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

[VOICE]: This [00:00:25] is Dental Leaders the podcast where you get [00:00:30] to go one on one with emerging leaders in dentistry. Your [00:00:35] hosts Payman Langroudi and Prav [00:00:40] Solanki.

Payman Langroudi: It gives me great pleasure to welcome Amal Hourani [00:00:45] to the podcast. Amara is a specialist Endodontist had a few [00:00:50] endodontists on and uh, I actually I was at the PDSA recently [00:00:55] and I was talking to the youngsters saying, what do you want to do? And very few people want [00:01:00] to become endodontist at that age. But all the Endodontist I know are very, very happy with [00:01:05] their choice. And so it’s nice to talk to them. So I want to get into some of endo itself [00:01:10] as well. But massive pleasure to have you man.

Ammar Al Hourani: Thank you so much for having me here.

Payman Langroudi: It’s been a long time [00:01:15] coming. I remember the first time we contacted each other was like, maybe just after Covid. [00:01:20]

Ammar Al Hourani: Yeah. I don’t think I was in the right headspace for it at that point. I think now [00:01:25] I’m in a good place to do this. But yeah, you contacted me two years ago. No chance.

Payman Langroudi: Yeah, it was [00:01:30] around that time. Maybe. Maybe a bit longer. I just remember the endo guys otherwise known as the Endo guy. [00:01:35] Yeah.

Ammar Al Hourani: It could be a play on words, I suppose.

Payman Langroudi: It’s a clever thing to call [00:01:40] yourself something, you know, become memorable.

Ammar Al Hourani: That’s a good. That’s a good name. I think it’s from the falafel guys in America. [00:01:45] Oh, is it, is it?

Payman Langroudi: Is that what your kind [00:01:50] of Scottish dude? In a way. So you came over from Syria? [00:01:55]

Ammar Al Hourani: Yeah, my parents were living in Saudi Arabia at the time and as a doctor. So I think [00:02:00] during the 80s, the the tick out of Syria is to be a professional. And I think a lot of people were [00:02:05] going to to Saudi Arabia because that’s where the wealth was. And I think that was like a launch pad [00:02:10] for a lot of people to go to the West as well.

Payman Langroudi: So did you go to one of those international schools in Saudi? [00:02:15]

Ammar Al Hourani: No, it was no. I went to nursery school in Syria for a little while. That’s how I can speak Arabic, I suppose, because [00:02:20] of that, thankfully.

Payman Langroudi: So you yourself didn’t live in Saudi much.

Ammar Al Hourani: For maybe [00:02:25] three years, maybe three, three years. Four years. Yeah. Not not a long time. Very small period of time. So I don’t really remember. [00:02:30]

Payman Langroudi: But you must remember getting to Glasgow.

Ammar Al Hourani: We didn’t come to Glasgow straight away. We came [00:02:35] to a small town called Bellshill which is just outside Glasgow. It’s in an area in Lanarkshire. [00:02:40]

Payman Langroudi: Do you remember that as a.

Ammar Al Hourani: Six year old? Yeah. Of course. Yeah. I couldn’t speak the language and have a clue what was going on. And you went from [00:02:45] Syria, which is, you know, it’s quite a nice place. Damascus. When I was a kid, to a much more, I would [00:02:50] suppose, a developed. What year was it? I was five, so what year was that? 90, [00:02:55] I don’t know, 1990, maybe 1991, 1991. Yeah, probably 86. [00:03:00] 91. Yeah. About. Right. So yeah, it was good. I didn’t I didn’t speak English, [00:03:05] didn’t have a clue, didn’t know what was going on. Um, and at the time we used to have like, uh, you know, [00:03:10] extra support at school to teach you the language, which was really good. My parents spoke good English, to be fair. So they did [00:03:15] teach us quite a lot. And my dad was always quite forward thinking. We always lived in very white neighbourhoods so [00:03:20] that we picked up the language. So we never really lived in any mixed neighbourhoods. So you picked up language [00:03:25] really quickly. Um, and then we travelled a lot with my dad all over Scotland because he’s a doctor.

Payman Langroudi: Kind [00:03:30] of doctor.

Ammar Al Hourani: Paediatrics. Uh, so he did the specialist training. So we were in Aberdeen. So [00:03:35] when Bellshill. Then we went up to Inverness for a little period of time, then lived in Aberdeen for ten years, and [00:03:40] then he got his consultant job in Stirling and that’s where we went from 1998 onwards [00:03:45] we’ve been in Stirling, which is between Glasgow and Edinburgh.

Payman Langroudi: How do you identify?

Ammar Al Hourani: How do I [00:03:50] identify myself? Yeah, I would say I’m definitely a Scot for sure. Yeah, I feel more like a Scot than [00:03:55] I do an Arab, if I’m being honest. But I’m quite. You know, I’ve got that. I’m proud to be [00:04:00] an Arab. I’m proud to have that sort of lineage. But I definitely think like a Scot, I talk like one. [00:04:05] I definitely think like a Brit. Um, so I’ve always sort of I’m very proud to be from here, but I’m [00:04:10] also proud to have that sort of the nice parts of being an Arab as well. So it’s good.

Payman Langroudi: Yeah, the falafels.

Ammar Al Hourani: Falafels, [00:04:15] the shower, the flat tyre.

Payman Langroudi: And have you been back to Syria at all?

Ammar Al Hourani: Uh, [00:04:20] last time was we, we used to go twice a year. Every year.

Payman Langroudi: Oh, really?

Ammar Al Hourani: Yeah, we used to go twice a year. Every single year because [00:04:25] my parents wanted us to learn the language. So I used to go quite a lot and I loved it. Really great. I did [00:04:30] my my dad was going to move back when I was just about going to secondary school. So I lived [00:04:35] there for about a year, year and a half. So I did my secondary schooling because in Syria you can’t go from primary school to secondary school unless you [00:04:40] pass an exam in primary school. So I did that primary schooling and then yeah, I was getting to secondary [00:04:45] school and I think my mum put pressure on my dad to stay here. So then we stayed here, which was I think that was a [00:04:50] good decision in hindsight. Otherwise we would have been lost.

Payman Langroudi: When did dentistry come into the [00:04:55] equation?

Ammar Al Hourani: At no point did they want to be a dentist. So I finished my. [00:05:00] So when I did my secondary schooling in Scotland, I got one of the highest marks in economics. [00:05:05] I actually got a scholarship for LSE to go and do economics at.

Payman Langroudi: Age Teen.

Ammar Al Hourani: Age Scotland. [00:05:10] You do your Highers a year before A-levels. So it’s it’s a [00:05:15] different system. Yeah. 17, 16, 16, 17. It’s the Scottish [00:05:20] Highers which is different. Works a little bit differently. And I got Scot. Yeah I got an interview came down. So you [00:05:25] know I met the chancellor of the Bank of England. That was your prize at the time which was good. Got [00:05:30] a scholarship. So what.

Payman Langroudi: Happened?

Ammar Al Hourani: Well, you come up, you come from a middle eastern background. [00:05:35] So your.

Payman Langroudi: Parents curtailed.

Ammar Al Hourani: The only the only professions that exist is medicine, [00:05:40] dentistry, engineering, law. So that was like, you know, do [00:05:45] something that has a career. You’re helping people, you know. I don’t think I think it was an alien concept. [00:05:50] Economics, I loved it, I thought it was really nice, but for them it was an alien concept. So it did [00:05:55] work experience with my dad’s a doctor and didn’t really enjoy anything in medicine, and it was at the time it was his [00:06:00] friend who said, come and come and watch me do what I do as a dentist. I like the gadgets. I [00:06:05] thought it was quite a good thing. So I’d done my application for Ucas at the time. I don’t know if Ucas still exists, but [00:06:10] for medicine, and I changed it overnight to do dentistry and I applied to dental schooling.

Payman Langroudi: Because [00:06:15] of that work experience.

Ammar Al Hourani: Just the work experience and because, you know, I was curtailed into a small group of [00:06:20] professions which was accepted by my parents, I suppose. So, um, yeah. So I ended [00:06:25] up doing dentistry, and actually, it’s been good. I’ve never regretted it really, ever since.

Payman Langroudi: I was going to go there. [00:06:30] Actually, that question of we all get curtailed somewhat. I [00:06:35] mean, it’s funny, I speak to some people, they say, I wish my parents had guided me more.

Ammar Al Hourani: No, my parents were.

Payman Langroudi: Not generally [00:06:40] Middle Easterners getting massive guidance, too much guidance. But where [00:06:45] I’m really going with it is you’ve got children. What degree of sort of [00:06:50] guidance are you giving? How old are they?

Ammar Al Hourani: Five and nine.

Payman Langroudi: All right. Too young, too young. But [00:06:55] you’ll get to it, right? Well, people say these lovely things like, I’m going to just let the kid do what they [00:07:00] love. Yeah. But the reality is not that many kids love very much. Like there [00:07:05] are a few. Many are just kind of following the path of least resistance and have no idea [00:07:10] what they want to do. So then it comes to you to then say something. Yeah. You know, they actually ask [00:07:15] for your advice. So what’s your advice? I mean, what is it advice, is it or are you going [00:07:20] to be quite forceful as your parents were?

Ammar Al Hourani: No, I think my parents weren’t really that forceful. I think they just wanted me to have [00:07:25] a good career, to be honest and in.

Payman Langroudi: A forceful way. In a.

Ammar Al Hourani: Forceful way. I mean, what do you know, at the age of 16 [00:07:30] or 17, what do you know really? I mean, I think I quite like the American concept, where at least you do a degree first, you mature a little bit, [00:07:35] and then you come up with your own ideas in life as to what your path in life would look like. I think at 16, what [00:07:40] do you know? Like you see your next door neighbour with a nice car, or you see your dad with good friends or the accountant that’s doing [00:07:45] okay, you know, and that’s that sort of guides.

Payman Langroudi: You imagine we fast forward ten years and literally your son [00:07:50] or daughter is saying, dad, what should I do? What should I do? What do you reckon you’d say?

Ammar Al Hourani: I’d [00:07:55] say, um, honestly, I would actually say to them, go and do medicine or dentistry or something along those lines, [00:08:00] do a professional degree.

Payman Langroudi: It’s so sad, isn’t it?

Ammar Al Hourani: It is. I think I think the only reason is because I think it’s it’s [00:08:05] a career. You know, there’s very few careers out there that, you know, you can work in and build your way up something. [00:08:10] A lot of it is sort of you get a degree and then you go, right, I’ve just done I don’t know, I’m going to make up a [00:08:15] degree like history. And then you end up working in retail and you’re like, how is that? How did that. Does that make sense? I’ve done history [00:08:20] and then I end up being a lawyer and you’re like, how did that happen? You know, so I think it’s a good career if you, you know, because if [00:08:25] I’ve done okay with it and maybe in the future if I have some assets with it, maybe it’s quite good to pass it down to someone [00:08:30] or some, you know, my daughter or my son, just to continue with the concept. So it gives them a dignified [00:08:35] life, I suppose. I don’t know, maybe I’m right, maybe I’m wrong.

Payman Langroudi: I find it a bit sad. I find it a bit sad. And I hear [00:08:40] exactly what you’re saying and I’ve given similar advice. Don’t get me wrong, I’ve given similar advice to my kids, but [00:08:45] I find it a bit sad because there would be no photographers. There would be no movie maker. [00:08:50] Movie makers. Um, some of the richest people in the world now are [00:08:55] gamers. Yeah. Gamers or developers? It developers, it all sorts of things. [00:09:00] Right. And we end up and I actually when, when, when I was talking to my my [00:09:05] son, my son kind of knows what he wants to do. He wants to do aerospace engineering. Sounds great actually. Actually it’s [00:09:10] not you know, it’s a lot of it’s defence really annoys me a little bit. You know, you spend your whole life telling your kid war is [00:09:15] wrong and then it’s a lot of it’s defence. He did he did his first work experience. It was like [00:09:20] missile guidance system, right? I was like, oh shit with GPS. But [00:09:25] my daughter doesn’t really know. And I’m kind of saying, hey, why don’t you be a dentist? And and as I [00:09:30] say it, one part of me thinks, hey, great, because dentistry has been good to us and [00:09:35] we can see. But another side of me says, hey, how? How is it that, you know, what do all these [00:09:40] other people do? Go and end up doing this and that and the other? And did I fail in some way [00:09:45] insomuch as I didn’t introduce her to enough stuff that she didn’t end up having [00:09:50] some sort of passion in some area that then she could go into. And [00:09:55] the best advice for your kid, I think, is just to do whatever very well.

Ammar Al Hourani: I [00:10:00] would agree, I think the only reason why I was saying medicine or dentistry is because I come from that type of background. So I can only advise [00:10:05] them on what I know. And so medicine dentistry feels familiar to me. It’s given my brother a good [00:10:10] life and my parents a good life. Yeah, but you’ve got patience.

Payman Langroudi: You’ve got a patient who’s a banker who’s got even a better life, right?

Ammar Al Hourani: Probably. [00:10:15] And that’s that. So I can only guide on what I know. You know, I can’t guide on the unknown because I can say, go and be a [00:10:20] banker, and you might end up being broke. I don’t know, you know. Yeah. Or losing Jane’s money because of a bad investment, and then you’ll [00:10:25] feel bad about it. You know what I mean? So I can’t really guide on something I know nothing about. So I can only give them guidance [00:10:30] on what I know. But if they find something better, I think they’ll always know that I’ll be there to support them no matter what. So [00:10:35] I think that gives that sort of safety net. So you can just go and experiment maybe a little bit more. I think because I came from [00:10:40] a second generation family, maybe I didn’t have that support network as such, you know, whereas [00:10:45] now I think I’m more comfortable. Maybe I’ve done a little bit, possibly better than my dad, so they can probably experiment [00:10:50] a little bit more. Maybe I wasn’t in that generation where I could experiment, or my parents just came to this [00:10:55] country and that is what they think is the best.

Payman Langroudi: Survival was the key to.

Ammar Al Hourani: Survival is like always like, you know, where are we going to [00:11:00] get you know, I don’t know maybe about your parents. It’s similar to sometimes it’s my parents, but it’s like, you know, you never [00:11:05] know. You know, tomorrow they might tell you to all leave. You know, it’s always having that. It’s not an abundance mindset. It’s a scarcity mindset. [00:11:10] Whereas I think we’ve come up.

Payman Langroudi: Yeah, I mean, we we were running away from revolution. [00:11:15] And so when you’re running away from revolution, safety’s all you want isn’t it. And so safety [00:11:20] ends up being a profession.

Ammar Al Hourani: Well, that’s the thing. I think it’s the same with my parents. I think at that time it was [00:11:25] the I think the 80s and 90s in Syria. You know, they had the uprising at that point as well. And I think a lot [00:11:30] of really good professionals left the country and they have that. They’ve got, you know, the military police and, you [00:11:35] know, secret services and all that sort of stuff they were running from. So I think they didn’t want us to live that fear [00:11:40] they had. But I think in a way it sort of dissipates into you anyway, so you sort of have it to a lower [00:11:45] degree. Exactly. But now my kids don’t have that because I don’t really I don’t I don’t feel I don’t [00:11:50] have that problem to deal with. Does that make sense? I’m sort of lucky from that respect. So I thanked my parents for that for 100%, for [00:11:55] giving.

Payman Langroudi: Your kids haven’t ever lived in Scotland or have they?

Ammar Al Hourani: No, they lived in London.

Payman Langroudi: So they haven’t got any Scottish [00:12:00] feeling about.

Ammar Al Hourani: Zero. I think they’ve gone to Scotland a handful of times. How funny. Yeah, [00:12:05] I know nothing about Scotland.

Payman Langroudi: So you went to Glasgow? What kind of a student were you? Number one and [00:12:10] number two. Around what point did you think I’m going to specialise? [00:12:15] And around what point did you think? Endo?

Ammar Al Hourani: Uh, yeah. [00:12:20] Glasgow was good fun. Great city. I don’t know if you’ve been to Glasgow, I love it. It’s my favourite city. Favourite city [00:12:25] in the UK? Um, I was an average student. I don’t think I was in any way, shape or form spectacular. You know, [00:12:30] my grades were decent. I knew my stuff clinically, I was good, my knowledge was decent, but I wasn’t like an outstanding [00:12:35] student. Nothing like that. You know, some some of the guys in my year were far better for sure, [00:12:40] no doubt about it. Uh, and though I was really lucky, so Glasgow had a at that [00:12:45] time, we were sort of the guinea pig year because the year before was nearly didn’t get all their degrees. Uh, [00:12:50] something to do with the GDC or not following the GDC guide. So the GDC basically wrote our curriculum in essence and [00:12:55] ran our program. So we were lucky in the last two years we did a lot of outreach. So you do specialist clinics [00:13:00] and then outreach. So we were doing for about two years really before we even graduated, which was great. At [00:13:05] the time, there was a guy called Prof. Murray called Murray. Uh, had well, I think he was head of research at [00:13:10] the time. He taught me endo and we had the specialist sort of clinics, and I would [00:13:15] get one on one because a lot of times the students maybe didn’t have a patient or didn’t turn up. So I had patients and I [00:13:20] just did it and I really enjoyed it. I started to get get into it. I didn’t think it was going to be my sort of cup [00:13:25] of tea because believe it or not, I actually wanted to become an orthodontist. I didn’t actually want to become an endodontist. Arthur was always my [00:13:30] thing.

