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[VOICE]: This [00:00:35] is Dental Leaders. The [00:00:40] podcast where you get to go one on one with [00:00:45] emerging leaders in dentistry. Your [00:00:50] hosts Payman Langroudi and Prav Solanki.

Payman Langroudi: It [00:00:55] gives me great pleasure to welcome Professor Tara Renton, OBE [00:01:00] onto the podcast. Does that mean I have to call you Dame now? No.

Tara Renton: Absolutely [00:01:05] not. It was the latest I know. I can’t believe it. [00:01:10] I’ve got goosebumps even talking about it. And have you been. No [00:01:15] no no no. You get you get a letter from um the Cabinet [00:01:20] Office like in big letters on the envelope I think. Oh my God, what have I done? This was like end of November [00:01:25] or what had my husband done more importantly. And um, and you open it [00:01:30] up and it basically is three sheets as a questionnaire. You fill in if you’re accepted or not, and a bit about your [00:01:35] E and D bits and pieces. And then, um, basically the letter says, um, [00:01:40] you have to keep this secret. You’re not allowed to tell anyone. Mhm. Um, and you’re [00:01:45] sort of in a state of disbelief. Um, and I managed to keep it [00:01:50] quiet for my husband for who’s of 39 years. Um, my sort of, my, [00:01:55] my, my biggest supporter, my silent weapon. I like to call him. Um, no, [00:02:00] no, actually for nearly two weeks. But the person I was most desperate [00:02:05] to tell was my 87 year old mum, I bet, and I was, and I just thought, I can’t, I can’t, [00:02:10] I’m so glad I didn’t. Um, and so I told my husband, we didn’t tell anyone. And then we were at a [00:02:15] New Year’s party with friends and one of them and found out and you get [00:02:20] this little trickle of people who obviously there’s some people obviously study it every year, like in depth. And I’ve got some [00:02:25] lovely emails from people and texts. Um, and then one of my girlfriends has seen it and [00:02:30] announced it at the dinner party. So most, not all, but most of my good friends know. [00:02:35] So yeah.

Payman Langroudi: And you’ve told your honour.

Tara Renton: I’ve told my mum. Yes. I think.

Payman Langroudi: She’s.

Tara Renton: I think [00:02:40] she’s inventing people to ring up and tell she’s absolutely buzzing. Bless her. So [00:02:45] she’s, she’s widowed. Um b 30, 32 years [00:02:50] this year. My father was a dentist and died at 62 on an exercise bike. So [00:02:55] um, as I mentioned, you know.

Payman Langroudi: Four generations, four generations. [00:03:00]

Tara Renton: Yeah. So, um, three guys, I make another Wolfson [00:03:05] candidate, a bit like Richard Porter and others. Um, but um, [00:03:10] yeah, my, my father was a GP. Um, he was, he did his national, he did [00:03:15] his guy’s dentistry and then he did, um, LDS and then he did national service. Um, [00:03:20] and that’s how he met my mother. He was out in Cyprus during the Suez crisis. And my mother’s father was a, in [00:03:25] the army. So they met and married um there and then my grandfather was a dentist, [00:03:30] a private dentist in Golders Green. So he did dentistry with um, with um, uh, [00:03:35] basically, um, what do you call it now? Just just. [00:03:40]

Payman Langroudi: Operated.

Tara Renton: Yes. Well yes, it was, there was a trundle his front room in his house at number [00:03:45] 11, North End Road. If anyone was, was his surgery, they had that distinct smell and we used [00:03:50] to go and visit them. Um he was just up the road from the um the the the palladium [00:03:55] golden screen palladium. So he had always his, his, uh, his waiting room, which was [00:04:00] doubled up as a dining room at the weekends, a big fish tank always people like Sid James [00:04:05] and Hattie Jakes, all the big names were often sitting [00:04:10] in the waiting room.

Payman Langroudi: And your great grandfather.

Tara Renton: My great grandfather’s a bit more of a leap because [00:04:15] he did. He qualified in surgery in 191887 at [00:04:20] Barts, and he, um, went into the Indian [00:04:25] Army Medical Corps, and he, I think he did 3 or 4 tours there. So he [00:04:30] was there for a long time and a bit of a naughty boy. So he, um, he, um, [00:04:35] my grandmother, my great grandmother left him, came back with my grandfather [00:04:40] and his brother, who’s brother actually ended up being the royal vet Proby Cautley. And [00:04:45] um, and, uh, he retired, came back to England. And [00:04:50] in those days before the dental Act, he could, he decided to do dentistry, and I always thought that was a bit of an [00:04:55] odd choice. But it turns out, thanks to when I did a bit of research for courtly Dental dynasty for [00:05:00] the British Historical Society. He was one of six officers, [00:05:05] medical officers that were invited back to do a special course at Guy’s Hospital and [00:05:10] doing dental extractions, because obviously we all know with the Napoleonic saying, can’t bite, can’t [00:05:15] fight, we know the repercussions in the army of dental unfitness. And in [00:05:20] that in that era, I mean, it was after the Boer War where more people, as many people, [00:05:25] died of toothache as they did of being shot. Yeah. Apparently, um, in [00:05:30] those days it was a real problem. That’s what made made, rendered servicemen just unfit. So they basically [00:05:35] thought, well, we’ll bring six surgeons, medical officers back, teach them how to do dental extractions. [00:05:40] And that was the beginning of the Army Dental Corps. That’s really interesting. So that obviously swayed [00:05:45] his choice. He thought he’d retire in Norfolk and become a dentist.

Payman Langroudi: Yeah. So I heard a statistic that 3,040% [00:05:50] of the of the military, the front line were [00:05:55] debilitated by dental pain, you know, back then.

Tara Renton: I’m not surprised.

Payman Langroudi: It’s so interesting.

Tara Renton: It is [00:06:00] fascinating. We live in today. I mean, we think 30% of, you know, the kids.

Payman Langroudi: Gas. [00:06:05]

Tara Renton: Gas. I mean, it’s, it’s, it’s the most common reason for kids under 12 to be [00:06:10] admitted to hospital is, is dental caries. It’s just, it’s, [00:06:15] it is shocking. And I, if you ask me about bugbears, that’s one of my bugbears. And [00:06:20] I know you’ve touched.

Payman Langroudi: On isn’t that like societal in the UK and that there [00:06:25] is a neglected bottom 10% in the UK or whatever percentage it is, but the. [00:06:30] And by neglected, I don’t necessarily only mean by the the the healthcare [00:06:35] system. It’s almost like the bottom 10% of everything in the UK has just been [00:06:40] let go. Everything. You know, you can have the best universities and you [00:06:45] can have the worst. You can have the best schools and the in the world and some of [00:06:50] the worst, the best restaurants in the world.

Tara Renton: And some of the words. I’ve never thought about it in percentages wise. [00:06:55] I mean, all these amazing initiatives, you know, Dental smile in Scotland [00:07:00] where they they get kids to read and brush their teeth with teddies and try and [00:07:05] encourage the parents to read with the kids and brush their teeth. I mean, there’s some fantastic incentives and you and [00:07:10] also increasingly now in nurseries, you know, I’ve got my first ever grandchild and [00:07:15] they’re talking about nurseries and we’re talking, they get breakfast and they get their teeth brushed.

Payman Langroudi: So it’s [00:07:20] how does it feel to become a grandmother?

Tara Renton: Oh my God, I never saw it. So surreal. 5th of December last year. [00:07:25]

Payman Langroudi: Is it surreal?

Tara Renton: It’s amazing. It’s amazing. And I’m not the most maternal person. [00:07:30] I, um, I never thought I’d have kids. I honestly didn’t all be married. No, I never did. [00:07:35] Never did. No. So all happy circumstance. I’ve got three lovely kids, and our eldest [00:07:40] son Tim’s had little sac and we were babysitting him yesterday. It’s. You can’t describe [00:07:45] it. I don’t think you just can’t describe it. It’s incredibly special and also slightly [00:07:50] anxiety producing as well. You think this world and what we’re talking about and yeah, [00:07:55] it’s.

Payman Langroudi: So did you feel the weight of becoming a dentist when [00:08:00] you were deciding this stuff? Because did you know about the three generations before you?

Tara Renton: I didn’t know, [00:08:05] no, I knew obviously my grandpa and obviously my father, but I didn’t know. So it’s a really good question. [00:08:10] Payman. Because actually, um, I thought perhaps in retrospect, [00:08:15] but actually at the time, I remember my dad being stressed all the time and [00:08:20] he loved his work. He loved his patients. He loved the NHS. It took me a while [00:08:25] to figure out at his funeral, actually, he was 17 when the NHS was invented. He was a massive [00:08:30] advocate of never doing private work, always doing NHS dentistry, and a lot of your [00:08:35] podcast people talk about the amount of admin work you do in general practice. My father was there till [00:08:40] midnight, 1:00 every night, every morning, doing all his old brown cards.

Payman Langroudi: Really?

Tara Renton: Yeah. [00:08:45] I mean, they saw so many patients. He had a dual surgery, he’d numb one patient up. [00:08:50] And then, you know, I mean, the volume of.

Payman Langroudi: And was it the traditional setup where you lived above [00:08:55] the.

Tara Renton: No, no, no separate practice. No. We lived about a mile up the road.

Payman Langroudi: Where where was.

Tara Renton: I? [00:09:00] Uh, Taunton, Somerset.

Payman Langroudi: Oh, a lovely place.

Tara Renton: It’s still a still a big practice. Now Bupa practice number [00:09:05] one. Staplegrove road. Yard house. So, um, so I grew up with my dad, and I could never [00:09:10] figure out he loved his work so much. And he was very, very dedicated. I could never understand what [00:09:15] it was. And it was sort of penny dropped, really. He never relaxed. He only ever took like two weeks holiday in [00:09:20] the summer. Um, and it was essentially at least 1 or 2 of his [00:09:25] partners just stressed him out. He hated taking time away from the practice because he’d come back and [00:09:30] something had been done or. Mhm. Um, and that was his big stress or he wasn’t probably the most [00:09:35] business oriented man either, which is I’ve inherited that. So I understood [00:09:40] that my. Yeah, I, I felt no pressure at all because actually when I [00:09:45] told him I could only do maths, I was pretty dyslexic at school, never diagnosed. I failed [00:09:50] my English O-level. Um. I struggled reading probably up until I got to university. Still, I struggled [00:09:55] then um and uh, but could do maths and physics. I got into girls grammar school, [00:10:00] you know, worked incredibly hard. Um, loved the sciency stuff. And I remember [00:10:05] thinking, what can I do with sciences? And I could do medicine, possibly do veterinary. [00:10:10] Um, in those days, probably still the same at some girls schools. I was offered nursing [00:10:15] or teaching. I was my mum was very ambitious for me. She never had a career, so she wanted me [00:10:20] to be independent and I did too. Um, and I remember thinking I kept coming back [00:10:25] to dentistry because I love art, I love using my hands. I love making things. I love using my brain. [00:10:30] I just thought, actually, I can travel, I can earn good money. I can work part time. What, [00:10:35] what a better job is there, you know, and, um.

