Payman Langroudi: This podcast is brought to you by enlighten. One of the most common questions I get is how do I do more teeth whitening? [00:00:05] The basis of that is to really believe in it, and the basis of that is to fully understand it. Join [00:00:10] us for enlightened online training on Enlightened Online Training.com to understand [00:00:15] how to assess a case quickly, how to deliver brilliant results every time. Next time whitening [00:00:20] underwhelms try and lighten.

Alex Hadley: I mean, it’s nuts and bolts pay. Yeah. It’s not. It’s not rocket science. [00:00:25] I think everyone’s terrified about it. It’s, um. No, as long as as long as you’re in itself. Don’t be scared [00:00:30] of it. Yeah, I don’t know. Well, Sanj Sanj explained it very well and he said, does anyone want to have a go? And I said, yeah, I’ll. Yeah, [00:00:35] fine. And it’s only, you know, it’s they’re only screwdrivers and tiny screws. Just don’t [00:00:40] drop them. That’s it. Just don’t drop the screws. Yeah. Or make sure you’ve got some spare screws. It’s handy. [00:00:45] Spare ones are good. They’re quite tricky to find. Um, yeah, I don’t know. [00:00:50] Restore restoring implants. Fairly straightforward. Um, making implants look [00:00:55] like teeth. Very different story.

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

Payman Langroudi: It [00:01:20] gives me great pleasure to welcome Alex Hadley onto the podcast. Alex is a young dentist, [00:01:25] young under 30.

Alex Hadley: Young I’m just under 30. Yeah yeah.

Payman Langroudi: Yeah. Young dentist [00:01:30] who I met at Bard.

Alex Hadley: Yeah.

Payman Langroudi: That’s right. January last year. [00:01:35] And you know, sometimes you just see fire in someone’s eyes, um, and passion. [00:01:40] And I straight away said to him, you should come on to the podcast because [00:01:45] put that passion out a little bit. But then later on I looked at your work and it’s beautiful work and [00:01:50] it’s quite complex work. Some of it, um, and quite impressive for someone of your age to [00:01:55] be doing that kind of implant work. And I saw [00:02:00] the composite bonding was beautiful. That’s very.

Alex Hadley: Kind.

Payman Langroudi: Very porcelain veneers were nice. Yeah, it’s all nice work. [00:02:05] Um, and I remember being 29, I think we started enlightened [00:02:10] when I was 29. Wow. So sometimes at that age, you kind of want to make a real difference. You know, [00:02:15] you kind of know where you’re at. Um, anyway, lovely to have you.

Alex Hadley: Yeah. Thanks [00:02:20] for having me on.

Payman Langroudi: Pleasure, pleasure. And one of the things about you is you’re incredibly [00:02:25] busy because we’ve been trying to fix this date since January. [00:02:30] Mhm. Yeah.

Alex Hadley: Yeah I do, I do keep myself quite busy I think.

Payman Langroudi: How many days do [00:02:35] you work.

Alex Hadley: Um it varies. Uh, this week, this week you caught me on a good week. [00:02:40] Um, I was only in three days this week. Okay. A nice chilled week, but.

Payman Langroudi: Generally 5. [00:02:45]

Alex Hadley: Or 6. Next. Well, so next week I’m in four different practices across [00:02:50] five days. Um, yeah. I try and simplify things by using one technician. [00:02:55] So that’s like the, the easier thing to do. Um, but yeah, it’s tricky organising, [00:03:00] you know, which lab works going where, you know at what time. And it’s, [00:03:05] it’s yeah, it’s often, often tricky work. So, um. Yeah.

Payman Langroudi: Don’t [00:03:10] you find I mean, it’s it’s complicated. I find I would find it difficult to use [00:03:15] lots of different nurses equipment and all of that.

Alex Hadley: I’m very lucky, [00:03:20] actually. The nurses are. The nurses are really good. Yeah. Um, nurses.

Payman Langroudi: Do you actively train [00:03:25] your nurse when when someone says you go to a practice and say, this is your nurse? Yeah. Do you start? Is there [00:03:30] a way you like things done that you try and get over to that nurse?

Alex Hadley: I, I think often the, [00:03:35] the nurses who either put themselves forward for, say, implant nursing, um, or end up [00:03:40] unlucky enough to work with me. Um, they are they already have some kind [00:03:45] of acumen for it. I think the I think the best nurses are kind of overqualified [00:03:50] for the job. Um, they’re, uh. Yeah, they’re really impressive. [00:03:55] And, you know, you couldn’t do you couldn’t do any of that work without them. Um, I do, [00:04:00] I think I don’t actively train them. I’ve seen dentists sit, sit nurses [00:04:05] down and say I want everything set out like this, I want everything. I don’t do that. Um, they [00:04:10] they kind of pick up the best nurses, pick up what you want, kind of what you’re asking for. [00:04:15] Yeah. And so, you know, within, say, a few weeks or a few months, I don’t have to ask for [00:04:20] something. It’s just.

Payman Langroudi: But what are you working in? Lots of practices. On purpose or by mistake. [00:04:25]

Alex Hadley: So I wouldn’t necessarily say by mistake. I think I think I go through phases of, [00:04:30] of kind of becoming a bit bored, not having enough work to [00:04:35] do. Um, difficult it’s difficult with, with implant dentistry in general practice. [00:04:40] Um or smile makeover type type work that that kind of work. [00:04:45] Um, sometimes in a practice, there might not be enough of those patients to fill a whole [00:04:50] list, right? So it’s quite common to jump around different practices.

Payman Langroudi: So [00:04:55] that’s kind of the reason you do it.

Alex Hadley: Yeah. The by mistake part is, is also is also [00:05:00] true though, because let’s say I get I get kind of, uh, like not not so [00:05:05] busy. Um, have a bit more spare time. Bit almost bored. Yeah. If I could be kind of [00:05:10] sat around a little bit bored. Not not, you know, not, um, not really excited about [00:05:15] the type of work I’m doing then. Then I have had a tendency to take on too many other [00:05:20] jobs all at once, and then I’m a bit stuck and too busy. Um. [00:05:25] It’s quite it’s quite difficult to unwind from an associate job that’s like [00:05:30] what I’ve learned. That’s true. You know, and then. Yeah. And then I. And then I [00:05:35] really worry about, you know, what? What about the the patients who I’ve treated, if [00:05:40] they have a problem making sure they’re looked after. Um, so, yeah, I kind of make [00:05:45] sure like if that if that’s going to happen, there’s, there’s a couple of practices where I’m kind of trying to leave [00:05:50] because they’re a bit too far away. One’s in Colchester. One’s the other side of London, in Feltham. [00:05:55] Um, so do a fair bit of driving. From where do you live? In Essex. Whereabouts? So, [00:06:00] uh, at the moment, Buckhurst Hill. But trying to move to Chelmsford? Oh, yeah. Um, because [00:06:05] my my other half’s a radiologist. She’s got a radiology job in Colchester. So [00:06:10] it’s a bit a bit too far to commute. Did you meet at uni? Uh, we met during [00:06:15] lockdown. After uni? Um, yeah. Yeah, when [00:06:20] you weren’t.

Payman Langroudi: Supposed to be meeting anyone?

Alex Hadley: Um, no no no no no no, it was in. It was in one of those windows where we were allowed [00:06:25] to meet. Meet each other. Yeah. Um, yeah. And we so we actually. Yeah, we actually [00:06:30] met, uh, interestingly, for the first time, um, in [00:06:35] my, I think my second year of uni at a uni night out and there are [00:06:40] photos of us kind of together and then like, we didn’t, we didn’t see each other for five years until [00:06:45] we, we matched on Tinder as is as is like the 2020 way of like meeting [00:06:50] someone and I. And I got penalised actually, because I didn’t remember the first meeting, but obviously [00:06:55] she did. So we know like, you know, women have these like sharp sharp memories this like internal [00:07:00] storage.

Payman Langroudi: So she trained as a medic at Sheffield as well. Yeah. Yeah okay. Yeah. So [00:07:05] look you’re obviously very driven, very passionate. Now it’s very obvious just with a five minute [00:07:10] conversation. It’s very obvious. But were you always.

Alex Hadley: Um.

Payman Langroudi: Yeah. [00:07:15] Did you become that way? Did something trigger it?

Alex Hadley: Uh, [00:07:20] I think as a, as a child, uh, my parents are probably the [00:07:25] main, you know, the main source of that. What do they do? Um, [00:07:30] so they. So dad was a policeman. Mum was a teacher. Um, nobody [00:07:35] in in the family had ever been to university? Um, yeah, I [00:07:40] think I think they, they, they definitely instilled, like, you know, needing to try my best to everything. [00:07:45] Um, which like I think sometimes [00:07:50] I questioned and they would say, I told you so, you know, or because I told [00:07:55] you. Because I told you to do it. You should just do it. Yeah. Trust me, it’ll be. It’ll be better if you just. [00:08:00] If you just crack on. Um, so. Yeah, I think I think I, I’m also [00:08:05] kind of things. Things do come naturally to me I think, which [00:08:10] I’m quite fortunate for.

Payman Langroudi: So were you at school? Were you good at studies. Good at sports, that sort of [00:08:15] thing.

Alex Hadley: Not as good at sports, I would say. But. But like. Yeah, studying like science and maths [00:08:20] from, from quite an early age. Uh, yeah I would my parents made [00:08:25] me do Kumon. Yeah. Yeah, I tried to force.

Payman Langroudi: My kids into.

Alex Hadley: That. Yeah, my my [00:08:30] parents did successfully forced me and my sister into that. And, uh, yeah, I remember [00:08:35] at primary school I would have started and I was, I was like, doing Kumon at lunch or something.

Payman Langroudi: Is [00:08:40] your mum a maths teacher?

Alex Hadley: No, she was a primary school teacher a primary school.

Payman Langroudi: Mhm.

Alex Hadley: Okay. Yeah. [00:08:45] Um.

Payman Langroudi: So why dentistry? How did like how did at what point did dentistry [00:08:50] come up and why.

Alex Hadley: Um so I think my, I think my, [00:08:55] my parents wanted like me to be a professional of some description, [00:09:00] um, like medic, dentist, lawyer, whatever. Like they were they, they, they [00:09:05] really just wanted more for me than they had. Yeah. Um, and they just gave everything to me [00:09:10] and my sister, so we were super lucky. Um, but so, so they they kind [00:09:15] of, um, pushed me to do, like, one of those things. I really don’t like hospitals, so [00:09:20] medicine was, like, out of the question. And although I don’t mind reading, I don’t think I could read [00:09:25] and write all day. Um, so, like being a lawyer, that would be out of the question. Working [00:09:30] in the city, I knew the hours were super long. You know, all these finance guys work super long [00:09:35] hours, hundred hours. I’m although I’m very driven. I don’t necessarily [00:09:40] think I’m like the hardest working. I think I kind of like, you know, I [00:09:45] tend to want to do a bit less.

Payman Langroudi: Work to live, live to work equation. [00:09:50] You know, people go into there’s there’s no right or wrong there. Right? I mean, [00:09:55] dentistry definitely does lend itself to stopping at 530. Yeah. [00:10:00] If you’re an associate.

Alex Hadley: Yeah. So, so so you’re. Yeah.

Payman Langroudi: Certainly not when you become an [00:10:05] owner.

Alex Hadley: No. When, when you, um, you were saying so where did where did the dentistry come from? [00:10:10] Um, I remember they kind of pushed me to do some work experience. And [00:10:15] I went to do some work experience at a general practice like our general practice in Southend. And, [00:10:20] and I remember the dentist, um, great, [00:10:25] great guy, um, probably at the time, like in his 50s, maybe late 50s, 60s [00:10:30] and um, and he was I don’t think I’ve ever seen anybody eat as much [00:10:35] cake and drink as much tea. Right. So he was full time chilling, just like, you know, [00:10:40] exams, small fillings, occasional crown, you know, having a nice time, private practice, den [00:10:45] plan list. Just chill. Um, and like, the only time he got stressed is when [00:10:50] his, his regular nurse wasn’t working with him where like, you know, it made, you know, many didn’t have as many tea breaks. [00:10:55] Yeah. Um, and then I was also very fortunate because we’re, um, [00:11:00] so I, I went to, I think I went to primary school with Paul [00:11:05] Palmer’s son, so like, uh, so he was the year above me at primary school, so we were like five and six or whatever. [00:11:10] Um, and I didn’t know son very well, but, you know, we knew of Paul because because of that. And I [00:11:15] managed to do some work experience at Paul’s. And so in the same week I saw a [00:11:20] man drinking loads of tea, eating loads of cake, and then I watched Paul play ten implants in 2.5 [00:11:25] hours. Wow. So that the patient and the patient paid big money on the way out. Um, [00:11:30] and I think for me, at that point, I realised there’s, there’s got [00:11:35] to be somewhere in between the, the the tea drinking [00:11:40] and doing complex implant surgery where I can probably slot in.

Payman Langroudi: Um, [00:11:45] did you listen to Paul Palmer’s podcast?

Alex Hadley: Yeah, I did. Yeah, I did. Yeah.

Payman Langroudi: Um, [00:11:50] so that was probably a big influence on you. Um, yeah. Because some [00:11:55] look, some people become dentists and don’t ever look at implants at [00:12:00] all. Yeah.

Alex Hadley: I’m, like, scared of them. Yeah. Yeah. A bit.

Payman Langroudi: Like me. I was scared of blood. Really [00:12:05] don’t like blood. Okay. Yeah.

Alex Hadley: You know, I have some nurses here. A bit scared of blood. Yeah.

Payman Langroudi: I’m not scared of blood. It doesn’t make me feel [00:12:10] sick, but I don’t want to be the dentist who cuts. Mhm. Flaps at all, let alone [00:12:15] draw bone. I just don’t don’t want to be that guy. Yeah.

Alex Hadley: I don’t know. I think you get used to that. I’m sure you like. Yeah [00:12:20] I’m sure it’s not for everyone, but I think it’s.

Payman Langroudi: Like endo, you know, you get used to endo. Some people adore it. Yeah. And [00:12:25] then most of us.

Alex Hadley: Not really my thing either. Yeah, yeah, yeah. It’s, um. So why? [00:12:30]

Payman Langroudi: Why Sheffield?

Alex Hadley: Oh. Um.

Payman Langroudi: Because my son’s applying [00:12:35] right now. Oh, yeah. Not to dentistry, revelatory but but applying and Sheffield came [00:12:40] up and said that was Sheffield. And then he went I don’t think I want to spend any time there.