Payman Langroudi: But specialising was always in your head, right? So it was another Middle Eastern [00:13:35] kind of.

Ammar Al Hourani: I guess it’s a paediatrician. Yeah. My brother was going into orthopaedics at the time as well. [00:13:40] So I felt like it can be a general dentist. You know, it’s one of those things. So it plays on your brain. You sort of compete in a sense [00:13:45] as well.

Payman Langroudi: I get it, I.

[TRANSITION]: Get it, I get it.

Ammar Al Hourani: Um, so yeah, I mean, I did my first couple of years, it [00:13:50] was called a senior house officer at the time I was in called DCT. That was the old currency. I did that for a couple of years. That was good. I had an under rotation [00:13:55] within it, which was nice, like.

Payman Langroudi: Restorative ones.

Ammar Al Hourani: Restorative with an endo. It was a massive endo slant to it, like cutting [00:14:00] down the waiting list essentially. So I was really good at it, I enjoyed it at that point. My trainer was had an MSC in Endo, [00:14:05] so he taught me endo.

[TRANSITION]: Oh wow.

Ammar Al Hourani: So that was the first time I started to understand Endo, because he was making me do it on the rubber [00:14:10] dam, sodium hypochlorite. You know, he had all the gadgets. So I got to play with it and I got a lot [00:14:15] of the endo thrown at me because no one wanted to do it in the National Health. So I got to do a lot of endo. So I got good at it, to be fair [00:14:20] in that respect. Um, I then worked in practice for a few years. My sister was [00:14:25] a little bit unwell, so I had to go back home. And so I worked in general practice. I started taking on a lot of the endo [00:14:30] referrals in-house, enjoyed it, bought my own mortar and all that sort of stuff. It was all the expensive stuff. You didn’t have any [00:14:35] of the sort of brands that you have now. You know all the Japanese and Korean brands you didn’t have that. It was mostly [00:14:40] the German stuff, so you had to buy the expensive stuff, basically. But all that stuff enjoy doing. Endo got really [00:14:45] good at it, went to some courses, it was good. And then when I came back from the refugee camps, there was a job that came out as [00:14:50] a staff grade in Endo and that’s when I realised I wanted to become an endodontist.

Ammar Al Hourani: It’s sort of the profession. [00:14:55] I don’t have to explain. It’s like the speciality chooses you over time. You sort of fall into it because you do it [00:15:00] so much. It’s sort of you go, you know what, let’s just do it. And that was the first time I enjoyed going to work. I [00:15:05] started doing that all day, every day. And I loved my job. It was because down to a guy called Robert Philpot, he’s [00:15:10] a consultant at the time and Endo at Glasgow, and he’d just come out of Eastman, gone to Australia, come back, became a consultant [00:15:15] at Glasgow and he was amazing. It was just contagious. He made it lovable and so [00:15:20] he was the driving force behind me becoming a specialist, basically this guy. So and even when in my thesis, [00:15:25] I actually wrote his name as the guy who who made me love Endo. So it’s who you meet in life I think guides [00:15:30] you. And also the profession seems to choose you. I don’t know how to explain that especially chooses you down the line. [00:15:35] Yeah. And so that’s how I sort of became an endodontist. And I’ve never, ever regretted it. I love my [00:15:40] job. Get buzz out of it every day. I feel it’s like a little hobby. I don’t actually feel like it’s a job.

Payman Langroudi: We’ll [00:15:45] come back to the end. Tell me about the refugee camp.

Ammar Al Hourani: 2013. [00:15:50] Me and my dad went to the refugee camps to work for a little while, and then a few other guys went along [00:15:55] with it. We had two dental clinics that we ran 24 hours a day, pretty much [00:16:00] in Rehaniya, which was a town between the city and the Turkish border, had 25,000 [00:16:05] people in it. No services. So then they opened up a hospital. It was a Kuwaiti hospital called the Orient. [00:16:10] My dad opened up a paediatric unit. There was an eye like a prosthetic [00:16:15] eye clinic as well, because a lot of people lost their eyes. That was next door to us. We did that on and off for about nine months. [00:16:20] Brilliant experience. It’s an absolute like.

Payman Langroudi: What was what was the equipment like? Was it. [00:16:25]

[TRANSITION]: Zero?

Payman Langroudi: Oh, really?

Ammar Al Hourani: Yeah. It’s what you get in most refugee camps, you know, like the [00:16:30] heat steriliser and, you know, the basic forceps, some drills, some files. You know, a lot of companies, [00:16:35] to be fair, our sponsor does. We got a lot of donations, but we were running out of money all the time, like we were digging into our own [00:16:40] pockets pretty much every single month because the volume was sensational. And [00:16:45] the problem was, when you go to a refugee camp, it’s a very unusual. You’ve got a very middle, [00:16:50] upper class or middle class families that now live in a refugee camp. They still have the mentality [00:16:55] of, I want the hand on the crown, I want the white filling I want. They don’t seem to have [00:17:00] realised that they’re actually now living in a refugee. They’ve lost everything. Does that make sense? And I think it’s a part of them still [00:17:05] wants to hold on to their identity. So they’ll come to you saying, oh, I’ve got this thing, can you do this? [00:17:10] Can you do.

[TRANSITION]: This?

Ammar Al Hourani: And I’m like, I don’t have I don’t have that type of material here.

Payman Langroudi: It’s a very good point. Yeah. Insomuch [00:17:15] as we feel like refugees are these downtrodden people.

[TRANSITION]: But [00:17:20] a lot of them.

Ammar Al Hourani: Are like me and you.

[TRANSITION]: Exactly like me.

Payman Langroudi: You forget. You forget that, you know, they were regular people, [00:17:25] professionals. Some of them were whose lives got overturned suddenly.

Ammar Al Hourani: Overnight, lost everything. Yeah, [00:17:30] yeah. Their teachers, doctors, I don’t know, pharmacists, you know, you name it, who’ve lost suddenly, lost [00:17:35] everything overnight because of a war. And so they’ve still got that mentality, [00:17:40] but in a refugee camp. And it’s very difficult. I mean, I sometimes it’s difficult to, to, to, to [00:17:45] work with them or achieve their ideal settings because I just didn’t have the materials [00:17:50] and that wasn’t that just wasn’t the right place to do it. You know, what.

Payman Langroudi: Did it teach you? Do you do you recommend [00:17:55] all of us do it?

Ammar Al Hourani: Yeah.

Payman Langroudi: Yeah, because Rona does. Rona goes to [00:18:00] Lesbos.

Ammar Al Hourani: I saw that. Yeah, it was very impressive. Yeah. I mean, like, listen, before I went, I was just [00:18:05] a I was a dentist. I was making good money in Scotland, to be fair. Very good money for my age group [00:18:10] playing football, chilling out with the guys. You know, like all of us. I was pretty selfish. Self-centred, [00:18:15] you know what I mean? Like the the life you thought you were. The whole world is based around you, basically. [00:18:20] And then you suddenly turn up to these places and you’re like, oh my God, I’m. What am I thinking? [00:18:25] And I did a lot of growing up, a lot of growing because you get a lot of time in silence where you just sit [00:18:30] with your own mind and you’re like, what am I wanting to do with my life? Because at that point I was sort of doing stuff, [00:18:35] but I didn’t really have a plan. Does that make sense? I was sort of like walking to nowhere. I was, you know, I was like, [00:18:40] blindfolded. I didn’t really know where my life was going. Didn’t know where my career was going. I was just doing a little bit of everything [00:18:45] in the hope that I sort of landed on something. And that was the first time where I sat down and [00:18:50] had a lot of time to think. And I was like, you know what number of things I’ve realised? One, [00:18:55] I’m not all that, you know, I’m actually a speckle. Two, [00:19:00] I’ve got all the resources in the world, but I’m not using it. Why not? Three people would love to be in my [00:19:05] shoes. Why am I not taking full advantage of that situation? And what was my limiting factor? [00:19:10] Me, I was just scared of taking a risk. And actually I realised that I also [00:19:15] had a lot of, you know, not great friends as well. So I had to get rid of some baggage. You know, you realise [00:19:20] very quickly, actually, there’s a lot of people holding me back. And four, am I being authentic? I’m not being myself. I’m [00:19:25] trying to please everyone around me, but not me. Does that make sense? And so it.

Payman Langroudi: Does. I mean, it’s interesting [00:19:30] that that sort of break, it takes a stop and a break and a change for [00:19:35] you to think about your life. I mean, Covid was a similar thing, wasn’t it? Yeah.

Ammar Al Hourani: It wasn’t really that ambitious either, to be fair. [00:19:40] So I came back as a completely different animal. I wanted it all not because I was greedy, but I was like, [00:19:45] you know what? I’ve got a great I’ve got a golden ticket in the UK. I could do, I could do whatever I want, genuinely.

Payman Langroudi: What about [00:19:50] the stories of the refugees? I mean, what were some of the things that you heard and how [00:19:55] long were people in that camp for?

Ammar Al Hourani: Years.

Payman Langroudi: Years and years.

Ammar Al Hourani: Yeah. Like you’ve got [00:20:00] swathes of population now who’ve never, you know, kids probably older than my kids now who’ve never had [00:20:05] an education, a formal education. They’ve been born in a refugee camp, never been to school.

Payman Langroudi: Wow.

Ammar Al Hourani: Probably never seen a pencil [00:20:10] case. First day I turned up. I’ll never forget this day. First [00:20:15] day I turned up literally ten. 12. Dead bodies on the floor. Blood everywhere, screaming everywhere. I was like, [00:20:20] what am I doing here? And then I got called up by a two guys like, oh, we’ve got this guy who’s [00:20:25] been shot in the face. Can you come and take the bullet out? Like sorry. Sorry. [00:20:30] What? What? Why? Why do you want me to do this? You’re the most qualified. I was [00:20:35] like, well, you two are wearing white coats. Why can’t you do it? Oh. We’re vets.

Payman Langroudi: Wow. [00:20:40]

Ammar Al Hourani: I’m like, okay. And so that’s the type of stuff. It’s just a bit of shrapnel I removed from his face. [00:20:45] But, you know, I’ve done a bit of Max Fox before, but again, you don’t deal with, um, with [00:20:50] gunshot wounds in Max Fox. That just doesn’t happen in the UK. Really? That type of violence. Maybe in bigger cities, but [00:20:55] not in Dundee, where I did it for a period of time. In Preston, you don’t get that type of stuff. So [00:21:00] yeah, it was uh, yeah, you see some horrors, but then you get used to it. I don’t know how to explain it. You become sort [00:21:05] of habituated to bad, bad news, you know, and it becomes part of your life. For a period of time, it was very cold. [00:21:10] That was another thing as well. Oh, really? Turkey’s freezing like it is cold.

Payman Langroudi: And what were your, like [00:21:15] living conditions?

Ammar Al Hourani: We lived in, uh, like, either we lived in a caravan or we lived in, like, a [00:21:20] little room that we had.

Payman Langroudi: Like you were in the camp itself. You weren’t, like, outside in a hotel or something, like. No, [00:21:25] no.

Ammar Al Hourani: There was no hotel. Where do you go? There’s no like I can’t. I can’t say like Payman. Let’s. Let’s meet up at that coffee shop [00:21:30] tomorrow. There’s no coffee shop.

Payman Langroudi: Are you in the camp? In a in a little caravan thing?

Ammar Al Hourani: Pretty much. Yeah. I can’t just go. [00:21:35] Oh, let’s grab dinner tonight or we’ll go to that restaurant. There’s no restaurant. You know, it just doesn’t exist. [00:21:40] It’s not. It’s not your normal day to day life. There’s nothing. It doesn’t make. It took me a good month or so just to get my head around it, to be [00:21:45] honest with you, because it just didn’t make any sense. Then after that, you you. It’s beautiful how the human body [00:21:50] just develops. It just becomes normal. It’s like, oh, you know, this this. I’m in a disaster [00:21:55] zone, basically. But it was good. It was good fun. I learned a lot from it. I learned I made some really good people, which I keep [00:22:00] in touch with to till today. And it made me grow up. I think had I not done it, I wouldn’t be the person I am today. [00:22:05] No chance I’d be. I’d be a very different person now. Yeah.

Payman Langroudi: So then you [00:22:10] come back with this new sort of mindset of you’re going to make the most of yourself. [00:22:15] Yeah. And you’d already done a bunch of endo, I guess. And so now you was [00:22:20] it. Now you decide I’m going to specialise and be, you know.

Ammar Al Hourani: So like I took that staff. Great job in Glasgow for [00:22:25] about nine months. I met this guy, Bob Philpot. Robert. Hi, Robert. If he’s listening to this, [00:22:30] probably won’t, but, um. And he was just amazing. And so it was just a waiting [00:22:35] list initiative, essentially, where you just reduce the waiting list for Glasgow Dental School so that for about nine months [00:22:40] loved it. Used to go to work with a buzz every single day. Every day. Enjoyed it. And I was like, you know what? This [00:22:45] is it. This is what I want to do. But the problem is, when my CV wasn’t strong enough, so I still had to go back to some maths facts, build [00:22:50] my CV to apply.

Payman Langroudi: Just to get in.

Ammar Al Hourani: Yeah, it’s quite competitive getting to the end though. There was only maybe 8 to 12 places [00:22:55] a year so I didn’t get in for a couple of times. I got in the third time at Liverpool. [00:23:00] Um, I approached a guy called Fadi Jarrad. He was the head of department at Liverpool, started chatting [00:23:05] and yeah, I went for an interview, got in. So like, I thank him for essentially having [00:23:10] faith in me to bring me on to the program because at that point I was starting to give up hope. You know, getting into that program is hard, [00:23:15] you know? So he saw he saw something in me, I suppose. So, like I’m quite grateful for that. And then I got [00:23:20] in and just yeah, I just really enjoyed the experience. For four years it was three, three, three, four years. Yeah.

Payman Langroudi: Part time. [00:23:25]

Ammar Al Hourani: Full time.

Payman Langroudi: Four years, part full time.

Ammar Al Hourani: So it was three years, but I had an extension to it. So I had [00:23:30] to do an extension for my doctorate because I didn’t finish it off in time. So I had to take.

Payman Langroudi: And you had to pay as well.

Ammar Al Hourani: Yes, sir. [00:23:35] Yeah. Pay money? No salary.

Payman Langroudi: So how did you pay for it?

Ammar Al Hourani: So I had [00:23:40] savings at the time, so I wasn’t lavish in my lifestyle, which was good. So I saved up a lot of my money, [00:23:45] which is good. So I used that. Um, I worked, yeah. So Monday, Tuesday, Wednesday was in clinic. I stay [00:23:50] in a library. Well, not library, either a library or the common room that we had till about 11 doing my research or [00:23:55] from home. Thursday I’d go and work privately doing endo in Huddersfield and in Liverpool. [00:24:00] So I worked in a few clinics. Friday I would do the lectures that we [00:24:05] would get trained on a Friday or get our seminars on the Friday. Then I used to do the second on call, either at Preston [00:24:10] during the weekends, or I used to do the EDS emergency dental services in Morecambe. [00:24:15] Preston. Was that part.

Payman Langroudi: Of the.

Ammar Al Hourani: Course? No, no.

Payman Langroudi: That was trying.

Ammar Al Hourani: To save [00:24:20] some cash basically. Yeah. And then weekends at work. So I did that for three years. Literally never took [00:24:25] a day off.

Payman Langroudi: Wow.

Ammar Al Hourani: And I had a kid at the time, so I didn’t. When I went into training, I didn’t really factor [00:24:30] in nursery school fees. Yeah. I didn’t factor in. I had a child or a wife. Does that make sense? I [00:24:35] didn’t factor in a family.

Payman Langroudi: When had you gotten married?

Ammar Al Hourani: 2014. [00:24:40] 2014.

Payman Langroudi: During all of this stuff? Yeah.

Ammar Al Hourani: So I came [00:24:45] back from refugee camps, met my wife, uh, got married at the time. My wife. Um, [00:24:50] yeah. And then the specialist training. And so, like, I had. Yeah, like a whole family [00:24:55] with me to deal with. I would definitely say do it if you’re single or just married with no kids, don’t [00:25:00] do it the way I did it. It’s really difficult on your marriage, for sure. It’s difficult [00:25:05] on a lot of things. It’s just you disappear. You disappear into thin air, essentially.

Payman Langroudi: I’ve spoken to a bunch [00:25:10] of specialists who talk about that sacrifice. Right. Um, at the same time, [00:25:15] it’s worth it, right? You know that.

Ammar Al Hourani: Well, it depends what’s worth it.

Payman Langroudi: Yeah.

Ammar Al Hourani: What is [00:25:20] worth it? What are you sacrificing? You know. So for me, uh, I just love my career. You [00:25:25] know, I’m quite young. I wanted to have a good life, to give my family a good life. I need to have a good life. Does [00:25:30] that make sense? So all permeates down. If you’ve got a good income, your family have a good income good, and so on and so on. [00:25:35] Uh, so yeah. So something had to give. To be fair, at the time, she was very supportive. She helped me out [00:25:40] tremendously. But it’s it puts a lot of stress on it as well. So special training [00:25:45] I would say do it if you’re not married and have kids, I definitely think so. If you’re going to do it afterwards, [00:25:50] I think it’s going to it’s a bit more tricky. You’re going to have to manage a lot more stuff, and it’s whether or not you [00:25:55] can manage it, you can come out the other end. That’s the difference.