Payman Langroudi: Back then was the percentage of women, much less. [00:10:40]

Tara Renton: Uh, well, it was my year at guy’s when I went to guy’s at 1979, was [00:10:45] the first year they had 50% girl students, so the movement had started. [00:10:50]

Payman Langroudi: 79. The year we got to Britain.

Tara Renton: Oh, really?

Payman Langroudi: Winter of discontent.

Tara Renton: Yes. [00:10:55]

Payman Langroudi: It was a tough time.

Tara Renton: It was.

Payman Langroudi: Tough. We were coming from Iran, which was like. It [00:11:00] felt like, I don’t know, whatever Dubai must feel like right now or something. Yeah. And we got here and it was dark [00:11:05] and it was raining and there was rubbish piled up because they hadn’t collected the rubbish. [00:11:10]

Tara Renton: All the strikes.

Payman Langroudi: Everyone was on strike.

Tara Renton: Yeah. And I thought such different times.

Payman Langroudi: And they [00:11:15] built it to us. You know, we were kids. Right. They built it to us as we’re going to England. It’s going to be great. I [00:11:20] was like, what happened here?

Tara Renton: Whereabouts in Iran did you come from?

Payman Langroudi: My, [00:11:25] we’re from the north. But. But we were living in Tehran. Right. Um, and we were very [00:11:30] lucky to get out in time. My dad had a few English people working for him. And when the UK embassy [00:11:35] told them, get out, we got out.

Tara Renton: So.

Payman Langroudi: So many people [00:11:40] didn’t manage to get out in time.

Tara Renton: You know, it’s a story that’s not told enough, I think. My husband was involved [00:11:45] with BP in Iran.

Payman Langroudi: Oh, really?

Tara Renton: And all through that transition, actually, it’s very interesting. [00:11:50] And I was very lucky. I got invited to lecture there about eight years ago and we went.

Payman Langroudi: Oh.

Tara Renton: It’s the most [00:11:55] beautiful country and lovely people. So sad. What’s happening? Yeah. [00:12:00] You must have friends and relatives. I’m so sorry.

Payman Langroudi: Yeah yeah, yeah. I mean, and, you know, they even managed [00:12:05] to block Starlink now.

Tara Renton: Yes.

Payman Langroudi: It’s you can’t even, you know, my [00:12:10] uncle, we’ve only spoken to him once in the last three weeks, and [00:12:15] he was too scared to say anything. Um, he just kept on saying I’m okay, [00:12:20] I’m okay. But he wouldn’t talk about the situation because, you know, [00:12:25] this sort of 1984 thing that’s happening across all countries. Right. Yeah. [00:12:30] Um, it’s it’s a weird thing. I remember reading that book thinking it was, [00:12:35] it was a warning about communism or something. And I think it was right. That’s Sorry. And [00:12:40] thinking like, that’s, that’s, that’s a period in the past rather than that’s a period in the future. But [00:12:45] you feel like with data and AI and all of that, we [00:12:50] are merging with the machines. It’s one of those crazy things that there’s no getting in the way [00:12:55] of it now, because billions and billions are being thrown at it. Yeah. So those people aren’t going to stop? [00:13:00]

Tara Renton: No.

Payman Langroudi: Do you have any thoughts about my my, my daughter was saying she wants to [00:13:05] be a dentist.

Tara Renton: Well, you see, when I, when I came back from school, having had this really [00:13:10] awful session with a careers advisor, loosely termed, I remember saying to dad, [00:13:15] you know, I really wouldn’t mind doing dentistry. And he went absolutely over my dead body.

Payman Langroudi: Really? [00:13:20]

Tara Renton: And I said, but you love your work. He said, I love the work, but I don’t like the business. [00:13:25] And I find it very you know, I never said stressful. That was not one of [00:13:30] his vocabularies. But he just said, I don’t want you to do dentistry. So in the end, um, [00:13:35] I he was, he was both my parents were very sporty and played lots of hockey. We used to watch them [00:13:40] play hockey at the weekends and we. We all got shoved out to do sport as well, so we weren’t under their feet. And [00:13:45] um, he said he, he sort of capitulated and said, well, okay, okay. [00:13:50] And he said, do medicine or do, do veterinary. And, and I just said, well, I don’t really know [00:13:55] what they do. So in the end, he said, well, I’ll tell you what, um, I’ve asked my veterinary veteran [00:14:00] hockey team and I think there was a vet, there was a medic, there was a psychiatrist, there [00:14:05] was a solicitor, a barrister, an accountant. Um, what else was there. Oh [00:14:10] there was a manager of a, of a hardware store. Anyway, he said um if [00:14:15] you go and do work experience with all of those and come back and say you still want [00:14:20] to do dentistry, he wouldn’t have me in the in the surgery, he, I had to go and work with one of his partners.

Tara Renton: Uh, [00:14:25] then we’ll have a conversation. So I did, I dutifully did, I lasted probably [00:14:30] 15 minutes at the vets, the first little fluffy creature that I was going to be put down. That was it. I was out of there. [00:14:35] Um, I remember thinking with the GP and these are the days where you [00:14:40] couldn’t have someone sitting in there or you could with patient’s consent. But, and I remember thinking, God, [00:14:45] these, these blokes are stuck in a small room with mad people all day. And arguably that’s [00:14:50] what I’ve ended up doing. But, you know, and, and I had no concept of specialisation [00:14:55] or what possible things there were in the future. But I came away from that thinking, [00:15:00] I definitely don’t want to do medicine. I definitely don’t want to do veterinary. I definitely don’t [00:15:05] want to do accounting. Um, and, uh, and, and I had [00:15:10] a conversation with dad and he said, well, okay, um, then then [00:15:15] go for it. But he, you know, he did say caveat. You’re like me, young lady. You don’t have [00:15:20] any business acumen. So be very careful.

Payman Langroudi: You know, you listen as an aside, [00:15:25] let’s talk about that because I know it’s a tough business. It is a tough business. You’re breaking your [00:15:30] back. You’re in it rather than on it. At the same time though, the [00:15:35] economics of it work out that you don’t have to be Gordon Gekko to make [00:15:40] some money as a dentist. You’ve just got to be good to your patients. Good to your staff. Yeah. [00:15:45] Obviously, the basics of any like a corner shop has to pay its taxes and [00:15:50] and its rates and all that. But but you know what I mean. As a business, I wouldn’t call it a difficult [00:15:55] business. Much easier business than the one we’re in. Yeah. Yeah. This business overnight could [00:16:00] could, could be worth nothing. Yeah. You know, based on some global competitor. Yeah. [00:16:05] Whereas if you want to practice in Surrey and you’re nice to your people and nice to your. It’s [00:16:10] not a bad business.

Tara Renton: No, but still, essentially, I think you have to be comfortable with running [00:16:15] a business, comfortable putting your face out there, promoting yourself, asking [00:16:20] for money. None of those things were something that I.

Payman Langroudi: Didn’t come.

Tara Renton: Naturally. No. And certainly [00:16:25] didn’t come naturally to my father.

Payman Langroudi: You go. You go from Taunton to the big city. [00:16:30]

Tara Renton: Yeah.

Payman Langroudi: Firstly, how were you with that? I mean, that must have been super exciting. [00:16:35]

Tara Renton: I was super excited. I was I got in, I was a bit younger, so I was just [00:16:40] 17 and I was ready. My grandma and I’d been the odd visit to my grandpa [00:16:45] and he’d taken me to Hamleys and a couple of. He introduced me to ballet, which was one of my passions. Oh, nice. [00:16:50] Um, so I sort of, I definitely, definitely was ready to go to a big city. I got into [00:16:55] several places. I got into Bristol and Manchester. Um. Um, [00:17:00] but actually I thought London was for me for four and a half, five years.

Payman Langroudi: And [00:17:05] I didn’t manage to do the introduction properly yet. But you’re right now you’re a world leader in [00:17:10] orofacial pain. Um, tell me just just make me, make me feel better and [00:17:15] tell me that you weren’t always that sort of super ambitious, super focussed person? [00:17:20] No. So as a student, you would just.

Tara Renton: I worked hard, I think because of my [00:17:25] dyslexia. I, I, I, it’s quite interesting before [00:17:30] all these types of learning. All my O-levels. My bedroom wall was covered in [00:17:35] coloured bits of paper.

Payman Langroudi: So obviously your strategy for getting around.

Tara Renton: That’s how I could remember things [00:17:40] and how I could learn things. And I got, you know, I failed my I mentioned I failed my English O-level, but luckily it was a girls [00:17:45] grammar school. So we did all those basic five a year early. So I had another chance [00:17:50] to bite at the cherry I managed to pass it with. But you know, I was getting A’s and I was in top sets [00:17:55] for everything, but asked me to read out loud in an English class. I just wanted to die. [00:18:00] And I, you know, I had a tough time for some of the, some of the teachers as well who just think [00:18:05] thought I was just not trying just so I had this, um, ethos. And obviously, [00:18:10] as I said, my mum was quite ambitious for me, definitely to work very hard [00:18:15] and I did work hard. And I remember my first day at 17 at Guy’s Hospital in a biochemistry [00:18:20] lecture and I thought, I have arrived, I love this, I could [00:18:25] swear, love this. Um, I just knew I was in the right place. I [00:18:30] loved all the dissection. I loved that smell of formula. And I love the Gordon Museum. I love [00:18:35] all of that. That was just my you know, and I, I’m very, very [00:18:40] curious, you know, on all fronts.

Payman Langroudi: I’m horrified by dissection.

Tara Renton: I [00:18:45] just thought we were so honoured.

Payman Langroudi: Those people, of course.

Tara Renton: You know, I saw it from that perspective [00:18:50] and I just thought it was just so interesting. And you know, every which way did [00:18:55] different angles. I, I absolutely loved it. I was flying the first two years. Um, [00:19:00] did you party? Yes, yes. I had a lovely boyfriend at the time. [00:19:05] Very healthy social life, didn’t do much dancing, didn’t do much sport, had a [00:19:10] bike. So I did a bit of cycling, which I still do now. Very passionate about that. But um, no, no, I [00:19:15] had a really, really good time. Lots, lots of drinking.

Payman Langroudi: And what would you say then if we’re talking, [00:19:20] what was the sort of inflection point to go from that to? You’ve [00:19:25] put out 250 papers now.

Tara Renton: There wasn’t Payman.