Alex Hadley: Oh, interesting. Yeah. No. [00:12:45] So I did. Um, so I obviously there aren’t that many choices in the UK which [00:12:50] Dental school to choose from. Um, I shortlisted them on, uh, how likely I [00:12:55] was to get in. Um, my GCSE results, although good. Weren’t, you know, [00:13:00] as good as some people applying. Yeah. Um, and so I knew that some, some kind of universities [00:13:05] would have like a big lean towards kind of GCSE results like Birmingham [00:13:10] or King’s or whatever. Like that might be an issue. My Ukcat score also wasn’t very good. [00:13:15] Um, you know, it was kind of above average, but not good. So I looked at all the, all [00:13:20] the, you know, all the universities, like which ones are going to, you know, going to short which ones are going to kind of [00:13:25] am I going to be short changed by applying to. Um, and so I applied to [00:13:30] uh, Barts, Sheffield, um, Cardiff [00:13:35] and Bristol and Bristol rejected me without an interview, which I was a bit annoyed about because it was lovely [00:13:40] and sunny on the day that I went to the open day and had a nice lunch with mum and it was, yeah, lovely, quite [00:13:45] nice. Nice city, like nice old buildings. Yeah. Um. And then, uh. Yeah. Where [00:13:50] else do I look around? I looked around Leeds, but I think it chucked it down with rain when I was looking around, which kind of tainted my, my [00:13:55] opinion of it. Um, and then, and then I got, I got three interviews and three offers from [00:14:00] the other three. Um, and actually, at the time I went on the open day, [00:14:05] Jaz Gulati was the Suds president president. So he just is an [00:14:10] incredible speaker. And he was so passionate about how good his time at Sheffield was that [00:14:15] I thought that I thought, ah, you know, I like this guy like he, you know, he’s got a lot of nice things to say about being [00:14:20] a student here. Yeah. Um, and, yeah, I thought, I thought I could spend some time there. [00:14:25]

Payman Langroudi: Yeah. I listened to a pod today. One of the producer pods. [00:14:30] I’m not even a dentist anymore. Right? Yeah. But it makes it Somehow he makes me want to be a [00:14:35] dentist again.

Alex Hadley: He’s a great guy.

Payman Langroudi: Yeah. Yeah.

Alex Hadley: I occasionally drop him messages about [00:14:40] about things, and I actually have done since that day in probably like 2012. [00:14:45] So for 12 years jazz were like occasionally see a message from me about something or other and it might [00:14:50] be like a podcast or it might be, you know, it might be like the splint course, or it might [00:14:55] be, you know, it might be something or I think I’ve referred a patient to him once as well.

Payman Langroudi: What [00:15:00] were you like as a dental student? Were you top of your class? Were you what were you.

Alex Hadley: Terrible party.

Payman Langroudi: Guy? [00:15:05] Which one were you?

Alex Hadley: Yeah, the latter party guy? Yeah, I think so, yeah. I don’t yeah [00:15:10] there’s that some. Yeah some, some of the, some of the people in my year have probably seen my name on this podcast and [00:15:15] they’ll think, oh Payman is scraping the barrel now. He’s. Yeah. Is that [00:15:20] rude in.

Payman Langroudi: Sheffield where all the bars are King’s Road, it’s not King’s Road, King Street or something. There’s [00:15:25] one road where there’s like. No there’s a.

Alex Hadley: Few. There’s a few. Yeah. Okay. I’m actually going [00:15:30] to Sheffield after this. There’s a beer festival at Kelham Island. Okay. And so I’m still very good friends [00:15:35] with with the guys, the guys who I know from from Sheffield and they live in some of them live in Manchester and [00:15:40] Newcastle. They’re all over. Um, but what did you make.

Payman Langroudi: Of the course? I mean, I remember being just shocked [00:15:45] at the Dental course. Yeah. At the. I didn’t do biology A-level either. Okay. [00:15:50] So that was doubly difficult. Yeah. I just remember thinking, bloody [00:15:55] hell, this is serious, man.

Alex Hadley: I tried, I tried really hard for about six months. [00:16:00] Maybe not even six months. Um, maybe like the first 3 or 4 months. [00:16:05] I remember in first year, I, you know, I tried to study and whatever. And then [00:16:10] I thought with the, the vision being, oh, if I get honours in like [00:16:15] one exam a year, then you know, that that would be that was my idea of like a successful [00:16:20] like dental school career. And I think I worked really hard. I didn’t [00:16:25] have enough smarts to kind of seek out the, uh, like, the past paper questions. [00:16:30] You know, the question bank, which is invaluable. Like nobody. Obviously, nobody’s getting on [00:16:35] us without the without the question bank. So I got 64% in the [00:16:40] first exam, which was 1% shy of the like the honours mark. Mhm. [00:16:45] And at that point I thought I’ll throw the towel in now and, and. Yeah. And go [00:16:50] to the pub. Yeah. So that’s what I was doing. Yeah. Ten. Well 12 years ago I guess.

Payman Langroudi: And then [00:16:55] the clinical side.

Alex Hadley: So I was um I didn’t take to that particularly well either. I’m a bit, [00:17:00] uh, a bit of a perfectionist with like the well, with, with, [00:17:05] you know, practical things that I’m doing. So I mean, it doesn’t necessarily have to be dentistry, but obviously now [00:17:10] it is. It’s all dentistry. Um, yeah. I almost [00:17:15] when when we started treating patients, I felt like I was doing them a bit of a disservice because [00:17:20] I, I felt like they would be better served seeing someone else, you know, if they [00:17:25] saw, you know, a dentist who’d done thousands of fillings, then obviously they beginning.

Payman Langroudi: We all feel that way, right? Yeah. [00:17:30]

Alex Hadley: Yeah. So I remember yeah, my first couple of fillings were on my best mate and [00:17:35] they’re still there. I think, I think, I think good, good. Um, yeah. [00:17:40]

Payman Langroudi: So then you you saw Paul Palmer very early on? [00:17:45] Yeah. Throughout dental school. Was it already in your head that you would. You would be [00:17:50] placing implants and implantology was something you were going to look at? Are you tactical [00:17:55] in that sense? Are you the kind of person who thinks because the acceleration’s admirable. Yeah. [00:18:00] Like, you know, in in 5 or 6 years, you’re you’re doing a lot of work that a lot of [00:18:05] people don’t even think about starting to do.

Alex Hadley: Yeah. No, I didn’t I didn’t have that in mind. Did [00:18:10] you. No, not at all. No, I was no, I, um, I thought about kind of finishing the course, and I [00:18:15] was a bit disillusioned with dental school in third year. You know, I didn’t. I didn’t fancy it. [00:18:20]

Payman Langroudi: Um, so what about your first job? Who was your first boss? Was it your first boss in Sheffield? [00:18:25]

Alex Hadley: Yeah. Uh, a guy called Randeep, Randeep Chung who I’m hopefully going to see this weekend. I haven’t seen [00:18:30] him for ages. Amazing. Um, very cool guy. Yeah. So, um, couple. He’s got a couple of practices [00:18:35] now. Like big, big kind of mixed practices. Um, yeah, [00:18:40] I think, um, he, I would, I would, uh, go into work thinking [00:18:45] we would be talking about, uh, you know, I might want to talk to him about this case that I’m doing. You know, maybe it’s like a bit of tooth wear or [00:18:50] something that makes it tricky. And he had a he had a or has a, uh, a [00:18:55] diploma in restorative dentistry from. I think it’s RCS as well. So he’s quite [00:19:00] clued up on, you know, doing, doing some nice work and does really, really cool, um, [00:19:05] composite build ups like direct build ups. Some of the patients around there, you know, finance, [00:19:10] finances, don’t allow them to have like, you know, really expensive makeovers and whatnot. Um, [00:19:15] but he’s doing a lot of bonding, and the bonding is really good. It’s a shame. It’s not like he’s not marketing composite [00:19:20] veneers. He should be. Yeah. Um, I might have to have a chat with him. Um, but. Yeah, So [00:19:25] I would I would go up to him and and show him, you know, all this, this case that, that I wanted to discuss. [00:19:30]

Alex Hadley: And he would, um, he would often show me he’d be like, [00:19:35] okay, cool. Alex. Cool, cool. Um, look at this video. This is me and my motorbike at the weekend at [00:19:40] Donnington, doing 150 miles an hour on on his Fireblade. Or at the same [00:19:45] time he was learning to, uh, he was learning to fly a helicopter. So now he’s got helicopter people. So [00:19:50] then like the following week, I do the same thing again. Like, try and show him this. Show him a case. He’d be like, yeah, yeah, yeah, that’s [00:19:55] cool. Alex. And then like, show me a video of a helicopter. So, um. Yeah. Nice. So that [00:20:00] that that was kind of a nice influence. Yeah. Like a non. Yeah. Non. Dental. Um, [00:20:05] yeah. Think, I mean he’s, he does cool stuff now like, um I [00:20:10] think he recently. So he does like the Dakar uh, rally. Rally. Yeah. Well no, no. Well [00:20:15] he did the original para Dakar route on a, on a bike. So you know there’s some [00:20:20] guys like they put, they put their bikes in a container and yeah. Yeah yeah. So he does all stuff like that. [00:20:25] So. Very. Yeah. Very interesting bloke. Um, did you stay there.

Payman Langroudi: Longer than the one [00:20:30] year or.

Alex Hadley: No, I think because I, we discussed that I’m a little bit lazy. I, um, I [00:20:35] took a few. I took a few sick days, uh, during PhD. Um, [00:20:40] yeah. Kind of like, kind of like at university as well, I guess. Um, and [00:20:45] yeah, his, his wife is the practice manager. I think she just thought I was a bit of a nightmare. Um, we’re quite friendly [00:20:50] now. No, I don’t work for them. But then I think, um, as soon as, [00:20:55] um, as then, then I worked in, uh, Retford in a, uh, [00:21:00] in an NHS practice, like most of the NHS practice, I’ve got friends who work in that practice [00:21:05] now actually, and they’ve done a bit of a private conversion on it. Principle’s really quite impressive as well. [00:21:10] Um, huge NHS contract, like 35,000 udas at [00:21:15] quite a high rate as well. I think, you know, they’re, you know, they’re bringing a lot of, a lot of NHS patients [00:21:20] in serving quite, you know, a huge swathes of the population out there. This is like Nottinghamshire. [00:21:25] Mhm. Um, and the principal’s doing some Invisalign and whatnot. Um but then, [00:21:30] then that was, that was, you know the lead up to lockdown.

Alex Hadley: So lockdown, [00:21:35] you know I had this NHS contract which was quite, quite cushty. Uh principal [00:21:40] was really nice. Yeah. He had a big NHS, NHS contract so I think I think yeah one [00:21:45] day I got, I got paid to go in. I think I told you about this. I think I got [00:21:50] paid to go in uh, to take one tooth out on one day for like my whole NHS contract [00:21:55] value for that week, which is still just the, you know, ludicrous. Um, [00:22:00] and then the rest of the time, it was quite a nice summer, actually. The rest of the time was just in, in Sheffield. [00:22:05] Um, in the sun, in the, you know, in parks and whatnot. Um, and then [00:22:10] and then made the decision to move, to move back to Essex more so [00:22:15] to pursue some private dentistry. I just knew that, you know, the the market [00:22:20] down here is much, much better for doing that. You know, doing doing higher [00:22:25] end work where I could probably, you know, do less work, [00:22:30] um, at a higher standard, a higher standard and you know, and be rewarded better [00:22:35] for it. So yeah. Yeah. Well, you know the.

Payman Langroudi: Rewarded better piece per [00:22:40] unit of course.

Alex Hadley: But yeah. But also but also like find it more rewarding. Yeah yeah.

Payman Langroudi: Yeah [00:22:45] yeah. No no. But let’s talk about the actual financial reward. Yeah. Oh yeah. That per unit you’re going to make more [00:22:50] privately. Yeah. But this, this guy you’re talking about with the high UDA value. Yeah. [00:22:55] Big number of patients doing a couple of Invisalign. That’s a cash [00:23:00] cow. Yeah. That’s a gigantic business for for one practice. Yeah. [00:23:05] For one.

Alex Hadley: Guy. For one.

Payman Langroudi: Guy. Yeah. Yeah.

Alex Hadley: And so I think now he’s, I think they’re now they’re like 9 or 10 surgeries now. [00:23:10] Wow. And he uses two therapists to do his NHS contract. So he’s doing like 12 [00:23:15] 15,000 udas himself through two therapists.

Payman Langroudi: But what I’m saying is at a higher [00:23:20] rate. Yeah. Yeah. The associate part of that deal is amazing for the [00:23:25] principle. Yeah.

Alex Hadley: Yeah. The associates I mean, I don’t know what it’s like now, but I mean, I was, I [00:23:30] was being paid £11 a UDA. I think it’s UDA. It’s probably 30, £35 or something. [00:23:35] Yeah. I mean so, so yeah. So every, every every check up. He’s getting paid more than me. Yeah. Way [00:23:40] more. Yeah yeah.

Payman Langroudi: Yeah. And in effect, he’s on, like, a 70 over 30 deal with you.

Alex Hadley: Yeah yeah yeah yeah [00:23:45] yeah yeah. Which I, which I knew about and I was a bit disillusioned by. But then, but then I was, I [00:23:50] was treated very well during like when there, when there was no work and you know I had some, I had some mates who worked [00:23:55] at private practices where they were, they were owed, they were owed money for work [00:24:00] done, work that had been completed. And then their principles kept it. Yeah. [00:24:05] And then they, I can imagine, fell out with them and then didn’t have any work. So. [00:24:10]

Payman Langroudi: Yeah. And, you know, my wife’s a private dentist. Uh, [00:24:15] Associate and zero throughout lockdown and [00:24:20] okay, we were okay. But I often think about what if you were a [00:24:25] single mum? Yeah. And, you know, a single mum putting two kids through school or whatever. Yeah, generally there [00:24:30] isn’t huge savings when that’s happening.

Alex Hadley: And I wonder.

Payman Langroudi: What happens to you.

Alex Hadley: Yeah. I wonder where income [00:24:35] protection comes into that. Like, you know, even then it’s going to be like, did it not I’m not sure maybe. [00:24:40] Yeah, I don’t know.

Payman Langroudi: Enlighten. You know, the day before lockdown it was shut down. You [00:24:45] know, I think we brought in that day £25,000 the day after zero. Yeah. [00:24:50] And then 000000 and way before they even mentioned the word [00:24:55] furlough or, you know, that 80% thing paying. Yeah. Yeah, yeah. We talk to our [00:25:00] team and said we have to lose half of you. Yeah. You know overnight. Yeah. Um, but it’s interesting [00:25:05] that different people have different things out of it. Yeah, yeah. So then this thing you’re saying about [00:25:10] you knew down south there’d be more scope for private. Yeah. I [00:25:15] suspect nowadays your peers, people who you qualified with, [00:25:20] almost everyone’s trying to get to private dentistry. Is that right? Yeah. Yeah. [00:25:25]

Alex Hadley: Because everyone in.

Payman Langroudi: My day, that really wasn’t a thing. But now it really has become that [00:25:30] way. Yeah. And so the competition [00:25:35] to get a private job. Yeah. Was, is that being part of the driver [00:25:40] to make yourself more employable, go on courses?