Payman Langroudi: So then how much is the [00:26:00] course?

Ammar Al Hourani: It’s about 20 grand a year cash, so you have [00:26:05] to pay it in two instalments or three instalments, 20 grand plus your living costs, which is about another [00:26:10] average living cost at the moment. How much would you need? About a month. Three grand, maybe 3 or 4. It depends [00:26:15] where you live, I suppose. Yeah, but for for us we need about three grand a month. About three, three and a half grand [00:26:20] a month. We needed to just about get away with it every month, you know, rent, kids, schooling and all that sort [00:26:25] of stuff. And that was tight, you know, it was tight, but it was okay. And my parents helped, you know, she helped a little [00:26:30] bit as well. You know, it was good. Like everyone sort of chipped in. So we made it work. If you want to make it work, it will work.

Payman Langroudi: Liverpool’s [00:26:35] a good town. Oh great I love Liverpool.

Ammar Al Hourani: Brilliant city. Love it. Brilliant people.

Payman Langroudi: Yeah. [00:26:40]

Ammar Al Hourani: Brilliant city. Good university. Yeah. It’s a very similar to Glasgow that the Celtic connection. The Irish [00:26:45] descent city you know ship making and stuff. So it felt home from home. It didn’t, I didn’t feel it’s [00:26:50] just the accent was a little bit difficult at the beginning to pick up. But after that it was all good. And it’s nice. It gets a bit. [00:26:55] Liverpool gets a bad rep. I don’t know why. It’s actually a great city. It’s not. It’s not that bad at all, you know.

Payman Langroudi: So [00:27:00] it’s my favourite. I like Scousers, they’re just funny, good fun.

Ammar Al Hourani: They’re chilled out, salt [00:27:05] of the earth.

Payman Langroudi: But you’re right, like Glasgow people. I remember when I was on the road, I used to stay [00:27:10] in Liverpool, over Manchester and Glasgow over Edinburgh and [00:27:15] Glasgow and Edinburgh. I just couldn’t understand how like 40 minutes could make such a big difference [00:27:20] to the culture of these people. Man. Correct. Because I was young, I was young enough to want to like, go [00:27:25] and go out and see what’s going on in this city in Glasgow, always end up sitting on the pavement [00:27:30] with 30 people sharing pizza. Yeah that’s Glasgow. In Edinburgh I wouldn’t meet a [00:27:35] single person like no one, no one. And I couldn’t understand how it could be so, so different. Yeah, [00:27:40] I agree, but they are no even massively accents. Massively different.

Ammar Al Hourani: Edinburgh doesn’t have much of [00:27:45] an accent. Yeah, it’s very very, you know, Queen’s English.

Payman Langroudi: And the funny thing is from the outside [00:27:50] you always think Edinburgh is so beautiful, stunning. You know, you always think Edinburgh is the place to be in [00:27:55] Scotland. Definitely Glasgow from the outside because of how beautiful it is. Right. I mean, the.

Ammar Al Hourani: Heritage [00:28:00] site isn’t it? Edinburgh is one of the nicest cities in Europe, isn’t it? Yeah.

Payman Langroudi: So yeah. No, it [00:28:05] always I always think there are lots of areas of cities that are pretty, [00:28:10] but not a city with a whole thing is so beautiful, you know. It [00:28:15] is. You know, you can find a nice bit of London, a nice bit of anywhere, right? But the whole thing [00:28:20] is just.

Ammar Al Hourani: It’s a beautiful city. But then the problem with Edinburgh is you also walk in town. I don’t know if you’ve noticed. It’s very touristic [00:28:25] and then you sort of reach the end of the city. You’re suddenly walking down Princes Street and you’re like, right, I’ve reached the end. Yes, [00:28:30] Glasgow doesn’t have that. Glasgow is just it’s a fun city. It’s great. It’s got a little bit of danger, a [00:28:35] little bit of a little bit of intrigue. But people are brilliant. Good laugh. You can always have a [00:28:40] chat with a guy in a bus stop. It’s very therapeutic. Um, no, I love Glasgow, it’s [00:28:45] great. But my brother went to Edinburgh and so like we, we have that sort of Edinburgh Glasgow clash all the time, but [00:28:50] they’re both brilliant cities to be honest with you. But.

Payman Langroudi: So it’s four difficult years I guess. [00:28:55]

Ammar Al Hourani: Yeah.

Payman Langroudi: You come out now, you’re a specialist.

Ammar Al Hourani: Yeah.

Payman Langroudi: What do you do next? [00:29:00]

Ammar Al Hourani: Well, you come out unemployed. That’s essentially what happens. Yeah. You come out, you [00:29:05] don’t have a job. You know, it’s not like medicine. You come out and you know you will eventually get a consultant job or something. You know, [00:29:10] a locum job, or you’ll sort yourself out, you know, you’ll get a job. You’re never going to be unemployed. Basically, as a doctor here [00:29:15] was a specialist and I didn’t really have a job. So yeah, at the time I’d sort of, [00:29:20] um, it was a discussion I had with my wife at the time. And, you know, I was going back to London. She’s from London. [00:29:25] So we came down to London. It was either Scotland, stay in Manchester or go down to London, you know, uh, [00:29:30] Scotland, I think I would have done well, but it’s a much smaller market. Manchester [00:29:35] was good, but it was already getting really saturated. You know, there was a lot of specialists coming out because of the end of the MSC [00:29:40] programme. You had Sanj, who was teaching at Liverpool at the time. You’ve got Uclan coming along, so there’s a lot of dentists [00:29:45] special interest, maybe not as many specialists, but definitely a lot of dentists special interest. So it was starting to get a bit saturated. [00:29:50] Or then you go down to London and London. You know, no matter how people say, London will always [00:29:55] need more, you know, like it’s just it’s just an all consuming city. But [00:30:00] the problem was I started from zero because I know, like, who am I? I didn’t.

Payman Langroudi: Know anyone.

Ammar Al Hourani: I didn’t know anyone. So [00:30:05] I had to take any job I got to. I had imposter syndrome because I wasn’t really I didn’t feel [00:30:10] like a specialist, you know, I didn’t have enough. I didn’t make enough mistakes to feel like a specialist. I didn’t. I [00:30:15] needed to make my mistakes, you know? I needed the volume. Three people had to buy you stuff [00:30:20] and believe in you because, you know, setting up an indoor referral.

Payman Langroudi: Is very.

Ammar Al Hourani: Expensive. Yeah. You’re looking at 30 [00:30:25] grand probably by the time you buy all this stuff. Probably more. Yeah. So, like, you know, if no one knew who I am and [00:30:30] I’ve got specialist badge and then I’m saying I’ve got me go and go and buy me 30 grand’s worth of stuff like, you know.

Payman Langroudi: So what happened? [00:30:35] How do you negotiate this?

Ammar Al Hourani: So some clinics approached me, which was great. I put adverts out, some [00:30:40] I sort of stumbled upon through friends and just grew it. And I was working in, I think at the time, like maybe [00:30:45] 12 different clinics.

Payman Langroudi: Wow.

Ammar Al Hourani: In two days here. Two days there. Yeah. Like I was just all over the [00:30:50] place, and I was just. No one knew who I was. And, you know, there was a lot of big names already here. You know, people who’ve maybe [00:30:55] written some of the textbooks I was reading or, you know, using the file systems they’ve developed. So I was like, literally, [00:31:00] I was a nobody. You know, you definitely felt like a nobody. And it was a new city. I’m not from London. I [00:31:05] must admit, I don’t like London as a city. It’s not my it’s not my place. I like living outside London. I don’t like London [00:31:10] per se. I like for dinners and stuff going out, but definitely not living in it. So it was very foreign to me. I was [00:31:15] now a Scot who was living in London. Uh, didn’t know my left from my right. Uh, I wasn’t [00:31:20] making a great income. Yeah, I was it was a lot going on at the same time. So that’s when I started Dental guys, basically [00:31:25] that was the that was the whole launchpad of the whole thing to get my name out there. [00:31:30] Essentially. That was it to get referrals like that.

Payman Langroudi: I like how open you are with that. [00:31:35] Yeah. Um, but how come you weren’t making good money if you were working in 12 different clinics?

Ammar Al Hourani: That’s [00:31:40] one. The pricing structure probably wasn’t the best in some places. I was. Still, I didn’t feel like I was worth. [00:31:45]

Payman Langroudi: Maybe you weren’t charging enough.

Ammar Al Hourani: No, I wasn’t charging enough. I think I was I didn’t feel I was worth more [00:31:50] than £600. I’m not being funny. I’m charging a lot more now. But at the time, you know, I went from charging, [00:31:55] what, £200, £300 in the end in Huddersfield. Yeah. To then suddenly saying it’s £600. So for me it was [00:32:00] already.

Payman Langroudi: Sounded like a.

Ammar Al Hourani: Lot. And I’m like oh my god £600. You know that’s a lot of pressure. And so I [00:32:05] just didn’t feel ready for that sort of jump yet. I definitely had imposter syndrome, there’s no doubt about it, you know. And, [00:32:10] um, yeah. Then you start competing, you know, comparing yourself to other, more established endodontists [00:32:15] and you’re like, oh my God, am I ever going to get there? Am I? Who am I? What am I doing? Am I in the right [00:32:20] city? Should I leave? You know.

Payman Langroudi: So how long did it take before you felt like I’m actually, [00:32:25] you know, making progress.

Ammar Al Hourani: 3000 handles, 3000 handles. [00:32:30] Later, I think I felt like I was ready to rock and roll. I could probably do, you know, I felt I could do just about more [00:32:35] stuff to a relatively decent level.

Payman Langroudi: So how long did that take? A couple of years.

Ammar Al Hourani: About four years. [00:32:40] Three. Four years.

Payman Langroudi: Four years?

Ammar Al Hourani: Yeah. Three. Four years of travelling and working. You know, making some mistakes here [00:32:45] and there and everywhere. Not big mistakes, you know, small little mistakes here and there where your brain starts going. Oh, [00:32:50] I’ve been here before. Don’t do that. Or, you know, take that turn. Not that turn, you know. And all these little experience I would [00:32:55] have bought, you know, if you told me, pay 100 grand for five years experience, I would have paid you a hundred grand right there and then for five years experience. [00:33:00]

Payman Langroudi: Yeah.

Ammar Al Hourani: Yeah. All day.

Payman Langroudi: Long. I mean, you’re right to sort of correlate experience with mistakes. [00:33:05] Yeah. Because that’s what it is. There’s there’s no getting away from that 100%. [00:33:10] You can’t buy experience. It’s difficult. It’s difficult.

Ammar Al Hourani: Very difficult. So. [00:33:15]

Payman Langroudi: So I mean, we will talk about mistakes later. Yeah. [00:33:20] Let’s, let’s let’s get to Endo. Let’s let’s talk about endo now. Yeah. Um, [00:33:25] I don’t know. I haven’t really looked at it for 20 years, to tell you the truth. Yeah. [00:33:30] Um, but I kind of want to go down sort of in each area. [00:33:35] I want you to give one solid, like, amazing tip that would improve [00:33:40] anyone’s. Yeah. So in each area diagnosis. What is it about diagnosis [00:33:45] here that most of us don’t realise or should realise or.

Ammar Al Hourani: Listen to the patient? [00:33:50]

Payman Langroudi: Go on.

Ammar Al Hourani: Listen to the patient. Honestly, the patient will tell you everything. See, [00:33:55] a lot of us jump to a conclusion by looking at a radiograph and the referral letter that’s been sent.

Payman Langroudi: Yeah. [00:34:00]

Ammar Al Hourani: So you go. Oh, okay. It must be this. Actually listen to the patient before. You know it [00:34:05] actually isn’t that at all.

Payman Langroudi: Or an example.

Ammar Al Hourani: An example.

Payman Langroudi: What’s a patient going to say?

Ammar Al Hourani: That’s what [00:34:10] patients, for example, will come in. Dentists would say could you do this root canal treatment toothless tip. [00:34:15] But that in itself is not diagnostic. Ttp standards to percussion could be [00:34:20] anything. Inflammation of the PDL can happen because if anything patient comes in they’ve got high filling. They’re [00:34:25] grinding their teeth. They’ve got something stuck in their gum. Their gums are a [00:34:30] bit swollen. Before you know it you’re like, listen, I think you should reduce the filling and your tooth is a lot. You [00:34:35] know, you do a bit of sensibility testing radiograph looks fine. Bit of widening of the PDL. Done. [00:34:40] No, no endo required. They’re delighted. They’ve come in wanting thinking they’re going to pay £1,000. [00:34:45] Fernando. Now you’ve said just I’m going to reduce your cusp down a little. You know your filling down a little bit. Keep an eye on [00:34:50] it. Get a night. Night night. Splint. Check that out. You know. Masters are massive. Temporalis is big. [00:34:55] You know, you’ve got tongue scalloping. You’re a bruxism. Go and get that sorted out. Done. [00:35:00] Patients happy? You know, literally little small things. Like just listen to the patient and do a proper [00:35:05] exam.

Payman Langroudi: That’s it. Let’s say you decide now you’re going to go and you’re going to do an endo. When you when [00:35:10] you’re looking at that radiograph what’s the key thing. Is it is it as [00:35:15] simple as you know the, you know pathway of that file and acts how the access needs to be for [00:35:20] that curve. Is that all we’re saying.

Ammar Al Hourani: I think the first thing is look at the radiograph properly. Go on. Okay. So look [00:35:25] at the I always split the radiograph into three parts. Crown middle of the root somewhere. You know where [00:35:30] the the bone level is and then the root. Look at all three parts really really well. [00:35:35]

Payman Langroudi: Yeah.

Ammar Al Hourani: Once you’ve broken that down then you know what to do with the crown. You know what to do at the coronal third which is relatively [00:35:40] straightforward to get into. You know, and then you can look at the apical third and then you can decide how am I going to access [00:35:45] this properly. Okay. So that’s number one. Number two if you’re going to do the access don’t go for ninja [00:35:50] access as in all that sort of stuff. You know, like if you’re a novice and you don’t do lots of handle, just make your life easy. Make [00:35:55] it big enough to do the job properly.

Payman Langroudi: Yeah. So just explain it. For people who don’t know, ninja access means you’re [00:36:00] super minimal.

Ammar Al Hourani: Super conservative.

Payman Langroudi: Cavity.

Ammar Al Hourani: So small that it’s like the size of the [00:36:05] bung of your, you know, k file, you know.

Payman Langroudi: Yeah. And amongst amongst you guys. That’s kind [00:36:10] of a kudos point, right? Like amongst the super specialists.

Ammar Al Hourani: The irony is a lot of us probably don’t [00:36:15] do ninja accesses.

Payman Langroudi: No. Just for Instagram. Right. Yeah we do.

Ammar Al Hourani: That on Instagram on where you’ve sort of fluked it and you go, [00:36:20] right, I’m going to take a photo of this and show this up. But the reality that’s only a snapshot in time. That’s not how we do it every single [00:36:25] day. Because honestly, you do that. Ninja access. Good luck. Cleaning it out. [00:36:30]

Payman Langroudi: Is the whole point of it. Just to conserve tooth, is that it? Yeah.

Ammar Al Hourani: I mean, yeah, the more you keep, [00:36:35] the better it is for long term. But then you don’t want to be in a situation where you keep so much that you actually have lost the biological [00:36:40] concept of why you’re doing endodontics, which is to get the rubbish out basically, you know, so if you’ve got [00:36:45] the pulp chamber still kicking around and you can’t remove that pulp stone, you can’t find the canals and you’re going to snap [00:36:50] an instrument down there because the access is so small, you’ve sort of defeated the whole purpose. You’ve just made your life more difficult and [00:36:55] you’re not going to get the outcome you probably want. So what was the point? Make it a bit bigger.

Payman Langroudi: I’m probably asking silly questions because [00:37:00] it’s been so, so long for me. But is the access always the same for [00:37:05] each tooth, or is it?

Ammar Al Hourani: Pretty much. Yeah. Once you’ve done enough. Yeah, it’s almost the same.

Payman Langroudi: Pretty much. You don’t [00:37:10] sometimes change the access for a particular curvature of the canal sort of thing.

Ammar Al Hourani: No. You want straight line access. [00:37:15]

Payman Langroudi: So you do something to make it bigger. Bigger? Yeah.

Ammar Al Hourani: I’ll just try to sort of. Yeah. Open it up so that I get straight [00:37:20] line access. So I put less stress on the file, meaning I don’t have multiple curvatures or multiple planes to the file. [00:37:25] So I don’t want to go in at one angle. I’m in a canal. Another angle. And then it’s a third angle that you’re going into. [00:37:30] Or a fourth angle sometimes can be turning away in two different planes. They’ve put for, you know, a cape. I [00:37:35] think what a lot of people misunderstand sometimes is the system that we use is a little bit like a [00:37:40] paperclip. It has areas of tension, compression. You keep doing that long enough, you’re going to snap it somewhere. These [00:37:45] files are great, but they don’t want that much stresses on them. So the less stress you put on them. [00:37:50] And obviously keep some arrogant in the canal so you don’t overheat it either. Temper it down, give it a glide path, [00:37:55] absorb a lubricant, I suppose. Yeah. Then it’s going to make your life a lot easier. So [00:38:00] I’ll get straight line access. I don’t want to put too much stress on that file.

Payman Langroudi: Do we need to discuss that? Is there anything you do [00:38:05] differently regarding isolation than.

