just see things immediately. As you well [01:37:10] know, things can be doctored and what have you. And it could be like like your colleague friend said, [01:37:15] that, you know, if you’ve been in a, in a, in a regime where you’re just being lied to continuously, [01:37:20] what do you believe anymore? Yeah, absolutely, absolutely. And I have huge sympathy. [01:37:25] I nothing else I can say really. I know dental schools in Russia [01:37:30] are being taught this sort of stuff and everything else. They’re not backward or anything like that at all. [01:37:35] But he was talking.

Payman Langroudi: About the public.

Avijit Banerjee: Yeah, absolutely.

Payman Langroudi: Tell me about fissure Sealants, because I remember [01:37:40] when when we were growing up, it was the flavour of the month. Yeah. And then they kind of got a [01:37:45] bad, bad press after that carries on. Yeah. Yeah. Where are we now.

Avijit Banerjee: Right again. This [01:37:50] again links back to my paper paying for prevention because what we’ve done now is mapped. [01:37:55] Actually the fact that NHS dentists with the Udas can claim for sealants because [01:38:00] this is important, because it’s a really important part of prevention. So if you remember I mentioned microinvasive, I said [01:38:05] non-invasive microinvasive and then minimally invasive. Right. So microinvasive are sealants and [01:38:10] infiltration. So sealants essentially there are three types [01:38:15] of sealant. You’ve got your therapeutic sealant, you’ve got. Well, let’s start from [01:38:20] the beginning. Sorry. You’ve got a preventive sealant first. Right. So that’s patient who’s not got caries [01:38:25] in the tooth, but the mouth is a bit high risk. So the classic erupting six. All right. In a [01:38:30] in a in a kiddies mouth where they’re having a bit of chocolate and things like that. So the mouth is at risk. [01:38:35] But the tooth at the moment hasn’t got caries. Yeah. So there you might well seal that [01:38:40] to prevent the early lesion from starting. So it’s a preventive sealant [01:38:45] right. Then you’ve got a therapeutic sealant. So this is when I was saying to you non cavitated [01:38:50] but a lesion into edge. Yep. Um there [01:38:55] you can seal that in. Essentially you’ll use your accents and [01:39:00] things like this and do your procedures properly. And you do it so you’ve got some disease and [01:39:05] you’re sealing it in and you’re using, if you like, the microscopic aspect of your sealant to embed [01:39:10] in, are you.

Payman Langroudi: Doing anything different than etch and seal?

Avijit Banerjee: You may you may [01:39:15] condition the surface with some air abrasion or something like that. If you want, you could, but you’re not drilling [01:39:20] out a cavity in that sense. Absolutely not. Yeah. And then and if you think about it, this is all just going along [01:39:25] a spectrum. So beyond that now you’ve got a tooth where you might think one pit. [01:39:30] Oh a bit suspicious, a bit deeper, the rest. Okay. It’s what we used [01:39:35] to call a preventive resin restoration.

Payman Langroudi: Yeah right.

Avijit Banerjee: A tiny little excavation, little drop [01:39:40] in, restore that and seal the rest. Yeah, yeah. And that’s now a sealant restoration. [01:39:45] Okay. And this is really important because the way you can claim, [01:39:50] if you’ve written in the notes and you’ve explained why he goes back to the care plan, not treatment plan. Yeah. [01:39:55] If you’ve written why and how you’re doing it, this is best clinical practice. And if you [01:40:00] put the claim in for that for your UDA, you will get it. And we are now going around the country [01:40:05] training local clinical advisors to understand that a sealant isn’t just a, you [01:40:10] know, somebody just poured some flowable resin composite onto a tooth and like cured it. And in fact, that [01:40:15] was the problem. You you made the comment. They got a bad rap for a period. Yeah. I remember lecturing [01:40:20] at a Denplan conference many, many, many years ago. And Richard Simonsson, who’s retired [01:40:25] now, uh, is American, uh, dentist. I met him when he was in Kuwait. [01:40:30] Really lovely guy, but he was on the team on the panel that developed fissure sealant. Well, [01:40:35] and he was talking in front of 300 basically specialist dentists in this audience. [01:40:40] And he said to them, I use an endodontic microscope to place sealants. [01:40:45] And that was the reaction. And there was a gasp. And I turn around. [01:40:50] I was in the audience said to people, yeah, but remember, this is a guy who invented him. So think about it. And the argument [01:40:55] is, and I talk about this a lot, and I show my own cases where I’ve done [01:41:00] a fissure sealant and it all looks fabulous and everything is great. And I asked people to it’s on the screen and I asked people to judge [01:41:05] it. Tell me what you think. Everybody thinks it’s okay. I said, no, it’s awful because people do them inherently incorrectly, [01:41:10] because people overfill the cavity, they overfill the fissures. If you do a fissure sealant correctly, [01:41:15] you should barely see it because it should be literally filling the fissure, not [01:41:20] flooding the occlusal surface so that.

Payman Langroudi: The occlusion doesn’t mess with it.

Avijit Banerjee: Correct. And again, [01:41:25] how many clinicians check the occlusion before they place the fissure sealants?

Payman Langroudi: Hardly [01:41:30] anybody. It’s important.