Alex Hadley: I don’t know. I think, um, [00:25:45] did you find it easy to find a job? Yeah. Yeah. Yeah. Well, I mean, yeah, you make [00:25:50] your own luck, right? So, I mean, I think what I did when I was in, when I was in, uh, in Sheffield, [00:25:55] I messaged Amit Patel, Essex dentist. Yeah. Amit Patel, a [00:26:00] guy in Brickfields. Okay. Tk and Amit. Um, and I, there’s [00:26:05] quite a few. Amit Patel has got to be quite, quite specific. There’s a few Ash Palmer’s a few few. There’s a few of them. Um, [00:26:10] so so uh. Yeah. Messaged Amit and, uh, he [00:26:15] was he was hiring for Brickfields, which is obviously a mixed job, but heavy, heavy private [00:26:20] mixed job. Yeah. Good practice, which is what I was, what I was after. So went to interview [00:26:25] at Amit’s. I think he had 60 applications for this one associate job. Uh, [00:26:30] did you know interviewed? No. Didn’t know him. Are you cold email? Yeah. Just like, uh. I don’t [00:26:35] think I emailed him. I think I messaged him on Instagram and he. Yeah, I went down for [00:26:40] a weekend, went to see my parents and then, you know, went to Brickfields and had a chat with him. Um, [00:26:45] and then he didn’t give me an associate job. But this was what for? For [00:26:50] nearly five years ago, he didn’t give me an associate job, but he passed my details [00:26:55] to dev. Dev. And that’s when. And that’s when. Because they’re good mates. Yeah, yeah. And then dev. [00:27:00] Yeah. Dev phoned me, um, and I was, I was out working in Retford, um, [00:27:05] and, and you know, they sold me the, the mixed practice Dental [00:27:10] beauty Romford kind of associate job. And yeah, [00:27:15] at that point in time, I think that was the third practice that they’d purchased. So it was the [00:27:20] third one and now they’re on like 45 odd. Yeah. [00:27:25] So I’ve kind of seen Dental beauty from.

Payman Langroudi: So we should, we should, we should say Dev Patel. We’ve had twice on [00:27:30] this podcast. Yeah. But the guy who started Dental beauty and they go they go into sort of 51, [00:27:35] 49 partnerships with principals. Yeah. And Amit was [00:27:40] his buddy.

Alex Hadley: Amit is just. Yeah. They’re just buddies. Yeah, yeah, yeah. Um, and.

Payman Langroudi: And Paul Palmer, [00:27:45] was he a professor in? Not.

Alex Hadley: I don’t think Paul’s prof. I think he Paul’s older [00:27:50] brother. Paul’s older brother was professor. Yeah. Um, yeah. Paul. Paul was very [00:27:55] kind, um, in, like, trying to help me get into dental school. I haven’t seen I haven’t seen [00:28:00] much of him. Um, yeah. Occasionally I send him pictures of implants. Like, you know what? [00:28:05] You know, x rays. Like, do you know what this is? He’s like very, very [00:28:10] kind, sometimes telling me what they are. Um, but I haven’t seen him very much. So now you’ve.

Payman Langroudi: Started [00:28:15] in Dental beauty, which is. It’s private, isn’t it? It’s not, it’s not.

Alex Hadley: It’s [00:28:20] mixed. It’s mixed. It’s mixed. But, um, it’s what, in the olden days we.

Payman Langroudi: Would call independent practice. [00:28:25] It’s kind of. Yeah.

Alex Hadley: There’s. So I think when I, when I joined, they [00:28:30] effectively wanted me to do no udas or, you know, the, the, um, [00:28:35] the premise being using the NHS list as a springboard to provide, [00:28:40] you know, private, private work. Yeah. Which was nice, um, you know, learned [00:28:45] to take photos and, you know, all, all manner of, you know, other private [00:28:50] treatments, but also mainly, mainly kind of communicating with patients, having a bit more time to do [00:28:55] that. Yeah. Um, I think the communication thing is quite is innate, right. I think most, [00:29:00] you know, most good communicators like yourself have probably always been a good communicator. [00:29:05] Um, And so yeah, I think it was nice to have it was nice to have some more [00:29:10] time to spend with patients, to get to know them, to build rapport, um, [00:29:15] and also to provide them with better treatment. So I think, yeah, [00:29:20] I, you know, lots of lots of associates are especially within corporates [00:29:25] can be a bit, um, I don’t know, uh, they probably hold back and, you [00:29:30] know, they’re not not, um, not huge fans of the corporate model. Um, but [00:29:35] I do. Yeah. Have to give Will and dev, you know, some, um, some some respect [00:29:40] for it. It’s, you know, they they definitely provided me with a platform where I [00:29:45] could kind of progress and do more complex work. I [00:29:50] even, even now don’t have an issue with getting materials [00:29:55] in or if I need a particular drill or, you know, stuff [00:30:00] that you need for implants. Obviously, all of it’s really expensive. Um, fixture removal kit [00:30:05] £1,500. You know, Will’s on holiday, like. Yeah, he’s [00:30:10] okayed it from Cape Town, I think. Um, so. Yeah, it’s nice. It’s [00:30:15] nice having, like, it being a small corporate. Obviously things have changed in the three, [00:30:20] 3 to 5 years that I’ve been.

Payman Langroudi: There for the company.

Alex Hadley: Right. For the company. Yeah. And for the [00:30:25] staff, I guess. Yeah. I think things have changed a bit on how. Oh, [00:30:30] um.

Payman Langroudi: Have they got few more procedures [00:30:35] and sort of.

Alex Hadley: Yeah. There are, yeah. There is like. Yeah, there’s definitely a little [00:30:40] bit more, uh, compliance focus, which you would expect. Yeah. [00:30:45] Um, yeah. There are more systems. And the I think as the [00:30:50] practices become established, the, the partner or principal can be kind of more hands off. Mhm. [00:30:55] Which is the, the objective. You know they’re kind of leveraging their time. That’s like the, the main [00:31:00] benefit to them. Um Yeah, I think I’m [00:31:05] not sure. I’m not sure kind of what else has what else has changed? [00:31:10] I think I think that’s probably that’s probably the most [00:31:15] notable thing. Like on the plus.

Payman Langroudi: Side, I mean, have they learned marketing better? Are you getting patients more [00:31:20] than you were three years ago? 4 or 5 years, I.

Alex Hadley: Think I am, but I’m not sure that’s that’s just I’m not sure that’s [00:31:25] marketing. Yeah. I think in fairness, we do get I get internal referrals from, uh, some [00:31:30] of Will’s other practices, which is really nice. Um, but yeah, I think implant dentistry [00:31:35] just selects for, you know, you to, to to get referrals or. Um, [00:31:40] yeah, it kind of selects for bigger cases generally because the patients [00:31:45] know that they’re expensive and they know that they’re, they’re kind of pre-qualified themselves. Yeah. For that. You haven’t learned. [00:31:50]

Payman Langroudi: Anything implant wise at the beginning of your. No. So when when did the implants come in. At what. [00:31:55]

Alex Hadley: Point. Well so that’s another that’s another DB thing. So Sanjay Sethi was uh, we were [00:32:00] referring implants to Sanj. Sanj was restoring implants in house and he [00:32:05] taught us how to restore implants.

Payman Langroudi: So he was actually visiting dentist?

Alex Hadley: Yeah, [00:32:10] but only I think he only came a few times, but, um, he came to [00:32:15] give a talk, um, in one of the surgeries, um, [00:32:20] after it was like after work on how to restore Sweden and Martina Prama [00:32:25] implants and Tommy from Sweden. Martina. He came along, um, and. [00:32:30] Yeah, like Sanj gave gave us, like, the, you know, the rundown on what to do, how to [00:32:35] do it. And then also had, uh, had a patient who Will had referred to him, um, [00:32:40] that we we well, I restored with Sanj. So the last [00:32:45] patient of the day, you know, like 5:00 till half five or whatever, um, which was [00:32:50] nice. Yeah. Like so, so, like practical.

Payman Langroudi: Side [00:32:55] of implants.

Alex Hadley: That way. And then sent some implants to Sanjay. And then I was doing, [00:33:00] then I’d done Ash’s course and I was doing more Ash Palmer and I’d done [00:33:05] I had I had I’d started doing more smile makeover stuff and I’d come across other implant brands, [00:33:10] you know, or other implants that had been placed in spaces that I wanted to [00:33:15] use. So then I was I was restoring implants in smile makeovers. [00:33:20] Yeah. Um, you know, learning about angled screws and, you [00:33:25] know, what needed to be cement retained or, you know, how how best to, um, you know, sound covered, [00:33:30] like all the all the good stuff on occlusion and, um, yeah, [00:33:35] I and I, I, um, so I was restoring them pretty routinely [00:33:40] and then I thought, oh, I would quite like to. I was seeing quadrants because I still do. [00:33:45] You know, I’m a general. I’m just a general dentist. Right. So I see some quadrants with spaces and think it’s [00:33:50] like it would be great to put an implant in there.

Payman Langroudi: So before we move on to the placement, um, [00:33:55] you know, learning about placement, What’s the crux of restoring implants? Like what’s [00:34:00] what’s an aha moment? What is someone who doesn’t do it right now and they want they want to do it. [00:34:05] What are the things that surprised you or.

Alex Hadley: Surprised me about restoring [00:34:10] implants?

Payman Langroudi: Things that you learned or key? Key aha moments for you? I mean, what’s the difference? [00:34:15] Okay. There’s the.

Alex Hadley: Impression. I mean, it’s. Nuts and bolts. Yeah. It’s not. It’s not rocket science. I think everyone’s terrified about [00:34:20] it. It’s, um. No, as long as. As long.

Payman Langroudi: As you don’t be scared of.

Alex Hadley: It. I don’t know. Well, Sanj Sanj [00:34:25] explained it very well, and he said, does anyone want to have a go? And I said, yeah, I’ll. Yeah, fine. And [00:34:30] it’s only, you know, it’s it’s they’re only screwdrivers and tiny screws. Just don’t drop them. That’s [00:34:35] it. Just don’t drop the screws. Yeah. Or make sure you got some spare screws. It’s handy. Spare ones [00:34:40] are good. They’re quite tricky to find. Um, yeah, I don’t know. Restore restoring implants. [00:34:45] Fairly straightforward. Um, making implants look like teeth. [00:34:50] Very different story.

Payman Langroudi: As in the gingival?

Alex Hadley: Yeah. The stuff you’ve seen, [00:34:55] the stuff you’ve seen at Bard like the. Yeah, the the connective tissue graft and [00:35:00] the depth of placement. Um, yeah. I think making implants [00:35:05] look good is an awful lot in the, in the surgery. Um, and.

Payman Langroudi: You know, I’m quite interested in this [00:35:10] idea of, you know, the planning, being from the restorative dentist. Sort of. I [00:35:15] want the tooth here. Mhm. And then that being sent to the [00:35:20] if you’re, if you’re referring. Yeah. That being sent to the implant ologist. Yeah. [00:35:25]

Alex Hadley: Well fortunately yeah.

Payman Langroudi: Between you and the implant ologist as the referring dentist it [00:35:30] should be the referring dentist saying where they would like the end result to be the angulations and so forth, [00:35:35] and then for the implant ologist to sort of translate that to the operation in a way.

Alex Hadley: So, so fortunately, [00:35:40] I think this is this is a good reason why some of the best implant guys [00:35:45] are not specialist oral surgeons, right? They’re Sanjay [00:35:50] Restorative, Robert Shetty, you know, these are these are guys with BDS. [00:35:55] They’re not specialists and their work is beautiful. Um, so that’s I [00:36:00] think that’s the objective. That’s like that’s that’s what you can be a specialist.

Payman Langroudi: Prosthodontist. Right.

Alex Hadley: You [00:36:05] can. Yeah, you can be.

Payman Langroudi: That could be a good starting point.

Alex Hadley: You can, you can be. That’d be. Yeah, that’d be a great that’d be a great [00:36:10] starting point. But then, you know, there’s no you know, there’s no reason why you, why anyone [00:36:15] couldn’t do that work without being a specialist. Prosthodontist. Of course it’s, it’s yeah, [00:36:20] it’s a different model now I think. Yeah. Maybe. I actually do remember [00:36:25] having a chat with Paul about specialist lists. Um, because I know, I know [00:36:30] those. I know he was involved in the, the creation of specialist lists. Right. [00:36:35] Um, and I did I did ask him, like, you know, do you think it would be worth doing it [00:36:40] now? And this was five years ago when I graduated six years ago. Um, and [00:36:45] he said, yeah. He was like, yeah, the the punters don’t really [00:36:50] know the Difference. Um. And I’m not sure. I’m not sure it would be [00:36:55] worth it. You know, it’s like you’re not sure it’d be worth your time to go back to uni, take a huge pay cut. [00:37:00] You know, you get this training number. You you may or may not become a specialist on a specialist [00:37:05] list. And then, you know, at the end you’re competing with everyone anyway because everyone’s [00:37:10] marketing the same, the same work. Um, so yeah, I think that the practice model has changed, certainly with, [00:37:15] with keeping keeping all the specialities in-house, even if it’s dentists with special [00:37:20] interests. Um, which I think it probably makes it difficult as a patient to choose [00:37:25] who who to trust. Yeah.

Payman Langroudi: Um, it’s the specialist thing is [00:37:30] interesting because, like, if someone said to me, should I go and specialise [00:37:35] in fixed pros, um, or should I do the whole choice [00:37:40] continuum? Maybe you could, in the same time and money that it takes you to do [00:37:45] a proper speciality training. You could do a whole lot of.

Alex Hadley: Other.

Payman Langroudi: Training.

Alex Hadley: Yeah. [00:37:50] I mean, I’ve spoken to, uh, I’ve spoken to a friend of mine, a very good friend of mine, uh, periodontist [00:37:55] about his perio training at Kings. And he said, yeah, they place like 20 implants [00:38:00] in a few years. Yeah. Well, I was like, you know, I placed a couple hundred [00:38:05] in a couple of years, so, like, you know who who learns more about implants? You [00:38:10] know, the guy who’s placing more or the, you know, or the specialist who’s having, like, really [00:38:15] good teaching. The benefit is really good teaching, you know, really good specialist [00:38:20] level teaching about a treatment modality. Um, the drawback is there’s, [00:38:25] you know, you’re not actually doing that much hands on work. So and in a job which is mostly [00:38:30] practical, the hands on work, the ability to, to learn new things [00:38:35] as you go is I think.

Payman Langroudi: It’s a hands on job. It’s a hands on job, there’s no [00:38:40] doubt about that. Um, we mustn’t underplay, you know what else you get from a [00:38:45] specialist training, right? Yeah. The critical thinking part of it. Yeah. Um. The [00:38:50] contacts? Yeah. I mean, you know, you’ve got a few contacts. You had a few contacts. Yeah. [00:38:55] I would consider some people don’t have those. Yeah.