Payman Langroudi: There was [00:19:30] no there must have been an inflection that you said, I want to be the best at something or I want to specialise. [00:19:35] I mean, not what tiny proportion.

Tara Renton: Specialise when I, when I walked out of, I got the [00:19:40] final year prize, I came second in the year, but that’s because I was loving [00:19:45] what I was doing and I worked hard. It wasn’t out of some focus of ambition. I [00:19:50] definitely, definitely knew I did.

Payman Langroudi: Not class yourself as an ambitious person.

Tara Renton: No.

Payman Langroudi: Really? [00:19:55]

Tara Renton: No.

Payman Langroudi: I love that.

Tara Renton: No. It’s serendipity. Honestly, I’ve [00:20:00] I’ve landed in a corner of my life in an area that I absolutely love. [00:20:05] I really enjoy the people I work with. I love still seeing the patients, [00:20:10] um, part. Retiring and moving away from surgeries made me realise how much I missed that. [00:20:15] Mhm. I don’t miss the admin. I don’t miss all the hassle that goes with the NHS. [00:20:20] Now. It’s so difficult to do things. So difficult to change things. Impossible [00:20:25] to be innovative. But no, I would not say I was an [00:20:30] ambitious person. I would always do. I always do my best on everything. And as I say with [00:20:35] that background, I just was doing in an area that I love. I remember qualifying in, [00:20:40] in dentistry, thinking, I’m never, ever going to come back and have to do any academic work ever again. Seriously. [00:20:45]

Payman Langroudi: How funny.

Tara Renton: But then I knew I didn’t want to do peds because it was just [00:20:50] too stressful working on children and their family. I knew I didn’t orthodontics.

Payman Langroudi: Similar [00:20:55] issues.

Tara Renton: And perio weren’t for me. And I remember Richard [00:21:00] Haskell was one of the consultants, an oral medic consultant, absolutely Armenian. [00:21:05] And he was a genius. He was intellectually brilliant. I remember him doing a giant [00:21:10] diagnosing giant cell arteritis and doing like a giant temporal artery biopsy, [00:21:15] just like that, you know, just and I sort of thought that’s the sort of person I would [00:21:20] really like. I’d like to be that good. I never thought I would would be anything like it. But, um, those [00:21:25] are the people that really inspired me.

Payman Langroudi: And did you, you must have had crisp and.

Tara Renton: Crisp [00:21:30] and Scully I love but never taught me. I had Roy Roy Castle, Roy Coulson, who was [00:21:35] an inspirational, inspirational Frank Ashley that comes later. [00:21:40] He was the one that pushed me to do a PhD. In the end, he was really.

Payman Langroudi: Edwina.

Tara Renton: Kidd. Edwina Kidd I [00:21:45] saw recently at the Dental day.

Payman Langroudi: Was she when you were.

Tara Renton: She was restorative. She was like a young lecturer and restorative. [00:21:50] Really. Richard Palmer. Oh, he was lovely. He’s still a good friend. He was a great mentor, actually, [00:21:55] as a student. Really lovely man.

Payman Langroudi: Have you put implants in as well? Yeah.

Tara Renton: Did implants. [00:22:00] This is how old I am. I think I put some of the first ever branemark and cor [00:22:05] vent and imz implants in, in my max fac training in Melbourne. So we’re.

Payman Langroudi: Going.

Tara Renton: Um, [00:22:10] when’s that 1987, 88, 89.

Payman Langroudi: So how long did it take [00:22:15] between qualifying and doing max max training. Was it pretty.

Tara Renton: Quick. Not, not it [00:22:20] was not an intentional thing. Nothing’s been intentional. And when a lot of the kids come up to me and say, oh, can [00:22:25] I have some career advice? I’m saying you’re asking the wrong person about career advice. My, my, you know, I [00:22:30] sort of focus down. I wanted to do a combination of, of medicine and surgery. [00:22:35] And the only options then were max fac. So basically, like a lot of people, you [00:22:40] know, the rich and porters of the world and other people, you think, actually, I’d like to get my first part [00:22:45] fellowship and I’d like I didn’t got an show with my, um, uh, [00:22:50] with Don Gibb, the Max fac surgeon who was the most of them were singly qualified or [00:22:55] singly qualified. Don Gibb um, and I remember did my first essay [00:23:00] and I thought, no, I really quite like this, you know, the, the casualty. And I’ve got some great stories about [00:23:05] what happened in casual and bits and pieces. And I really, I guess I just like being stretched [00:23:10] and in an area that I love and it just the potential just keeps.

Payman Langroudi: Going, going.

Tara Renton: And, [00:23:15] um, and then with Don Gibb’s help, I suspect I got shortlisted [00:23:20] for a Esho at Torbay Hospital and I was a massively keen windsurfer at the time. [00:23:25] So I applied for all the jobs along the South coast and I got the job at Torbay [00:23:30] and I was there for a year as an SHO. Stayed on for another year as a SHO forward slash registrar. [00:23:35] Hugh Brock he used to rock up to work either on a horse or on a motorbike. [00:23:40] He was a real character, had handlebar moustaches and a handlebar moustache and alongside [00:23:45] bands. He was a genius of a man and sadly died of bowel cancer far too young. Another [00:23:50] inspiration in my life. And um, I loved that work that and again, [00:23:55] work hard, play hard. Great doctors, great, great people. A lot of people just stayed [00:24:00] in Torbay. I don’t blame them. Um, and that was amazing.

Payman Langroudi: The work.

Tara Renton: It was, it [00:24:05] was, it was.

Payman Langroudi: Hard. The whole thing.

Tara Renton: Yeah. 1 in 2 on call, I think I did. Oh I did nine 1 [00:24:10] in 8 years, 1 in 2 on call. You add it all up. Yeah.

Payman Langroudi: The old NHS. [00:24:15]

Tara Renton: The good old days. Yeah. 72 hours on. Yeah. Um.

Payman Langroudi: But you loved [00:24:20] it. Oh, I loved it. So then you decide to do Max factor training?

Tara Renton: Well, no, because I had [00:24:25] with my family guys, I was offered to do free medicine. And I remember thinking, [00:24:30] going back to that girl who did the work experience with her dad’s veteran hockey team, I don’t [00:24:35] want to do medicine. What is it going to change me? You know, surely I can do what I want to do without having [00:24:40] to spend another five years of my life doing. I don’t want to do that. Um, what I hadn’t realised [00:24:45] is obviously that time expired senior registrars were just beginning to happen. So [00:24:50] there’s still a chance you could get through single qualified. But actually I just on [00:24:55] principle I was not going to do that. So I thought I did really just under three years [00:25:00] at Torbay Hospital. I thought right, I need some time out. I’m not sure if I want [00:25:05] to use my ovaries or not. I need time out just to think about what I want to do. So I got a job as a ski rep with Inghams, [00:25:10] and in the first two weeks I met my husband who helped to put my skis on the [00:25:15] back of the bus and he was working in Australia, so I quit that job, went back, got a job [00:25:20] in practice in Bournemouth with my windsurfer, Barry Nibbs, a real character, recently retired [00:25:25] and did eight months in practice whilst I waited for my migrant visa to come through. And we got [00:25:30] married and I followed my husband out to Australia. So we knew each other for two weeks.

Payman Langroudi: Whirlwind, [00:25:35] but especially for someone who decided not to. Wanting not to get married and have kids.

Tara Renton: I [00:25:40] was telling my brother the night before I met Tony, I’m never going to get married. I [00:25:45] have a certain type if I do, if the biological clocks. The clock [00:25:50] is ticking. I’ll just go to a Danish, Asperger’s or sperm [00:25:55] bank pick and, you know, like the Scandinavians [00:26:00] and all. Yeah, and the rest is history. The perfect man [00:26:05] turned up the next day. Yeah. I knew he was the one. I told my mum. I went back for Christmas. My [00:26:10] mum and I said to mum, I think I’ve met the man I’m going to marry. She said, oh, don’t be so stupid. [00:26:15] To finish the washing up and, uh, and yeah. And then two weeks, a week [00:26:20] later, he proposed, went off to Australia and I went out for a holiday to meet [00:26:25] him, but he was posted in Papua New Guinea for most of that time, which was disastrous. Um, but [00:26:30] yeah, got married in August. That was 39 years ago.

Payman Langroudi: Were you not considering staying in Australia [00:26:35] after that stint?

Tara Renton: I never wanted to go to Australia. I went I followed Tony to Australia, but the the reason I’m telling [00:26:40] that story is in order to get my migrant visa, I had to get jobs in practice. So [00:26:45] I got jobs in practice. I registered with Victoria State Dental those days it wasn’t federal [00:26:50] Dental board, it was um state. Um, so I ticked all the boxes to try [00:26:55] and maximise getting my migrant visa. And that included getting offered jobs in, in practice. [00:27:00] So I was working three days in dental practice, two days a week as a volunteer at the National [00:27:05] Art Museum. That’s my passion is. And I just thought, actually that’s what I was going to do. I was going to [00:27:10] finally do art. You know, my my dad had Pooh poohed that right at the start. Um, and [00:27:15] I remember Carlo Roberts, who’s a South African, uh, practice, [00:27:20] uh, principal real character took me on two days a week in lovely Beaumaris in Melbourne. [00:27:25] And, um, I’d finished a day’s work and um, he [00:27:30] said to me, oh, Tara, I’m supposed to be giving this tutorial tomorrow night. I just can’t be bothered, [00:27:35] you know, more about you’ve done more oral surgery and wisdom teeth. Why don’t you give the tutorial [00:27:40] about wisdom teeth? So I thought it’s fair enough. He’s done lots of favours. I can do that.

Tara Renton: And [00:27:45] there was about it was for the Royal Australasian College of Dental Surgery. So the RA [00:27:50] CDs, which is the RCS equivalent here. And um, [00:27:55] there was about 12 young mainly blokes, um sort of students, not [00:28:00] post-grad. No, they’re postgrads. And um I gave my tutorial [00:28:05] and there was a bloke sitting at the back and then I thought very old bloke sitting at the back and [00:28:10] he didn’t introduce himself, he just disappeared off. And then two weeks later, I got this telephone call [00:28:15] at work saying, um, is that Tara Renton? I took all my married name because I used to be Tara [00:28:20] Courtly. And, um, and I said yes. And he said, oh, it’s a professor Peter Reid here. I run [00:28:25] the Oral medicine, Oral pathology and Oral maxillofacial program at Melbourne Hospital, [00:28:30] Melbourne University. Um, I listened to your I was very impressed [00:28:35] by your talk you gave the other day, and I’m sorry I didn’t introduce myself. I had to rush off. He said, I just wanted [00:28:40] to ask you, um, this was November, [00:28:45] late October, early November. He said, um, we have a very good, um, [00:28:50] maxfax maxillofacial program, which is four and a half to five years. [00:28:55] And we have two candidates a year and one of the candidates just dropped out and [00:29:00] it starts in January. So I remember thinking, oh my.