Ammar Al Hourani: Rubber dam.

Payman Langroudi: And liquid.

Ammar Al Hourani: Rubber dam and liquid dam? That’s it. That’s all you need.

Payman Langroudi: Okay. [00:38:10]

Ammar Al Hourani: Yeah. Keep it simple.

Payman Langroudi: So. And the instrumentation itself. Yeah. Does any [00:38:15] one hand file any more at all? Is there a is there a place for it or is it 100%.

Ammar Al Hourani: I mean, you still need the hand filing the size [00:38:20] eight and ten k file to get your patenting and your initial sort of glide path. I mean, that that still is [00:38:25] the hardest part of antibiotics, you know, trying to get down with the K file. Yeah. And trying to [00:38:30] get patency. That still is the hardest part. And that part you still have to understand how to do [00:38:35] well. Understanding the k file when it clicks, when it works, when it cuts, when it doesn’t work, that’s [00:38:40] actually the skill. Once you’ve got a size ten, they’re relatively loose. You’ve got so many great file systems [00:38:45] now in the market that will blast away all the way through it. That’s still the hardest part. So yeah, you still need to understand [00:38:50] hand instrumentation very, very well to that point. But do you need to do stepwise technique like [00:38:55] we used to do in the past? No I know you don’t need that. You’ve got such a great file systems now that are not [00:39:00] that expensive. Really that will do you a great job, a very predictable job. And ultimately it’s just [00:39:05] there to create space for the arrogant. Yeah. And it was all about bleach. Like literally if you boil it [00:39:10] down to one thing, it’s bleach. Get the arrogant into the apical arrogance.

Payman Langroudi: Not moved on from bleach.

Ammar Al Hourani: No, [00:39:15] bleach is still the king.

Payman Langroudi: Delete it.

Ammar Al Hourani: No. No.

Payman Langroudi: Is that. Is that an old thing? [00:39:20]

Ammar Al Hourani: You’re. You’re already at body temperature anyway. You’re already at body temperature. So what’s the point?

Payman Langroudi: You know, I thought maybe you heat [00:39:25] it so it kills more bacteria or something.

Ammar Al Hourani: It can do. It can do. It’s more effective. But the problem is then it becomes more runny. And if it goes through [00:39:30] the apex. Good luck. Yeah.

Payman Langroudi: Becomes more funny when you.

Ammar Al Hourani: Eat a bit more runny when you heat it. So you don’t want to be overheating [00:39:35] it too much. I don’t see the point because you’re also activating it when you activate it. You’re also warming it up a little bit. [00:39:40] So your tooth is already a basin at body temperature. So it’s going to naturally warm up irrespective. And [00:39:45] you’re using lots of volume. So because you’re using lots of volume it’s going to do the job. You know it’s all about volume [00:39:50] and time and again it’s the apical third. You get it there. You’re going to be really good. [00:39:55] It’s what you remove. It’s not what you put back in. So as long as you.

Payman Langroudi: So you’d say if you had to choose one or [00:40:00] the over the other. The irrigant. Bleach is more important than removal [00:40:05] of sort of infected dentine or something like this.

Ammar Al Hourani: Yeah. Still bleach I think is number one. I mean, they both actually. [00:40:10] You need both. Yeah. That’s why it’s called chemo mechanical. Because you need the mechanical to create space and maybe remove some of that [00:40:15] infected debris on the dentine. But the problem with that is you don’t remove enough. If we’ve got a lot of cbct studies, [00:40:20] which shows that files only touch maybe less than 50% of the surface. So that means because, you [00:40:25] know, the canal is an ovoid, you’re creating a cylinder within an ovoid. So that means two sides of the ovoid are never going to [00:40:30] be touched. And the only way you’re going to get in there is by activating with an arrogant. So you need the activation to move it. [00:40:35] It’s like having a bath. You need to jump in it to move the whole thing around. So it’s the same concept. The problem is with needle [00:40:40] irrigation, you can’t get the irrigate into the apical third. It’s just not possible. Like again it’s. You think [00:40:45] bleach is thin, you know, runny. But actually when you use it under the microscope, it’s actually quite thick. It’s not as thin [00:40:50] as you think it is. It is far thinner. So that’s when you start seeing the disparities. So you need [00:40:55] to push that arrogant down there. So you have to use either PowerPoint, just push it in, or you’re gonna have to use an activator [00:41:00] of some form. There’s a lot of cheap products out there that can do that for you. So we’re in a great era of [00:41:05] really affordable, great products, if I’m being honest with you. So.

Payman Langroudi: And are they. Okay. So now now [00:41:10] I’ve sort of opened it up. I’ve got bleach around. Are they good [00:41:15] and bad? Apex locators and um, is it a type [00:41:20] you should stick to or.

Ammar Al Hourani: I’ve got one type I love the pro Pax Pixi by Dentsply Sirona. I think it’s a [00:41:25] really great apex locator does a great job for me. Anyway, you’ve got the Morita, which is probably the most studies. [00:41:30] Apex locator. I think that’s really good, but it’s a little bit jumpy in my hands, so I don’t really use it [00:41:35] as much. And then you’ve got a lot of other apex locators. So what works in your hands? As long as you get consistency it’s what works in your [00:41:40] hands. Use whatever you like.

Payman Langroudi: But are you are you sort of system agnostic when it comes to [00:41:45] preparation and filter?

Ammar Al Hourani: Yeah. If you come to the clinic, everything’s OCD, everything’s in [00:41:50] a stage. So if you people are more than welcome to come and shadow me, by the way. But yeah, if you come and watch me, [00:41:55] my setup is, you know, it’s exactly from start a from the burr all the way to Obturation. It’s all set [00:42:00] up in a chronological order. And it’s always been like that. It doesn’t change.

Payman Langroudi: But you don’t follow a particular [00:42:05] type of like, uh, school of.

Ammar Al Hourani: Uh, so I like I like going for much more minimal taper [00:42:10] now, uh, and I don’t like the big tapers anymore because I think you’re stripping away too much dentine. So I do [00:42:15] like the minimal taper, but I still like to make, you know, strip out enough, not strip out, but clean out enough. The dentine, [00:42:20] I suppose, or remove enough of the infected dentine. But yeah, I like to go minimal a minimal now [00:42:25] much more minimal. Keep as much tooth as possible. The more you keep the better the outcome, because whenever you remove you can’t replace. [00:42:30] No material out there is going to replace what you’ve just lost. So I like to stay as minimal as possible. So [00:42:35] that gives us the best long term outcome.

Payman Langroudi: And then the filling.

Ammar Al Hourani: Filling is in the obturation or the coronal [00:42:40] seal filling.

Payman Langroudi: No the obliteration.

Ammar Al Hourani: Obturation I use bioceramic sealers now. So I love bioceramic sealers. [00:42:45] You know, MTA derivative sealers, which is really great. Very good work. Really. Well, the science is backing up [00:42:50] nicely obviously. Be careful what bioceramics you’re using because there’s a lot of them out there in the market. So it has to be truly by ceramic. [00:42:55] So there’s some good products out there that you could use.

Payman Langroudi: That’s the sealant.

Ammar Al Hourani: Sealant and then a single cone technique. [00:43:00] So it’s called obturation. Now you’re not even having to heat it anymore. You just have a correlating GP point which fits [00:43:05] the file system that you’ve used. Put the sealer in and you just put the GP in position. Cut it. You’re [00:43:10] done. It doesn’t take that long now it takes seconds.

Payman Langroudi: But then where are the errors [00:43:15] in that bit? I mean people sort of pull it out by mistake while they.

Ammar Al Hourani: Yeah it can do. Yeah. You [00:43:20] can pull it out. Yeah. You can pull it out if you use the Bunsen burner and your nurses cigarette lighter. Yeah, of course you can. That [00:43:25] obviously that the good.

Payman Langroudi: Old.

Ammar Al Hourani: Days, the good old days. And believe it or not, that’s still a lot of practice mantra in the UK. [00:43:30] A lot of people still do that. So you could I think now you can buy really cheap cutting systems that are as [00:43:35] low as £60 on the market, so you don’t really need to do that. I think people just need to invest. If you invest a little bit [00:43:40] of money, you can make your life tremendously easier. It won’t come out.

Payman Langroudi: And then the next bit, the sort of [00:43:45] the coronal seal, coronal composite.

Ammar Al Hourani: Yeah. So either you reroll the tooth beforehand, [00:43:50] you put it back into a class one and do your root canal treatment, or you do your root canal treatment and then rebuild everything up [00:43:55] for your refining dentist. I think the refining dentist likes you to do, especially with with those endodontists [00:44:00] now, I think we’re more restoratively driven endodontists. So we’re not just endodontists, you know, Cottonwool pellet, [00:44:05] you know, GIC and back to, you know, we do quite a lot of that stuff now for you. And if you ask [00:44:10] us to, we would do it. And I think we like doing it for two reasons. One, it keeps our skill up in that respect. [00:44:15] So we have our finger still on a bit of restorative dentistry. And two, we’re much more confident with the coronal seal. So when [00:44:20] it comes to you and we ask you for an only or a crown, we’re comfortable with what we’ve put in there. So it makes us a bit happier [00:44:25] that we’ve removed the decay ourself.

Payman Langroudi: Because you kind of you own the coronal seal.

Ammar Al Hourani: You own the whole thing. Yeah, yeah, yeah, yeah. [00:44:30] But we expect you to do a really good crown because if you do a terrible crown that’s going to leak back in. So again, [00:44:35] you know, the crown or the only is still very, very important.

Payman Langroudi: How soon after. [00:44:40] Straight away. As quick as you can.

Ammar Al Hourani: Um I would say usually give it 4 to 6 weeks [00:44:45] just to let things settle down. Patients probably paid a lot of money now for the endo. Maybe they’ve come and seen you twice. Um, [00:44:50] you know, it’s a lot of cost.

Payman Langroudi: Did you always advocate some [00:44:55] form of crown.

Ammar Al Hourani: If you’ve lost? Yeah. If you’ve lost a marginal ridge, you’re going to have to use cuspal coverage, especially on a posterior tooth, because [00:45:00] it’s more likely to break. So yeah, you’re always going to advocate. And usually I would usually ask, you know, [00:45:05] advise on what material I would like you to use as well. So it depends on your occlusion. So we check [00:45:10] the occlusion I check the guidance, I check all that sort of stuff. So when I send you a letter back I’ll say could you please do it in X, [00:45:15] Y and Z? And there’s a particular reason as to why I’ve sort of said that. If not, I’ll say choose whatever you want. [00:45:20]

Payman Langroudi: How do you know? Yeah. From my days when I was a dentist, man, when you get in [00:45:25] to the to the pulp cavity. Right. And there’s like, cracks. How [00:45:30] do you know what crack is?

Ammar Al Hourani: A good crack?

Payman Langroudi: A good crack.

Ammar Al Hourani: Is a bad one.

Payman Langroudi: And [00:45:35] ones. Which one is it? When, how? How can you tell whether a crack is a problematic crack [00:45:40] or not? Or can’t you?

Ammar Al Hourani: Well, there’s a number of things. First, discuss the symptoms of the patient. So one, [00:45:45] you know, are they getting symptoms when release on bite. So that usually will tell you that the crack maybe is a little bit deeper down [00:45:50] than you think it is. Two. Look at the bone levels. Have you got any horizontal bone loss? A vertical bone loss [00:45:55] around the margins, which are very important. That’s probably where it’s stopping. Third thing is [00:46:00] we I die. If I die the crack and I see where it is. If it’s still in the coronal pulp chamber on [00:46:05] the sides, I’m good with it. If it’s in the canal, maybe in the first millimetre or two, it’s a bit more problematic. [00:46:10] But we’d still give it the benefit of the doubt and still do the root canal treatment for you. If it’s on the floor of the [00:46:15] pulp, then I think, let’s call it a day.

Payman Langroudi: Even if it’s a tiny little hair.

Ammar Al Hourani: Yeah, yeah, that’s that tooth is splitting apart. [00:46:20]

Payman Langroudi: Okay.

Ammar Al Hourani: And you want predictability. You’re not going to charge the patient. The best part of what, a [00:46:25] thousand £1,200 and then a crown to go. I’m really sorry. That only lasted an hour. You know, a couple of days [00:46:30] or a couple of years. You know, I don’t think most patients would be happy with that. And also, you’re also worried about the bone loss [00:46:35] because if you start losing a lot of bone, you’re going to really compromise the implant placement as well. So again, I’ve sort of [00:46:40] now made you lose a tooth and not great about bone. So the crack as long as [00:46:45] in a nutshell, as long as it’s in the crown, you’re okay? Um, I.

Payman Langroudi: Think it’s [00:46:50] kind of back to the. If the tooth is broken down way, sort of gingerly.

Ammar Al Hourani: Broken [00:46:55] down is in the filling, you.

Payman Langroudi: Mean. Yeah. Before you start.

Ammar Al Hourani: It depends if you if you could do crown [00:47:00] lengthening. Yeah, I’d try to. I’d always advocate trying to save that tooth.

Payman Langroudi: Yeah, but I’m sort of. [00:47:05] At what point does hero become a problematic. You know that’s [00:47:10] that’s the question.

Ammar Al Hourani: There’s two things here. I think the first thing is I know this sounds like, you know, bringing it [00:47:15] into camps, but the first thing is I would say is look at the age group of the patient. If they’re about 19, 20, 21, you [00:47:20] take that tooth out. What are you going to put in there? Are you going to put an implant every ten, 12, 13 years, 15 years? You’re going to have to change [00:47:25] it. So they’re going to change it about 6 or 7 times in their lifetime. That’s a lot of work. Yeah. You don’t know what disease they might have in [00:47:30] the future. Will the implant even be an option for them down the line? You know, it’s all that sort of stuff. So you’re now opening up a lot [00:47:35] of that unknown. If I could buy you a few more years and I’ll buy it might be not the best scenario [00:47:40] that we’re in, but you’d be surprised at how many times you do these and they [00:47:45] last like ten years, you know. So yeah, again. So I try to push based on age group, I’d like to [00:47:50] push that younger patient kick that can a little bit longer.

Ammar Al Hourani: If it fails, we can always do surgery [00:47:55] on that route by a few more years. Again kicking it again. You know, it’ll reheal hopefully with a bit of fresh bone, [00:48:00] then have the tooth out. That could be 15 years down the line. Great. Well, you know, you’ve left that ace [00:48:05] card down the line. You put the implant, now you’re going to be losing more bone. You’re going to have to have more implants. You’re going to have more [00:48:10] disease around the implant, more complications. You might develop patio systemic disease where it might become more difficult [00:48:15] now opened up a lot of unknowns. I’d rather just be predictable. Nothing will replace your tooth. But [00:48:20] obviously sometimes you look at it and you’re like, that’s enough. There’s only so much I can take. Once we’re below bone level or [00:48:25] at bone level, I think you’ve pushed it. I think that’s enough. So I do try my best. [00:48:30] Yeah, but it’s all about consenting. It’s all about consent. Yeah, it’s all about consent [00:48:35] and pulp.

Payman Langroudi: Like pulpal anatomy, Canal anatomy is like. I think [00:48:40] I used to have an endodontist boss as well. Yeah. And he told me, look, there’s [00:48:45] a hundred little side canals and things you can’t see. So what [00:48:50] happens there? Is the sealant going in those, or is the bleach going in those, or is what’s what’s [00:48:55] going on.

Ammar Al Hourani: So yeah, you’re you’re activating the arrogant. Hopefully some of that bleach is going to go into the, into those [00:49:00] little lateral canals. But you can never clean it all out. That’s a problem. We can’t sterilise the tooth. We’re disinfecting it as much [00:49:05] as we possibly can. Yeah. And we’re reducing the bacterial load as much as we possibly can. And then entombing [00:49:10] what we’ve got left in the hope that you don’t give it any substrate to regrow. But obviously we are getting [00:49:15] a lot more emerging science on bacteria and microbiology within endodontics. We also have sampling errors [00:49:20] still within endodontics. So we don’t really know 100% about what’s what’s happening within it. [00:49:25] So there’s that science is constantly emerging. But as long as you’re cleaning sufficiently [00:49:30] that you allow the body to start to heal and the patient symptoms don’t get any worse, and that lesion isn’t getting any bigger. [00:49:35] Slowly, hopefully shrinking, then we’re okay. It’s buying you time. It’s the [00:49:40] science of buying time. Endodontics. That’s all it is.

Payman Langroudi: But if I’m if I’m a general dentist and I can’t find [00:49:45] the what was it called? Mtv2. Am I doing my patient [00:49:50] a disservice?

Ammar Al Hourani: The first thing, not every specialist finds M2. Just to put it out there, I [00:49:55] don’t find M2 every single time.

Payman Langroudi: Is that right?

Ammar Al Hourani: Yeah. Like I’m human sometimes. Take a cbct. And I still don’t find [00:50:00] M2. Like, it’s.

Payman Langroudi: Just sometimes it’s not there, right?