Avijit Banerjee: Right. How many check afterwards. Hardly anybody. You need to check [01:41:35] before and after because that’s where it goes wrong. Because you overfill. Right. [01:41:40] They go away. The patient goes away. Bite together, chips a bit off. Guess what? You get leakage, [01:41:45] they come back or they don’t come back. Which is the other problem because they do need to come back for your active surveillance. [01:41:50] My fourth domain of minimum intervention oral care. They’ve got to come back. This idea that you just [01:41:55] send them on their way, never see them again. Nonsense. They’ve got to come back. They’ve got to value [01:42:00] what’s been done. They’ve got to show they’re using their toothbrush properly and everything else. Otherwise they won’t work. And if they [01:42:05] have bitten on it, it’s chipped. You could catch it and repair it or you don’t. And then you get caries under [01:42:10] it. And everybody says the fissure. And it’s terrible.

Payman Langroudi: I mean, as a general point, checking the occlusion before [01:42:15] doing anything is.

Avijit Banerjee: Vital, is.

Payman Langroudi: Vital. Absolutely. It’s such a it’s such an obvious hack. [01:42:20]

Avijit Banerjee: There’s no one.

Payman Langroudi: Hardly anybody does filling.

Avijit Banerjee: Hardly anybody does it. Check the occlusion.

Payman Langroudi: Correct. We do composite. Correct the [01:42:25] occlusion.

Avijit Banerjee: It’s absolutely so.

Payman Langroudi: Useful to do.

Avijit Banerjee: Absolutely. It’s a must really. It’s what’s taught. It’s [01:42:30] in the book. But again does everybody do it. Does everybody use moisture control properly. Probably not. And [01:42:35] I know it can be clinically very difficult. But if you can’t get good moisture control i.e. [01:42:40] rubber dam then think about using a GIC, a glass ionomer based sealant. They [01:42:45] exist and they can work very, very well. So my point is it goes back to my golden triangle understanding [01:42:50] histology, the handling and the chemistry I think almost.

Payman Langroudi: I remember when I was a dentist, there [01:42:55] were there was one type of sealant that was kind of filled and you could see it, and there was one that was [01:43:00] sort of completely invisible. You want to be able to see it? Absolutely.

Avijit Banerjee: And if you look at if you [01:43:05] look at some of the GRC based ones, they are they’re orange in colour. Is that right? Right. And [01:43:10] there there is obviously meant more for children and difficult, you know, clinical management [01:43:15] and moisture control. But yeah, I mean the point and that’s my argument for a sealant, [01:43:20] if you’re placing it properly it will be the thinnest line on the occlusal surface. So actually you do [01:43:25] want it to be a bit of a different colour. Yeah. To know it’s been done. Otherwise you’ll just never know. Yeah. Yeah. And it’s [01:43:30] got to be in the notes because if you know and we should in a perfect world have notes that [01:43:35] go with the patient. So if the patient moves and goes to another practice, the practice should get the notes and see, oh [01:43:40] a sealant was done. Otherwise they might think, oh it’s a white line in the Fisher pattern. Oh gosh. Is that is that demineralisation. [01:43:45] You know, and this is my point. So it’s really important that you [01:43:50] are loops. You are magnification. So you can see things properly with good headlights. All these [01:43:55] things are part of modern contemporary operative dentistry. Things that when we were growing [01:44:00] up were fancy. You think, oh my gosh, who would use those? It should be automatic now. [01:44:05] It should be absolutely automatic. Like you wearing gloves, you should wear loops.

Payman Langroudi: Let’s [01:44:10] move on to darker. Questions.

Avijit Banerjee: Okay, now I’m getting worried.

Payman Langroudi: Well, [01:44:15] this what we like to talk about errors. Mistakes sort [01:44:20] of in that. Do you know about black box thinking? Let’s do it in that black box thinking [01:44:25] way of trying to learn from each other’s mistakes and trying to not [01:44:30] sort of run away from our errors, trying to say, look, this was the mistake I made and this is [01:44:35] what I learned from it. What comes to mind when I so.

Avijit Banerjee: From a from a clinical [01:44:40] perspective, I think the case I mentioned earlier with, with the caries was a genuinely interesting [01:44:45] one, because that was a pretty heart stopping when that patient came back, because I suddenly thought. [01:44:50] I’m in trouble here. Um, but it did made me realise that, actually, [01:44:55] you’ve got to have some faith in the decision making you have. Luckily, [01:45:00] my notes were good. And they were very contemporaneous and explained why I didn’t go [01:45:05] in. And that goes back to this care planning bit. So in the end, I learned those sorts [01:45:10] of aspects. I do periodontology in private practice now. Okay. On the on the [01:45:15] sessions I do once a month. And um, in those I’ve had cases where [01:45:20] you do and I and I’m not I, I’m happy and proud to admit [01:45:25] I’m a good dental hygienist. I’m not trying to make out that I’m some [01:45:30] amazing periodontist that does microsurgery and all this stuff. I do perio [01:45:35] for the masses.

Payman Langroudi: Non-surgical.