Payman Langroudi: God. [00:29:05]

Tara Renton: And I thought, and I remember thinking, I don’t want to do max work. And what it was is [00:29:10] max FAC program very much like the American model. So basically integrates medical studies. You [00:29:15] don’t end up you don’t walk away with an M.D. but and it’s very orthognathic [00:29:20] lots of trauma, lots of dental alveolar, a smattering of head and neck, [00:29:25] bit of plastics. So it was very much the American model. And of course, I didn’t have to go and do five [00:29:30] years of medicine. And I thought, actually, I’m quite tempted by this. But then I didn’t [00:29:35] know how long we were going to be in Australia for because Tony was on a temporary visa with BP. So the reality was two, [00:29:40] two and a half years max. So I went back and had a chat with my long suffering husband [00:29:45] and just said, actually, I’m really quite tempted by this. He said, well, look, if you want to do it, do it. But [00:29:50] you know, I don’t think he realised how what hard work it was going to be. And it was hard work, but [00:29:55] incredible training. So that’s how I ended up with a max fac qualification. But then when [00:30:00] I came back to England five years later, pregnant with my firstborn unintentionally. [00:30:05] And, um, yeah, for those girls in the audience on the pill and, [00:30:10] um. And couldn’t get a job. Why so [00:30:15] xenophobic about foreign qualifications? Yeah.

Payman Langroudi: So interesting, isn’t it?

Tara Renton: Couldn’t [00:30:20] get a job. Um, so I managed to scrape in through the back door back at guy’s with Pat [00:30:25] O’Driscoll, and I did a locum SPR for him in max vac. I did that till [00:30:30] I dropped my first born, Tim. Um, and that’s really good that I did that in a way, because [00:30:35] it just got my foot back in the door and people remembering who I was. And, and so [00:30:40] when I had sort of six months just looking after Tim, I was hoping to get back to work part time, [00:30:45] no part time jobs in oral surgery didn’t exist. It was just max vac, [00:30:50] um, oral medicine. And you needed medicine to do that as well. So what I did is I put my [00:30:55] CV in the post to three main teaching hospitals in London and heard back from two [00:31:00] of them. And one of them was Mark McGurk. Professor Mark McGurk, who basically said, [00:31:05] look, I’m prepared to take a risk. And he did. I had an interview with him. To my chagrin, [00:31:10] I managed to get pregnant with my second son after being offered the job before starting it. Wow. Um. [00:31:15] And, uh, but anyway, he was, he was great. So three days a week, he was doing research [00:31:20] for the Royal College of Surgeons, sort of some research funding he had. And it was basically three, [00:31:25] it was three days. I did three, um, uh, 3GA [00:31:30] third molar lists and three clinics. And I did that for ten [00:31:35] years.

Payman Langroudi: Wow.

Tara Renton: Um.

Payman Langroudi: And were you at this point now thinking of research [00:31:40] as well?

Tara Renton: Well, because it was the research, because it was already research. Yeah, I was, [00:31:45] I was doing it and I used to bump into Frank Ashley. I mean, I then had two young [00:31:50] boys, um, and, uh, and I remember thinking, actually, this is great part [00:31:55] time ticks all the boxes. Loving the research side of it. Um, really [00:32:00] loving the operating sort of ticking all the boxes and sort of five, five years in and then just [00:32:05] just about to have my daughter. And I remember thinking, what’s the career prospects here? There was none. So [00:32:10] I was I had been made an associate specialist. Um, definitely [00:32:15] wasn’t going to do medicine. Um, because I didn’t think how that would change my practice and it wouldn’t [00:32:20] have done.

Payman Langroudi: Yeah.

Tara Renton: And, um, sort of got started thinking and I was thinking, [00:32:25] you know, what to do. And every time I was late, often late doing my, you know, finishing [00:32:30] off everything, I’d get in the lift at guy’s. And one of the downsides of that of the [00:32:35] guy’s hospital on the, you know, the Dental hospital on different floors is you rarely interact with [00:32:40] people, different specialities. But one of the upsides is that blooming lifts, because you’re waiting for them [00:32:45] for ages and you’re in them for ages. And I used to see Frank Ashley a lot, who was then Dean, and he used to say [00:32:50] to me, Tara, you should be doing a PhD. The research you’re doing is really good. And I said, look, [00:32:55] for God’s sake, I’ve got two young kids. I’ve got another one on the way. I can’t do a [00:33:00] PhD. And he said, yes, you can. So I spoke to Mark about it and he was very, [00:33:05] very supportive. Something that got me going as well as [00:33:10] that, they advertised for a bombs trainee and I didn’t get it and I was really upset about [00:33:15] that. Um, so I thought actually the only option is to have a career is to do a [00:33:20] PhD. And that would give me the options to follow through with academic oral [00:33:25] surgery. So that was the academic omfs as it was called. So that was my only option. And so [00:33:30] call me ambitious, I don’t know, I just I knew that what I was doing was not enough. [00:33:35] Um, it ticked a lot of boxes. Um, but [00:33:40] I wanted more, I wanted to do more. And I guess I did want [00:33:45] some recognition for it. Looking back, I guess I did that I wasn’t happy just to sit doing [00:33:50] all that work. Um, as an associate specialist.

Payman Langroudi: I’d like to, I’d like to delve [00:33:55] into the juggle of being, you know, that person with three children, [00:34:00] you know, the, in that in that era as well. Um, [00:34:05] how you pulled that off. But I’m even more interested in the notion of the [00:34:10] recognition and the, you know, the driver [00:34:15] for doing things. I was, I was funny, I was talking to my wife about it that [00:34:20] let’s say we sell enlightened for a stupid amount of money, like $1 billion. It’s, [00:34:25] it’s not worth anything near that. I was saying to her then then we’d be going [00:34:30] walking, trying to get a coffee like we are right now. Yeah. Having done that. But [00:34:35] it’d still be me and you going to try and get this coffee and. But there’d [00:34:40] be something in the back of your head that you feel like you achieved something or some something like that. [00:34:45] Yeah. But what’s, where’s the deficit that [00:34:50] wants me to feel that feeling? And of course, there’s, there’s, you know, whether you want to call [00:34:55] it ambition or deficit or whether these are bad words, maybe, but but, you know, like recognition, [00:35:00] is there an aspect of, you know, you have that the weight of the generations before you. [00:35:05] So you want to show that you did something.

Tara Renton: That’s not Payman that’s not my driver.

Payman Langroudi: Or is it something else? Is it is [00:35:10] it is it someone who underestimated you as a, as a woman or whatever? As a as a [00:35:15] young girl? Like, where does this come from? I’m so interested in it.

Tara Renton: It’s it’s fascinating. [00:35:20] Um, such an interesting question. I think for me, I’d [00:35:25] look at it as a different perspective, as a curious person. I think it’s the what’s next? [00:35:30] So you’ve sold your company for zillions of. Zillions of pounds. You’re walking down the road to get [00:35:35] a coffee with your lovely wife. You’re going to be thinking, what shall I do now?

Payman Langroudi: Maybe, maybe. [00:35:40]

Tara Renton: So for me, I’m flipping it. But that’s probably more where I was. [00:35:45] I had no aspirations to do more academia. I regard [00:35:50] myself as academia.

Payman Langroudi: You know how you said when you got an OBE, the first person you wanted to tell was your mum? Yeah, yeah. [00:35:55]

Tara Renton: That’s probably that’s probably it.

Payman Langroudi: There’s something there. Yeah. Why? Why was the first person you [00:36:00] want to tell your mum to sort of tell her that all her hard work was worth something?

Tara Renton: Yeah. No, [00:36:05] she was very ambitious for me and I never realised quite so much. [00:36:10] And she had a she basically never had proper schooling. She was an army child. So they were post-war [00:36:15] Germany. Then they were Malta, then Cyprus. So. And she’s a very bright, [00:36:20] bright lady, one of five Cornish family um, did all sorts of jobs [00:36:25] when I was growing up. So I grew up with a working mother. She was a PE teacher, green shield stamp lady, a model, um, [00:36:30] second hand clothes shop, uh, rental, wedding rental business. So [00:36:35] that’s interesting. Always working. She’s always finding a channel.

Payman Langroudi: Your definition of normal, [00:36:40] seeing your mum was someone who was working really hard.

Tara Renton: Yeah, yeah yeah, yeah. My father, my father, we hardly [00:36:45] saw dad. Yeah. And the only time I could speak to my dad was coming downstairs at 1030 [00:36:50] at night, and he’d have his unofficial second dinner, which my mum was always. He’s always [00:36:55] on a diet and he’d have his big jar of Horlicks, and like a jam [00:37:00] and bread, and with all his dental notes, doing his dental admin. And that was the one time [00:37:05] I’d often. Often, if I’d come back from a party, you know, or come back from the pub with [00:37:10] friends, I’d sit down and chat with him. And that’s when I had my valuable time with dad.

Payman Langroudi: Let’s [00:37:15] talk about the juggle.

Tara Renton: Yeah. The juggle. Yeah.

Payman Langroudi: Let’s talk about the juggle. Three kids, academic [00:37:20] career, PhD research. I mean, it’s a lot. What [00:37:25] gives in that situation? Did anything give. Do you feel like something gave.

Tara Renton: Oh, [00:37:30] definitely. Um, I don’t think you at the at the time you’re just in [00:37:35] the jungle. You’re fighting the fire. Yeah. Um, and you’re very aware of the compromises [00:37:40] that other people are making for you particularly. Um, I think there’s a, I don’t think [00:37:45] it’s just women, but you have this guilt, you know, I’m a rubbish mother. I’m a rubbish wife. Um, [00:37:50] I mean, I do talk about my husband. He really is my secret [00:37:55] weapon. He’s been so supportive. And I mean, I did a part time PhD five [00:38:00] years with three kids under five. I mean, I was it [00:38:05] was it was only like a couple of years later when Ella was like 3 or 4 and she was doing, you know, those stick pictures [00:38:10] they do at school. There was Mummy and Daddy, you know.

Payman Langroudi: Pictures. Yeah, yeah.

Tara Renton: So it was Mummy and Daddy, two [00:38:15] brothers, Cat and Ella and I had this big square black box here. [00:38:20] My laptop.

Payman Langroudi: Oh, no.