Ammar Al Hourani: Maybe it’s just not there. So then you go. You know what? We’ll keep an eye on it. But the thing, [00:50:05] the beauty of it is, then I can review it over time. And if it doesn’t work out, I can always do surgery. I can go back in and B [00:50:10] and b1 and B2 chop off the the root and buy myself more time. So I’ve still got that skill set to fix that problem [00:50:15] if I can find it. I think if you’ve got a periapical lesion on on that root [00:50:20] and you don’t find nb2, I think yeah, it might not work. I think maybe start thinking about telling [00:50:25] the patient about referral to a specialist or dentist special interest to maybe find that under magnification, if [00:50:30] the patient then says no, which a lot of them would do, then it’s all down to consenting. You’re going to have [00:50:35] to say, listen, I’ve done my best. I’ve got to the full length of the main canal, cleaned it really well. I’m hoping [00:50:40] that it merges with the main canal. Nb2 merges with Nb1 about 80% of the time anyway, [00:50:45] and hopefully you’ll get away with it for a short period of time, maybe a few years, and it [00:50:50] might fail again, and maybe revert then onto a specialist and they might deal with it. So it’s a matter of having that conversation [00:50:55] with the patient. Because honestly, you need to be pragmatic. Not every patient is going to afford £1,000. [00:51:00] And, you know, in terms of economy, you know, hardships and recessions and whatnot, people [00:51:05] are not going to be able to afford it. It’s a lot of money. It is a lot of money, you know. So I respect patients. If they can’t afford [00:51:10] it, try your best to clean it as best as you can, obturate it to the best of your ability and keep an eye on it in the [00:51:15] long run. Um, and then if it doesn’t work out, refer it across or refer it before [00:51:20] you obturate it. If you’re 100%, if you’re not 100% certain.

Payman Langroudi: And what what [00:51:25] is the predictor of a flare up after you finish?

Ammar Al Hourani: Well, [00:51:30] there’s a number of things. So we’re not putting rubber dam on. For example. You’re going to get a lot of saliva in there. So you’ve changed [00:51:35] the ecosystem in the canal to uh, maybe you’ve put some [00:51:40] sealer, not sealer, some arrogant through the apex a little bit off. It sometimes can cause a bit of a flare up. It might not [00:51:45] be a full blown hypochlorite accident, it might just be a little irritation. Yeah. Over prepping the canal. So you’ve gone through [00:51:50] through the other end. So you’re basically going into the PDL? Yeah. And then you need to remember your [00:51:55] flutes have also got infected dentine debris. So what you’ve done is you’ve essentially created a [00:52:00] cut and then you’ve rubbed soil into it. Yeah. So that’s what’s happened. So you’ve drilled a you know, you’ve you’ve [00:52:05] gone past the apex, you’ve drilled a little hole in the PDL in the bone, and then you’ve rubbed infected [00:52:10] debris into it. So you’re going to get a bit of a flare up after it. And the.

Payman Langroudi: Pa area, [00:52:15] a pre-existing.

Ammar Al Hourani: Period.

Payman Langroudi: That’s going to be more likely to flare up.

Ammar Al Hourani: Yeah, yeah. [00:52:20] Especially if it’s the larger the area. Also the more likely it might just blow up just [00:52:25] because the body also needs to start to heal. So you’re going to undergo inflammation to heal. And that inflammation might [00:52:30] not be very kind to you. So it’s you get facial swelling. I’ve had maybe 2 or 3 of these now in my in my career so [00:52:35] far where it’s just, you know, I thought it was a relatively okay treatment And it’s just blown up. Whereas if you’ve got a sinus, [00:52:40] ironically, it’s unlikely to get a flare up because you’ve already got an exit valve already. Yeah, yeah. So that’s [00:52:45] probably not going to happen. So you’re sort of going to get away with it really a bit more.

Payman Langroudi: But yeah I mean is [00:52:50] it is there a situation where you can. Is there something you can do to minimise [00:52:55] post-op discomfort.

Ammar Al Hourani: Yeah. So I usually give my patients ibuprofen before [00:53:00] they start before.

Payman Langroudi: The start of the treatment, before.

Ammar Al Hourani: We start the treatment ibuprofen beforehand because [00:53:05] you know it just reduces you know they’ve got anti-inflammatories in their system already. Make sure [00:53:10] that your working length is spot on. Make sure your prep plant is going to be spot on. Um, irrigate really, [00:53:15] really well. Obviously rubber dam is crucial. Have a great coronal seal between appointments. [00:53:20] Make sure if you’re going to do two visit endo. Make sure you.

Payman Langroudi: Ever do that.

Ammar Al Hourani: Yeah but I would say 10% of those are two visits [00:53:25] 10%. 10%. Yeah. Comfortably.

Payman Langroudi: You know why why would you choose to do it. Because in the first [00:53:30] visit you just couldn’t.

Ammar Al Hourani: So either I’ve, I’ve run out of time or [00:53:35] the patients had a lot of pain. So we want things to settle down a little bit. A sinus, I like the sinus to go away [00:53:40] before I do. Finish off the endo. Um, big pay off collision. Because I told you I’ve been stung a couple [00:53:45] of times, so now I like to let it settle down. If it’s going to flare up, it’s going to flare up now. So at least I can go [00:53:50] back in and still do something about it. If I go in and there’s a malodour, you know, retreatment there’s a malodour, it stinks. [00:53:55] Maybe there’s pus discharging, exudate discharging, blood discharging. I’ll put something. I just want that settle down. [00:54:00] Um, so or, you know, sometimes it could be just a difficult patient. And I’m like, I don’t want this [00:54:05] patient to complain down the line. I’ll put, you know, I’ll do everything as I can so that you don’t come back and haunt me down the line. [00:54:10]

Payman Langroudi: And what do you put while you’re in between the two points?

Ammar Al Hourani: Hydroxide. Calcium hydroxide. Yeah. [00:54:15] Ptfe tape. And then I’ll put cava and GIC two layers and that again, another reason for a [00:54:20] flare up is if your coronal seal in between appointments has been lost, you might get a flare up.

Payman Langroudi: So it’s not good enough. [00:54:25]

Ammar Al Hourani: No, no I’ll go down. Yeah. Cava and GIC I always put cava and then GIC on top, which [00:54:30] is good.

Payman Langroudi: You’re right. It’s an unnecessary risk, isn’t it? For for for one minute extra [00:54:35] to Put something stronger in there.

Ammar Al Hourani: Yeah, exactly. I think sometimes I just feel like if I’m not sure [00:54:40] or my gut instinct is what’s going on here, it’s a bit different. I’ll put calcium hydroxide. Let things settle down. [00:54:45] Bring the patient back in. Do a good endo. And I’m sort of, to an extent, maybe protected [00:54:50] medical eagerly because I’ve done everything by the book. There’s nothing more I could have done differently. Does that make sense? So if you compare me to someone [00:54:55] else, what else could they have done any differently than I could have? Nothing. You know what I mean? So I’ve done [00:55:00] everything I can at that point.

Payman Langroudi: What do you think of. I had someone here who was talking about pulpotomy. [00:55:05]

Ammar Al Hourani: Vital pulp therapy.

Payman Langroudi: Yeah. What do you think of that?

Ammar Al Hourani: I think it’s a [00:55:10] very, very interesting emerging science.

Payman Langroudi: So do you ever do that?

Ammar Al Hourani: Uh, I’ve done a handful. [00:55:15] I’ve not done that many. Uh, just because I’m still not confident enough with it. That’s me. On a personal [00:55:20] level, I’m not talking about the science. I think the science is there, but I’m just not confident with it. And maybe I’ve not had the [00:55:25] cases, really, where I’ve had that sort of patient between the reversible, irreversible Pi test, [00:55:30] that sort of early irreversible pulpitis. I don’t really get a lot of these patients. That’s a problem. I get a lot of patients who’ve [00:55:35] already had endo. They’ve had a flare up. They’ve had a sinus. They’ve had a chronic period collision. So the dentist has already gone and [00:55:40] then done something. So I don’t really get that clientele. I don’t get irreversible pulpitis basically, you [00:55:45] know. So I’ve not had enough of these cases to do.

Payman Langroudi: If I fracture the [00:55:50] instrument in the canal, what must I and my must not do.

Ammar Al Hourani: I [00:55:55] think be honest with the patient number one.

Payman Langroudi: Yeah.

Ammar Al Hourani: You have to tell them.

Payman Langroudi: Yeah.

Ammar Al Hourani: Yeah. Because ultimately it’s their [00:56:00] tooth.

Payman Langroudi: In my day, they say. Yeah, tell the patient it’s kind of like the root canal filling. Fill it. And it’s all [00:56:05] good.

Ammar Al Hourani: So I think I think we need to take a few steps back. I think if you’ve done it at the end of the treatment and you’ve been irrigating [00:56:10] with hypochlorite and you’ve been agitating the Aragon, and it’s been done perfectly, but then for [00:56:15] whatever reason, you’ve gone back in, you know, that one last attempt just to, you know, make sure it’s definitely clean and [00:56:20] it snaps, then you’ve essentially cleaned it in a clean canal. So you’ve obturate with nightly. You [00:56:25] probably will get away with it. That should be, I think. Okay, I’m not saying it’s 100% okay, but [00:56:30] I think you will be alright because you’ve been working through hypochlorite. You’ve cleaned the air, you know. So it’s sort of happened in a more sterile [00:56:35] environment. Okay. If you’ve done it at the beginning of treatment, that’s. Yeah, you’re going to have to fish [00:56:40] that out basically. So tell the patient. Just be honest with them. That’s the consenting process. Tell them that’s going to be a [00:56:45] risk. Tell them about it. Refer the patient on. Now will I be able to always remove it.

Payman Langroudi: No [00:56:50] definitely. They shouldn’t try to take it out themselves.

Ammar Al Hourani: No, that’s I mean, even for us that’s difficult, I would [00:56:55] say I would say hand on heart. For me the hardest two things is ledge management. Removal of files like that for me is [00:57:00] ledge management.

Payman Langroudi: When someone else has alleged it and now you have to try and fix it.

Ammar Al Hourani: They’re so difficult. Honestly, that’s the devil’s [00:57:05] work. That is that is really, really for me. That’s that’s my Achilles heel. That and Fractured Instruments [00:57:10] 100%. I think most specialists would tell you that as well, to be honest, I think. But if you would not disagree with that. [00:57:15]

Payman Langroudi: What about Retreatment? Should [00:57:20] a general dentist without a special interest try retreatment?

Ammar Al Hourani: No, I [00:57:25] think that’s really difficult. Really, really hard because the treatment you need to understand why has that failed in the first place? The [00:57:30] two questions you have to always ask yourself, as any dentist is why is that happened? Can I [00:57:35] fix it? If you can’t diagnose why it’s happened and then you go and fix it, it’s going to fail again because you’ve never really dealt [00:57:40] with the cause.

Payman Langroudi: What if what if you can see the previous end is not the best? So that’s why it’s [00:57:45] happened.

Ammar Al Hourani: Yeah, but.

Payman Langroudi: Then can I fix it?

Ammar Al Hourani: I’ll give it a go.

Payman Langroudi: Well, [00:57:50] well, well, no, this this thing that I was never good at anyway. But let’s say you’re good at Endo. Yeah. Is there something you need [00:57:55] to know about removing the old one? And should you, I don’t know, use [00:58:00] different irrigant. Should you, should you should you now do things differently [00:58:05] the second time?

Ammar Al Hourani: So I think the first thing is why has it been short. So the reason [00:58:10] is maybe the dentist didn’t get to the full length because they didn’t handle it or they didn’t prep it, and then the ledge [00:58:15] didn’t filled it. Yeah. So if that’s happened, good luck getting through that. That’s not really. [00:58:20]

Payman Langroudi: That’s not for a generalist. Right.

Ammar Al Hourani: I think that’s really difficult work for even for us it’s pretty tricky to Retreatment is still pretty [00:58:25] tricky for most specialists. So I would say definitely pass that on.

Payman Langroudi: And if [00:58:30] a patient asks you what’s your success rate? Do you sort of quote the [00:58:35] papers or.

Ammar Al Hourani: I mean, that’s the only papers that you can quote. But I also quote myself, to be fair, [00:58:40] like so I think when you quote papers, you’re always quoting other people’s work. Yeah. So if you’ve done 300 [00:58:45] randos and all of them are worked over a five year period, just tell me that I’ve done 500 and they’ve all worked over five [00:58:50] years. You’ve got 100% success rate. Great. Okay. Or survival, whatever way you want to look at it. Um, [00:58:55] I would usually still quote the papers, but then I would say in my hands, I’ve [00:59:00] been working here for the last six years, and I’ve had I get a handful of patients back every, every year. And it’s within [00:59:05] those that were already ropey to start off with, but they’ve maybe lasted four years.

Payman Langroudi: So it’s [00:59:10] a success rate of no worse than the first time.

Ammar Al Hourani: Yeah, retreatment is always worse than [00:59:15] second retreatment with the lesions. Worse again. Third retreatment not great. [00:59:20] Probably less than 50%. So because you’re, you know, you’re making things bigger again, you’re going in again, you’re blasting [00:59:25] everything open again. You’re weakening everything up. So it’s probably the best. So yeah, Retreatment [00:59:30] is less and then retreatment because the bacteria is different. The microbiology is different. You’re not dealing with Nicholas [00:59:35] and Candida and Fusobacterium Nucleatum and all sorts of other bacteria that live [00:59:40] in extreme spartan conditions. They’re really difficult to get rid of. So you’re now dealing with a completely different ecosystem. And [00:59:45] so even with bleach, they can evade bleach, you know. So how. Well. So yeah.

Payman Langroudi: Can [00:59:50] you humour me with internal whitening a little bit?

Ammar Al Hourani: I love internal. I do a lot of it. Okay. I think [00:59:55] it’s great. So it works.

Payman Langroudi: What’s your problem? Are you leaving that protocol?

Ammar Al Hourani: First [01:00:00] you need to. So you need to understand what caused the internal discolouration in the first place. Is it trauma associated or [01:00:05] not? If it’s trauma and the tooth is really dark, it’s going to be a little bit more tricky. If it’s someone’s done an endo and then [01:00:10] the GP’s become discoloured, you know, and you remove that GP, the tooth almost instantly lightens up. So it depends. [01:00:15] And once you start using bleach it lightens up with the bleach as well. So a lot of times actually.

Payman Langroudi: The hypochlorite the. [01:00:20]

Ammar Al Hourani: Hypochlorite.

Payman Langroudi: Peroxide.

Ammar Al Hourani: Yeah. So by the time I’ve removed the GP point it starts to whiten up because the GP point was above [01:00:25] the siege. And so you can see it if it’s a trauma case, I. Yeah. [01:00:30] Um, really, really. Well use a little bit of ultrasonic just to clean up the dentine a tiny [01:00:35] bit.

Payman Langroudi: Yeah. Good idea.

Ammar Al Hourani: Acidic acid, that chip. You know the Kaiser? Kaiser. Kaiser [01:00:40] protocol. Yeah. Uh, bleach for five minutes. So not bleach. Acid etch, five minutes. [01:00:45] And then I’ll just put the internal whitening and just leave it.

Payman Langroudi: Would you use.

Ammar Al Hourani: I [01:00:50] use Opalescence endo, which is 35% peroxide. And it works [01:00:55] really well. It’s licensed in the UK at the moment. So I use that. And that’s been.

Payman Langroudi: And what did you the walking bleach then.

Ammar Al Hourani: You [01:01:00] walking bleach.

Payman Langroudi: I suppose.

Ammar Al Hourani: I start with walking bleach first to see how that goes. And if it doesn’t work then believe it or not [01:01:05] I then start using your stuff. So I start using the internal whitening internal external with the enlighten [01:01:10] system that works really, really well. It’s worked beautifully.

Payman Langroudi: Do you, do you, do you? Look, people are telling [01:01:15] me, some people are telling me there’s no need. Once once you’ve let’s say you’ve you’ve removed [01:01:20] the GP, you’ve gone to say a millimetre below the HCG. Some people [01:01:25] telling me there’s no need to actually seal that root canal system.

Ammar Al Hourani: With like, something else. I [01:01:30] think there’s always that risk of maybe external cervical resorption. That’s why we do it.

Payman Langroudi: Yeah, yeah, but but telling me [01:01:35] that that used to happen before because of heating the peroxide with a hot [01:01:40] instrument. Possibly. Yeah. And doesn’t happen anymore.

Ammar Al Hourani: To be honest with you, I don’t really know much about that heating [01:01:45] process. To be fair, I still do it the old school way. I cut it under the seat by maybe a couple of millimetres.

Payman Langroudi: Leave it open. [01:01:50]

Ammar Al Hourani: Put a lining of glass Ionomer thin lining glass ionomer. Keep it open. Get the patient you know, obviously. Tell them how to [01:01:55] clean it and then squirt the the gel in and have the whitening tray.

Payman Langroudi: And overnight for how [01:02:00] long do you leave that?

Ammar Al Hourani: I ask them, I usually ask them to change it every 2 or 3 hours by the way.

Payman Langroudi: Yeah, yeah.

Ammar Al Hourani: For a good week. [01:02:05]

Payman Langroudi: And then you leave it open for a week. Yeah. Oh, really?