Alex Hadley: I would consider my, you know, my non-specialist [00:39:00] contacts, like, as good. You know, these are, these are guys working to specialist level doing, [00:39:05] you know, whatever they’re doing, you know, Rob and Sanj to help, help problem [00:39:10] solve. That’s you know, I think actually you hit the nail on the head there. It’s clinical. It’s just problem [00:39:15] solving. It doesn’t matter whether you’re a specialist or not. Um. Yeah. The ability [00:39:20] to fix your own problems is super important.

Payman Langroudi: And Rob Moretti, how did you [00:39:25] come across him? But how did you come across Bard? Sanjay.

Alex Hadley: Sanjay. Sanjay and Nick. [00:39:30] Yeah. It’s funny. He dragged me there. Yeah. Yeah, yeah. They said you should. You should. You’ll really like it. You should come.

Payman Langroudi: And you [00:39:35] know, that’s how. That’s how we met. Like, it’s an interesting thing, right? Because if if Sanjay Sethi [00:39:40] wasn’t the implant ologist at Dental beauty.

Alex Hadley: That if I hadn’t messaged Amit. Amit hadn’t put [00:39:45] me in touch with dev. Dev wouldn’t have like, you know, got me in the practice stage. I [00:39:50] wouldn’t have met Sanjay. I wouldn’t have met Nick, and it wouldn’t have gone to bad, you know.

Payman Langroudi: And it goes to show, you probably know the other [00:39:55] Payman, the beautiful Payman. Payman.

Alex Hadley: Yeah, he’s a good guy. He’s also [00:40:00] DB.

Payman Langroudi: He’s also Dental.

Alex Hadley: Beauty, also a bard. I met him at Bard first.

Payman Langroudi: Yeah, well, he told me his brother’s [00:40:05] practice. I don’t know if you’ve ever seen that one. No, it’s a stunner. Okay, it’s a stunner. It really is [00:40:10] beautiful. Um, actually, they moved, and now it’s. I think it’s not as stunning as it was, but. But it [00:40:15] was a stunner. Yeah. Um, very successful practice. He said the whole practice, [00:40:20] beginning to end, was dependent on one patient. And I was like, how could that be? And [00:40:25] he said, yeah, it was this one Qatari guy who came in. He had toothache. Yeah. They [00:40:30] if I remember, I can’t remember the story exactly, but he he excavated the pulp and [00:40:35] the guy said, how much? And he said nothing. He said, just come back in for an examination [00:40:40] that that connection, they got him the Qatari embassy and all that. Now they’ve got [00:40:45] a point where they go to Qatar and treat the royal family. Yeah. Cool. Yeah. Because of that one? [00:40:50]

Alex Hadley: Yeah. Just one interaction. Yeah. It’s almost like a cascade of. Yeah.

Payman Langroudi: But it goes to show you don’t know which one [00:40:55] of the interactions of the hundreds that you have is the one that’s going to [00:41:00] be one of those. Yeah. And so important isn’t it. Like me and you meet [00:41:05] over a coffee over in Bard. Yeah. Being, being being humble in all of those [00:41:10] interactions, or being a good person in all those interactions can lead to so many different things. [00:41:15] Yeah. And it’s a good lesson. Although personally, I’m very shy, you know. So if I go into [00:41:20] a room where I don’t know people, generally I won’t approach people. Right. Um, so, [00:41:25] you know, it’s something I could get over. Yeah. So some people are shy and some people are very forward. Right.

Alex Hadley: Have you done a [00:41:30] personality test?

Payman Langroudi: No. I just know I’m shy.

Alex Hadley: Yeah. You should do, like, one of the big five [00:41:35] traits.

Payman Langroudi: No, I have. Of course, of.

Alex Hadley: Course, I’ve done a few of those. I was gonna say. Yeah. Yeah. They’re interesting. Yeah. I’m about. I [00:41:40] think I’m about as extroverted as you. Yeah. Like the 98%. Yeah. [00:41:45]

Payman Langroudi: Yeah. Which one? Which one was your favourite personality?

Alex Hadley: The Jordan Peterson. Understand myself? [00:41:50] Oh, really? That’s a really I’ve done that a couple of times because I actually a couple of times like a few years apart. [00:41:55] Um, and I wondered whether they, whether those, those traits had changed, [00:42:00] like, whether, you know, has like my environment changed how I would answer those questions [00:42:05] in a few years. It’s basically exactly the same. So, so.

Payman Langroudi: Human interaction feeds you.

Alex Hadley: Yeah. [00:42:10] Yeah. Like, if I spend too much time on my own, I’m like, [00:42:15] I get a bit edgy. Yeah. Really need to go and talk to people. [00:42:20] It doesn’t really matter what I’m talking to them about or who they are. Which which. I mean, it’s [00:42:25] kind of like at work. I know, I know, I, I know I’ve met a lot of dentists who are really introverted. [00:42:30] Um, who it almost like saps the energy out of them. Yeah, yeah. Like [00:42:35] talking to people at work, you know, by the end of the day, they’re they’re, you know, they’re they’re completely [00:42:40] toast. I’m toast. But it’s because I’ve been thinking too much. I’ve been talking too much. [00:42:45] Um.

Payman Langroudi: Look, private industry is important to really connect [00:42:50] to each patient. I mean, it’s very important. Yeah.

Alex Hadley: Eight facts. [00:42:55] Sorry. Eight. Eight facts. Yeah. You should try and gather. Oh, is that right? Eight [00:43:00] pieces of information. This is. This is Ash Palmer gem. Oh, really? Really. Ash Palmer gem. Yeah. Facts. Before [00:43:05] you go. Eight facts. Yeah. So, uh, you’re asking the patient. Yeah, asking [00:43:10] the patient, like all. So he pretty much standardises, like, all the, um, like the questions [00:43:15] that he asks because it’s easier for the teacher to teach us. So, um, you know, [00:43:20] uh, have you been here before? Are you local? Um. So are you local? [00:43:25] Leads to, like. Oh, where do you live? Who do you live with? Do you have any children? Do you have any pets? Uh, [00:43:30] what do you do for fun? Um, those all those questions. You can ask those questions to anyone? [00:43:35] Yeah. Um, and then make sure they’re recorded the answers to those questions [00:43:40] because as a clinician, you will forget what the answers are. Okay. But the patient won’t forget that you ask them, [00:43:45] so they’ll think and then.

Payman Langroudi: Refer back to those.

Alex Hadley: Yeah. Yeah I mean yeah ash does. Yeah. [00:43:50] Particularly in like proposing treatment plans and whatnot. Um, he wouldn’t necessarily refer [00:43:55] back to them, but it’d be it’d be a reminder of kind of who the who that person is. Yeah, [00:44:00] yeah.

Payman Langroudi: And what I was going to say was in private dentistry, those conversations are absolutely [00:44:05] key. Yeah. Absolutely key. I mean, you know, whether or not someone [00:44:10] recommends you to a friend has more to do with whether [00:44:15] they like you.

Alex Hadley: Yeah. Than the work they say you’ve got you. There are three, [00:44:20] three things, right. It’s like you you either say there are three three [00:44:25] categories. Like the first is the patient likes you. Yeah. Uh, the second is doing the right treatment and [00:44:30] the third is doing the treatment. Well, it’s like you need two of those three. Yeah. I [00:44:35] like the ability to fall back on the patient liking me. Yeah. Because I’m sure at some point, you [00:44:40] know, there’ll be some. One of the others will, will will fall back. Yeah. Because, you know, you can you can be like a real, [00:44:45] you know, hard, hard dentist, like, you know, you know, kind of, uh, [00:44:50] not particularly friendly with patients, but you’re going to have to do the right treatment and do the treatment. Well, every [00:44:55] time, like, every single time. Um, but, you know.

Payman Langroudi: The other thing, I mean, the patient has no idea [00:45:00] what’s really going on in his mouth. Yeah. I mean.

Alex Hadley: Until you put the photos on the TV. [00:45:05] Well, and then they’re like, you’re horrified.

Payman Langroudi: You don’t have to put the photo. But but we all know there’s there’s [00:45:10] there’s many things you do that no one will ever know that you did. Yeah. The [00:45:15] the the way you put that particular matrix on. Yeah. You know what I mean? [00:45:20] I mean, all the way to just all the occlusal checks that you do. Excursions. Yeah. You [00:45:25] know, the patient has no idea how much care you are or [00:45:30] aren’t taking. They can get a feeling for it.

Alex Hadley: They definitely get a feeling.

Payman Langroudi: Get a feeling for it. But liking you. [00:45:35] Super important and having the time and being listened to and all of that sort of [00:45:40] stuff super important, especially if, you know, the patient used to be NHS [00:45:45] and was sick of not being talked to, sick of being seen late, sick of not [00:45:50] being listened to. Yeah. And I often feel that feeling if I go to the GP, [00:45:55] um, to the point that I’m looking for a private GP. Yeah, that he’s always 45 [00:46:00] minutes late. Always. Yeah, they might as well just tell me 45 minutes after they tell me. [00:46:05] Yeah, yeah.

Alex Hadley: And then I’m quite bad for running late. Incorrect. But not but [00:46:10] not incorrect. But not really. Not but not not not. Yeah. Not really bad. But you know, occasionally.

Payman Langroudi: I think [00:46:15] my GP is great. He’s a good guy like him. Yeah. He’s got no time man. Yeah. He doesn’t [00:46:20] even look up.

Alex Hadley: Yeah. 45.

Payman Langroudi: He asks questions. He asks questions and he’s typing. [00:46:25] Yeah. The whole time he’s he doesn’t look up.

Alex Hadley: Yeah. That’s that’s one of the worst things we can do I think you know the, the [00:46:30] typing the notes while the patient comes in. Yeah. So no, always go get your own patient. [00:46:35] Yeah. Always patient. They feel like you’ve taken the time. I mean, even if it takes 20s [00:46:40] one of those things.

Payman Langroudi: About the, you know, training your nurse thing. Yeah. Um, training your [00:46:45] nurse to write the notes. Yeah. Yeah. Is super good idea. Yeah. Until, [00:46:50] of course, you have to, you know, adjust them or whatever. Um, we were talking [00:46:55] about Kalish. Was that before we turned on the.

Alex Hadley: Yeah. Before we turned on. Yeah.

Payman Langroudi: He uses two.

Alex Hadley: Nurses. [00:47:00] Yeah.

Payman Langroudi: Yeah. And and, you know, his his hourly rate is [00:47:05] unbelievable. Yeah. Yeah. And when you realise that, you realise that the hourly [00:47:10] rate is through the roof. Because. Partly because. Yeah, there’s two nurses taking [00:47:15] care of everything, you know.

Alex Hadley: Yeah. Yeah yeah, yeah. I mean, yeah I could, I often make use of two [00:47:20] nurses, like with on an implant day. Like if I’ve got a couple of nurses then, you know, they’re, [00:47:25] they’re sometimes I always joke that they got unlucky that day. Yeah.

Payman Langroudi: Let’s continue. [00:47:30] So let’s continue with you then. Decided I wouldn’t mind sticking some of these implants in. So what [00:47:35] do you do next?

Alex Hadley: Um, I did the smile Dental Academy Pgdip. [00:47:40] Why do you pick that one? Sanj sanj Sanj recommended that I do. I think [00:47:45] he knew Rob and Martin were teaching on it, and, uh. [00:47:50] Yeah, I don’t know if he knew. I don’t know if he knows. Um, I think they I think they know each other, [00:47:55] but, um. No, I think he was more recommending the, um, the, the, the teaching [00:48:00] on the day, you know, with, you know, knows the guys quite well. Um, and [00:48:05] I was looking for one in London that started like, you know, soon. Yeah. Kind of because it’s going to take [00:48:10] a year to do all the lectures and then, you know, it’s, what, 18 days? Um, no. The good [00:48:15] that actually. Um. Yeah. Gin and Kirsch, they’re, uh, they’re quite humble guys, [00:48:20] right? They like, they they look like larger than life characters. They kind of are with, like, the hair and the facial hair, [00:48:25] but it’s all I think it’s all marketing like this, you know, the pointing at each other and the. But they’re, um. Yeah, [00:48:30] they’re really nice guys.

Payman Langroudi: Pleasant when you get to know them, because you imagine one thing and then you get [00:48:35] to know them. And it’s a totally different thing to what you imagined it would be.

Alex Hadley: Yeah, I’ve got a few. I’ve got a few friends like [00:48:40] that. I’ve got a couple of friends, um, a couple of friends who I’m still friends with from from university. And they, uh, [00:48:45] they, I remember them walking into the first lecture, uh, like, around. Well, first, [00:48:50] first lecture of the day around Christmas. And they were wearing matching Christmas pudding jumpers. [00:48:55] Right. And they were, they were half an hour late. So they walked all the way down to the front and sat at the front. [00:49:00] And I thought, I’m never going to be mates with these guys. These guys are ridiculous. I’m never [00:49:05] gonna be friends with them. Here we are like 12 years later and I’m really like nearly [00:49:10] best, you know, best mates with these guys. Yeah. Um, yeah. Really funny. So gin and Kirsch. Yeah. They, you [00:49:15] know, take, you know, your first glance, you think, oh, I’m not going to like these guys. And then they’re just really humble, [00:49:20] nice guys. Um, yeah. So, so they, um, I think they’re [00:49:25] like, they’re great kind of orchestrators, like, you know, conductors of the of the of the orchestra. [00:49:30] Um, and like, they, you know, they just bring loads of good guys in. [00:49:35]

Alex Hadley: Um, the other good thing about the Smile Academy was the [00:49:40] access for mentorship in practice. So if you can do all the stuff [00:49:45] that we were talking about before the communicating with patients, they’re talking to them about the best treatment options. [00:49:50] And then, you know, discussion of all the risks and benefits and pros, cons, time, cost [00:49:55] implications, whatever else. Um, then then, you know, there was an [00:50:00] availability to get mentorship in practice so I could start placing implants [00:50:05] on my own patients. And I can, I can imagine for for some people, that’s kind of tricky. If you if you [00:50:10] don’t have access to the patients, um, or the principal doesn’t trust you to be placing implants [00:50:15] on, on their patient, then then that that might be hard work. But actually it kind of all worked out really [00:50:20] well. You know, I get really good level of clinical freedom at all the practices I work in. Um, and, [00:50:25] you know, some Sermon and cash coming in to help with the surgery. It was really good. [00:50:30] And then I already, already kind of knew what I was doing with with restoring the model.

Payman Langroudi: You pay for the is [00:50:35] it did you say 18 days?

Alex Hadley: Yeah. So it’s I mean it’s about it’s about ten grand plus VAT [00:50:40] ten. And then you pay.

Payman Langroudi: For the mentorship on top.

Alex Hadley: You pay for the mentorship on top. But they’re fairly reasonable. [00:50:45] It’s like £300 an hour, something like that. But you’re charging the patient for so you know, not [00:50:50] not lots but I’m charging you know, charging the patient. Um.

Payman Langroudi: And so your first [00:50:55] few literally over the shoulder, you’ve got someone. Yeah.