Avijit Banerjee: Non-surgical, you know, pmpr, super [01:45:40] sub, you know, SPT, all this sort of stuff, all the stuff that the perio guidelines say. Okay, I [01:45:45] used to do some flap surgery in the good old days. I haven’t done it for too long. I wouldn’t claim to be able [01:45:50] to. However, 95% of perio in [01:45:55] real life primary care is that it’s probably only 5% that needs the fancy stuff, of [01:46:00] course, so I do it. So I’m very proud to say I think I’m a decent dental hygienist. It [01:46:05] helps having professor in front of your name that people listen, and that’s very important because it’s about [01:46:10] the listening, isn’t it? It’s the motivation. And in one case that does come to mind, not so much the [01:46:15] operative bit, but it was the patient handling bit. And I got it all wrong. You [01:46:20] know me, I’m known for my personality being a little bit of a bit of a [01:46:25] bit effervescent, a bit in-your-face. Yeah. You know, say it as type of thing. [01:46:30] And and I’m like that with everybody. At least you know I’m not I’m not two faced in that respect. I’m helping [01:46:35] others but not in that respect. And so, you know, it is what you see is what you get. And that’s my nature with people [01:46:40] and. Such words.

Avijit Banerjee: It’s been great for pretty much [01:46:45] everybody, but there was one person where it didn’t work and and obviously at [01:46:50] that level is all about behavioural change and getting the brush properly and the technique and everything else. [01:46:55] And the did my operative work in the pmpr and [01:47:00] then went through all the oral hygiene really carefully with them. They came back a month later and nothing had improved. [01:47:05] And I was talking to them, and their perception of what I was saying was that [01:47:10] I was basically scolding them and being aggressive and whatever. When I was trying to [01:47:15] explain that things haven’t changed and we need to modify again. And the patient felt they can’t do [01:47:20] any more and they didn’t like that, so they put a complaint in. So that had to then be [01:47:25] diffused. And it’s a matter of then sitting down and looking at how you come across how you’re [01:47:30] perceived. And so I suppose for me, a lot, a lot of the errors, uh, are [01:47:35] based on those sorts of things. I’m lucky again, [01:47:40] enough at Guy’s Guy’s Hospital, specifically where I work, I look after [01:47:45] the aural rehabilitation of oral cancer patients. So that’s the other thing I do. And again, that [01:47:50] is an incredible privilege to look after these patients. They’re incredibly complex, as you [01:47:55] can imagine, you know, and over the 25 years I’ve been doing it, I’ve seen you’ve [01:48:00] moved away from doing the big obturators, you know, to now, because the surgeons [01:48:05] are so clever and with the radiotherapy that they actually conserve tissue, they’re more minimally [01:48:10] invasive.

Avijit Banerjee: And they, they, they take flaps from different parts of the body and reconstruct [01:48:15] incredibly well and put implants in. So now a lot of my work is implant retained [01:48:20] dentures and bridges and things like this. But in patients who can only open maybe ten millimetres [01:48:25] or things like that. Yeah. And the patients come to me and we sit down [01:48:30] and I’m incredibly honest with them and just say, do you know what I’m learning? Yeah, [01:48:35] I’m a professor, but there’s no textbook about treating you. There’s [01:48:40] no protocol. So I’m going to go back to basics and do each stage as well as I can. [01:48:45] We’ll probably take two steps forward, one step back, two steps forward, one step back. [01:48:50] And you’re going to come with me on this journey. First. When I was younger. I didn’t [01:48:55] explain it like that. Patients used to get very upset. These were complex cases. I mean, you’re talking [01:49:00] 30 visits. Yeah. To treat a patient. And I don’t mean wasted visits. [01:49:05] I mean really intense.

Payman Langroudi: I worked on one of those clinics.

Avijit Banerjee: So, you see, you know what I’m talking about.

Payman Langroudi: Every case is completely, [01:49:10] absolutely.

Avijit Banerjee: And you really have to think outside the box. And when you’re a junior, that’s tough. Yeah, that’s [01:49:15] really, really tough. And I’ve had cases where, um, I was treating [01:49:20] a patient, they had some incredible mechano inside their mouth. The implant guys had gone [01:49:25] to town. Incredible amounts of mechano and cross-bracing and zygomatic [01:49:30] implants and all sorts. And I was trying to and it was for an obturator, and I was trying to take an impression and [01:49:35] it got jammed. Oh, and I was there for like three hours with the consultant [01:49:40] and the poor patient, you know.

Payman Langroudi: Kind of like emperor gum stuff.

Avijit Banerjee: Basically. [01:49:45] Yes. And it just got locked in and it was horrific. It was horrific. I was practically in tears. [01:49:50] I’m not denying it because you just don’t know what to do.

Payman Langroudi: How was the patient?

Avijit Banerjee: Patient was [01:49:55] actually surprisingly calm because they could see it wasn’t negligence. It wasn’t stupidity. [01:50:00] You know, it was something that happens. And I think it potentially had happened before as well. [01:50:05] They were being very stoical about it. So things like that can happen. And and I [01:50:10] know that’s not quite what you’re getting at but, but I think you also and when [01:50:15] I learned I was in that position and that that role has been reversed when I’m the consultant and a junior staff, that’s [01:50:20] happening to what.

Payman Langroudi: Happened with the perio case. So he put in a complaint.

Avijit Banerjee: Yeah. And what happened? And you know what? I had [01:50:25] a really good principal at the practice because this is in private practice who sat down with the patient, talked [01:50:30] to the patient first and then called me in and we had a chat, a three way chat and, and basically [01:50:35] dealt with it and did not let it brew. That’s okay. No, no. In the end, fortunately [01:50:40] she got a.