Ammar Al Hourani: So a little bit in keep it overnight. Keep [01:02:10] changing it. And then maybe after three four days stop doing it. Put a temporary filling in yourself. So I [01:02:15] usually give them some temporary filling or tell them where to buy it from from Amazon. And then I’ll say wait for a week and then [01:02:20] come back and see me, because then it’ll rehydrate. There’s no point. Come and see me straight away. Two reasons one, I can’t bond onto it properly. [01:02:25] I need to give it a bit of time. And then secondly, you know, I want to see whether when it rehydrates, [01:02:30] does it actually look good? Because it might look frosty. And then I’m like, well, that looks great. And then it discolours over that period of the week. [01:02:35] Does that make sense? So I’ll usually let it settle for a little while. Come and see me. You know, a week, two weeks, usually [01:02:40] two weeks because patients can’t come and see me whenever they want to see me. And plus, sometimes they don’t have the space to see them. That’s the problem. I’m not [01:02:45] in that clinic. I might be in that clinic in two weeks time. By the time they come back. Let’s take another photo. Do you like it? [01:02:50] No. I want a bit more. Go back and do a bit more. We’ll remove that filling. Clean it all up. Start again till they [01:02:55] get in a comfortable position. And to be fair, it’s quite predictable. And with the enlightened system. I’m not trying to sell your product, but with enlightened system it’s [01:03:00] worked really well. I’ve not had any issues. Patients are happy.

Payman Langroudi: I like that. Think about teaching. [01:03:05] Do you think there’s a need? I think there definitely is a need. Right. Insomuch [01:03:10] as people are coming out of dental school, having done like one, I heard less [01:03:15] than one molar. Yeah, well, one, one canal of a molar. Yeah.

Ammar Al Hourani: Yeah, [01:03:20] I.

Payman Langroudi: That was an Audi. That wasn’t the case. We did. We did a few [01:03:25] more than that.

Ammar Al Hourani: So the thing is, the thing is that it’s been a change in culture. So we used to have it wasn’t competency based. [01:03:30] We were numbers based. So you had to do like I don’t know I can’t remember what was Glasgow 30 maybe. Yeah. You had to [01:03:35] do in 20 cobalt chromes and 300 fillings and whatnot. And you had the patience. Yeah. There was always patience in [01:03:40] Glasgow. You can’t not have the patience for, you know, now the same students [01:03:45] are struggling to find an A&E in Glasgow.

Payman Langroudi: Why is that?

Ammar Al Hourani: I don’t know. I have no idea. I don’t know what’s happened.

Payman Langroudi: It’s [01:03:50] weird, isn’t it?

Ammar Al Hourani: They’re struggling to get like Nando’s and they’re starting to. So now it’s become competency based. So you could do one good [01:03:55] access and one good obturation. And you’re you’re safe. And I said [01:04:00] to you earlier on, I had to do 3000 before I felt comfortable.

Payman Langroudi: As a specialist.

Ammar Al Hourani: A specialist, you know. So [01:04:05] how is that possible?

Payman Langroudi: Listen, I’m not really 100% what’s going on in the NHS here, but there’s plenty of [01:04:10] endo NHS endo going on which doesn’t pay.

Ammar Al Hourani: No.

Payman Langroudi: And [01:04:15] it’s what my understanding is they shove it off to the to do Mm ft [01:04:20] to do PhD. Like someone who’s got no no experience whatsoever is now doing [01:04:25] the endo.

Ammar Al Hourani: I mean I think the listen as an NHS concept, I [01:04:30] like the concept. I think it’s a great concept as a healthcare healthcare. I think it’s a great concept. Okay. Has [01:04:35] it been done. Well I think it could be done a lot better personally. The thing is, you can’t do something when [01:04:40] the cost of the material costs more than the treatment itself, because then you don’t factor in the dentist. There’s expertise [01:04:45] there years. The cost of running a clinic is really expensive and you’re in the UK. There’s not a cheap [01:04:50] country. I don’t care where you live in the UK. The UK is still an expensive country, so [01:04:55] it’s been done almost as a charity. Yeah, so a lot of people just don’t want to do it. So they become de-skilled in it, or they go [01:05:00] privately and say, oh, I do all this stuff. I don’t do endo. Yeah, you know, that’s a majority. I don’t do dentures. Yeah, [01:05:05] yeah. Just fair enough. I think from that point of view that latter at least you respect the fact that you don’t [01:05:10] do endo and you don’t want to do endo. You want someone else who knows how to do endo to do. And I think that’s good. That’s honourable. I like [01:05:15] that the NHS system however, is everyone should be doing it. You have to offer it to the patient, but [01:05:20] I’m not very good at it. So how can I offer you heart surgery? And I don’t do heart surgery. You [01:05:25] know, you don’t go to your GP and ask them, can you do, you know, can can you start my kidney? They [01:05:30] don’t know how to do that. They refer that on. So we don’t have a great tertiary system in this country for dentistry. We [01:05:35] don’t have a referral system. You know, dental schools are clogged up. Maybe the funding isn’t there. Maybe they don’t have the staff [01:05:40] to do it.

Payman Langroudi: Yeah.

Ammar Al Hourani: And so you’re sort of stuck between a rock and a hard place. And you’ve got litigation also. [01:05:45] I mean, that’s I would always say that the biggest advancement in dentistry in the UK are what’s driving advancements. Litigation isn’t [01:05:50] even the science. It’s I don’t want to get sued. Let’s be honest. You know, that’s the elephant in the room, [01:05:55] right? What’s changed in dentistry over the last 20 years? Being sued?

Payman Langroudi: Yeah.

Ammar Al Hourani: Let’s be honest. Right. No [01:06:00] one’s going to deny that. So I think I feel sorry for a lot of these dentists. You [01:06:05] know, if you told me to do an NHS endo without the equipment I have at the moment, the expertise I [01:06:10] have, I’d do a terrible job being honest.

Payman Langroudi: The majority of endo is being [01:06:15] carried out in the country or those. Right? Yeah.

Ammar Al Hourani: And are they working? Probably some of them are [01:06:20] working. Some of them aren’t working. And I think if you’ve got a nice patient you’ll probably be okay. [01:06:25] And if you don’t, you might become a problem for you down the line.

Payman Langroudi: Terrible thing. You have [01:06:30] a friend or family member says, I’ve got toothache here and it calls me up. Let’s say he’s not near [01:06:35] me or anyone I know. My first piece of advice is don’t have it done in the NHS like my [01:06:40] first first thing I say go.

Ammar Al Hourani: And see a specialist.

Payman Langroudi: First thing I say. Yeah. And [01:06:45] that’s a sad state of affairs, isn’t it? It is. Especially [01:06:50] in endo, you know, because it’s time consuming, expensive procedure. That dentist [01:06:55] is not going to be paid for.

Ammar Al Hourani: No, it’s a minefield. This is a political minefield. Nhs dentistry [01:07:00] is a political minefield. You know, it’s either you change it dramatically.

Payman Langroudi: Where [01:07:05] maybe if you were the king of the world, what would you. How would you change it then? If you liked the idea, [01:07:10] you like the idea, right? You like the idea of healthcare?

Ammar Al Hourani: Yeah, I think I think have a universal. I quite like the Northern [01:07:15] Ireland system to an extent. They have a small number of codes which the dentists do, and then [01:07:20] a lot of it is private. So like the government tops some, you know, does some of the stuff pays for some of the stuff, and then you [01:07:25] have to pay some for some of the stuff, or you go down an insurance policy where the government pays a little, you pay [01:07:30] a little and the insurance pays a little, and that also might work. And that’s what I would do if I was to change it tomorrow, [01:07:35] I would have everyone on some sort of insurance policy. It would come with your work or something like [01:07:40] that. You know, a bit like America. You know, you have your health and dental care comes in with your employment job and then everyone [01:07:45] gets you pay a little premium. Or if you’re at a certain threshold, the government pays the rest of [01:07:50] it. And then you have a lot of centres where you have dentist special interests that do it to a relatively good standard. And anything [01:07:55] above that has to go to a specialist and they get paid for it.

Payman Langroudi: If it was me, what I would do is I would [01:08:00] means test first of all, here. The only only people earning below [01:08:05] X can get any access to NHS, NHS dentistry. [01:08:10] We’re talking leave medicine to one side for now. Then I would take the [01:08:15] budget, which is at the moment it’s 2.5% of the health care budget, and divide it [01:08:20] by the number of people below earning less than £35,000 or whatever the number is. And [01:08:25] I distribute that money here as a voucher to be spent at any dentist. [01:08:30] Yeah, that would work. And those people can go to the dentist by teeth whitening, go to [01:08:35] the dentist by whatever the hell they want for the dentist. Yeah. And that’s the amount of money they’ve got [01:08:40] to spend at the dentist.

Ammar Al Hourani: I think that’s quite nice, I think. Or you would have it at the basic functional [01:08:45] stuff you would pay for. And I think above that you might have to. Yeah. But apart from.

Payman Langroudi: Your basic functional stuff [01:08:50] is an endo is the basic functional stuff, isn’t it.

Ammar Al Hourani: But then that money could then be used towards a specialist [01:08:55] in your endo or a dentist. Interesting. Your endo? Yeah, yeah. And not the GDP per se, unless you’re very, very good at it. [01:09:00] So you can then use that coupon anywhere essentially. Yeah that would work. Yeah.

Payman Langroudi: It’s mad. I think [01:09:05] the one thing we can be sure of here is no more than 2.5% of the budget is coming to us. You know that, if [01:09:10] anything less than that. Yeah, I think I.

Ammar Al Hourani: Think it’s.

Payman Langroudi: I think it should be more creative. It’s not going to be more [01:09:15] though. You know, that’s you know, that’s just not reality. Yeah. So I’d say [01:09:20] as a profession, we need to think of it as less is going to come or the same amount is going to come. [01:09:25]

Ammar Al Hourani: I think just going to an insurance.

Payman Langroudi: What are we going to do with that money? Yeah you’re right. Insurance. But the country’s not set up. [01:09:30]

Ammar Al Hourani: No we’re not. Yeah.

Payman Langroudi: We don’t we don’t enlighten. We don’t offer our team dental insurance.

Ammar Al Hourani: No [01:09:35] one does. I don’t know. One of.

Payman Langroudi: Their benefits. But. But if there wasn’t or there isn’t a [01:09:40] really good one. But if there wasn’t NHS dentistry, that would be part of the culture. People would be asking for [01:09:45] dental insurance when they come and get jobs, you know.

Ammar Al Hourani: Yeah. Or you could have it, I think, in some countries where [01:09:50] you cap the fees.

Payman Langroudi: Yeah.

Ammar Al Hourani: So every treatment has got a fee. Yeah. And it’s capped by the. So [01:09:55] although it’s a free market economy but it’s still capped. The government is like you know, you can’t be more than £100 for a white filling, [01:10:00] let’s say. And then it becomes affordable to the masses. You know that could also work.

Payman Langroudi: What [01:10:05] would you say is the difference between a good endodontist and a great endodontist?

Ammar Al Hourani: Experience. [01:10:10] Honestly, it’s all about experience. [01:10:15] Yeah, but I think experience and then also giving something back to [01:10:20] society, I think. And what I mean by that is by teaching a lot more of the future. [01:10:25] A lot of specialists don’t know. That’s not true. I think some specialists do [01:10:30] do a lot of stuff with the, you know, with undergrads, Post-grads and some of them don’t. I think giving back also [01:10:35] makes you a great specialist. I think it’s fair enough.

Payman Langroudi: But outside of giving back, I mean, I technically I’m [01:10:40] no, no, not only technically I’m referring here. Let’s say I’m a referring dentist and [01:10:45] you’ve got Nancy and me here. What’s the difference between a good one [01:10:50] and a great one like now? Let me give you an example. When I used to refer to my perio guy. Yeah, [01:10:55] he was, he was very good at the gums. Yeah. But patient used to come back saying [01:11:00] periodontist said I need crowns on this, that and the other and this tooth can take it. That tooth can’t. [01:11:05] And full restorative treatment plan would come back. Sold. Yeah. Sold [01:11:10] by the specialist. So it would be like. I’d be like. I’m sending more patients to him. Yeah. Because, because [01:11:15] because, you know, he’s he’s a sort of a higher authority. He’s saying this tooth can take [01:11:20] a crown. This tooth can’t. And he says tells the patient, I would crown that one and send them back. Okay. [01:11:25] That’s that’s not technical, is it? That’s that’s like almost a service he’s giving back to [01:11:30] me as the referrer. You tell me. Is it technical? I think it’s going to be the skill. Do [01:11:35] you do you presale, pre-sell, the crown, that sort of thing?

Ammar Al Hourani: I do.

Payman Langroudi: Yeah. To the patient.

Ammar Al Hourani: Yeah. Yeah. [01:11:40] Of course. Yeah.

Payman Langroudi: Prep them for that.

Ammar Al Hourani: So I think I think it’s going to be similar to yourself. I mean I [01:11:45] do quite a lot of the chords myself. So I would say doing the chords, doing a lot of the hard work for you, prepping [01:11:50] you up for the essentially the, the glory shot being the crown, you [01:11:55] know, and I think that for most dentists would be great because they now know that and it’s been done well. [01:12:00] The core is being done well, being diagnosed properly. They’ve maybe picked up on other stuff that need to be dealt with. You know, [01:12:05] do that filling, do this filling. There’s maybe something here, something there. Keeps them busy in that respects. And [01:12:10] then you’ve got the crown ready for them. That makes you I think that makes you great. And I think being close to the referring dentist very, [01:12:15] very important, having that interpersonal relationship. So a lot of the dentists actually have my personal phone number. They’ll just call [01:12:20] me, text me, voice, message me at one in the morning, sometimes with a problem they’ve had. I think that’s quite nice being [01:12:25] able to be there. Sometimes it’s just counselling. I swear to God, sometimes it’s counselling.

Payman Langroudi: Look, [01:12:30] running a referral practice is a whole skill in itself. It’s a whole art [01:12:35] in itself because by its very nature, you’re constantly losing referrals, [01:12:40] aren’t you? It’s just the way it is. People fall off or they get an in house guy [01:12:45] or something.

Ammar Al Hourani: That’s why you have to constantly do study clubs and lunch and learns [01:12:50] and courses and talks and webinars and all sorts of things.

Payman Langroudi: Are you are you like sending back [01:12:55] like pretty reports and things as well?

Ammar Al Hourani: Yeah. More so intern in house. No, I don’t [01:13:00] do the reports because like it’s already in house. Like you just open up, you know, Dental and check it, you know. Yeah. Yeah, yeah. Externally. [01:13:05] No. Right. You had a really nice rapport with some x rays. Maybe some photos of this cracks. I’ll show you everything. So you [01:13:10] look at it and you go, wow, I’ve never seen that before, you know? And it’s quite nice in itself as educational, but like when I got Cbct report. [01:13:15] Yeah, the same thing. If it’s a really nice, beautiful one with all the angles and shots, [01:13:20] I’m reading it. I’m like, wow, I’m learning from this, you know? So that’s that I like. So yeah, I think [01:13:25] the majority of times I will send a referral, but if you’re in house I don’t send you a referral. I’ll just just read the reports [01:13:30] and have a look at my x rays.

Payman Langroudi: You’ve worked in so many practices. Tell [01:13:35] me your reflections on practices.

Ammar Al Hourani: I think some are really great and [01:13:40] some not so much. And I think it comes down to the principle.

Payman Langroudi: Do you, do you?

Ammar Al Hourani: Yeah. A [01:13:45] principles who works in the clinic and does as many hours as you do and really busts a [01:13:50] gut and works really hard and really shows that, you know, appreciates all the staff around them, [01:13:55] you work that little bit harder for because they’re there, they’re in the clinic, they know what’s going on. [01:14:00] They can they can do it. Whereas in clinics where the principle is not there to sort of sometimes associate Ron, [01:14:05] and then maybe there’s a manager. I’m not saying, you know, there’s some fantastic managers out there, but I don’t [01:14:10] think you’ll ever love your clinic as much as the owner themselves loves it and looks out for [01:14:15] it. Does that make sense? Like your own little baby when they’re there working really hard? Yeah, it motivates [01:14:20] you a little bit more as well to do better. And I think that found the most successful clinics where the principles [01:14:25] they are working with you. They’re the best ones.

Payman Langroudi: I’m more interested. I’m interested in that. [01:14:30] That’s beautiful. It’s wonderful insight. Yeah, but you’ve seen so many, so [01:14:35] many. Yeah. Like, let’s say 25 clinics where you’ve worked in [01:14:40] way more than your average dentist. So culture wise, [01:14:45] like you said, work hard. That’s one thing. Yeah. Yeah. But, you know, you get sometimes [01:14:50] you get a principle who works hard. But he’s awful at like, hiring. Yeah. [01:14:55] Or awful at firing. I find awful at firing is one of the biggest crimes here. I’m definitely [01:15:00] guilty of that crime myself. Yeah. Yeah. Um. And so, like you were saying [01:15:05] to me before, one of your ambitions is to open your own actually multi [01:15:10] sort of specialist centre, not only Indo multi [01:15:15] specialist centre. What sort of lessons are you going to bring to that from [01:15:20] all the practices you’ve worked in. Like what mistakes have you seen.

Ammar Al Hourani: I think number one [01:15:25] I think value your nurse or value the nurses. Honestly I can’t I can’t stress that enough.

Payman Langroudi: I agree with that. [01:15:30]

Ammar Al Hourani: I can’t you can’t.

Payman Langroudi: Stress running the whole running the whole goddamn show, man.