Alex Hadley: Yeah, yeah. Placed like [00:51:00] five on the first day. They got so many. Yeah. Wow. Yeah. No it was good. Like, [00:51:05] it had, like a full surgical guide and all sorts. Oh I see. So it was like it was fully planned, you know vivo [00:51:10] Dental lab at the time. So, um. Yeah, you know, we. Yeah. [00:51:15]

Payman Langroudi: So immediately you’re almost confident. Almost. I [00:51:20] mean, that’s a big thing to say. Yeah.

Alex Hadley: I mean, yeah. Is that a thing? I don’t know whether it’s. Yeah. Is that [00:51:25] I think I’m. I think I’m where as, um, where as a student, I thought, [00:51:30] ah, um, the patient would be better seen by someone else. Now, I think [00:51:35] it could be a lot worse if they saw someone else. So I feel much, you know, I feel I feel very [00:51:40] confident that I’m trying to do the best thing for the patient. And so that’s the main [00:51:45] thing. Like, I’m not going to leave them, you know, stranded without an option or without a tooth [00:51:50] or you know, what, you know, with a complication that could be quite bad. With implants, the complications get [00:51:55] a bit messy. What was the.

Payman Langroudi: First complication you had?

Alex Hadley: Oh.

Payman Langroudi: Something [00:52:00] that surprised you?

Alex Hadley: Oh, I placed an implant. Then within two weeks, there’s kind of pus everywhere. [00:52:05] Had to take it out. I think it was just. I think it was high torque. It was quite high torque [00:52:10] and Solanki.

Payman Langroudi: The implant is a funny thing. Sometimes you do everything right, and yeah, it doesn’t [00:52:15] work.

Alex Hadley: No indication that the patient, you know, you know, relatively young guy like 30s, 40s. [00:52:20]

Payman Langroudi: Not smoker.

Alex Hadley: Not a smoker, medical history. You know, it’s like, you know, very. No, [00:52:25] no, nothing weird on the medical. Um, yeah. Surgery was [00:52:30] straightforward. Um. Didn’t do anything. Didn’t do anything. Didn’t do anything extra. What was the [00:52:35] first grafting? Gum grafting. What was the first.

Payman Langroudi: Complication that you learned something from? Because I guess that one was. [00:52:40]

Alex Hadley: The first complication ever.

Payman Langroudi: The first thing.

Alex Hadley: You learned.

Payman Langroudi: In a poignant. Yeah. In implants. [00:52:45] Learned a poignant lesson from.

Alex Hadley: Mhm. Well, that I mean [00:52:50] there are a few. Right. I can’t remember which one was the first failure but they, they fail. They fail [00:52:55] at say like, you know, 1% of the time they fail. So I’ve had a, you know, good few failures. [00:53:00] Um, I think you learned something different from each one. So I mean, that that one. Yeah. That case was, [00:53:05] you know. Oh, well, I knew it went in at pretty high torque. Um, so next time, [00:53:10] you know, don’t don’t put it in such high torque. You know, don’t push on the bone. Bone won’t necrose. [00:53:15] Um, yeah. Other other ones. Um, yeah. If the [00:53:20] bone is super hard, you know. Don’t use such an active implant. Um, you know, if you [00:53:25] get crestal bone loss around the implant, maybe place it a little bit deeper, or, you know, you can learn something else from from every [00:53:30] from every failure. There is, like, a reason, you know, why or [00:53:35] even every complication. And it’s like it’s an iterative process where you, you clearly [00:53:40] only really know what you’re doing when you’ve placed 500, 1000, you know, [00:53:45] that’s when you can kind of foresee what the problems might be before you place the implant. [00:53:50] Um, and kind of adjust your, your whole process in order [00:53:55] to favour success, whatever that success, whatever your, your definition of that success might be. [00:54:00] Um, whether that’s, you know, the aesthetic stuff or, you know, lower risk of complication [00:54:05] or, um. Yeah. Or or anything. Um, so [00:54:10] yeah, I think, I think it’s a, it’s a process and, and, and after that, talk to me in five years, [00:54:15] I’m sure I’m sure the complication rate will still be there’ll still be complications. There’ll always be complications, [00:54:20] but it’ll be.

Payman Langroudi: I’m interested in the early ones because they’re what puts people off going in. [00:54:25]

Alex Hadley: Yeah, but but like like you, you have to be honest with the patient. If you’re honest with the patient from [00:54:30] the get go, that this might not work. There might be problems with this. These are the potential [00:54:35] problems. Yeah. Um, then when you have a problem, it’s much easier to talk to them about the problems. [00:54:40] And if they if they do kick up a bit of a fuss, you know, you say, well, you know, I [00:54:45] was honest with you that this is a risk. Um, yeah. You [00:54:50] can do everything you can to try and avoid those, those those risks. You know, you’ve got guided surgery [00:54:55] or having a mentor or, you know, just different, different techniques. [00:55:00] Um, but but, you know, you can’t you can’t get rid of the risk of complications. [00:55:05] So you have to be you have to be confident that you can deal with the communication about the [00:55:10] the complication. You know what what happened? Why did it happen? Perhaps. [00:55:15] Um, sometimes I’ve, I’ve spoken to some dentists who’d rather say, oh, you know, I just [00:55:20] didn’t kind of didn’t didn’t work out. Um, and I try and try and, uh, like, [00:55:25] skirt over the issue, whereas I sometimes I feel, I feel like the patient kind [00:55:30] of knowing that if you, if you, if you do plan to replace the implant, like why it’s probably [00:55:35] still got a good chance of success. That’s quite handy. Yeah. So you know, oh, well, in this case, [00:55:40] this happened. You know, it failed. But, you know, I think I think I [00:55:45] know why it might have been a problem. Um, in future, I might think they might do things a little bit differently. [00:55:50]

Payman Langroudi: You know, some, some, some young dentists are paralysed by the fear of things [00:55:55] going wrong. Yeah. And constantly thinking about that.

Alex Hadley: I was I was talking to [00:56:00] a guy. Yeah. Uh, at, um, like, [00:56:05] at the weekend at Martin and Nick’s FP1 course. There’s a max. Max dude [00:56:10] from from Brisbane. And he said he’s, um, he’s so he’s, [00:56:15] he’s insured ensured to place implants but not restore them because GMC registered, not GDC [00:56:20] registered. Um, so obviously like placing the implants fine. Not doesn’t count as dentistry. [00:56:25] But he said he gets more more like more kicks [00:56:30] or like more stress. You know, the adrenaline from placing an upper central implant [00:56:35] versus doing these big cancer resections like, you know, cutting brain. He [00:56:40] reckons he’s 100,000 times more likely to get sued for the upper central implant [00:56:45] than the brain surgery, where, you know, they’ve consented the patient. You might [00:56:50] not be able to see or taste or, you know, hear or, you know. Yeah, [00:56:55] yeah. How interesting. Yeah. Really interesting.

Payman Langroudi: Because it doesn’t paralyse you somehow.

Alex Hadley: Um, [00:57:00] well, I mean, we like I all you all you can do is provide [00:57:05] the patient with it. Yeah. I mean, all you can do is provide the patient with the options, discuss which one you think is [00:57:10] the best option and why. Um, and kind of guide them. And [00:57:15] yeah, if something goes wrong, I mean it. Something, something. Something goes wrong. [00:57:20] It’s it’s both. It’s both a learning point and, [00:57:25] you know, a problem to solve. But you had a problem to solve before. Sometimes you place an implant. [00:57:30] Implant fails. What’s the what’s the real downside risk? Well, they’re only in the same position [00:57:35] that they were before. Yeah. Um, okay. Admittedly, sometimes it could be it could be a trickier problem to fix, [00:57:40] but but, um, no. Overall, I think, um, no, I’m not I’m not paralysed [00:57:45] by it. I, I think I think just speaking to people [00:57:50] frankly about what’s happened is sufficient. And you have insurance. [00:57:55] It’s not like, you know, everyone’s going to get a letter.

Payman Langroudi: It doesn’t. We can all sort of talk [00:58:00] about it and logically sort of say it. Yeah. But some people, their demeanour is to [00:58:05] be paralysed by that fear and some people their demeanour isn’t.

Alex Hadley: I think we can hit the, um, the [00:58:10] personality trait. Yeah, exactly. Again, my super low in neuroticism. Yeah. Yeah. Lots [00:58:15] of people like to say, oh, I don’t care what other people think. Yeah. I actually don’t [00:58:20] really don’t really care what they think. Yeah. What they think. Um, you know, it’s just it’s just [00:58:25] like a rational, problem solving mentality. It’s like, if this, then this, if that.

Payman Langroudi: Then what’s [00:58:30] the what’s the most complicated implant case you’ve done? I mean, how how far have you complicated. Do you graft. Do you sinus [00:58:35] lift.

Alex Hadley: Do you do some stuff that I know? Uh, well I know [00:58:40] Paul. If he’s listening, it doesn’t. He’s not big on immediate loading or bone grafting or any of [00:58:45] that stuff. Like he likes just using, like, host bone and whatever. But I think increasingly immediate [00:58:50] loading full arches is becoming the norm. Um, so what. [00:58:55]

Payman Langroudi: Do they call for?

Alex Hadley: Yeah. So I’ve got I’ve got a few of those lined up. I’ve [00:59:00] not done much immediate loading yet. Um, like in the grand scheme of things [00:59:05] I have, I have done. Well, I guess I have done quite a bit of immediate loading, but not, um, I it’s all relative, [00:59:10] right? Compared to Martin and Nick, I’ve done nothing. Yeah. Um, compared to your average dentist placing, [00:59:15] you know, 12 implants a year? I’ve done loads. Um. But. Yeah. Immediate [00:59:20] loading. Full arches is really tricky. Um, but, [00:59:25] yeah, I mean, I mean, what? I was trying to work this out yesterday. I’m probably including, [00:59:30] like, travel and food. I’m probably 100 grand in courses, so [00:59:35] I, you know, you just need to speak to people who who have already experienced [00:59:40] all these. But there are two different ways to learn, right? There are two different ways to learn either. Um, find [00:59:45] out from your own failures or find out what to do from other people’s failures. [00:59:50] Yeah. It’s quite. It’s nice to find them out from someone else. Of course. Really [00:59:55] handy to avoid the failures in the first place or avoid avoid the complications. Um, so [01:00:00] yeah, I mean, Martin and Nick, also, guys that I met from bath.

Payman Langroudi: Um, Martin [01:00:05] and Nick, ten Dental. Yeah. Yeah.

Alex Hadley: Good. Great. Great, [01:00:10] guys. Yeah. And then, um. Yeah. Met Paulo Carvalho last last week [01:00:15] at their course, and, uh. And he’s speaking at Bard. So, um, [01:00:20] I hope he’s speaking on the. I hope he’s speaking on the Friday because Martin tasked me with [01:00:25] looking after him on Friday night. So let’s hope he’s not like a Saturday morning lecture. Oh, no. See [01:00:30] if we can break the Portuguese man. Yeah. Um, but. No. But but so? [01:00:35] So, yeah. You know, um, you just got to have have, you know, guys who’ve done it before, [01:00:40] who’ve had these problems before. Yeah. And if you can’t fix it or if the patient doesn’t want you [01:00:45] to fix it because they’ve lost faith in you, which fortunately hasn’t happened yet, you. It’s [01:00:50] nice to have guys like them who are super knowledgeable and, like, really generous [01:00:55] with their knowledge, um, to help you fix the problem or to fix the problem for you.

Payman Langroudi: Well, [01:01:00] in that vein, in the vein of learning from each other’s mistakes. Yeah. We come to the darker [01:01:05] part of the pod. What comes to mind [01:01:10] when I say clinical errors? What clinical errors have you made that other people can learn from?

Alex Hadley: It’s [01:01:15] all it’s all communication based. I [01:01:20] treated a patient in PhD, um, trying to do some heroic [01:01:25] dentistry on, you know, a couple of lateral incisors that were root treated. They [01:01:30] were also bridge abutments for a four unit bridge. 2 to 2. Yeah. And so I spoke [01:01:35] to my, my, you know, PhD trainer, and he was like, yeah, yeah, yeah, we’ll we’ll do it. We’ll root treat that abutment [01:01:40] and then you’ll replace the bridge. And I wouldn’t even do that now. Mhm. Um but he thought [01:01:45] oh it’d be good. You know it’s good practice for you patients you know being treated on the NHS. We’re trying to do them [01:01:50] a favour but I don’t think I hadn’t, I hadn’t communicated all [01:01:55] the risks properly. When I went to take the temporary bridge off.

Payman Langroudi: Um, half [01:02:00] the tooth fell off.

Alex Hadley: Yeah. Obviously, obviously the obviously the prep kind of dechlorinated in the temp [01:02:05] and there’s a click, you know. But the click was the the luxe attempt fracturing, not the tooth fracturing [01:02:10] which was already fractured. You know, it was kind of mobile when she came back. Um, and so [01:02:15] she her opinion was that I had broken the tooth. And so, you know [01:02:20] what I mean? What did we do? I think now now, what I would do is like [01:02:25] everything possible to not leave that lady without teeth. Uh, but at the time, [01:02:30] got my trainer in. He was a bit, you know, bit old school, like, very, very good [01:02:35] dentist, but a bit old school. He was like, right, we need to take an impression. You need a denture. This denture [01:02:40] time, it’s denture time. Right. So we’ll get quick turnaround on a denture. You have a couple of days. You know. [01:02:45] We’ll get it sorted over the weekend. Coming on Monday we’ll give you a denture. So like 3 or 4 days turnaround. [01:02:50] How old was she? Uh, she was like in her 60s, but obviously devastated. She lost her front [01:02:55] teeth. Yeah. Um, what would I do in hindsight? Well, first of all, wouldn’t have been planning that, um, [01:03:00] just en route, treated abutments, you know, probably probably wouldn’t have bothered now.

Alex Hadley: It would be an [01:03:05] implant case. Right now it would be an implant case before I touched it, um, would have [01:03:10] a CT and have spoken to her about the best option. And then if if she [01:03:15] chose the, you know, the alternative option, which is not the implants and [01:03:20] something went wrong, I’d be you know, I’d be saying, well, I told you about this. We discussed it at length. [01:03:25] You got a letter? Yeah. You remember the letter that you read? And so. Yeah. Like that’s the. Yeah. So so yeah, [01:03:30] that that, that that’s probably the worst one. That was um, I think she decided after a, after a couple of years. [01:03:35] So it’s still, you know, it was probably only a couple of years ago, uh, we got a letter, like [01:03:40] a solicitor’s letter. She obviously, you know, had a denture, wanted [01:03:45] implants, wanted them for free. Still felt, you know, um, still felt [01:03:50] that she’d been kind of affronted or, um, so that it kind [01:03:55] of it went nowhere. Like the note. The note. Our notes were perfect, right? It was like, you know, this this is what happened. [01:04:00] And then it was corroborated by my PhD trainer. And he was, you know, his [01:04:05] vicarious liability. You know, we both spoke to DS, uh, at the time [01:04:10] and then, you know, later, and we were trying to do her a favour and it was, [01:04:15] you know, you know, the intention was, was known.