Tara Renton: Yeah. So and also, you know, [00:38:25] it’s just and I was aware I was, I was aware, I mean, I did function, I got them to school, I got [00:38:30] them to all their clubs. I was working three days a week. I didn’t have the nanny when the two days a week I wasn’t working. So I [00:38:35] was trying to be a good mum. Um, and we did lots of stuff at the weekends. I’ve [00:38:40] never been ever. My husband doesn’t encourage me to talk about work at home, so that’s [00:38:45] sort of off limits, which I think is really healthy actually. Um, and [00:38:50] it’s only since the kids have left home and we’re both retired that we’ve actually realised [00:38:55] some of the similarities we have. I would say we were completely polar opposites. But you know, we both [00:39:00] love getting things started. He, you know, he’s a bit of a businessman. He likes getting things started. [00:39:05] Has some great ideas. So we have a lot more in common than we probably realised [00:39:10] during this fire fighting period. Um, but his career came first. You [00:39:15] know, when we were BP and and I was working part time, he was working quite hard. And then, [00:39:20] um, serendipity in a way. At 52, he’s the clever, smart one.

Tara Renton: He was [00:39:25] on the full pension. He could walk away from BP and he wanted to. And we had a long chat about that. And obviously, [00:39:30] you know, he had other opportunities. He could have travelled and done gone up the chain. And but [00:39:35] we made he made that conscious decision. And at that point, that’s when I got offered [00:39:40] the job at QM. Shmuel. After doing my PhD. So I was offered a senior senior lectureship [00:39:45] at Shmuel. Um, uh, and it was full time or [00:39:50] nothing. So that was just serendipity that those phases worked in. So [00:39:55] he could be, um, he still was working. He was making much harder. I joke, having left [00:40:00] BP, we always call it the protected workshop. A lot of these corporates, you know, it’s not so much now, [00:40:05] but you know, end salary schemes, secretaries super [00:40:10] well looked after. Yeah. So he started up quite a few bits and a few companies. [00:40:15] He’s been very successful. So he was working but he was at home a lot of the [00:40:20] time still boxing, boxing a little bit. Um, but I and that we sort of basically swapped, you [00:40:25] know, um, yeah, still working very much as a partnership, but that’s probably that [00:40:30] facilitated that.

Payman Langroudi: So then the skills it takes to become [00:40:35] a leading academic specialist, I can, I can [00:40:40] take, I can, I can imagine some of them, right? You’ve got to work hard. You’ve got to be imaginative. Yeah. You’ve [00:40:45] got to think outside.

Tara Renton: The.

Payman Langroudi: Box passionate. But what about like the politicking [00:40:50] and.

Tara Renton: The power.

Payman Langroudi: Games that go on.

Tara Renton: Not very good at that. I have I [00:40:55] have literally been. I was offered the job at [00:41:00] QM and had a difficult [00:41:05] time. That was another learning experience there. I have to say I was I was very badly bullied. There [00:41:10] was an article about it in the times, I think December 24th about [00:41:15] the culture change of the misogyny, and it was really bad. So I was the only [00:41:20] single qualified person in the group in the department. And, um, it [00:41:25] was tough. It was really tough. I lost about a third of my hair. I lost my eyebrows, my eyelashes. When I look back [00:41:30] at the pictures now, I just hadn’t realised the physical. I was commuting like an [00:41:35] hour and a half, two hours a day.

Payman Langroudi: Um, each way.

Tara Renton: Each way full time. [00:41:40] It was only full time job. Um, and that’s when thing cracks became [00:41:45] really happen. And it was the first time in my life I didn’t want to go to work. I’ve always [00:41:50] loved my work. Um, always jump out of bed in the morning [00:41:55] and, you know, skip to work. It’s the first time, and I really didn’t want to go. My husband was just saying, walk. Just walk. It’s [00:42:00] not worth it. And I thought about whistle blowing. Came very close to that. Actually spoke [00:42:05] to a few different people. Um, everyone knew. I mean, sounds very [00:42:10] much like things may not have changed that much, but who knows? Um, and, [00:42:15] you know, a lot of there have been a lot of catastrophes before me. Um, mine [00:42:20] was just another, you know, one along the road and I [00:42:25] basically, um, went to my boss at the time. Lovely, lovely boss [00:42:30] and just said, look, either I go part time and I don’t have to go to these consultant [00:42:35] meetings and be humiliated and screamed at on a regular basis for nothing, or [00:42:40] I walk. And that was a really hard thing for me to do because I, [00:42:45] you know, love my work. Um, she capitulated and that [00:42:50] made life much better. So I was offered that job in the first place, which, you know, was a learning [00:42:55] because I often was very dismissive of there were not many girls in that environment, obviously. But, [00:43:00] you know, girls were talking about fellow fellow women talking about being bullied, bullied at work. And I always [00:43:05] remember thinking, oh goodness, just stand up for yourself, you know? Boy, oh boy, was [00:43:10] the shoe on the other foot during that period. It was awful.

Payman Langroudi: And the kind [00:43:15] of woman who goes into oral surgery tends to be the get on with it type of person.

Tara Renton: Absolutely. [00:43:20] Well, as Stephen, Stephen was saying, is it something like 8% of [00:43:25] surgeons are psychopathic?

Payman Langroudi: That’s right, that’s right.

Tara Renton: And I’ve always joked, actually, I think you have to [00:43:30] be a little bit psychopathic to cut into another human being. Yeah, maybe as a dentist as well, I don’t know. But [00:43:35] you have to have that bit of your personality.

Payman Langroudi: But who do you blame for this incident? I [00:43:40] mean, clearly the perpetrator, but it’s.

Tara Renton: The culture of the department is, you know, is ongoing [00:43:45] for years there being, no female fatalities before? Before [00:43:50] me who’d been, you know, come and gone.

Payman Langroudi: But the culture of the the the profession, [00:43:55] I mean, you know, it starts in dental school, isn’t it? You get you get some [00:44:00] some poor student who gets targeted by by some teacher.

Tara Renton: Well, [00:44:05] there’s bullying everywhere. There’s bullying in the schools. I mean, thank God, you know, all this social media stuff has got worse, [00:44:10] I think. I’m so grateful. A, I didn’t grow up with that. And B, my kids, my kids. [00:44:15] 33, 31, 28 we didn’t, I mean, mobile phones were just coming [00:44:20] through. My daughter was going to senior school, so we were so lucky to. And my kids are lucky to have not. [00:44:25]

Payman Langroudi: But would you say the culture in academia is any better now?

Tara Renton: Uh, yeah. No, it is, it is, [00:44:30] it is. There’s still, you know, relatively fewer women, um, in [00:44:35] senior academia, particularly in, in medicine. Um, no, I think [00:44:40] it, I think it’s pretty good actually. I’m, I’ve not never been that. [00:44:45] So I was going to say that I then got. Basically offered to apply [00:44:50] for my job that, you know, I now have a Kings. And I know when a difficult time was happening [00:44:55] and I’d gone part time and I was thinking I was part time for about six months. I then got that message from Nan Wilson [00:45:00] saying, you know, um, the job I, the job I thought I was going to offer [00:45:05] you 18 months ago no longer exists, but actually there’s a chair first chair [00:45:10] in oral surgery. Would you, I want you to be at the interview. And I remember saying to him, I don’t have enough tickets [00:45:15] for that. So it’s not me aggressively looking for the next step up. I’ve, you [00:45:20] know, on three counts max fac training in Melbourne, I would argue actually even [00:45:25] the show at Torbay, I’ve been given those opportunities. You know.

Payman Langroudi: Sometimes [00:45:30] it’s nicer. It’s nicer when someone doesn’t go for an opportunity. Like those are the people [00:45:35] you want to push forward sometimes.

Tara Renton: Well, there’s an element of that. I think there’s a lot less of that now. I think I think [00:45:40] in the dental environment, you know, our trainees, the kids that want to come and do oral surgery. [00:45:45] I mean, the ratio of applicants to successful training posts is [00:45:50] ridiculously high. And most of those kids are worthy of it for sure. [00:45:55] So it’s, um, it’s, it’s probably. Yes. [00:46:00] I’m not very good at playing the political games. I’m very aware of that. So [00:46:05] meetings, I would avoid those as much as possible. I always felt there were great waste of time. [00:46:10] I would go to meetings where I thought there might be a change at the end of it, something concrete. [00:46:15] But I often felt that actually it was a lot of meetings. For meetings sake. I was great [00:46:20] at getting in there doing. I loved, I ran the the undergraduate oral surgery program [00:46:25] for 11 years and made that really good. I loved it, great teachers, some still [00:46:30] around, which is amazing.

Payman Langroudi: You were head of department, right?

Tara Renton: Yeah, head of department. I was the first chair, first chair in [00:46:35] oral surgery appointed and obviously the first female. And there’s been lots since. Um. [00:46:40]

Payman Langroudi: Let’s let’s talk a little bit about orofacial pain. Yeah. And [00:46:45] about surgical safety. Mhm. Which [00:46:50] are your two main areas of interest? Um, firstly, [00:46:55] I, I’m really interested in this notion of it seems clear that [00:47:00] psychological stress, uh, sorry. It seems clear that that [00:47:05] chronic pain causes psychological stress, but it’s not so obvious. [00:47:10] But but it’s certainly true that psychological stress brings on pain.

Tara Renton: Absolutely.

Payman Langroudi: So it’s a two way [00:47:15] road.

Tara Renton: Absolutely.

Payman Langroudi: And when you’ve got that patient in front of you that several others have probably looked at [00:47:20] and, and baffled by or, or it’s a difficult patient. Do you start [00:47:25] by trying to unpick the which which came first, the chicken or the egg or does it not? [00:47:30]

Tara Renton: You have to.

Payman Langroudi: Oh you.

Tara Renton: Do. You have to. So, I mean, I was so blessed in my job at King’s. [00:47:35] Um, I wrote several business plans, which obviously a bit of a challenge for me and set up [00:47:40] this multidisciplinary clinic. So we have, um, uh, headache neurologists. [00:47:45] Peter Goadsby, who’s like king of migraine. He’s the guy that did a lot of the research [00:47:50] behind the antibodies for migraine. He’s super, super, super chat. So [00:47:55] some of his fellows would come and work with us. We have, um, a liaison psychiatrist, [00:48:00] which is really interesting. Never been taught anything about psychiatry. Wow. That was an eye opener. [00:48:05] Then we had a fantastic clinical psychologist, Sarah Barker, who now works privately. And [00:48:10] we have a big psychology team at the dental school in Kings, um, at [00:48:15] Denmark Hill. And we have a neurosurgeon and we had, uh, [00:48:20] we have visiting ENT and some other specialists and obviously restorative the [00:48:25] likes of Martin Keller, her and Serpell before she retired, we dragged them down and asked them questions. [00:48:30] Is this crown? You know, um, Endodontists you know, Rachel, she popped down [00:48:35] and help us out with some of the patients because I haven’t done dentistry for proper dentistry [00:48:40] since early 88. So I’ve done [00:48:45] lots and lots of wisdom teeth, lots of operating, lots of, you know, maybe some bits and pieces, but but [00:48:50] not not general dentistry as we know it. So going back to your question, that [00:48:55] team basically opened up my eyes. It was one of the best things, probably one of my biggest achievements work [00:49:00] wise, because you actually learn from we’re so siloed in our training. And [00:49:05] I think particularly dentistry, that’s one that is a big bugbear. We’re underappreciated and we’re very [00:49:10] siloed, and it’s partly our own fault a little bit. Um, the it [00:49:15] was fascinating. Payman I and even now I get a kick going, you know, [00:49:20] um, so obviously, um, there.