Ammar Al Hourani: You know, they don’t earn enough money [01:15:35] as it is. I think they do. I mean, without my nurses that I work with, honestly, that I do end up with, I can’t achieve the level [01:15:40] of end that I can do. They. They get everything. They order stuff for me. They keep an eye on my book. They talk [01:15:45] to my patients, they keep them comfortable. They do a lot of work that I don’t have to do myself. [01:15:50] Whereas when you start getting temp nurses, oh my God, that becomes tricky. Not because they’re difficult people. They’re [01:15:55] actually a lot of them are really nice, hard working people. It’s not their it’s not their surgery. They don’t know where everything is suddenly. Now [01:16:00] that I know that, it takes me an hour and a half, taking me two hours. You know, it’s just a hard day. It feels like you’re walking [01:16:05] through mud all day. It’s a horrible situation. So look after your nurses is number one. [01:16:10] Second thing is having. Having a great TCO is wonderful because they deal with [01:16:15] all the money, all the chat, all the stuff that you feel you know, a bit uncomfortable with. I don’t like talking.

Payman Langroudi: About the nicest things [01:16:20] about endo is you don’t really have to sell anything though.

Ammar Al Hourani: No, it’s all so so but there the price, you know, sometimes they might [01:16:25] need an endo and a core and they need this. And does that add up to a point. And you go right. You know speak to so and [01:16:30] so. So I’m really lucky. For example, in Grantham I’ve got a couple of, you know, people that do that for me in other clinics. They do that for me [01:16:35] and they do all that talking for me. I don’t have to talk about money. It’s like, well, go and see so-and-so and she’ll walk [01:16:40] you through it and finance and whatnot. They’ll also look after your book, the referrals coming in or referrals coming [01:16:45] out, keeping an eye on things, keeping an eye on your book, making sure it’s busy, keeping in touch with your [01:16:50] referring dentist. That’s what’s going to make your work book work like clockwork, [01:16:55] you know? So I would do that differently. Um, generous Principles. [01:17:00] What do I mean by that? They buy you anything you want. I’m very lucky with the principles I work with. Now, if I send [01:17:05] them a list tomorrow morning, it’s in my drawer. They’ll never say, oh, why do you need this? Why do you need that? There’s an element [01:17:10] of me which also needs to use new stuff that’s coming out in the market. Sometimes you bought me a lot of stuff, but [01:17:15] now I need new stuff. And if you’ve got a progressive person in that clinic, they’ll be like, go for it. Because [01:17:20] they also want to keep going on with the times.

Ammar Al Hourani: Every five years things change. You know, file systems are changing all the time. You [01:17:25] know, there’s always new stuff. And I want to play with the new stuff. Otherwise I’m now stuck. Does that make sense? I’m now behind the times. [01:17:30] And because I teach, I need to also be preaching what I teach. If I’m saying, oh, buy this, this and this and I’m not [01:17:35] using it, I’m a bit of a hypocrite as well. To be fair. So you’ll come out very quickly, or when I’m demoing, it’s [01:17:40] going to look like I’ve never used that file system. Does that make sense? So I’ll look really stupid really, really quickly. So again, from that point [01:17:45] of view, generous principles are very, very good progressive principles. But then at the same time, they also need you to [01:17:50] be progressive as well. You need to be good. Talk, talk the talk patients need to be happy, comfortable with [01:17:55] what you’re doing. You’re not getting complaints. You know, you’re not getting a lot of retreatments and reworks of things that are failing. You [01:18:00] know you’re not causing more ruckus in the clinic. Does that make sense? So you’re also steadying the ship? So that’s why specialist [01:18:05] is a good job, but also a difficult job because I need to make sure I’m happy. Patients are happy. Principal [01:18:10] is happy. Referring dentists are happy. Staff are happy. Everyone has to be happy. It’s a lot of [01:18:15] constituencies. A lot of people have to be happy with your outcome. You’re always examined. Basically, every [01:18:20] end has been examined.

Payman Langroudi: Yeah.

Ammar Al Hourani: And so yeah.

Payman Langroudi: That must be hard.

Ammar Al Hourani: At the beginning. [01:18:25] It is. But then now it’s not. Not so much. I think you get comfortable with it. It becomes your life.

Payman Langroudi: The other thing is, while [01:18:30] you haven’t got your own clinic, from the business perspective, your [01:18:35] earnings are capped only by the number of Indos you can physically [01:18:40] do.

Ammar Al Hourani: Yeah. Hours that you can do. Yeah.

Payman Langroudi: Like, there’s no. There’s no dream of. Hey, I might [01:18:45] double the business next year. No, that can’t happen.

Ammar Al Hourani: No, I already do 4 or 5 [01:18:50] days a week and I hit the absolute limit, so I’ve sort of saturated now, you know.

Payman Langroudi: But [01:18:55] at the same time, I mean, while I was, I was advising all these students yesterday become [01:19:00] an endodontist. The reason I was doing that was because most lenders I know are really happy, man. Yeah, [01:19:05] they’re really happy. They’re earning good money. Yeah. What do you charge?

Ammar Al Hourani: Anywhere between 12. [01:19:10] 1000 to £1200 for a primary retreatments up to £1,400. [01:19:15]

Payman Langroudi: Could be more than that.

Ammar Al Hourani: No, I’m pretty good because I work in different demographics. So, [01:19:20] like, some areas can afford more than others. But I’m on a higher percentage. I’m in some clinics, I’m in higher than 50%. So [01:19:25] I’m always I’m doing I’m all right.

Payman Langroudi: And there’s a lab fee.

Ammar Al Hourani: There’s no lab fee. And also the good thing is [01:19:30] it’s a it works in both ways. You know, like if I work in your clinic because I do a lot of stuff and I do lots of courses [01:19:35] and stuff, you’re also getting a bit of free advertising. You know, you’re being put on the map as well at the same time. So it’s like, think of it as a [01:19:40] football player who gets the royalties for the shirts that they sell.

Payman Langroudi: How does it take you from over.

Ammar Al Hourani: About an hour.

Payman Langroudi: So [01:19:45] you’re doing like four a day or more.

Ammar Al Hourani: For four hours a day? Yeah, 4 to 5 a day.

Payman Langroudi: It’s not bad. [01:19:50] It’s not bad at all, man.

Ammar Al Hourani: Good. Good day’s income. Yeah. It’s not.

Payman Langroudi: Bad. And then. And then how many times a week are you [01:19:55] stumped? Like in trouble or month?

Ammar Al Hourani: In a month, maybe. [01:20:00] A handful of times. And my nurse knows that because she can smell my aftershave. She’s like, when [01:20:05] I smell your aftershave. I know you’re sweating. Yeah. And I start to. I start to breathe more heavily under the mask. I’m like, you know, [01:20:10] I’m really breathing hard because I’m getting angry. Not angry, but frustrated by the situation, you know? [01:20:15] But I think once you’ve done enough, then I know. I know at what point I can stop and say, you know what? [01:20:20] Payman. I’ve done everything I can. I’ve spent an hour on this. Like I don’t feel I can do any more. I’m [01:20:25] happy to refer you to another mate of mine to give it a go, but I think they’re going to also be going to be stuck. But it’s up to [01:20:30] yourself. Or we can finish now. Do surgery. Keep an eye on it. You know, I’m more confident now to say that’s [01:20:35] as far as I can push it. What would you like me to do going forward? Maybe 2 or 3 years ago? Not so much. [01:20:40] I would have kept pushing, pushing, pushing. Ten our mistake took place, you know, and then you’re like, oh, we shouldn’t do [01:20:45] that.

Payman Langroudi: Tell me about the teaching then. What is it? What’s what courses do you run? [01:20:50]

Ammar Al Hourani: So I run the. So two things I’ve essentially got two companies. The Indo Guys is [01:20:55] one. I started that off with my best friend during lockdown as a just keep me busy. So I started doing like webinars [01:21:00] for free and then it became I started working with a couple of companies doing almost. I [01:21:05] did free courses for about six months with a friend of mine, so I did that and that was really busy. And it was it was [01:21:10] good in two ways. Dentists were getting free courses and I was learning how to teach it, which is good. So [01:21:15] I was like, it was everyone was happy. So I’ve refined that and then started to slowly grow into Scotland. And then [01:21:20] I teamed up with my mentor, Sanjay Bhandari. He trained me as, as a doing my [01:21:25] specialist training. So that grew again. That helped me out. You know, he his experience was invaluable. He taught me [01:21:30] to be a good teacher as well, to be honest with you. But also you learn from a lot of people. You learn a bit here and there and you learn some stuff. [01:21:35] You’re like, no, I don’t like that. I’m not going to do that. So you create your own philosophy after a while.

Ammar Al Hourani: My philosophy was I [01:21:40] used to hate going to courses when I was at GDP, because a lot of it was a sales pitch to go and buy their bigger courses. [01:21:45] I hated that, I can’t tell you how much I hated it, or they would talk about how wonderful they are for half a [01:21:50] day, and then you do a little bit hands on an afternoon, you’re like, mate, how can I use that tomorrow morning? Like I’ve not learnt nothing today, [01:21:55] you know. So I wanted to do it. On how I would want to do it myself. So if I was now a delegate, what would I want? [01:22:00] Do the webinars or a lot of the teaching online and do a lot of the hands when I turn up? It’s all hands on. [01:22:05] By the time you’re done, you’re exhausted, so at least you’ve taken on 5 or 6 new tips that you could use on Monday [01:22:10] morning. So we do the principles of endodontics and I do the advanced endodontic course modules. They’re [01:22:15] both Royal College accredited. It’s fantastic. So they’re quality assured. And [01:22:20] we do a Cbct course as well, which is really nice. So that’s my UK courses.

Payman Langroudi: And then what’s the content [01:22:25] I mean the the first. So okay so how many days is it, how many webinars is it. And then how many [01:22:30] days is it.

Ammar Al Hourani: So principles of antibiotics is two days. Um webinars usually a day. Or we [01:22:35] do all the talks in the morning in an hour a couple of hours. Done. And then it’s access cavities, [01:22:40] uh, canal location, mechanical preparation using different file systems. But we teach you [01:22:45] the principles of it once you understand the principles of the whole concept. Kind of location. Pre-colonial. [01:22:50] Flaring. Patency. Glide path prep. You could use it on any file system, then obturation [01:22:55] or vertical and then just single cone technique, which is really straightforward. And a little bit about posting [01:23:00] cause when to use them. That’s day one. That’s day one and two. So by day two you’ve, you’ve sort of [01:23:05] got four years off. And on two days the advance is a little bit more. Obviously there’s trauma management, open [01:23:10] apices, perf repair RCT file fracture removal, ledge management, calcified [01:23:15] canals. So that’s a that’s a different thing. But I would always say maybe do a few more rondos before turning up [01:23:20] to that course because that’s much more advanced, you know. And you could you could tell who’s got the skills for it [01:23:25] and who doesn’t. I only do that maybe once or twice a year. Not not as often. Uh, and then. [01:23:30]

Payman Langroudi: If I wanted to become a dentist with a special interest in endo, you reckon if I do those [01:23:35] two courses, I’m anywhere near.

Ammar Al Hourani: No, I think that’s just for your day to day running of [01:23:40] things. You know, your bread and butter sort of dentistry. If you want to be a dentist, special interest, go and do a diploma. A [01:23:45] diploma.

Payman Langroudi: Okay.

Ammar Al Hourani: Pgcert or a diploma, or maybe finish it off and do your MSC. Msc is just the write up in [01:23:50] year three.

Payman Langroudi: Where would I get that?

Ammar Al Hourani: You could. Lots of great courses out there. So you can do the MSC at King’s, [01:23:55] the long distance one. Um, I think indoor art does one that’s really, really good with Bhavin and [01:24:00] his colleague. Um, where else? They simply end up in Liverpool. There’s Uclan that does a two year [01:24:05] accelerated master’s program with patients, which is fantastic, I think. [01:24:10]

Payman Langroudi: So yours is kind of a step before that.

Ammar Al Hourani: It’s a step. Yeah. I’d like to do one [01:24:15] where it’s a diploma.

Payman Langroudi: I haven’t got around to it yet.

Ammar Al Hourani: One, I haven’t got around to it. I’ve been really busy with a lot of other things. And [01:24:20] also, you need a team for it, and you need a lot of your time. And you need to cut down your clinical work to do it because it [01:24:25] takes up a day of your week just, you know, making sure they’ve got the cases and it becomes its own in [01:24:30] every sense, its own business, of course. Yeah. You know, with cohorts and people are paying a lot of money. So you need to make sure [01:24:35] that they’re getting the quality that they deserve. So that needs a lot of its own attention. And and it needs people [01:24:40] to partner up with me that will be able to do that at my the way I want to do it. And that’s tricky [01:24:45] to be honest. So and then the other course I do is in India. That’s my India courses and the restorative [01:24:50] with two of my really close friends. And we do that.

Payman Langroudi: How often do you do that?

Ammar Al Hourani: 3 to 4 times a year. [01:24:55]

Payman Langroudi: Wow.

Ammar Al Hourani: I love it.

Payman Langroudi: Is it in the same place in India?

Ammar Al Hourani: Every time? Yeah. Mumbai. Yeah.

Payman Langroudi: It’s fantastic fun in India. [01:25:00]

Ammar Al Hourani: I love it.

Payman Langroudi: Why is it fun?

Ammar Al Hourani: Love it, love it, love it. Brilliant, brilliant. Country people are lovely. [01:25:05] It’s changed my.

Payman Langroudi: Life. Delegate wise, what’s the main difference between Indian delegates?

Ammar Al Hourani: So [01:25:10] the first thing. I think we’re lucky in the UK that we’ve got more of a standardised training. [01:25:15] I think when you come at dental school, you’re all very much similar.

Payman Langroudi: Or you get lots of different.

Ammar Al Hourani: You’ve got lots [01:25:20] of dental schools. I mean, I think after Brazil they’ve got the second most dental schools in the world, so you’ve got all sorts. [01:25:25] The second thing is we get a lot of specialists on our course.

Payman Langroudi: And specialists.

Ammar Al Hourani: And those specialists, because a lot of [01:25:30] them, you know, there’s obviously different ways of teaching Ando and some of them is theoretical, some of them with little hands on patients, some of them with [01:25:35] just K files. They’ve never used rotary. So I would say about 30% of our delegates are actually endodontists. Wow. [01:25:40] Because they want to learn rotary. They’ve never, never tried rotary.

Payman Langroudi: Yeah.

Ammar Al Hourani: So that’s really, really nice. So that ups your [01:25:45] game a little bit more because now you’re dealing with people who understand the theory very respectful, very hard working [01:25:50] people. They really value education. They don’t take it for granted, which is very, very important because it’s very expensive. [01:25:55] You know, we charge 350, £400 for the course for two days in India. People [01:26:00] take out a bank loan for that.

Payman Langroudi: Wow.

Ammar Al Hourani: Yeah.

Payman Langroudi: What do you charge for your course here? [01:26:05]

Ammar Al Hourani: Just charge for 1000.

Payman Langroudi: For two days.

Ammar Al Hourani: Two days? Yeah.

Payman Langroudi: Again, that seems a little cheap.

Ammar Al Hourani: I [01:26:10] want it to be affordable for the masses. You know, my bread and butter. I’m really blessed in that I [01:26:15] earn good money from my private practice. That I don’t really have to rely on. My. This is sort of like a [01:26:20] bit of a bit, not a bit of charity, but, you know, a little bit of something different that I do once or twice a month. Does that make sense? It’s not my bread [01:26:25] and butter income. Yeah. So I keep it on. Sometimes I do it as low as 700 £850. [01:26:30] It depends. If you come in a group it comes down in price a little bit more. So it’s affordable. It still [01:26:35] earns me what I would earn in practice on those two days. And so therefore I’m not out of pocket. I’m not making it as a profitable [01:26:40] business. I’m not running it that way.

Payman Langroudi: I guess you get the referrals off those people.

Ammar Al Hourani: You get the referral. Yeah. Yes and no. If I’m doing it in Manchester [01:26:45] or Scotland, I’m not getting any referrals from it. So it’s like the people that teach with me that get the referrals, but [01:26:50] I’m doing it because I enjoy the teaching. You get to meet people, you’re out of the clinic. You know, you’re not stuck in that room under [01:26:55] a microscope. Under the microscope, it’s you versus you. You know, you’re in your own brain. Yeah. You know, you’re stuck in that little box, [01:27:00] which is the tooth, basically. And it can get a bit frustrating if you do it all day, every day. You know, it does get frustrating. [01:27:05] So you get burnt out. You can get burnt out really quick. I think as an end dentist, that’s the thing you have to be careful of. [01:27:10] So that’s why you know your mental health, playing sport, socialising, it gets [01:27:15] out of your brain, you need to get out of your brain. I know that sounds weird, but you know you’re in your brain all the time. It’s for real. You know, [01:27:20] I think.

Payman Langroudi: Any, any bit of dentistry, which is intense. Yeah, intense. [01:27:25] Much of dentistry is intense. But but if you’re if you’re doing things to a certain standard, I [01:27:30] think four days a week is enough for me.

Ammar Al Hourani: Not enough. I mean, I do five because I’m busy.

Payman Langroudi: Cos [01:27:35] you’re hardcore.

Ammar Al Hourani: But no, it’s not because I’m hardcore. It’s just you’re busy, you’re waiting list. You know, people are waiting.

Payman Langroudi: Up, [01:27:40] your prices up.

Ammar Al Hourani: But yeah.

Payman Langroudi: Really that’s the correct move. But I’m just saying. Four days. You can be peak. [01:27:45] Not everyone. I know some dudes. Yeah, there’s six days a week.

Ammar Al Hourani: I don’t know, six days.