Payman Langroudi: Worse situation than that.

Avijit Banerjee: One. Do you know what? I [01:50:45] don’t want to tempt fate because if I say I haven’t, then something’s going to happen now, isn’t it? But I suppose [01:50:50] I don’t.

Payman Langroudi: You’re not. You’re not practising. No, I’m.

Avijit Banerjee: Not, because I do such a different. My [01:50:55] job is is so different. I’m not seeing patients every day, doing clinics every day. If [01:51:00] I was, I’d have plenty more.

Payman Langroudi: Any errors with other students? Teaching, kicking [01:51:05] someone out, not kicking someone out. Something like this, anything like that.

Avijit Banerjee: Well, [01:51:10] you just want to really dig up dirt now. Gosh, students make errors. They’ll make clinical errors that you have [01:51:15] to deal with. But I’d like to. I lost my rag a few times. I’m not going to deny it. You know, in [01:51:20] my not not with patients. Yes. Not with patients.

Payman Langroudi: I came across some of your students actually, and [01:51:25] they were saying, yeah, Prof. Banerjee is really strict. Yeah. I was saying having such a soft he’s not [01:51:30] strict at all. But all of them. Yeah. No, it’s a reputation.

Avijit Banerjee: It’s a reputation.

Payman Langroudi: So you’re [01:51:35] a strict guy.

Avijit Banerjee: As a teacher I am, but it is. And in front of patients can’t see you being strict. [01:51:40] No. Because. Do you know why? There’s a very simple reason. It’s upbringing. [01:51:45] It was the upbringing I had. And I don’t, you know, from my own parents. And it was the upbringing [01:51:50] I had from my own professors and consultants when I was a student. I’m not saying it’s right or wrong, [01:51:55] but that’s how it’s coloured what I do.

Payman Langroudi: You know, we always start this pod with, where were you born? [01:52:00]

Avijit Banerjee: I was actually born in, I was born in Kuala Lumpur in Malaysia, but came to the UK when I was a baby. [01:52:05] Really? Um, but of my upbringing was quite strict, very loving, very, [01:52:10] you know, no problem. But it was strict. So yes, I am a bit. And I am with my children. I am with everybody. [01:52:15] Are you? Unfortunately, yeah. You can ask my kids. If they were here, they’d be nodding away like fury. So [01:52:20] yeah, the students know that. And in front of patients I will be very particular with them. Obviously [01:52:25] not rude, not anything bad or nasty, but you can see [01:52:30] them starting to bristle and starting to panic because, you know, they get themselves tongue [01:52:35] tied. And then I because my argument is, you know the answer. I’m not asking [01:52:40] something you don’t know. I know you know the answer. And I’m going to get it out of you. And we’re going to do it nicely because [01:52:45] there’s a patient there and everything else, and we get it. We have a three way discussion and it ultimately works. [01:52:50] They come out with it and suddenly the penny drops and everything’s cool.

Avijit Banerjee: If we’re in a seminar [01:52:55] or a, you know, non clinical situation. Oh yeah. Then you know [01:53:00] I’m tough on it because I want them to learn. You know that’s my point. And and [01:53:05] not being funny I remember who I was taught by when I was at guy’s when I was in their shoes. And you didn’t [01:53:10] at the time realise the great and the good who were teaching you. And I’m not suggesting I’m at that level [01:53:15] at all. But I always joke to them, you know, you’re [01:53:20] not taking full advantage. I’m right in front of you. When you graduate, you’ll be paying cold, hard [01:53:25] cash to go to lectures of mine, and I’ll be saying the same thing. So you’ve got me. You’ve got you’ve [01:53:30] got me here right now, you know, use me, you know. Good point and tap, you know, [01:53:35] provoke me, get me interested, get me thinking, and you’ll get even more out of it. Because [01:53:40] I don’t believe there’s teaching to a level I don’t teach to BDS or to Masters or to this [01:53:45] I teach.

Payman Langroudi: So when someone’s doing a specialising [01:53:50] in fixed cross. What happens. You start all over again from the beginning. [01:53:55] Is that how the course works?

Avijit Banerjee: No. Not necessarily. The candidates come in. [01:54:00] Obviously they need to have a base level of knowledge, which is why I made the comment about being doing some general practice [01:54:05] and things is quite important. Um, so they’ve got to come in with base levels of knowledge. Absolutely. [01:54:10] And there is assumed knowledge and they are actually tested. So they do sort of clinical skills tests [01:54:15] on, on, on, you know, phantom head, as we used to call it, just to make sure basic operative skills [01:54:20] are there obviously for obvious reasons. And then because the level of supervision isn’t necessarily [01:54:25] going to be the same as an undergrad, and then it develops in terms of care planning and case [01:54:30] scenarios and everything else. And the specialist trainees I have are usually on my [01:54:35] outpatient new patient clinic. So it’s more for care planning. Mhm. Because [01:54:40] we get a range everything from oral cancer through to tooth wear through to you name it. [01:54:45] Basically what’s referred in and what they’ve got to do is not just [01:54:50] assume because they can see a space for missing tooth or what size implant can I get [01:54:55] in there? But think about everything and plan it properly. And is that the right answer? And [01:55:00] that’s what I’m trying to teach them. They have obviously huge other clinics and and [01:55:05] treatment sessions and things to learn hone their operative skills. I my [01:55:10] role is more the that general care planning aspect.