Payman Langroudi: Was some, some [00:49:25] examples of cases that came through. So yeah, so.

Tara Renton: One of my take home stories, which [00:49:30] I talk about sometimes in my lectures is never, ever judge a book by its cover. And I’ve always [00:49:35] thought that anyway, if you’re dealing with people, you never can. But this is a really good example. She [00:49:40] was Iranian. Interestingly, she was 23. She was drop dead [00:49:45] gorgeous. She was wearing all her matching Gucci boots, everything super.

Payman Langroudi: Super [00:49:50] uniform.

Tara Renton: Super, super. Yeah. Don’t don’t get me started. She had a gorgeous fiance [00:49:55] who would patiently sit in the waiting room. Now she’d had a wisdom tooth out. Very straightforward [00:50:00] and ended up with a lingual nerve injury, which was painful. And that’s what I did, my PhD. And that’s how I got into [00:50:05] pain. So and I remember, and I see a lot of these, I mean, I probably [00:50:10] advise like sometimes up to ten cases a week even, you know, of LA [00:50:15] or Endo or whatever. And I remember she, [00:50:20] um, she was broken and I just couldn’t figure out this young, [00:50:25] beautiful girl with seemingly everything. Why, why was her response [00:50:30] so brittle? Why was she so vulnerable? And, um, and I, [00:50:35] tried to try to work my magic. So, um, all through this multidisciplinary [00:50:40] care, we pre assess our patients. So we do a plethora of tests around looking at [00:50:45] anxiety, depression, PTSD is relevant in these cases. Sleep. Um, [00:50:50] so we look at OSA sleep disorders. Um, we look at prior abuse and neglect. [00:50:55] Um, and we look at some types of personality disorders that are associated with chronic [00:51:00] pain. Um, so, so this is something that I started doing and I actually, I [00:51:05] even did it in my PhD. I even did a chapter because I remember seeing [00:51:10] when I was doing my part time PhD, it was all around wisdom tooth surgery. Smartest move I ever did. If [00:51:15] you do a PhD, do it around something that you love doing and that you’re doing lots of at the time, [00:51:20] and you can actually make it happen without having to take five years or three [00:51:25] years out of your life and transplant somewhere else, then come back.

Tara Renton: So, so I was basically doing [00:51:30] patients after third molar surgery, morbidity and looking at nerve injuries. And what I couldn’t [00:51:35] understand is these patients had numbness and they had pain. And that would never that was never recognised before. [00:51:40] So we now notice neuropathic pain. We didn’t know then. That’s what it was. So I was thinking, [00:51:45] how can these people have numbness and pain at the same time? And that’s basically what nerve injury does. Sensory [00:51:50] nerve injury does. And if if you’re having breast surgery thoracotomy limb [00:51:55] amputation, there’s like a 30, 30 to 45% chance you will have that [00:52:00] pain for the rest of your life having those procedures done. It’s massive. Massive. Um, [00:52:05] any trauma, surgery, trauma, physical trauma, burns, radiation, chemotherapy [00:52:10] can all cause neuropathic pain as well as diabetes and M.S. and other things. So [00:52:15] I go this patient and it just, it didn’t compute for me because I’d seen quite a lot of patients and I [00:52:20] was, you know, done my PhD and felt fairly expert in the area. [00:52:25] And I kept thinking, why is she so brittle? And I, I, [00:52:30] you know, pre assess the patients. I knew she had some degree of anxiety, depression. I [00:52:35] knew she definitely had PTSD. I was about 70% of all patients with nerve injuries have PTSD, if they [00:52:40] particularly have the pain.

Tara Renton: And, um, and I sort of do [00:52:45] my very open lots of hugs, apologise, you know, on behalf of the profession. I’m really [00:52:50] sorry this has happened. You know, I know you’re warned about it. And it’s like, you know, [00:52:55] we all know when you walk across the road, you can get run over by a bus. No one sees this coming. And when [00:53:00] it happens, if you’re the wrong personality type, anxiety, depression and no sleep, it’s [00:53:05] going to hit you really, really hard and you may not actually get over it properly. So [00:53:10] I was thinking at that time and I said, look, I think you need to see my I saw her twice. And I said, I [00:53:15] think you really should see our clinical psychologists, you know, and [00:53:20] maybe, maybe the psychiatrist. Anyway, I got her back. [00:53:25] She wouldn’t she wouldn’t do it. So I got her back for the third time. And I, and I spent quite a long time, at least 45 [00:53:30] minutes with these patients. And this time I just said to her, look, I I’ve done my best [00:53:35] with you. And normally by this stage after one visit, most people understand become [00:53:40] a little bit more accepting, understand what the neuropathic pain is. It’s, it’s nerve injury that’s sending [00:53:45] signals to your brain like a text message. Emma Beecroft is great at this. And her lectures, [00:53:50] text messages is going to brain saying, pain’s still happening in my finger or in my tooth, but actually it’s [00:53:55] the brain that’s misrepresenting the signals going through.

Tara Renton: And, [00:54:00] um, she, she broke down again [00:54:05] and I just said to her, look, what can I do? And I just said, you know, what’s [00:54:10] happened? And she said, well, obviously it’s confidential, but [00:54:15] no one knows who she is. And um, she said, well, my parents brought [00:54:20] my sister and I to London when actually, you know, my parents brought [00:54:25] me to London when I was five years old When I was nine, [00:54:30] my parents had a difficult marriage. When I was nine, my mum had my baby [00:54:35] sister and a year after that, or 18 months after that, my [00:54:40] dad was killed on a bike on his bicycle outside Selfridges. So my mum was obviously [00:54:45] very dependent. I think she had one, quite some family members in [00:54:50] London and she looked to them to support this [00:54:55] patient, then got sexually abused by one of the uncles. And [00:55:00] obviously bigger stressor was to make sure that it didn’t happen to her younger sister. This [00:55:05] fell out. Her mother decided the best place for them to go back to Iran. So [00:55:10] they went back to Iran to be closer to other family members. Um, and [00:55:15] her, it didn’t go well. So she [00:55:20] obviously she had an English passport. She came back to England, basically cared for [00:55:25] her sister, brought her sister back so her sister could go to university in England and [00:55:30] she’d set up a very successful business. Um, put all this stuff behind [00:55:35] her, met her lovely fiance, goes the dentist, has a wisdom tooth taken [00:55:40] out.

Payman Langroudi: Wow.

Tara Renton: And has a nerve injury. And this is the proverbial straw on the camel’s [00:55:45] back. And she just could not pick herself up afterwards. And you think. [00:55:50] And I got I get goosebumps just recounting. I’ve got so many stories like this. You [00:55:55] know, she.

Payman Langroudi: I mean, look, interestingly, it took three visits to unlock that story. Well it’s. [00:56:00]

Tara Renton: Time. Yeah. It’s a time and trust.

Payman Langroudi: Yeah.

Tara Renton: And you talk about that a lot. You know, and, [00:56:05] you know, I talk about it a lot with wrong site surgery and bits and pieces. Because [00:56:10] as a specialist, you generally just see patients. And with increasing with the NHS demands on [00:56:15] time, you have such limited time to build trust with that patient. And actually trust really [00:56:20] underpins consent. Yeah. You know, effectively, you know, Henry Marsh who [00:56:25] Stephen referred to the neurosurgeon. He talks about he did a fantastic seminar [00:56:30] on consent at the Royal College of Surgeons a couple of years ago. And he basically says, you know, consent is [00:56:35] about trust. If my patient needs to understand what I’m doing when I’m taking a brain tumour out, they need to go and do 11 [00:56:40] years neurosurgery training and like another ten years post-grad. Then they’ll understand what I’m doing. [00:56:45] It’s trust. So that’s what I try and establish with my patients. I think [00:56:50] I am very empathic, I’m very interested in their stories. I have time for them to tell me [00:56:55] their stories. But for me, one of the key things is to have this pre-assessment. And for the life of me, [00:57:00] I don’t understand why. In general, medicine, dentistry and physio, beauticians, particularly [00:57:05] aesthetic aestheticians, I don’t know how I couldn’t work now [00:57:10] without having this. I’ve developed a web app with a partner with my PhD students, which basically [00:57:15] gives you all this summarised very simply. It’s a brilliant tool. Orofacial [00:57:20] pain facial pain.org. It’s geared for orofacial pain patients, [00:57:25] but it could definitely have a use just to see how difficult your patient’s going [00:57:30] to be or what a difficult time your patient’s having.

Tara Renton: And like you say, it’s a flip side [00:57:35] stress because of this or stress already before it. Yeah. So we know if you have high levels of [00:57:40] anxiety, depression, those same neurotransmitters and neural pathways, anxiety, depression, [00:57:45] stress, they’re the same as chronic pain pathways. So if you’ve got stuff going [00:57:50] on already in those pathways and you’ve got like this new nerve pain, the system just doesn’t [00:57:55] cope. And, and you’re much less resilient if you’ve had prior life abuse, neglect, [00:58:00] adverse events. And we know that your brain developed now is they [00:58:05] used to say women 2022 men 2224. They think it’s even later. [00:58:10] Now it’s like late 20s when your brain, your somatosensory system, your neuro system is [00:58:15] fully developed. If you have a critical life event during that development, something [00:58:20] happens. It makes you much more fundamentally at risk of chronic disease, [00:58:25] not just chronic pain, diabetes, cardiovascular. Yeah. So [00:58:30] those resilience, your resources are diminished significantly if you’re not sleeping, [00:58:35] if you’re anxiety anxious, you’re depressed, your resources diminished, you [00:58:40] can’t cope with this extra stuff that’s happening. So, so you cannot see a lot of patients, [00:58:45] I would argue, not just chronic pain patients without fundamentally understanding what’s going [00:58:50] on behind the patient, behind that very nice smiley face and a Gucci handbag when they turn [00:58:55] up to your clinic. Yeah. You need to understand what’s happening there, particularly, I think if you’re doing complex [00:59:00] elective work. So, you know, doing implant work, aesthetic work, I think you need to be able to understand [00:59:05] if that patient’s motivations are right.

Payman Langroudi: Of course. [00:59:10]

Tara Renton: And not falling into that trap, that horrible, horrible medical legal trap where [00:59:15] things go, go wrong of.