Payman Langroudi: Too much, but. [01:27:50] But my point is, if it’s if it’s any level of dentistry where, you know, it’s very intense, the, [01:27:55] you know, let’s face it, dentistry is physically hard. First of all, you’re back and your eyes and all [01:28:00] that. But then mentally hard too. And then the thing you said about being sued. Yeah. That’s constantly [01:28:05] in your face. Right. So it’s mentally hard in different ways. Yeah. I’d say four days enough, [01:28:10] man. Um, let’s move on to errors. We like talking about mistakes. From [01:28:15] from black box thinking. The idea that, you know, people will actually learn from your mistakes. [01:28:20] What what what comes to mind when I say clinical errors? What [01:28:25] mistakes did you make and what can we all learn from it?

Ammar Al Hourani: Um, [01:28:30] so yeah, choosing the wrong materials is one is one mistake. I’ll never forget that. Did [01:28:35] an access cavity? I thought I had an endo z-bar to open up the access. Yeah, and I actually had that [01:28:40] tungsten carbide burr like a proper cutting bone burr and I drilled the bloomin tooth, and [01:28:45] that was a mistake.

Payman Langroudi: Tell me about the endeavour. What is that?

Ammar Al Hourani: So the Endo Z burr is a is a bald [01:28:50] tip burr side cutting bolt. So if you go into the axe, you know, if you.

Payman Langroudi: Yeah yeah yeah. [01:28:55]

Ammar Al Hourani: Yeah.

Payman Langroudi: You’re not going to do too much damage.

Ammar Al Hourani: You can’t you can’t perforate unless you really put your welly into it. It’s really, [01:29:00] really hard. You’re gonna have to really go at it to, to perforate it. Yeah, yeah. Here I took a bird that looked almost identical. [01:29:05]

Payman Langroudi: I just picked up the wrong.

Ammar Al Hourani: Picked it up. I just didn’t see it. Picked it up, put it in before you perforated.

Payman Langroudi: Yeah, [01:29:10] because you were thinking it can’t.

Ammar Al Hourani: Oh, I was like, oh, this is really nice and smooth. It didn’t feel [01:29:15] any different.

Payman Langroudi: Yeah.

Ammar Al Hourani: Yeah, yeah. And I was like, what the hell is this?

Payman Langroudi: Oh, interesting.

Ammar Al Hourani: And it was essentially [01:29:20] created an osteotomy. Uh.

Payman Langroudi: What happened? [01:29:25]

Ammar Al Hourani: Well, first off, I, you know, shat myself. Yeah. I’m not going to lie to you. I was [01:29:30] I was panicked, and I’m really difficult. I just don’t know how to lie. Like, it’s [01:29:35] sort of like you could see some things happen. You can see it from all aspects of my body.

Payman Langroudi: Basically the [01:29:40] everything.

Ammar Al Hourani: I’m just like, read. I’m just, like, bewildered by what just happened. Has it just happened to [01:29:45] me? You know, that type of thing? I just said to the patient, I’m really, really sorry. This is what’s happened. I think it’s beyond it’s beyond repair now [01:29:50] because I really screwed it. But I was honest, I was like, I’m really sorry. I’m going to pay for the for your implant. [01:29:55] I’ll fix the whole thing up and I’ll pay for any future implant. And it’s my really, really good friend Adeel. Adeel Ali, [01:30:00] great guy. Implant just called him up and I was like, mate, I’ve. I’ve created a booboo here. Could you do this for [01:30:05] me? And I’ll owe you one down the line. And that was exactly what happened. Did it for nothing. And [01:30:10] I was lucky because I’m lucky with the people I work with.

Payman Langroudi: Was he cool? Was the patient cool?

Ammar Al Hourani: Very cool, very cool. I said, [01:30:15] like, I’m really sorry. It’s a mistake. It’s never happened to me. It was my mistake. So whatever you want to do going forward, do. [01:30:20] If you want to complain, complain if you want to. But I can remedy for this.

Payman Langroudi: One that didn’t go so well. [01:30:25]

Ammar Al Hourani: Um, okay. So I had a patient that comes in sometimes you have to you have [01:30:30] to take on how do I explain this? You have to listen to your gut instinct.

Payman Langroudi: Yeah, yeah. Your spidey sense. [01:30:35] Right.

Ammar Al Hourani: Patient came in, uh, pretty nasty to reception. Pretty nasty on the phone. [01:30:40] Nasty guy, you know, but a really nice to me. That’s the first thing I learned, [01:30:45] you know? Now, like, this is when I was maybe three years, three, four years ago. So the patient. [01:30:50] Massive crack across the whole tooth. Big lesion, sinus, deep localised pocket. [01:30:55] This tooth is gone. Kept begging me to investigate it for him. Do that until I [01:31:00] went against my judgement. I felt sorry for him. You know, he’s like, you know, [01:31:05] I’ve got this. And that’s when my daughter’s not well and my son’s this and I’m looking after my mom. You know, he’s just sitting there going, [01:31:10] you know, if I, you know. So I did it because I thought that was the right thing to do. Started doing the endo. The tooth was [01:31:15] gone, took photos and a video, and I had a gut instinct. This guy wasn’t nice. You know, I had a bad feeling about this guy. So [01:31:20] I videoed the whole thing. And then I told him, it’s not going to be it’s not going to work. So I made him an appointment [01:31:25] again with my colleague. Same one. He then didn’t turn up to his appointment. Great. Cool. No [01:31:30] problem. Then the complaints start coming from 7:00 [01:31:35] in the morning till 12 in the afternoon. He’d already sent about 11 complaints. Each complaint [01:31:40] was almost like a chapter out of Pathway to Pulp.

Payman Langroudi: Oh my God. What a nutter.

Ammar Al Hourani: All sorts of stuff. All [01:31:45] sorts of allegations. Like I’m lying to him. I’m trying to pay my debts. I’m trying to make money to pay off my car. [01:31:50] My lifestyle mate. Like I have a normal lifestyle. I don’t I’m not lavish in any way, shape or form. And [01:31:55] this went on for hours. Hours. Then I got a letter [01:32:00] from one of the law partnerships. Crap. Myself, obviously. [01:32:05] Again because I was just about to go on holiday, so I was like, you know, it just happened before I went on holiday. Thankfully, the learning [01:32:10] experience here is I took videos and photos of everything, so that got quashed instantly. So [01:32:15] I was lucky in that respect. But that learning experience was just listen to your gut instinct [01:32:20] and take photos of everything. Because had I not taken photos, it’s you, you know, he said. She [01:32:25] said. And it’s always on the side of.

Payman Langroudi: The letter came in from Dental law and then similar.

Ammar Al Hourani: To Dental law was in Dental [01:32:30] law is a different one of those different. One of the other lawyer law companies.

Payman Langroudi: Called your.

Ammar Al Hourani: Indemnity. I was like, what the hell [01:32:35] is going on here? And I was with TDs Taylor Defence Society and I know Neil Taylor. [01:32:40] He used to do some talks for us when we were at doing so. I knew him a very, very [01:32:45] long time ago and bumped into him a few times. And I literally in that email said, I want to speak to this guy directly. I want to go straight [01:32:50] to the barrister. I don’t want, you know, I’m sorry. I don’t want anyone in the middle ground. I want straight to him. He [01:32:55] wrote a great letter. He was like, listen, this part here, paragraph [01:33:00] one. Yep. If you want to take him, take him. The other stuff, my my, my my client is going to take you for [01:33:05] slander, because unless you can prove.

Payman Langroudi: And it went away, he disappeared.

Ammar Al Hourani: Yeah. [01:33:10] We sent the video, sent everything, then disappeared.

Payman Langroudi: That’s nice.

Ammar Al Hourani: And it was the the law partnership to be [01:33:15] fair on them. That company, it wasn’t Dental law partner. It was a different company altogether. They also were starting to deal [01:33:20] with that individual. And I think they also thought that this guy’s a bit of a nutter.

Payman Langroudi: Yeah.

Ammar Al Hourani: And they wanted nothing to do with [01:33:25] it either. And because they saw all the allegations, like, how are you going to prove any of that stuff that I’m using it to pay my debts and I [01:33:30] don’t have any debts. I’ve paid my debts off a long time ago, you know what I mean? So it’s now it’s very difficult to prove the five [01:33:35] six hours worth of fare.

Payman Langroudi: I mean, you lucked out a little bit. I was very lucky because, you know, dental law partnership number [01:33:40] one, they go and buy dental cases from other law firms. Really, because they know how to weaponize [01:33:45] dental cases. They in the in the legal world they’re famous for that how quickly they buy [01:33:50] dental cases. Um, but number two, the fact that your spidey sense kicked in and [01:33:55] you videoed and documented properly.

Ammar Al Hourani: And I think the third thing I think is quite tricky. I [01:34:00] think that’s another thing about being a specialist. It’s pretty tricky to go after a specialist, I think.

Payman Langroudi: Yeah.

Ammar Al Hourani: Because I [01:34:05] can defend myself. Honestly. I can go to court and I’ll go and read the papers.

Payman Langroudi: Right.

Ammar Al Hourani: Pull all the papers out. And actually I would [01:34:10] speak to all my friends and I’d be like, guys, would you be interested to go in? And they would all like a little fight as well. And they’d all come up [01:34:15] and they’ll all be like, listen, this is nonsense. So it’s very difficult to prove I’ve been below [01:34:20] satisfaction because I’ve done everything by the book. Well, what could I’ve what could have someone else done different than [01:34:25] me? So it’s very difficult now to prove. And most of the studies are great for studies on a, you know, [01:34:30] that, you know, on a cat, you know, on a goat, on a dentine tubules slab, you [01:34:35] know, on a on a test tube. How does that show that? I’m. I’ve worked below standard. You can’t prove [01:34:40] that I’ve done anything wrong here. Does that make sense? It’s very difficult to get these studies now to say, because I could turn around and say, well, that was [01:34:45] done on a cat. So we don’t have that problem in, you know, human teeth.

Payman Langroudi: Yeah. [01:34:50]

Ammar Al Hourani: And before you know it, you can. Yeah. But it’s going to take you years to get out of that. That’s I mean, that’s going to be ongoing [01:34:55] for a long time before you get out.

Payman Langroudi: I think you take it for granted. Right. Because you’ve done the the [01:35:00] specialising you’ve done the PhD. So navigating your way around evidence based dentistry [01:35:05] is like drinking water for you. Yeah. A regular guy with panic. Panic. And [01:35:10] then some expert witness comes in and says something. Yeah.

Ammar Al Hourani: And then when was the last time you did dentistry? [01:35:15] 20 years ago.

Payman Langroudi: Suddenly your career, your life’s on the brink. Right.

Ammar Al Hourani: And that’s a shame. That’s a real shame. That’s [01:35:20] a real, real shame.

Payman Langroudi: Well, I don’t I don’t want to be the guy who scares everyone. I was talking to these young kids. [01:35:25] They’re all scared of it, right? And it’s not, you know, peak GDC is over.

Ammar Al Hourani: I think [01:35:30] so, I think now they’ve got all this newer filter systems, which are quite good. I think they are sort of slowly changing [01:35:35] with the times, which I think is even.

Payman Langroudi: Dental all partnerships over. You know.

Ammar Al Hourani: I think because, yeah, I think because they’re having to [01:35:40] be a bit more crafty with who they take on because I think they’ve lost a lot of the insurances on failures, I think. So I think [01:35:45] that’s why they’re now being more I think, I mean, I know a lot of people talk about the American system, but in America [01:35:50] you’ve got market forces. You can’t just, you know, if you sue me wrongly, I can go after you and everyone that’s [01:35:55] ever known you, you know, so you’re going to be extremely careful as to who you’re going to go after. And I think [01:36:00] that then stabilises the market. Does that make. Causes a natural equilibrium.

Payman Langroudi: Whereas here they’ve been suing [01:36:05] each other longer than we have. You know, it’s they’ve figured that stuff out. Exactly.

Ammar Al Hourani: Whereas we were sort of a little [01:36:10] bit of a sitting duck. It’s like, oh, you shouldn’t really sue your patient, you know, all that sort of stuff because it does feel bad, like [01:36:15] you really shouldn’t be doing it. But at the same time, you can’t just come up with a crap, you know, crazy complaint [01:36:20] against me and not expect me to do something about it. It’s like being punched in the street. You’re not going to not punch the guy back, you [01:36:25] know what I mean? It’s like it’s human nature to defend yourself, you know? So we’re not like, we’re not all [01:36:30] like that. Sort of like holy, holier than holy. Yet, you know, I don’t think we’re we’re not there. [01:36:35]

Payman Langroudi: I’ve really enjoyed it, man. I’ve really enjoyed it. Hour and 40 minutes in, I’m gonna finish [01:36:40] off with the usual questions.

Ammar Al Hourani: All right.

Payman Langroudi: Fantasy [01:36:45] dinner party. Three guests. Dead. Dead or alive?

Ammar Al Hourani: Dead or alive? Uh, first one, [01:36:50] I’d sit down with Jose Mourinho. I love Jose.

Payman Langroudi: Mourinho. Yeah.

Ammar Al Hourani: He’s cool. He’s a he’s a cool guy.

Payman Langroudi: I think [01:36:55] he’s a football fan.

Ammar Al Hourani: Yeah. United fan. Huge. Um, I think he’s a great guy. I love the way [01:37:00] he talks. There’s an element of mystery about him. I think he’s very smart. He’s a very smart guy. Um, [01:37:05] yeah. I’d love to pick his brains. Uh, the second one, I mean, these are now the two one [01:37:10] people would know. People one people wouldn’t know first. The second guy salaheddine. I’d love to sit with him, you know, through the crusader [01:37:15] time, because he did a bit of a miracle for the Arabs at that time, when things were looking pretty damn bad. And [01:37:20] it was a miracle, basically what he did, what he achieved. So I’d like to just sort of pick his brain as to what made him do what he did. Was [01:37:25] it coincidences? Was it luck? Was it you know, I think there’s always a tactics and all that [01:37:30] sort of stuff. The third one people won’t know this is Khalid ibn Al-Walid. Now he’s a leader. [01:37:35] During the time that the Prophet Muhammad was just starting to expand outside the Asian Saudi [01:37:40] peninsula or the Arabian Peninsula as the expansion was happening. And he’s a military leader that [01:37:45] is one of the most studied. He never lost a battle. He is he committed miracles all the time. [01:37:50] And so that’s a guy that I like reading up about a lot just to know what is it? [01:37:55] What was it about him basically, you know, is it because he was very good at deception, battle, deception and all that sort of stuff [01:38:00] at that era? So he committed absolute miracles with a lot of the battles. And I actually studied [01:38:05] a lot of it studied in British history as well. They study it a lot in Sandhurst, how he did all this stuff, because it’s quite [01:38:10] novel. I think that’s the three people I talk to. I’d like to understand how they work.

Payman Langroudi: Are you religious? [01:38:15]

Ammar Al Hourani: Um, I wouldn’t say I’m religious, but I would say I fear God. Yeah, I love [01:38:20] God, I fear God. I try to do my prayers. I try to be as good a muslim as I can be.

Payman Langroudi: Isn’t that religious? [01:38:25]

Ammar Al Hourani: But no, I think religious is when you go above and beyond. I think, you know, I think that’s the basics. I think I think that’s the [01:38:30] absolute basics to be a good Muslim. I think I think if you do the basics well as a muslim, I think you’re okay. [01:38:35] Obviously I’m not preaching it. Don’t, don’t you know? But I think if you’re a good person, you’ve got good intentions [01:38:40] in life and you do the basics well, you don’t, you know, you don’t mean any harm to anyone. [01:38:45] I think. I don’t see why you shouldn’t have a good chance of going to heaven, you [01:38:50] know, because you’re not doing any bad.

Payman Langroudi: So. So the final question, the three pieces of advice is that have [01:38:55] you just given them to me or what’s up? I know it’s honestly the.

Ammar Al Hourani: Best advice for me, honestly, is always [01:39:00] if I was speaking to my friend the other day about it and I was like, you know, work hard, um, have good intentions [01:39:05] and eventually everything comes to you. It just does, whether you like it or not, it [01:39:10] will always come good, will always come to you, you know? Just don’t harm anyone. Just be a good person. And if you.

Payman Langroudi: Are, the intentions [01:39:15] point is a really brilliant nuance. Yeah, it’s a really brilliant when when things go wrong. [01:39:20] If your intentions were right that you should be much better. [01:39:25] Much better.

Ammar Al Hourani: And even if it doesn’t go in your way, you can at least sleep at night because you did it by your intentions. [01:39:30]

Payman Langroudi: You know, intentions are really important.

Ammar Al Hourani: And I think that’s the beauty of the whole thing. I really.

Payman Langroudi: Really [01:39:35] enjoyed it. Really learned a lot, man. Really, really enjoyed having you. Thanks so much for coming in after all this time.

[VOICE]: This [01:39:40] is Dental Leaders, the podcast [01:39:45] where you get to go one on one with emerging leaders in dentistry. Your [01:39:50] hosts Payman Langroudi and [01:39:55] Prav Solanki.

Prav Solanki: Thanks for listening guys. If you got this far, [01:40:00] you must have listened to the whole thing. And just a huge thank you both from me and pay for actually [01:40:05] sticking through and listening to what we had to say and what our guest has had to say, because I’m assuming [01:40:10] you got some value out of it.

Payman Langroudi: If you did get some value out of it, think about subscribing. [01:40:15] And if you would share this with a friend who you think might get some value out of it too. Thank [01:40:20] you so, so, so much for listening. Thanks.

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