Payman Langroudi: And [01:55:15] how much training are the hospitals under as far as the number of referrals coming [01:55:20] in and you know capacity to take them?

Avijit Banerjee: The pre-COVID, there was a huge strain. [01:55:25] Covid came along, changed a lot of things in terms of what’s being referred, how they’re being referred and [01:55:30] everything else. I am not 100% okay with all the data [01:55:35] guys, so I can’t give you absolute numbers, but I was aware, I think now the numbers are starting [01:55:40] to come back to pre-COVID levels of referrals. Different things are coming in, different types [01:55:45] of patients are coming in. We’re getting patients with a huge amount more disease clearly [01:55:50] than ever before because people can’t find a dentist outside, for example. You know, [01:55:55] there have been issues, as you’ve been hearing on the news about oral cancer diagnosis and things like this. [01:56:00] So those clinics are pretty full. But again, I’m guesstimating here, so [01:56:05] I don’t know. I don’t want to give figures because I don’t know them and I don’t want to mislead, but I know [01:56:10] the management team from the trust side are working overtime to try to to [01:56:15] maximise patient throughput and the efficiency.

Payman Langroudi: We’re coming to the end of our time. There’s one other [01:56:20] burning question I’ve got. Yeah. Is that when was the last time when you saw something, [01:56:25] a bit of research, a piece of equipment, something that made you think, wow, like [01:56:30] a like a, like a moment of that’s that’s something that’s going to change the world.

Avijit Banerjee: So [01:56:35] I was again, this is now 2017 or 2018. [01:56:40] And I was invited to an oral health council run by 3 a.m., [01:56:45] as it was then known as solvent Am now Oral care. But it was 3 a.m. then, and I was one of their [01:56:50] sort of key opinion leaders. They invited about a dozen of us from around the planet to the States, [01:56:55] and they were asking our opinions about all sorts of things, and [01:57:00] they asked us to produce two PowerPoint slides, one about [01:57:05] what the current trends are in dentistry and the big things. Just one PowerPoint slide [01:57:10] and then another one for what’s going to happen in ten years time. And this was 20 1718. [01:57:15] Yeah. And in my ten years time, one, I was wanting and predicting [01:57:20] that we just like we have, as I mentioned, the smartwatches that are taking your heart rate [01:57:25] and all your bodily functions and everything. Why couldn’t we have something for the mouth? So [01:57:30] why can’t we have an Intraoral sensor that then goes to your watch or your app on your phone [01:57:35] that’s telling you the pH, the bacterial balance, the flow rate, all this sort of stuff because [01:57:40] then it enhances awareness.

Avijit Banerjee: I’m not saying it will totally change dentistry, [01:57:45] but it enhances awareness. And remember, we’ve just been talking about getting the message out to the public. Yeah, just [01:57:50] like you do your steps, you know, and all this sort of stuff. So I mentioned this at the beginning [01:57:55] and the, the chief of the of three oral care at the time was [01:58:00] asking me questions specifically at the end of the three day meeting, two and a half day meeting, [01:58:05] they then presented what they were doing, and there was talk about they already had the prototype [01:58:10] for an Intraoral sensor. And I thought something that you can literally bond on with some adhesive bonding [01:58:15] agent onto the lingual surface of the molar or something and would give you these readouts. And [01:58:20] I was thinking, wow, because it goes back to all the things we’ve covered behaviour [01:58:25] change, motivation. You know that that the longitudinal analysis of what’s [01:58:30] going on and that is ultimately what prevention will be, in my opinion. And [01:58:35] that’s where I think we need to move forward to.

Payman Langroudi: Amazing. It’s such a pleasure to have you. [01:58:40] Are you going to be at the dentistry show?

Avijit Banerjee: Unfortunately not. Not. Unfortunately not.

Payman Langroudi: No [01:58:45] shame. I was going to. We’re having a bit of a do on our stand and no.

Avijit Banerjee: I know I [01:58:50] this time, this one I’m not. But.

Payman Langroudi: Q2 listeners 4:00 4:00, and our stand [01:58:55] on on both days. Okay. Good drinks. Um, our final question is always the same. Okay. [01:59:00] Fantasy dinner party. Right? Three guests, dead [01:59:05] or alive. Who would you like?

Avijit Banerjee: Wow. Okay, now, I could try to be all cerebral and [01:59:10] pick three philosophers from, you know, so well, you know, but I’m not, um, [01:59:15] I am, uh, Liverpool Football Club follower and have been since [01:59:20] probably 1977. I say follower. I haven’t gone to a huge number of games, but followed [01:59:25] them religiously. And so to be honest with you, my hero at the moment is is [01:59:30] JK Jurgen Klopp. Klopp of course as a motivational inspirational [01:59:35] person, how what he’s done, I mean we need him in public sector. [01:59:40]

Payman Langroudi: The study were two best friends of Liverpool fans and they said no. They said this exact [01:59:45] same thing. Klopp should be the Prime Minister.