Payman Langroudi: The patients that you get sent, which are [00:59:20] the ones that are sort of most common and easy for you to clear [00:59:25] up and which are the opposite. Like.

Tara Renton: Oh, I love a toothache. Give [00:59:30] me a toothache.

Payman Langroudi: Toothache as well. You don’t the person doesn’t know. [00:59:35]

Tara Renton: I tell you, the toothache, the chronic toothache, pain. I’ve got some great examples.

Payman Langroudi: Oh, so then you [00:59:40] work with the endodontist on that or.

Tara Renton: Well, no. Generally the tooth is. By the time we’ve seen one, the pain clinic [00:59:45] know it’s time for extraction. Yeah, yeah. I tell you, I love I really miss [00:59:50] my wisdom tooth list. It was just so nice. Pericoronitis. Take the tooth [00:59:55] out. Oh, I miss those days. Um. Yeah. No, it’s.

Payman Langroudi: If [01:00:00] you break them up into the kind of categories.

Tara Renton: Okay, so tooth related. What else? So you’ve got odontogenic [01:00:05] pain. Um, so there’s I cop International Classification of Orofacial Pain published in 2020. [01:00:10] Cephalalgia. I was part of an international team. We’re revisiting it at the moment. It’s [01:00:15] a faulty document. But the aim was there’s this massive conglomerate so that if you go to pain [01:00:20] meetings, which I’ve been to a lot in my life, you’ll have the rheumatologist and the headache neurologist arguing [01:00:25] who’s more important, who, which owns the most pain in the world. And, and [01:00:30] arguably, they both kind of like up their 40% ish. Um, [01:00:35] so, um, what was I going to say? We were talking about, uh, [01:00:40] I’ve lost my, lost my focus on that. What was the question?

Payman Langroudi: Different types of oh, [01:00:45] different types of pain.

Tara Renton: So I got basically, um, so the going back to headache neurologists, they, uh, [01:00:50] international Association of study of Pain iasp is massive. And basically they [01:00:55] have these big classification systems and the big classification system that touched on our region [01:01:00] was the International Headache Society and the International classification of headache [01:01:05] disorders HD. So they have that and they have like trigeminal neuralgia in there. They [01:01:10] have some neuropathic pain, uh, no acute pain. So so when [01:01:15] you’re doing this work, you’re trying to use the right diagnostics to make sure that the research is valid and robust. [01:01:20] But we didn’t really have a good classification system. We didn’t have one that is aligned to those. [01:01:25] So we’re talking the same language, and we didn’t have one that included acute pain. So a [01:01:30] chronic and acute. So we now have a system that’s acute and chronic. So there’s toothaches. [01:01:35] So odontogenic pain not just toothache. It’s um mucosa bone teeth but dental [01:01:40] alveolar salivary salivary gland. Yeah. And [01:01:45] then there’s muscle group which is mainly temporomandibular joint myogenous group. Then [01:01:50] there’s arthrogenic TMD joint pain. And then there is [01:01:55] the title. It’s basically neuropathic pain cranial nerve lesions of cranial [01:02:00] nerves leading to pain, which includes trigeminal neuralgia. Glossopharyngeal really [01:02:05] rare. But the most common thing is post-traumatic neuropathy, which is nerve injury, which is what I deal with. And that’s what I [01:02:10] did. My PhD in burning mouth, burning mouth, I think should be neuropathic burning. So we’ve [01:02:15] got neuropathic, then we’ve got, uh, neurovascular conditions mimicking headaches. So we [01:02:20] see loads and loads of migraine in the face that’s misdiagnosed and trigeminal [01:02:25] autonomic cephalalgias, which is cluster headaches. Loads and loads. And then the last one clinical [01:02:30] group is the um idiopathic which I hate, which includes at the moment [01:02:35] burning mouth, which I think should be neuropathic and actually persistent idiopathic facial pain and persistent [01:02:40] idiopathic or persistent dento alveolar pain. So intra-oral extra-oral [01:02:45] idiopathic persistent pain. Most of those have neuropathic features. So I’m hoping one day that [01:02:50] that number six will go. And then the seventh category is the axis two, which obviously is all important. [01:02:55]

Payman Langroudi: Axis two.

Tara Renton: Which is psychological.

Payman Langroudi: Or psychological.

Tara Renton: So that’s all important because [01:03:00] you can’t. So so it’s a really nice classification.

Payman Langroudi: So out of those ones which are the hardest [01:03:05] to spot, which are the hardest to spot.

Tara Renton: The conditions, it’s the patient.

Payman Langroudi: Oh, okay.

Tara Renton: Just [01:03:10] like dentistry.

Payman Langroudi: Okay.

Tara Renton: You know, um, Richard was talking about doing? [01:03:15] I can’t remember. It was a simple procedure. If the patient’s really difficult. And I think [01:03:20] that’s something we underestimate, I think, well, I’m longer in the tooth than you are, but after a certain time [01:03:25] seeing patients, you get like an antennae, a feeling that something’s not quite [01:03:30] right here. Yeah. Um, you know, I think we should be much more out there thinking [01:03:35] about what personality? The hateful patient that again, Richard [01:03:40] alluded to and the Richard Groves paper in 1978. I talk about this. We’ve just published [01:03:45] a paper in um Dental update about complaints. Now, is it the patient or [01:03:50] is it the procedure or is it the. And a lot of it, you know, I, I’ve [01:03:55] had one complaint against me in my career that I know about that went to the GDC. This guy [01:04:00] complained about eight people at the dental school. So that’s the only complaint. And I remember [01:04:05] getting a letter, another long story anyway, from the GDC, didn’t even know the complaint had happened, saying the [01:04:10] complaints dismissed. And I just thought, oh my God, I didn’t know I had a complaint. And it was like [01:04:15] literally like, I think a year, the last year of retirement.

Payman Langroudi: Pretty good going in a 40 year [01:04:20] career in in pain.

Tara Renton: Incredible.

Payman Langroudi: Pain. It wasn’t 40 years in pain, but it was 20 [01:04:25] years. But high risk area.

Tara Renton: It is. It is. And they’re very tricky [01:04:30] patients. So so for me, it’s not the condition that’s difficult. That’s the that’s [01:04:35] the low hanging fruit. I mean they’re difficult to manage. But you’re not managing [01:04:40] the pain. You’re managing the patient with the pain. And I think if you’ve got a complex patient, [01:04:45] which some of them are, I mean, I’m seeing private patients now mainly online, um, [01:04:50] and see some to face to face. Um, but you go through the history and [01:04:55] it is, it’s heart sink. I mean, there’s so much stuff, but often what’s [01:05:00] really relevant is what’s happened before. So, you know, another, another group of patients, the [01:05:05] idiopathic facial pain, which I hate and I don’t believe in it. So definition of pain, you can feel pain without [01:05:10] physical injury. Yeah, we all know that. When my daughter started at Surbiton School, [01:05:15] two days in, she had her mobile phone. I was in the middle of a busy clinic. The phone goes. [01:05:20] I’ve got on the wrong train. I’m thinking, oh, [01:05:25] God. So I said, calm down, darling. You know, which train are you on? Well, I’ve just left Kingston, [01:05:30] but I don’t know where it’s going. It’s not going home. And I said, well, can you look for a nice lady and [01:05:35] just let me speak on your phone? So find nice lady talking to the nice lady on the phone.

Payman Langroudi: Was she like 12?

Tara Renton: She was 11.

Payman Langroudi: Yeah. [01:05:40]

Tara Renton: And, um, and the woman’s going. Oh, yes. No, no, your daughter’s here. Yeah. No, it is the wrong train. [01:05:45] Don’t worry. I’ll. I’ll get her out on the platform and get her going in the right direction. Oh oh. Oh, no. And [01:05:50] I said what’s happened? She said, oh, I think your daughter ran back to get her bag. And the doors have closed. [01:05:55] So my daughter’s now on the wrong train with no phone, no one to talk to. And I remember that [01:06:00] even now, I get that visceral pain. Yeah, it’s a really good example. There’s loads of different [01:06:05] examples, but that’s how I, you know, you don’t need to have physical damage to have pain. So we [01:06:10] see patients who have decades or sometimes decades, but many, many [01:06:15] years of chronic pain, difficult patients, complex history, [01:06:20] lots of anxiety, depression. There’s a bit of PTSD going on there. And [01:06:25] you get chatting to them. And sometimes they’ve just had a terrible, terrible [01:06:30] early year life. But sometimes it’s something like the [01:06:35] husband dies. There’s this massive tax bill that they didn’t know about. The dog’s [01:06:40] ill. Their best friend’s had some bad news. It’s just these little red flags, [01:06:45] these tipping factors that just tips them. They can’t cope anymore. And actually we’ve got [01:06:50] I keep meaning to write it out. We’ve had nine patients, um, one man, [01:06:55] mainly mainly ladies and basically their pain went with grief counselling. Um [01:07:00] so that makes sense. It makes total sense that if you’re managing the patient holistically. [01:07:05]

Payman Langroudi: You must be really good at by now. You must be really good at sort of explaining [01:07:10] to the patient that the stress is a big factor.

Tara Renton: Absolutely.

Payman Langroudi: But but I remember [01:07:15] I used to do one session a week with a guy called Doctor Jagger in [01:07:20] Cardiff.

Tara Renton: Yes, I remember that.

Payman Langroudi: He used to have a pain clinic as well. It was, it was kind of a TMJ [01:07:25] clinic. But but you’d get burning mouth syndrome and trigeminal neuralgia thrown in there. [01:07:30] And I remember as a young dentist, just really struggling with trying to get over [01:07:35] to the patient that, look, the number one cause of this issue is stress. Whereas [01:07:40] sometimes when you say to a patient, look, it could be that there’s something psychologically or stress going on, [01:07:45] a lot of times they think you’re dismissing them. Yeah. And just trying to get through that, that it’s a real [01:07:50] thing. Don’t worry about it.

Tara Renton: No, it’s really it’s really true. But I think there’s much more acceptance around [01:07:55] that now. I mean, when I’m talking to my patients, I’m talking about anxiety. [01:08:00] Obviously I’ve got fantastic measures. Now I can actually broach that subject. People are more open to that. [01:08:05] I always remember thinking when we started doing the psych screenings, we started off like hard copy. I [01:08:10] remember thinking, none of the patients are going to do this, you know?

Payman Langroudi: Yeah, yeah.

Tara Renton: To be fair.

Payman Langroudi: I’m talking a [01:08:15] 25 year old story today. The taboos are much, much easier.

Tara Renton: It’s very, very rare. [01:08:20] We get patients saying, actually, I don’t want to do your questionnaire because there’s too many personal questions there. [01:08:25] It’s very rare we have that. It’s more around technical issues that they can’t do the online thing.