Alex Hadley: And so it didn’t go anywhere. But [01:04:20] it took ages for, um, the indemnity organisations to take that off, [01:04:25] you know, to like, you know, clear your record. Yeah, yeah, yeah. It took years, like [01:04:30] three years or something. Um, yeah. Now I’m with TDs. I [01:04:35] can’t speak highly of them. More highly of them, to be honest. Like you had to call them. Uh, [01:04:40] yeah, I yeah, a couple of times. Um, interestingly, never like [01:04:45] the there’s never the high risk stuff. There’s always like, fillings or something. Yeah. You know, a patient, you know, [01:04:50] patient turns up saying, oh, you know, you drill too much of my teeth and it’s sensitive. It’s like, well, no, [01:04:55] I’ve got a photo. Yeah. You know, just where they get a bit. Yeah, they just get they sometimes get [01:05:00] a bit funny, which comes down to communication. Yeah, it’s always like it’s always treatment [01:05:05] that I’ve kind of, I think because I see the case and I think, look, I can, I can sort you, I can help you out. Now, [01:05:10] you know this. Um, actually, one of one of these. Yeah. Was not, um, wasn’t even a sensitive [01:05:15] tooth.

Alex Hadley: A patient came in with, like, a little, you know, chipped, uh, like, [01:05:20] incisal edge on a central and had clearly been repaired with composite before. And I said, well, you know, [01:05:25] I probably don’t even need to use local. I can, you know, get this off for you and, uh, and put, [01:05:30] put a new composite on and it’s the bread and butter. I do, you know, thousands a year. So [01:05:35] you know why? You know what would what would be the problem? Um, but it’s like the treating the patient without [01:05:40] having built the rapport, you know, rushing to get to the treatment, because I think that it’s [01:05:45] more effective for them. Yeah. What’s the best option for them for fix the tooth now. But actually [01:05:50] that, that, that, that can put you in a tricky situation where, you [01:05:55] know, maybe it would have been better to find out why this patient is [01:06:00] so worried about me removing the old composite. You know, what’s this? You know. Do they have some? Almost [01:06:05] like, psychological profiling? Yeah. Um. And now working in the Botox practice, you [01:06:10] know, face mad, um, that there’s, you know, the the patients [01:06:15] are great. The patients really want aesthetic treatment, but there they are. [01:06:20] Yeah, they are very discerning. Yeah. So tell us.

Payman Langroudi: About that practice. Face met.

Alex Hadley: Uh, [01:06:25] face met. Uh, Billericay. Yeah. Um, yeah. The the, [01:06:30] uh, principle is not dentist. She’s a medical nurse with 20 plus [01:06:35] years in facial aesthetics. Super interesting. She’s really cool. Yeah. [01:06:40] Um, incredible businesswoman, Monica Barranger. Uh, her son’s a dentist. [01:06:45] Works in the practice. Um, there’s another dentist and myself. There’s an [01:06:50] operating theatre downstairs, and, uh, they have plastic surgeons [01:06:55] on rotation. Station is plastic surgeons take referrals from Monica for, you know, off [01:07:00] her list for blepharoplasty or liposuction or whatever. Um, [01:07:05] and then there’s a foot and ankle surgery list, bunions, that kind [01:07:10] of stuff. Like there’s almost like an NHS list there as well. Um, yeah. [01:07:15] Very cool. Cool. Cool practice. Uh, really nice setup.

Payman Langroudi: Does it look nice as well?

Alex Hadley: Yeah. [01:07:20] Everything’s white. I kind of feel like it’s almost like this. Payman. Um, it’s [01:07:25] like. I feel like, um. I feel, you know, uh, in Bruce Almighty, like, uh, Morgan [01:07:30] Freeman is, like, in heaven, right? He’s like in heaven. Everything’s white. That’s kind of how I feel in face med. It’s, [01:07:35] uh. Yeah, very clean, very, very clinical. Um, but, yeah.

Payman Langroudi: The patients. [01:07:40] Are you doing similar work or more complex work there?

Alex Hadley: Similar work? Yeah. So general dentistry [01:07:45] and general dentistry. Implants and smile makeovers. Yeah, yeah, yeah.

Payman Langroudi: Let’s talk about [01:07:50] smile makeovers. So you worked with ash for a while?

Alex Hadley: Yeah, for short for [01:07:55] a short while. Yeah.

Payman Langroudi: And you did the course?

Alex Hadley: Obviously. Yes. Yeah.

Payman Langroudi: And you do a lot of small makeovers. Porcelain [01:08:00] smile.

Alex Hadley: Makeovers? Yeah. Do a good mix. Mostly. Mostly ceramic. Yeah.

Payman Langroudi: And I [01:08:05] noticed quite a lot of composites as well.

Alex Hadley: Yeah. Well, I mean, the, um. Yeah, you can’t [01:08:10] you can’t discount composites as a as a material, but it’s definitely an inferior material. [01:08:15] Right. It doesn’t it doesn’t last as long, of course, you know, chipping, staining whatever else. [01:08:20] Um, but yeah, lots of patients want it. And, you know, they don’t want prep prep [01:08:25] teeth. Um, sometimes I do. I’ve done some, uh, indirect, [01:08:30] uh, kind of ceramic composite hybrids as well. So I’ve done some of that prep [01:08:35] and no prep. Probably a mistake. No. They’re okay. I’ve not had problems with them. I’ve not had problems [01:08:40] with them. Yeah. No. Hard to get that right. Yeah. They are tricky. As long as you’ve got the right tooth shape. You need [01:08:45] a good tech. You need a good tech. Right? Yeah. Um, and also the good techs, they tend their tendency is to make [01:08:50] them too thin. Mhm. Because they want like, you know, they almost want to show off like ideal. [01:08:55] Yeah. So they kind of make this the indirect, um, kind of composites, the milled composites [01:09:00] a bit too thin, especially the hand finishing them from half a mil thick to, [01:09:05] you know, when you say too.

Payman Langroudi: Thin, what is it, the.

Alex Hadley: Risk of fracture. Oh, it’s a risk of fracture. [01:09:10] Yeah. Yeah, yeah.

Payman Langroudi: Had issues with that from physical?

Alex Hadley: Yeah. It’s just mechanical. Yeah. But I mean, at least [01:09:15] they don’t stain up. They look nice at, you know, three years, they still look good. Like [01:09:20] composite bonding. You know, patients, if patients don’t look after them, even if [01:09:25] they do look after them maybe kind of five years, they start to kind of stain up [01:09:30] and then got them off and. Yeah, we.

Payman Langroudi: Teach on on. We teach [01:09:35] to bleach them.

Alex Hadley: Oh yeah. Yeah, yeah I get them to that and sensitive toothpastes because [01:09:40] they’re less abrasive. Yeah.

Payman Langroudi: Um, we’ve done the bleach, the composites one one [01:09:45] day a month. Okay.

Alex Hadley: Yeah.

Payman Langroudi: To prevent from.

Alex Hadley: Stain. Yeah. I met Depeche at Bard as well. That’s [01:09:50] right. Yeah, yeah yeah.

[TRANSITION]: Yeah.

Alex Hadley: Yeah. No. Yeah. In fact he, he, he did a, he did a talk [01:09:55] with the, the, the amazing photo of the fractured tooth with one of his [01:10:00] engineers with the four layers. That’s just. Yeah. Crazy. I’m not I’m not big on kind of layering [01:10:05] composites. I don’t you know, I’m not a single shade. Yeah. Like mono shade builder. I think Patience [01:10:10] in Essex wants straight white teeth. They want primary anatomy. Yeah. You know, as as.

Payman Langroudi: Primary anatomy is [01:10:15] the key. Yeah. People who try and get on to secondary and tertiary without [01:10:20] doing primary properly. Yeah, there’s lots of that going on.

Alex Hadley: It looks a bit silly.

Payman Langroudi: It’s silly, [01:10:25] it’s silly. If you could just do primary, you’ll make most patients happy. Yeah. And many [01:10:30] people can’t just do primary, you know. Can’t do it. Well, yeah.

Alex Hadley: Um, I think [01:10:35] you have to have a bit of an eye for it. It’s handy. Composite works handy for the implant stuff because [01:10:40] of the temporary PMMa temps. Yeah, if you’ve got a patient in temps. Yeah. Yeah, it’s kind of [01:10:45] handy because you can. Yeah. I mean, you can add composite and change like the contour, the restoration [01:10:50] and move, the gingival zenith and all this stuff. Um, yeah. Yeah. [01:10:55] So sometimes I get a try in restoration back and it’s, [01:11:00] it’s easier for me to prep the tooth that let’s say it’s like a, a cantilever bridge [01:11:05] central on, like a single central implant. Right. And it’s, and it’s a little bit rotated I can just prep it back, [01:11:10] you know, change the shape of it and then scan it Intraorally [01:11:15] send that to the tech or take a little putty of it, and then he can copy that. Exactly. Take a full face photo. You can [01:11:20] move the midline. Um, and like, you know, it’s it’s a one step finish. Yeah. [01:11:25] Whereas if I just take a photo and send it to him, it’ll come back. It’ll still be wrong. [01:11:30] It’s obviously still going to be wrong. Um, yeah. Having a technician who’s good, who you can [01:11:35] work with that closely is really, really handy.

Payman Langroudi: Really important. Yeah. You know, I think [01:11:40] people underestimate how much they can learn from their technicians as well.

Alex Hadley: Yeah, I mean, I took it I [01:11:45] forced him to come with me to Martin and Nick’s next course last week. Yeah yeah yeah yeah.

Payman Langroudi: I learned loads [01:11:50] from one of my technicians. The guy was just brilliant. Yeah. And I learned loads and loads and loads [01:11:55] from him. Um, I think people underestimate how much they can learn from sales reps. Yeah. The constantly [01:12:00] sales reps being stopped from seeing the dentist. The sales reps got this like loads and [01:12:05] loads of knowledge from the market. Yeah. Yeah. Um, that the receptionist [01:12:10] would do well to encourage sales reps. Yeah. I mean, I’m not I’m not even talking from [01:12:15] the selling anything to the to the dentist. I’m talking about that sales rep has talked to a [01:12:20] thousand dentists. Yeah. Yeah.

Alex Hadley: And and dentists know they’re being sold to.

Payman Langroudi: No, [01:12:25] no, but this has spoken to a thousand dentists, right? Yeah. So understands what lots of people [01:12:30] are saying. Yeah, yeah. About any aspect of, of the, of [01:12:35] course, the aspect that that sales rep is selling. Let’s say he’s a scanner seller. Yeah. He’s [01:12:40] talked to a thousand dentists about scanners. Yeah. The questions that different people are asking, what they want [01:12:45] and all that.

Alex Hadley: And you can modify the product.

Payman Langroudi: But also those thousand dentists have told him things like, I can’t find [01:12:50] a nurse, or I found a place to find a nurse or, you know, in the chit chat, you [01:12:55] know, it’s important. It’s important. I want to move on [01:13:00] to the future. Yeah. Because, you know, you’ve got a lot of potential. [01:13:05] Um, I said, I started off by saying I started enlightened. Same age as you are now. [01:13:10] Yeah. Are you the type to start a practice? [01:13:15] Are you the type to teach?

Alex Hadley: I think I think the the practice is [01:13:20] the logical next step. I think it I think it is. Um, do [01:13:25] you think it’s.

Payman Langroudi: Something you do alone or in partnership or.

Alex Hadley: Um, I think I do it alone. Having [01:13:30] looked at the personality test that, you know, we were discussing earlier, I think I would [01:13:35] need to hire for my, my deficiencies. So I think, you know, my organisational [01:13:40] skills are pretty poor. I’m quite big picture thinker. Um, so. Yeah. Have [01:13:45] it. You know, I need someone detail oriented to to sort that out. I think practice is is [01:13:50] going to happen.

Payman Langroudi: Um, I wouldn’t discount a partnership if you’re that person. Yeah, [01:13:55] because it’s good to have a partner who’s obsessed by systems. Okay. [01:14:00] Yeah. Because if you’re not. Yeah, yeah, yeah. Um, you can say I’ll hire someone in for that [01:14:05] job. Yeah, yeah. But then let’s let’s say you’re not good just for the sake of the argument. Say you’re not good with accounts. [01:14:10] Yeah, yeah. If you don’t understand a spreadsheet and you know, the way [01:14:15] the profit and loss and all that, you can hire someone in for that. Yeah, yeah, but [01:14:20] a.

Alex Hadley: Partner is going to have like a vested interest in it. Yeah.

Payman Langroudi: No partner. Yeah. Is is [01:14:25] what you want in that situation. Yeah. You want someone to really understand and not, [01:14:30] by the way, steal from you. Yeah. You know there’s so many. What are you going to do. Hand your, your bank [01:14:35] card over to someone you don’t know at all. You know, I’m not saying it’s the wrong. Yeah, yeah. There [01:14:40] are people who who don’t want partners. Yeah, and they shouldn’t have partners because they’ve [01:14:45] got very strong ideas and they don’t they don’t want to sell an idea to anyone. [01:14:50] Mhm. Um, but I’m saying don’t discount it anyway. Yeah.

Alex Hadley: Yeah. [01:14:55] So. Yeah. Yeah. Noted. Yeah. Thanks. Thanks.

Payman Langroudi: Well, how far are you? Are you. Are you [01:15:00] literally looking or.

Alex Hadley: I’ve been looking for. Oh I’ve been looking for a while. There is like [01:15:05] a. Yeah there is. Yeah. I’ve got something cooking but. Oh, really? Sure. Yeah. It’s not nothing set [01:15:10] in stone, as you all know. So. Yeah.

Payman Langroudi: Can you tell us anything? Squat or. Existing. [01:15:15]

Alex Hadley: Existing. Existing. Practice? Yeah. Room. Room for lots [01:15:20] of extra surgeries.

Payman Langroudi: It’s a good idea. Good idea to do that. Right.

Alex Hadley: Good car parking. [01:15:25]

Payman Langroudi: Good car parking.

Alex Hadley: So it’s like, you know, there are fundamentals that are good. Um, [01:15:30] no, I have tried I’ve tried to buy a couple before. I’ve put put a couple of offers in, but nothing’s worked out. [01:15:35] Um, and then one.

Payman Langroudi: Thing you should bear in mind is that the Dentist [01:15:40] nurse relationship, which I’m sure you’re great with all your nurses is different. [01:15:45] Yeah. When you’re the owner, is it? Yeah.

Alex Hadley: Very, very different. It can be quite jovial. [01:15:50] Yeah. I’ll turn up as the associate and, like, make jokes.