Avijit Banerjee: But I’m joking aside, we’ve we’ve you know, in [01:59:50] public health, in public sector, not just in healthcare but policing, education. You need people like [01:59:55] him to motivate and get get everything running again. You know. And I think he’d be quite an interesting character [02:00:00] I think. So that’s one person. So that’s that one. Then I was thinking [02:00:05] again, I could try be clever, but I’m not going to be. I was going to say Steven Spielberg, [02:00:10] because the stories he could tell about all the people he’s worked with over the [02:00:15] years in Hollywood and how he’s developed his movies and all that sort of stuff. Again, [02:00:20] there’s science behind it. There’s all the social aspect. I think it’d be quite [02:00:25] an interesting talk, an interesting conversation could be had there, you know, and he’s hopefully spill the beans [02:00:30] with enough, enough alcohol and then going scientific I thought I have to go somebody [02:00:35] scientific. Um, I would probably go with I know he’s obviously [02:00:40] not here now, but you said dead or alive would be, uh, Stephen Hawking. Oh, Professor Hawking, because, [02:00:45] again, just to be able to talk to him about his life [02:00:50] and how I know we’ve all watched the Hollywood movie and everything else, but that’s just a, [02:00:55] you know, narrative. Yeah, exactly. It’s a narrative. And I, you know, the [02:01:00] guy literally had a brain the size of a planet or a black hole, all right. And it would be just incredible [02:01:05] to tap into that. And having read several of his books that he wrote for the lay public, he [02:01:10] had the skill and I know he had helped writing it, but he had the skill to translate such [02:01:15] complex science. Yeah, no one can understand, let’s be honest, unless you’re everyone. [02:01:20]

Payman Langroudi: Was reading those.

Avijit Banerjee: Books and people could lay people could understand. And again, to me, it goes back [02:01:25] to what we said at the beginning. You know, if you’re going to do research, you’re going to push the boundaries. It’s all well [02:01:30] and good doing all of that. But you’ve got to be able to translate it to the real person in the street. And whether that’s [02:01:35] clinical, whether that’s explanation and understanding. And I think [02:01:40] it is interesting in the world we live in now, when you watch TV programs and these books, there’s more and more, [02:01:45] you know, the Brighton professor, Brian Cox’s of this world, that type of thing, who are translating what [02:01:50] is incredible science into something that’s understandable and tangible. [02:01:55] Yeah, yeah. But I think Stephen Hawking was the grand master in [02:02:00] the modern era, obviously.

Payman Langroudi: In the in the same vein, who, who, who would you say in your field? I mean, [02:02:05] who were your who who are exceptional brains and. That [02:02:10] you’ve come across what comes to mind?

Avijit Banerjee: Living then currently you mean [02:02:15] alive or just generally?

Payman Langroudi: You’ve come across so many.

Avijit Banerjee: I know, and. But I’m going to be. Yeah. [02:02:20] I’m going to give you the standard answer here. And it’s going to be the gurus I grew up with because they were the ones who [02:02:25] affected me the most. And that’s your question, isn’t it? Yeah, obviously there are people I’m working with now who are absolutely [02:02:30] amazing. Yeah. And what they will do will have a huge impact. But it’s in [02:02:35] the future. Yeah. Yeah. Yeah. Right. Right. You know, I look there was a wonderful article [02:02:40] in just the last BJ on on Bernard Smith. Yeah PG and Smith. Right guys [02:02:45] who’s a professor of restorative at Guy’s prosthodontics. And again absolute.

Payman Langroudi: Legend. Did [02:02:50] he write the first version.

Avijit Banerjee: He did absolutely. He wrote the first few versions of Picard’s. Absolutely. [02:02:55] And he was one of my teachers and became a friend, you know, again, dare [02:03:00] I say Professor Edwina kid is. And again, who’s who’s not. I wouldn’t say shoes, I thought, because that would [02:03:05] be very arrogant. Not at all. But again, who instilled a lot of [02:03:10] who I am professionally in terms of the investigation being really precise [02:03:15] and intricate with everything. So there are lots of people like that. [02:03:20] And I picked out two. And that’s a bit unfair because there are there are plenty of others and [02:03:25] they did make me who I am. There’s no debate about it in [02:03:30] the modern day. We’ve talked about Professor Shannon Wilson again as a mentor [02:03:35] later on in my life, and the advice and the career he’s had that is somebody, [02:03:40] again, I feel personally is inspirational. Really. Yes. You know that again, I [02:03:45] everybody’s each their own and whatever. But you don’t get to that level in your profession without having something. [02:03:50] And I and you know he’s another mentor and there’s [02:03:55] few others. There’s a few others, uh, Professor Ian Chappell at Birmingham, all these guys [02:04:00] and and a close friend, now my third mentor. I’ve always I’ve always said, this is why I’m saying [02:04:05] it publicly is Steven Hancox at the BJJ. He known him for 20 years. Different, [02:04:10] different angle on life. Yeah. But somebody who just gives [02:04:15] just such sage advice and and is you just learn so [02:04:20] much from not just about dentistry, but about life and about being a better person. I feel that.

Payman Langroudi: Way about [02:04:25] the late, great Louis Mackenzie. Yeah, there we go. He was never a teacher of mine. Yeah, [02:04:30] but. But I learned so much from that man.

Avijit Banerjee: Yeah. No. Yeah. Well, already I [02:04:35] don’t want to. I don’t want to get upset. Um, it’s still obviously incredibly raw. What happened? I [02:04:40] had the pleasure of knowing him for nearly 20 years, and we worked together. We wrote papers [02:04:45] together, we lectured together, and we had so many good times teaching, having fun, [02:04:50] you know, you know that you were part of that. The guy touched [02:04:55] so many people professionally and personally and socially. Yeah, [02:05:00] he had his humour, his wit, his acerbic wit. I used to love [02:05:05] when he had a few, many, too many to drink and his, his South African accent came out [02:05:10] and, you know, it was just priceless. And he was the life and soul and I what’s [02:05:15] happened? I can’t begin to feel [02:05:20] for his his children, his wife Jilly and what they’ve gone through, what they’re going through. [02:05:25] Um, but I’ve said to them directly that Louis will live on his [02:05:30] pictures are in that book. Um, I use his images fully [02:05:35] credited, obviously, in lectures with. And I had his permission before he.

Payman Langroudi: And [02:05:40] he came from such a, you know, you you’ve been in academia, academia from the beginning. Louis came from private general [02:05:45] practice.

Avijit Banerjee: Absolutely.

Payman Langroudi: And yet got himself involved.

Avijit Banerjee: In he did because he [02:05:50] was a smart man. Yeah. Yeah. I don’t like saying was I’m going to say is I’m.

Payman Langroudi: Sorry, clever [02:05:55] guy.

Avijit Banerjee: Because smart in so many different ways. Because I remember when we were introduced, I was lecturing, he [02:06:00] was in the audience, and we were introduced because he came over and said, do you know what? [02:06:05] I’m doing all this me stuff and I’ve got all these pictures, and you know how a fabulous [02:06:10] clinician he was and the images and the pictures, he took his clinical pictures. What a library, you know. And [02:06:15] we were put together to lecture where I was doing the clinical academic bit. And then he was [02:06:20] this is how you do it. And wowzers, we we went around the country in Europe for probably [02:06:25] a decade, 12 years. Wow. And it was just.

Payman Langroudi: The you must have.

Avijit Banerjee: Had the best times. [02:06:30] It was the best lecturing with him, but also, [02:06:35] dare I say, partying with him and being with him because I he was [02:06:40] like a brother and that’s how I saw him. To me, I he’s affected so many people in so many different ways. [02:06:45] You know.

Payman Langroudi: When I wrote the we put we put the podcast out again and I was writing [02:06:50] the obituary, the thing that got me this 11 times the best man, [02:06:55] 11 times the best man. There you go. You know, that speaks volumes.

Avijit Banerjee: It speaks [02:07:00] volumes. And this is the point. I mean, he you know, he didn’t really have a bad [02:07:05] word to say about anybody. If he didn’t like something, he’d joke it off. He’d never. Be nasty. Yeah. [02:07:10] You know, um, students love them. Undergrads. Post-grads. Uh, people went to his lectures, [02:07:15] loved him. Family friend. You know, it’s just such. [02:07:20] I mean, we used the word tragedy a lot in the world nowadays, right? This [02:07:25] is the absolute dictionary definition of tragedy on [02:07:30] so many levels, on so many levels. And I don’t know what else to say, because [02:07:35] the effect he’s had on me is huge. And it will live on in the books, in [02:07:40] lectures and all of this sort of stuff that I promise, as long as I’m doing that stuff, his name will live [02:07:45] on 200%.

Payman Langroudi: Let’s get to our final question. [02:07:50] It’s a deathbed question.

Avijit Banerjee: Oh, gosh.

Payman Langroudi: You’re on your deathbed, [02:07:55] surrounded by your friends and family. Anyone who’s important to you will hopefully, by that [02:08:00] time, grandchildren and great grandchildren. One of three pieces of advice you would give [02:08:05] them.

Avijit Banerjee: Wow. Okay. Um, considering, [02:08:10] um. About. I’m not quite a baby boomer. I’m Gen x, x [02:08:15] Gen X, just Gen X, and these people will be Gen Z and [02:08:20] Gen Alpha. Yeah. Exactly right. And their outlook on life will be very different. [02:08:25] And I’ve all right. Not deathbed conversations, but I’ve already had some similar conversations [02:08:30] with my children. It’s an interesting point. My children are grown up now. First thing I’ll probably [02:08:35] say to them is don’t regret decisions you make. Right [02:08:40] now. Not because I have. Because that’s not what I mean. But I think the world [02:08:45] they’re living in, they’re going to have so many decisions they’re going to have to make. They can’t always be right and wrong. Don’t judge [02:08:50] them on being right and wrong.

Payman Langroudi: Does that mean does that mean don’t look back?

Avijit Banerjee: No. [02:08:55]

Payman Langroudi: It’s what if the decisions were wrong.

Avijit Banerjee: Yeah, but they’ll learn from them. But my point being, don’t regret them. [02:09:00] Even if it’s a wrong decision. Don’t regret it. Don’t regret it. That’s my point. That’s exactly [02:09:05] my point. We can always look at the positive decisions and things that work. That’s easy. Life is easy. Then, as [02:09:10] you said earlier, we’re talking about mistakes. It’s the negative things that make us stronger, isn’t it? Right. And [02:09:15] we’ve all made decisions in our lives. Some right, some wrong, some intermediate. Okay, [02:09:20] fabulous. They’re going to have to make even more in the world they live in and the society [02:09:25] we live in it. So don’t dwell on it. Make decisions, go for it and don’t [02:09:30] regret them. All right. That’s point one then I think [02:09:35] linked to that I suppose it’s it’s take opportunities. Now [02:09:40] this is something I have discussed with my children a lot because I’ve stayed at guys and at Kings [02:09:45] pretty much all my life, uh, professionally. Right. And it’s certainly [02:09:50] not done me any harm. I’m not saying that, but I’ve not been to other places to work and and [02:09:55] gain those experience, those life experiences. And there’s always yin and yang. There’s always [02:10:00] positives and negatives from this. Yeah. Now they’re growing up in a world where again, opportunities are going to be [02:10:05] thrown at them left, right and centre. And yes, it does link a bit, as I said to my first point, [02:10:10] but don’t be frightened to take opportunities and grasp them.