Payman Langroudi: Brilliant associate. It was a brilliant [01:15:55] associate, man. And me and the nurse were, like, in a team together. And our room was very proud [01:16:00] of what we did. I would always represent the practice myself. Try really hard to explain what the [01:16:05] practice is doing and all that. Yeah, yeah, yeah. As an owner. So stuff comes up that just. It’s [01:16:10] just unpleasant, man. Yeah. Unpleasant stuff comes up. Um, yeah. As an associate, it’s very [01:16:15] rare that unpleasantness happens to you.

Alex Hadley: Leave that at the door. Yeah, yeah, yeah. I mean, that [01:16:20] is. I’m in the fortunate position. I think it’s probably one of the reasons why I could progress clinically so quickly is I [01:16:25] have nothing else to worry about. Right. I don’t have to worry about making payroll or whatever [01:16:30] else. I can just concentrate. Just know kids. Yeah. Um, mortgage? [01:16:35] No kids, no mortgage? No. Like, I’m a I’m a I’m a free man. Oh, lovely. [01:16:40] Um, yeah. So. So, yeah, I’ve almost. I could effectively have almost no [01:16:45] overheads. Um.

Payman Langroudi: It’s interesting. You should. We should have a conversation about what you should do in [01:16:50] this moment. Yeah. Um, but what about teaching?

Alex Hadley: Yeah. Would like [01:16:55] to would like to teach a prep course or, you know, small makeover course from [01:17:00] patient journey through to, you know, planning and execution of [01:17:05] small makeovers with, you know, bonding porcelain veneers. Um, and then I think [01:17:10] the I think the plan is when, let’s say when in five years [01:17:15] when I’m, you know, as, as, as good at some of these other guys doing FP1 full arches [01:17:20] and, and soft tissue grafting then. Yeah, I think an implant course would be good as well. Um [01:17:25] but I think I need to, I need to get through to that thousand implant mark.

Payman Langroudi: So you reckon [01:17:30] in the porcelain area you’re further ahead than you are in the implant area? As [01:17:35] in, you feel confident that you can teach the porcelain. Yeah.

Alex Hadley: Yeah, yeah. So I’ve done. Yeah, I’ve. [01:17:40] I was trying to work out how many smile makeovers I’ve done on like, through in, like, composite or [01:17:45] ceramic and it’s got to be, it’s something like, you know, from 4 [01:17:50] to 20 5 or 4 to let’s say 28 units. I don’t think I’ve ever done a 28 unit, but let’s [01:17:55] say 4 to 24 units. I’ve probably done over 500 cases, like probably [01:18:00] nearing a thousand, you know, mini smile makeovers with composite veneers or [01:18:05] porcelain veneers or bigger, bigger cases.

Payman Langroudi: I mean, no wonder Will buys you whatever you want. [01:18:10] Yeah, you’re you’re a profitable associate, right? Yeah. If [01:18:15] that’s the case.

Alex Hadley: He I guess he knows that he does know that he’s a good he’s a good [01:18:20] principal as well. He is good.

Payman Langroudi: So what are we talking this courses on the horizon [01:18:25] like. Yeah.

Alex Hadley: So I’m planning of course. Yeah. We’re planning the course. We. Yeah I say [01:18:30] planning. We’re in the very early stages of planning a course. Um, yeah. Everything from kind [01:18:35] of photography, communication, presenting cases to patients or presenting a treatment [01:18:40] plan, and then the the steps involved in, you know, prep [01:18:45] review fit and then a final review and and [01:18:50] like everything everything that we’ve learned in that.

Payman Langroudi: So so give me a little hint [01:18:55] on is there something you do differently to, I don’t know, Gallup grill [01:19:00] technique because I spoke to Sam Jethwa.

Alex Hadley: No.

Payman Langroudi: So he does. He [01:19:05] does. He does it differently. Yeah.

Alex Hadley: Interesting. So, um, no. So Gallup grills apt [01:19:10] technique. Right. Which is, um, is effectively what ash is teaching. Um, yeah, [01:19:15] I think no, I think that is, that is like a standard veneer preparation [01:19:20] technique. Now that’s like that is how so minimal. So then the value add.

Payman Langroudi: The value [01:19:25] add you’re saying the value.

Alex Hadley: The value add is is is all in communication. [01:19:30] And the patient journey from start to finish. And then.

Payman Langroudi: And bits and pieces. Right. [01:19:35]

Alex Hadley: Bits and pieces. There are some crucial bits and pieces. Don’t hit me.

Payman Langroudi: With one of those.

Alex Hadley: Oh, use the right [01:19:40] burr. Use a sharp burr, you know. Use this burr. Burr. Use this new burr. Yeah, [01:19:45] use this burr. This is the one that you need to use. Yeah. You know, um, yeah, [01:19:50] I think I think, um. Yeah. Fractures in temporaries. You know what? What, like troubleshooting [01:19:55] things like that?

Payman Langroudi: Because when I used to do veneers, uh, porcelain veneers when I was a [01:20:00] dentist. Yeah. And one thing that used to just pain me used to hurt me. I didn’t, [01:20:05] you know, the the tension between when the, when the stats came out on the bond [01:20:10] strength to enamel compared to the bond strength to dentine. Right. Yeah. The tension between [01:20:15] trying to stay in enamel. Yeah. And yet. And then.

Alex Hadley: Prepping heavily enough, prepping.

Payman Langroudi: Heavily enough [01:20:20] that the technician can see the line. And also sometimes the the more you prep [01:20:25] the better the look of the. Because because you know, you don’t want the veneer to be bulky.

Alex Hadley: You’re [01:20:30] not wrong.

[TRANSITION]: Yeah.

Alex Hadley: So, yeah, I mean, you have to. Yeah. Which is I guess.

Payman Langroudi: It is the Gallup grill technique that sort of. That’s the whole point [01:20:35] of the Gallup.

Alex Hadley: Get your get your wax up. Right. And then it’s fine. Yeah. Then you can then you know that you know that you [01:20:40] have a happy patient. And, um, I mean, even now with. So I’m [01:20:45] even learning stuff from, uh, say, Martin’s course where the, [01:20:50] uh, implant treatment planning could be effective for demonstrating [01:20:55] smile makeover outcomes for patients, where you’re doing where they’re not [01:21:00] additive, where you’re subtracting, you know, where you’re making teeth smaller, something that we can’t try in the mouth. [01:21:05] So, um, yeah, I mean, yeah, the key is the key is to have the [01:21:10] wax up as close as possible to the finals. Yeah. So you have as little alteration [01:21:15] as. But I mean, we’ve all been there, right? If you if you were doing veneers, you know, you’ve had a patient in the chair, you know, [01:21:20] 18 hours messing around with temporaries. You know, patient’s not happy a [01:21:25] little bit dysmorphic, you know that what they’re what they’re thinking is [01:21:30] what? You know what they think. All these. All these beautiful, enlightened marketing photos. [01:21:35] Smiles look like, you know, that’s what they want. They think they’re going to get there by changing their teeth. And, [01:21:40] you know, it’s often like a, you know, a broader, um, [01:21:45] you know, a broader problem.

Payman Langroudi: If you’ve done that many small makeovers, you must have come [01:21:50] across that that nightmare situation where after fit [01:21:55] patients, family member says, don’t like them and the patient comes back and says, I don’t like [01:22:00] them anymore. Yeah. Whatever they said about temporary.

Alex Hadley: Yeah, yeah, yeah. Because [01:22:05] patients are patients are of course. Yeah. Of course it’s happened.

Payman Langroudi: The um how have you handled that.

Alex Hadley: Well [01:22:10] that’s difficult. Have you ever had.

Payman Langroudi: To re prep like. Because once once the patient once let’s [01:22:15] say you do the temporary the patient says I love that. Yeah. You put you fix them permanently. [01:22:20] Patient says I don’t love that. Yeah. Yeah. Now you’re in such a terrible situation because if you’re [01:22:25] prep and that’s going to cost you time and money and effort and.

Alex Hadley: Yeah, I don’t I don’t actually think they’re going to.

Payman Langroudi: Be [01:22:30] successful the second time because yeah that patient something up. Right.

Alex Hadley: Well ash [01:22:35] would keep ash would keep going until the patient’s happy I know.

Payman Langroudi: But what you know, the patient was happy [01:22:40] at the temporary phase. Yeah, yeah, yeah. So that’s a bit weird. Yeah.

Alex Hadley: Or there or they, they decided a shade and [01:22:45] they weren’t happy with the shade after a while. And then you, you know, charge them a lab fee or something to replace it. You tend [01:22:50] to.

Payman Langroudi: Push patients into whiter than they think or into darker than they think.

Alex Hadley: Uh, [01:22:55] my I’m tending to. Well, so we’re in Essex, right? This [01:23:00] is, you know, patients want straight white teeth. If they get if they get super tanned, I [01:23:05] think Bl2 can look really silly. You know, sometimes it can look really silly. So [01:23:10] I try and I try and show them. They’ll often just choose the lightest shade tab you show them. [01:23:15] So I try and talk to them. Yeah, I try and talk them down from bleach three, [01:23:20] down from bleach three. And my technician can we can decide on a bleach three and he can stain them up and [01:23:25] like knock them back. So we. Yeah we can sometimes we can sometimes get between shades [01:23:30] but yeah increasingly. And do you ever.

Payman Langroudi: Use different shades cements to.

Alex Hadley: Yeah. [01:23:35] Yeah yeah I mean I’m a bit I’m more of a fan of uh, using the lighter [01:23:40] cements on the basis that if there if there is a marginal gap, it’s [01:23:45] easier to hide with a light coloured cement. So if there’s any kind of if there’s any kind of marginal gap [01:23:50] then it’s, it’s more easily hidden because if the, if the, even if the stump shade is quite, [01:23:55] quite light, um, if you’re using it a clear cement or, you know, translucent [01:24:00] cement, it might especially if we’re using bleach three, you know, veneers. Um, [01:24:05] then yeah, it’s a bit of a. Yeah. Using this like neutral cement. It’s [01:24:10] it’s not I don’t find it as useful as some of the other guys to kind of [01:24:15] alter. It alters the shade so, so minimally that I don’t, I don’t find, I [01:24:20] don’t find it that helpful. Um, the also your layer of cement is so thin [01:24:25] that it doesn’t really doesn’t really matter. Um, but you know. [01:24:30]

Payman Langroudi: You can use more opaque cements as well.

Alex Hadley: Yeah. I mean, yeah you can. Yeah. So I mean that’s probably [01:24:35] more, that’s probably more, more important. Like whether you’re going to use an opaque cement or whatever. I think the thickness [01:24:40] of the material is probably like the main, the main thing. Yeah. If you got a tooth that’s really dark, [01:24:45] don’t bother using an opaque cement. Just, you know, you have to prep it a bit more.

Payman Langroudi: What are you charge [01:24:50] a unit. Does it depend?

Alex Hadley: It’s quite reasonable, actually. Um, yeah. Eight, £900 a unit. [01:24:55]

Payman Langroudi: And typically do eight or.

Alex Hadley: More in. Well, it depends. [01:25:00] I mean, I do whatever’s whatever the, whatever the clinical indication [01:25:05] is. Yeah. But I don’t, I don’t like, I don’t, I don’t like doing six. Yeah. So I mean that’s [01:25:10] quite common. Not not enjoying doing six. Um, so.

Payman Langroudi: You’re bleaching for the canine and then. [01:25:15]

Alex Hadley: Um, yeah. Although although, like the patient said, canines bleach terribly. Right. We know that, [01:25:20] um, just loads of dentine. Um, yeah. Usually like upper and lower tooth whitening [01:25:25] for doing a small case, like a four unit case. And then make sure that make [01:25:30] sure that we’re, we’re happy with the shade. I mean, you can get away with slightly lighter for like front, front for [01:25:35] teeth, but, um, yeah, I mean otherwise for 810. Um, [01:25:40] not huge on doing veneers on sixes, but you know, maybe like overlays [01:25:45] or whatever if, if.

Payman Langroudi: Lower veneers as well.

Alex Hadley: Yeah. Yeah. Sometimes. Yeah. So I mean I’ve [01:25:50] yeah. Got some, some cool cases where I’ve done um like mixed cases where I’ve placed the implants [01:25:55] to replace, you know, primary teeth, C’s and E’s and [01:26:00] whatnot, and then, you know, have the patient at increased ovd prep, like, [01:26:05] uh, 4 to 4 on the upper 3 to 3 on the lower. Um, and then, [01:26:10] you know, weight things, dial in and then prep [01:26:15] the posteriors and restore, you know, uh, restore all of the anteriors first [01:26:20] and then prep the fives and sixes a bit later on. So yeah, that’s where [01:26:25] I have to use my brain. I really like those. That’s my favourite. That’s my favourite, my favourite type of case. You [01:26:30] know something where there’s a little bit of clinical problem solving. Um, and where.

Payman Langroudi: Cases [01:26:35] as well.

Alex Hadley: Yeah, yeah yeah, yeah. So yeah. So again like learned from [01:26:40] working with ash you know using composite ball or leaf gauge. Um measuring CJ to CJ [01:26:45] you know propping patients open. Not I mean he’s he’s not a big [01:26:50] fan of prepping everything all at once. I also don’t fancy prepping everything all at once. I don’t think it’s I don’t think [01:26:55] it’s necessary. Um, yeah. Yeah. So all sorts really. [01:27:00] And yeah, it’s interesting what patients will tolerate. Like they’re kind of changes that they’ll tolerate. Um. [01:27:05] Yeah.

Payman Langroudi: Really until one doesn’t. Right.

Alex Hadley: Yeah. Well that. Yeah. Well that’s. [01:27:10] Yeah, that’s the thing. Right. Yeah. Some, some patients when you do this kind of work, particularly at increased OCD, [01:27:15] my actually my least favourite thing for a technician to do is increase the [01:27:20] ovd on the finals. So you know, not so. We do our best to try and mimic [01:27:25] exactly what we want in the in the finals, in the temps. And I scan them and [01:27:30] I say copy that. And then they say, oh, I just, I just did a [01:27:35] little bit, just like I’ve just opened them up by, you know, one and a half mil. So on the cusp [01:27:40] of the canines or whatever or cusps of the, the premolars, you’re like, well, now I’m [01:27:45] going to have to I have to prep those. Yeah. You’ve made my life really difficult now because [01:27:50] especially if the patient’s like, um, kind of, uh, fixated [01:27:55] on their occlusion, you get these patients, these kind of bruxism that [01:28:00] are constantly mentally taxing. They’re. Yeah, they’re mentally fixated on their, like, on tapping their teeth and [01:28:05] just seeing like, where is it like what’s it what’s heavy? Where’s the heavy contact. There’s always [01:28:10] going to be like, uh, you can use t scan, you can get the models equilibrated. [01:28:15] You know, you can do you can do all sorts of things, try and fix this. But yeah, if they’re if they’re occluding [01:28:20] on a little bit of ceramic that they weren’t expecting to, but they liked the temporaries, they’ll be thinking, [01:28:25] what’s, you know, what’s wrong. And that’s like that, that that takes hours to train. You know, you.