Avijit Banerjee: And then the third [02:10:15] bit of advice again links. Sorry then they’re not totally all separate is enjoy it. Go [02:10:20] in head first, feet first. Immerse yourself. Don’t try to do [02:10:25] something half heartedly and then come away thinking I didn’t like it. Do it properly and [02:10:30] then come away with a judgement. And it’s funny because I’ve witnessed this a lot [02:10:35] and we’ve been talking about research a lot, obviously, because that’s what I do. And and one of the things I [02:10:40] say to students when they’re dabbling and thinking, shall I try do some research? [02:10:45] It’s what happened to me, I tell you. My first research project was I was in in the third year at dental school. [02:10:50] Yeah, right. And I did it. And I persevered in the middle of exams and staying in labs late and everything else. [02:10:55] You have to immerse yourself and do it, at the end of which you can then make [02:11:00] a proper judgement call. I love it, I’m not bothered or I hate it, but [02:11:05] if you just dip your toe in. Yeah, how can you make that judgement call? Yeah, do [02:11:10] you know what I mean? Yeah. So that’s what I would say. I would say, you know, don’t [02:11:15] regret, take opportunities, don’t regret them and immerse yourself in one massive.

Payman Langroudi: Point, isn’t.

Avijit Banerjee: It [02:11:20] though I like to be.

Payman Langroudi: A goody.

Avijit Banerjee: Goody. Yeah.

Payman Langroudi: I [02:11:25] mean, you know, we all have different situations. Some people will give their right arm to be you, some [02:11:30] people give their left arm to be me or whatever. We all know life is a bitch. Life’s hard. Yeah. [02:11:35] Um, how do you. How do you stay happy? What’s. What do you class as happiness. [02:11:40]

Avijit Banerjee: Wow. I do like being with my family. I love being with friends. Genuinely. [02:11:45] I, you know, we my we socialise a great deal. And I love people’s company. [02:11:50] I I’m not I don’t like being on my own very much. I’ll admit that I love travelling. [02:11:55] So it’s those sorts of things at the moment. And the problem is that we were [02:12:00] joking about my CV at the beginning and, and there’s a lot being crammed in and there [02:12:05] isn’t a massive amount of time. I’m not somebody who has amazing hobbies. I have so many colleagues that do it. I’m jealous, [02:12:10] very, very envious. And and hopefully one day, you know, when I do retire and ease [02:12:15] back, I can take up some of these things and try to do them. But at the moment [02:12:20] I get a buzz from being with people, you know, socialising, [02:12:25] talking, eating, drinking, travelling, those things because I can still do them [02:12:30] and when I’m not fit enough to do them, then I’ll find something else. I, you know, it’s, [02:12:35] it’s I’ve had this question asked me many, many, many times and I, [02:12:40] I’m not the greatest in the, in the, in the sense of switching off. You know, [02:12:45] when you send me emails, you’ll get a reply. It doesn’t matter what time, day or night. Yeah, yeah, you’ll get a reply [02:12:50] pretty much immediately. And that’s not healthy and I’m not proud of that. But then at the same time, I’m [02:12:55] sort of known for it and it’s what I do.

Payman Langroudi: Your biggest strength is always your biggest weakness as well. You know, it’s one [02:13:00] of those things, isn’t it? One of those things, isn’t it? Final, final question. How would you like to be remembered?

Avijit Banerjee: Wow. [02:13:05] Um. Somebody. You made a difference, [02:13:10] and I’m going to leave it at that because that you can take the connotation, whether it’s personal or professional, [02:13:15] whatever, somebody you made a difference or at least tried to make a difference, try to make a difference. [02:13:20]

Payman Langroudi: Amazing. Prof. Thank you so much. Thanks particularly for coming [02:13:25] in as well. It’s my pleasure, a real honour.

Avijit Banerjee: My pleasure. Thank you.

[VOICE]: This [02:13:30] is Dental Leaders, the podcast where you get to go one on one [02:13:35] with emerging leaders in dentistry. Your [02:13:40] hosts. Payman Langroudi and Prav Solanki.

Prav Solanki: Thanks [02:13:45] for listening, guys. If you got this far, you must have listened to the whole thing. And [02:13:50] just a huge thank you both from me and pay for actually sticking through and listening to what we’ve had to [02:13:55] say and what our guest has had to say, because I’m assuming you got some value out of it.

Payman Langroudi: If [02:14:00] you did get some value out of it, think about subscribing. And if you would share [02:14:05] this with a friend who you think might get some value out of it too. Thank you so so so much for listening. Thanks. [02:14:10]

Prav Solanki: And don’t forget our six star rating.