Payman Langroudi: Could you can [01:28:30] have all sorts of articulators, T scans, whatever you like here. There’s no way of accounting for [01:28:35] the patient’s psychological state on that day. No. Yeah. On that day, he could be stressed [01:28:40] and his muscle tone could be different to what it is normally especially like.

Alex Hadley: And sometimes [01:28:45] TMD exacerbated by keeping your mouth open for a long time. So, you know, patients like after you’ve prepped [01:28:50] everything, put them in temps are feels a bit weird. Got this. You know, occluding on one side.

Payman Langroudi: How much have you gone into occlusion? [01:28:55]

Alex Hadley: Um, well, I’ve done a couple of days with, um, with [01:29:00] Riaz. So, um, I know, you know, ash. [01:29:05] Ash teaches very similar stuff. T scan, uh, protrusive excursions, [01:29:10] like lateral excursions, you know, protected, mutually protected occlusion. Um, [01:29:15] and then and then, uh, like different. So I think you learn [01:29:20] an incredible amount about occlusion doing composite veneers if [01:29:25] you, if your occlusion is is not, is not working in composite. [01:29:30] First of all, say if the patient doesn’t tolerate it very well, you can get rid of it, which is great. But that is so [01:29:35] infrequent. I got that very, very, very infrequent. Um, and [01:29:40] then you can, you can dull dull patients in on threes and fours to get a little bit of. Oh yeah. [01:29:45] Yeah. So like if you don’t have enough occlusal like incisal space into incisal space and they don’t want ortho. [01:29:50] So yeah, you can learn an awful lot about occlusion doing [01:29:55] composite veneer cases. Um, yeah. And then um, and then t [01:30:00] scan and making sure you’ve got a good, a good like TMJ assessment, you know, [01:30:05] make sure there’s a good record of like, what you’re doing, why you’re doing it. If you’re doing a wear case [01:30:10] record what the wear index is or, you know, have your photos and your scan chat [01:30:15] with the patient. You know, they’ve got to know that there’s you know, some people don’t tolerate having the, you know, [01:30:20] the teeth increase in length. But yeah, it’s I mean, you can you can do things [01:30:25] carefully. Right. I know some I know some, some, some dentists are really like they [01:30:30] really like trialling things in composite and then prepping and putting ceramic transitional. Yeah. [01:30:35] I’m not a big I’m not big on that. Not big on that. Just like unnecessarily stretching [01:30:40] the the patient’s already long treatment out.

Payman Langroudi: Lots of precedents [01:30:45] going that way though I’ve noticed that. Yeah. Um, let’s move on to outside of [01:30:50] work. If you had a I mean, you’re very busy guy, man, but if you had a day off. [01:30:55] Yeah. No expectation on you. Yeah. What would you do? Come do.

Alex Hadley: A podcast. [01:31:00] No, no, I work. Yeah I know. Um, no. What do I do? [01:31:05] Um, I’m big into kite surfing. Oh, really? I like kite surfing. Yeah. And [01:31:10] do that in Southend and abroad. In the cold. In the cold. Yeah, [01:31:15] yeah, yeah.

Payman Langroudi: Where’s the best place you’ve ever done it?

Alex Hadley: Oh Cape Town.

Payman Langroudi: Oh really?

Alex Hadley: Cape [01:31:20] Town really cool. Yeah. Egypt’s pretty good. Very windy. Right? Yeah. You just need. Yeah, it just needs to [01:31:25] be windy. Yeah. Um, and I also have a powerboat that I like to take [01:31:30] my mates and my dad out on. Oh. Nice for lunch. Yeah. In Southend. Um, in, [01:31:35] uh, it’s kept in, uh, Burnham like around there on, on the Crouch. Um, so [01:31:40] that’s quite fun in summer. But yeah, we’re a bit unlucky with weather in the UK. We don’t get [01:31:45] that much time. Yeah, it was a bit of an impulsive.

Payman Langroudi: Kitesurfing looks extraordinarily difficult. Is it? Very [01:31:50] hard. It’s the. I think.

Alex Hadley: It’s easy. No, I’ll tell you what’s difficult. Surfing is difficult. Surfing is really difficult. [01:31:55] Like reading like waves and and and like picking your picking the right moment, [01:32:00] positioning yourself in the right place. But yeah, I do. I love water sports. I grew up sailing dinghies, [01:32:05] um, racing them around the Thames Estuary. That’s, you know, where I spent, [01:32:10] you know, most of my free time. I wasn’t at school. Um, and. Yeah, it [01:32:15] was. Yeah. So I think, um. Yeah. Kitesurfing. You. I mean, it depends what? Your experience [01:32:20] of sailing. Have you done any sailing? So if you understand, do you understand the physics [01:32:25] of how it works? Yeah, I remember I was at Bard, I was talking to Basil about because I’d just come back from [01:32:30] Cape Town. Uh, and, uh, I told him. Yeah, I told him I was, I was in Cape Town doing [01:32:35] kitesurfing. And, you know, I could see he was like, right. How does that work then? I was like, well, you [01:32:40] know, you generate lift by to use second nature. Yeah. By like steering the kite [01:32:45] and by changing the angle of attack of the kite, you know, you can you can build. It’s like using a clutch in a car, [01:32:50] you know that. But I could see I could see his brain like, you know, he’s like, you know, the mechanics [01:32:55] of, like, oh, how does that work? How does kite surfing work? Um, interesting. [01:33:00]

Payman Langroudi: Let’s move on. We’ve come to the end of our time. Let’s move on to the final questions. Fantasy [01:33:05] dinner party. Three guests, dead or alive, who would you have? [01:33:10]

Alex Hadley: Um, so I’ve heard you ask this question a few times. Yeah. Um, [01:33:15] I it was quite an easy. It’s quite an easy answer for me. Yeah, I think so, [01:33:20] because I, I um yeah, I so my, so [01:33:25] both, both grandfathers who are no longer with us. [01:33:30] Uh, and a great grandfather who I never met. Oh. Um, [01:33:35] just interesting group of guys who I don’t get to talk to, who [01:33:40] I think would be interested in in the kind of stuff that I’m doing now, but more, more. So I’d be interested [01:33:45] to hear about their experiences.

Payman Langroudi: Um, you did meet both grandfathers? [01:33:50]

Alex Hadley: Yeah. Yeah. So, um. Yeah, my maternal grandfather, um, [01:33:55] was diagnosed with dementia at 68, and it was like, a pretty nasty decline. [01:34:00] Um, and but he was he was a painter and decorator. [01:34:05] Had some businesses in Essex. Um, yeah. I think that’s where some [01:34:10] of the manual dexterity comes from. Or like the, you know, but also maybe like, uh, sometimes [01:34:15] if I’m a bit short with someone or like my terrible driving, like, you know, some traits that I think potentially [01:34:20] genetics can account for. Um, and then my paternal grandfather [01:34:25] was raised in an orphanage in Birmingham. Wow. [01:34:30] In the got to be the 40s. And then his mother took him back when he was [01:34:35] 11, when he was old enough to to work. So he worked in a worked in a factory in Birmingham, [01:34:40] did A-levels at night school. So, you know, 12 hour shift, then night [01:34:45] school. Uh, then became a petroleum engineer for BP. And I made [01:34:50] a real success of himself. So, you know, it’d be really interesting to talk to him about that. He was quite, a quite [01:34:55] a private guy. Um, how.

Payman Langroudi: Old were you when? When both of them passed? [01:35:00]

Alex Hadley: Um, well, one more recently than the other. So one kind of five years ago, I [01:35:05] think I’m pretty terrible with dates. And then the other about about ten years ago. Um, [01:35:10] and then my, my great grandfather, uh, [01:35:15] actually they lived not far, lived in Romford, like in Gidea Park, not not far from where the where [01:35:20] the practice is now. And um, he so he interesting [01:35:25] story. So he, he was an airman in, um, World War two and [01:35:30] he, um, he, he went, like, absent without leave [01:35:35] because his mum couldn’t afford rent. So he, you know, took himself [01:35:40] from France back to London and was, um, was kind of humiliated [01:35:45] by, you know, he was a man who was, you know, in London, not at [01:35:50] war. And he was, you know, he took whatever kind of social stigma that, that had. [01:35:55] Yeah. Um, and I think, I think he was kind of, uh, almost [01:36:00] a bit punished for it, um, post post war as well. So I mean, he [01:36:05] went back to he went back to the war and then, um, I think afterwards there’s something [01:36:10] I’ve spoken to. I have some Californian families of my, you know, have some cousins and, [01:36:15] um, that we’re related by, you know, by the same, same, same kind of tree. And they [01:36:20] said, um, they think he might he might have been, um, kind of tax [01:36:25] dodging around then because he didn’t want to be, you know, penalised heavily for kind [01:36:30] of having left without, without leave. So he was a I think he was an illegal bookie. [01:36:35] What a character. Yeah. In the East End. Um, so yeah. Really interesting guy and I think [01:36:40] I yeah, he, he died I believe like either the, it was either the year I was born or, or, [01:36:45] you know, just before, um, so yeah, it would be really interesting to see. Is that your mum’s [01:36:50] dad. That’s my, my mum’s, my mum’s. Mum’s. Your mum’s grandfather. Yeah. My mum’s [01:36:55] grandfather. Yeah yeah yeah yeah. Interesting guy. Yeah. So so those. Yeah [01:37:00] those Those. Those three guys. Amazing. And I don’t. I can’t think of anyone else I’d rather, you know, [01:37:05] catch up with.

Payman Langroudi: But our final question, it’s a deathbed. If [01:37:10] you had to leave three pieces of advice for your loved ones, what [01:37:15] would they be?

Alex Hadley: So this I haven’t really thought about, [01:37:20] but I think I think, um, I would probably give similar advice to the advice that [01:37:25] served me pretty well so far. Um, so [01:37:30] being be honest, don’t lie to people. Try [01:37:35] your best at everything because it doesn’t matter. Like whether [01:37:40] whether you, um, whether you perform like to the standard that you [01:37:45] set yourself. As long as, you know, you try your best, nobody can ask anything [01:37:50] more of you. Um, and the third, I guess, just, like, have fun. Do [01:37:55] do some other stuff, you know, don’t, don’t, don’t get bogged down in, like, the the minutia, there’s, [01:38:00] you know, there’s there’s cool things, there’s cool things to do and people to see.

Payman Langroudi: I’m [01:38:05] gonna I’m gonna throw out a couple of quickfire. Best [01:38:10] course you’ve ever been on.

Alex Hadley: Best course. I can’t give you a quickfire, I [01:38:15] don’t know, I learned different things from all of them. Our best course. Um, he’s [01:38:20] a great speaker. Uh, and, like a good friend, Rob Moretti. Hard and soft tissue grafting. [01:38:25] Yeah. Any any any implants.

Payman Langroudi: Of course, you’re desperate to go on. Or [01:38:30] you could click your finger and get yourself in that course right now. What would you [01:38:35] do?

Alex Hadley: I don’t know, after seeing Paolo last week, it’s got to be one of Paolo’s. Yeah, I’m sure, I’m sure if that man runs [01:38:40] a soft tissue grafting course, like, get me on it. Um, yeah. Oh, actually, [01:38:45] no. Yeah. So I’m. I’m, uh. So, uh, I’ve kind of run out of [01:38:50] UK courses now. Zucchelli zucchelli soft tissue grafting. Yeah, just like down the rabbit hole. [01:38:55]

Payman Langroudi: Um, favourite book?

Alex Hadley: Favourite non-fiction or fiction? I’m pretty, I’m [01:39:00] pretty bad with. With fiction books I get distracted. Yeah. Um. Favourite [01:39:05] book? Don’t have one.

Payman Langroudi: Dental book?

Alex Hadley: Oh, [01:39:10] I don’t know. At the moment, I’m flicking through Zooey Kelly’s, uh, mucogingival [01:39:15] surgery. Yeah.

Payman Langroudi: Bit of kit.

Alex Hadley: Favourite bit of kit? Um, [01:39:20] the get out of jail kit. The neo biotech fixture [01:39:25] removal? Yeah.

Payman Langroudi: Favourite practice in the UK that you [01:39:30] don’t work in?

Alex Hadley: Favourite practice in the UK? I don’t work in. Well, [01:39:35] I mean, coolest practice I’ve seen is pools, [01:39:40] right? It’s just this state of the art practice. Have you seen it? No. Oh, it’s like [01:39:45] an like the operating. The the surgeries are built like operating theatres, right? They’re all on an overpressure. [01:39:50] Everything’s like very. It is the his definition. [01:39:55] It’s the definition of of sterile. Right. Or like, you know, sterile environment. [01:40:00] There’s no where is it? It’s in Thorpe Bay, right around the corner from where my parents live. Oh, yeah. Okay. [01:40:05] Yeah. It’s, um. Yeah, on the sea front. So. Yeah. That’s cool. But, I mean, that’s specialist practice. That’s right. [01:40:10] I’m not going to be in there. Think of another one. Think of another one if you want. Well, [01:40:15] I’ve heard big things about Andy. More advanced, but I’ve not seen it. And I’ve not met Andy. [01:40:20] Yeah. What a guy. Yeah. That’s cool. Yeah. You should put me in touch with him. That’d be cool. [01:40:25] Just to have a chat with him.

Payman Langroudi: Yeah, he’s a good guy.

Alex Hadley: Yeah, I’ve heard he’s into it. Yeah, yeah yeah, yeah. [01:40:30] He probably goes. Probably goes, like to warm places. It might be a bit more. Well, he’s.

Payman Langroudi: Friends with Branson. [01:40:35] So they go. They go on that island BVI.

Alex Hadley: Yeah.

Payman Langroudi: Well, well Branson [01:40:40] is friends with the guys from Google. Okay. So the guy from Google has a huge kite [01:40:45] surfing event that he does every year. Yeah, yeah. On another island?

Alex Hadley: Yeah. No, I think Branson did. Uh, Branson [01:40:50] did a kite surf across the English Channel. There you go. Yeah, he did like the [01:40:55] kite foiling and stuff. You need to get into that.

Payman Langroudi: He’ll like you to. It’s been a massive pleasure, man. You got. You [01:41:00] got a wise head on your young shoulders. But keep going, keep going. Yeah, and keep enjoying. [01:41:05] Yeah.

Alex Hadley: Thank you. Thanks for having me.

Payman Langroudi: Pleasure.

[VOICE]: This [01:41:10] is Dental. Leaders the podcast where you get to go one on one [01:41:15] with emerging leaders in dentistry. Your [01:41:20] hosts, Payman Langroudi and Prav Solanki.

Prav Solanki: Thanks [01:41:25] for listening, guys. If you got this far, you must have listened to the whole thing. And [01:41:30] just a huge thank you both from me and pay for actually sticking through and listening to what we had to [01:41:35] say and what our guest has had to say, because I’m assuming you got some value out of it.

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