Payman Langroudi: Because [01:08:30] they.

Tara Renton: Can’t use a keyboard or something. But that’s not too often. But it’s just so important. [01:08:35] And I love it because I have my summary and I get my consultation [01:08:40] documents together. That’s how I’ve worked for the last 20 years, and I feel like I know what’s coming [01:08:45] through the door. I’m prepared for what’s coming through the door rather than spending like the first 15, [01:08:50] 20 minutes of the consultation, which would be much more difficult because you’re not ready for the [01:08:55] patient. You know, we had a little summary on the computer screen, anxiety up there, depression [01:09:00] up there. Ptsd, no sleep, you know. Um, it’s [01:09:05] just makes total sense to me that we should be doing that with all our patients. Yes. [01:09:10] And I’d love to see a day when we and, you know, arguably it’d be very interesting to look at personality disorders [01:09:15] because those are the people who are really difficult, difficult to manage. They have, you [01:09:20] know, with pain. They have to accept that they have to take tablets, they have to do other things like improve their [01:09:25] nutrition and their microbiome. Talk a lot around my patients around, you know, cheap [01:09:30] pain. You know, you don’t like taking tablets. Well, there’s evidence base for these vitamins [01:09:35] that will reduce migraine. There’s evidence base that actually, if you eat this kind of diet, you’re going to have [01:09:40] loads more dopamine going around serotonin, serotonin, you know, all those natural pain [01:09:45] endorphins you can make with a good diet.

Payman Langroudi: What do you mean? Which diet gives me more serotonin [01:09:50] and dopamine? So tell me immediately.

Tara Renton: Well, I can give you.

Payman Langroudi: I’m a bit of an addict of those two [01:09:55] substances.

Tara Renton: All of my websites, all of my orofacial pain.org.uk. And [01:10:00] then there’s a specific one nerve injury. But and actually I’ve got a I do an annual I call them my [01:10:05] two virtual children, not my three real children. And I do an annual update. The annual update is happening in February. [01:10:10] So there’s a lot more stuff around nutrition going in there as well. And again, it was really refreshing hearing Richard talk about [01:10:15] that as well. And actually a couple of other much more. A microbiome is an amazing thing. And I’ve [01:10:20] had time now I’m retired. I cycle every morning. Um, I take much more care about [01:10:25] my tummy.

Payman Langroudi: Is it like kefir and this sort of stuff? Yeah, yeah.

Tara Renton: There’s a, it’s a mix of stuff. It’s [01:10:30] different colour, you know, the good old Zoe kind of stuff, you know, nuts, seeds.

Payman Langroudi: Several [01:10:35] different different.

Tara Renton: Vegetables.

Payman Langroudi: Yeah.

Tara Renton: Yeah.

Payman Langroudi: Excellent.

Tara Renton: I haven’t, I haven’t touched red meat for years. [01:10:40] Have you got. I will do if someone serves it at a dinner party I’ll eat it. But yeah. Um cutting [01:10:45] down the alcohol, which is probably for me the toughest thing.

Payman Langroudi: Um, I find coffee difficult [01:10:50] to like. Coffee. Giant amount of coffee. Do you?

Tara Renton: I used to, I went off [01:10:55] at all three pregnancies and red wine and I’ve never gone back there. So yeah, it’s funny, isn’t it. But coffee can be [01:11:00] really good for you.

Payman Langroudi: Yeah, I heard.

Tara Renton: There’s some headaches that respond to coffee. You drink coffee last thing at night, [01:11:05] and it cures your headaches. So there’s some really interesting things.

Payman Langroudi: Let’s get on to the darker part of [01:11:10] the pod. Actually, before we move on. Yeah. It’s such a privilege as a [01:11:15] dentist to be able to alleviate pain. Mhm. Yeah. And we’ve all done it. Your [01:11:20] patient comes in toothache, you extirpate it, and you kind of find [01:11:25] a few canals. And, you know, when that patient gets home and things are warmed up, you’ve [01:11:30] done a you’ve done a great job. They’re your sort of detective work that you have to do that [01:11:35] when you finally get to a solution for someone like that [01:11:40] Iranian lady you were talking about, there must be a massive sense of of achievement. [01:11:45]

Tara Renton: Absolutely. Love it. Payman. And the problem with chronic pain is you don’t necessarily get the patient [01:11:50] out of pain.

Payman Langroudi: Oh.

Tara Renton: But you’ve dealt with all these holistic [01:11:55] issues. You’ve given them a clear diagnosis, A clear prognosis [01:12:00] and some possibilities, some tools that they can do. I love it. I do feel like [01:12:05] Inspector Clouseau on the clinic.

Payman Langroudi: Sounds like it. Yeah.

Tara Renton: Because you’re literally at different pebbles, [01:12:10] different things.

Payman Langroudi: Lifting up different bits.

Tara Renton: So interesting.

Payman Langroudi: Let’s now get to the darker [01:12:15] part of the pod. We like to talk about mistakes. And now with your medico legal work, [01:12:20] you see loads and loads of mistakes. So I’d like to get into some of that. How, how, how do people [01:12:25] avoid the common things. But I also like to get into any clinical [01:12:30] areas that stand out. Your own clinical areas that stand out to you.

Tara Renton: Um, I’ve got [01:12:35] one not so funny for the patient and one. I mean, I, so [01:12:40] I remember my father taking out the wrong premolar on his best friend, his orthodontist [01:12:45] friend’s daughter. So for me, that was I remember him coming inside. Yeah. Wrong side. [01:12:50]

Payman Langroudi: Oh my.

Tara Renton: Goodness. And and I remember he was like that pale grey colour before you have a coronary. [01:12:55] He was like that for like three days. So that’s been always with me. But I only reappeared when [01:13:00] I was involved in the lock slips and the wrong site surgery. And I’ve done it. I’ve taken out [01:13:05] four wisdom teeth on a 60 year old or 17 year old boy. I should have had just two wisdom teeth taken out. [01:13:10] Didn’t realise. Gah! Just no. Just just routine. [01:13:15] I’d written it up wrong. You know, I always wrote my own treatment plan. Never, never delegated anyone else on [01:13:20] the board in front of me with the X-ray checked. And I managed to do that. And I remember as [01:13:25] soon as I.

Payman Langroudi: Realised.

Tara Renton: Realised I just I and I went, obviously [01:13:30] the patient was taken to recovery and I went straight at his mother’s in the waiting room and I just said to look, I’ve [01:13:35] made, I’ve made a mistake. I’ve taken out all his four wisdom teeth.

Payman Langroudi: The uppers instead of [01:13:40] two.

Tara Renton: Yeah, exactly. Yeah. And I said, look, I’m really, really sorry. Um, [01:13:45] this is, you know, wrong. Um, I’ll give you my details. And and she [01:13:50] said, oh, thank God for that. She said, because we were telling the orthodontist said the dentist said that [01:13:55] he only needed two out, but actually we wanted to have four out because he’s going travelling next year. So I was [01:14:00] so lucky. But it’s very poignant because it stays with you. It’s just so [01:14:05] easily done. I mean, when I was others, I’ve written lots of papers around wrong site surgery [01:14:10] and and, and patient safety. What we do as dentists [01:14:15] is really, really difficult. And I know you’ve touched on this on quite a few podcasts. So [01:14:20] we as dentists, as you say, we’re individual practitioners. Yes. We have our dental nurse with us. We’re in [01:14:25] a room by ourselves most of the day, or none of our patients want to come and see us. They all know they’re [01:14:30] going to get pain, even a little, tiny bit. They’re going to get pain. Most patients actually [01:14:35] just even looking at the appointment card, if you take an MRI of their brain, [01:14:40] the amygdala, the limbic system is lighting up basically that, [01:14:45] you know, that non-physical pain is already happening in their brain when they get into the [01:14:50] car park. It’s almost actually happening before you get a needle or anything near them, and then [01:14:55] when they see the dental chair or they hear their drill and in the next door surgery, or they [01:15:00] see a syringe. Yeah, they’ve already got the pain. You can literally just [01:15:05] do.

Payman Langroudi: Yeah.

Tara Renton: And they’ll have the pain. Yeah. Yeah. So I think, and you know, we, we [01:15:10] work in that environment. We are immune to it.

Payman Langroudi: Yeah. We’re normalised.

Tara Renton: And I have said, [01:15:15] you know, if I ever became dean of a dental school, which I haven’t and I won’t, I always said if I would change [01:15:20] dental training, I would say you sit down with your patient in a medical conversation, a medical consultation [01:15:25] model. You sit eye, eye to eye level in two chairs next to each other and have a conversation. [01:15:30] You do the consultation like that. You you do your consent [01:15:35] like that. You only put them in the dental chair to examine them, take them out again to carry on [01:15:40] the conversation about what you found, and then you put them back in the dental chair to do your treatment. And I honestly [01:15:45] think if we did that, patients would retain more, they’d hear more and actually probably be better [01:15:50] in a room without the dental chair because that’s a massive, massive trigger for many, many patients. [01:15:55] Can we give painless blocks, painless injections? I don’t [01:16:00] think so. I mean, with all the stuff I’ve written about LA around minimising nerve injuries, but more [01:16:05] about optimising pain management patients, you don’t need to give blocks very often. You use [01:16:10] infiltration dentistry. All Implantologists been doing that for years and you’re [01:16:15] smart. You know, you can give them topical local anaesthetic or a bit of ice. It’s probably [01:16:20] the most effective. Give them the articaine buccal articaine get it so that you’re blanching [01:16:25] the lingual mucosa without going, you know, lingually.

Payman Langroudi: Don’t push so hard on the plunger. [01:16:30] Right.

Tara Renton: Just gentle. I mean, and also, you know, it’s, [01:16:35] it’s just we’re immune. You know, we there’s no way that [01:16:40] you can do dentistry with an ID block painlessly. You can’t. The pulpal anaesthesia rates are [01:16:45] so poor. If that injection was invented now and said, oh, dentists, we’re going to be doing this from it, we’d laugh them [01:16:50] out of the room. It’s just it just doesn’t work well enough.

Payman Langroudi: Do you have any tips and tricks on.

Tara Renton: I [01:16:55] have some good tips and tricks.

Payman Langroudi: Well, don’t do them.

Tara Renton: No, no, no, it’s not that. [01:17:00] So I’m, I’m not a great advocate of um of of the direct [01:17:05] Halstead. I rather do indirect. So you’re not going through the lingual nerve. In fact what I started doing in [01:17:10] my later years, if I was going to give a block is do a gow-gates. Go higher. They’re just as effective as a Halstead, [01:17:15] but they. They completely miss the lingual nerve. Okay. And the ID nerve. [01:17:20] So you just go higher up and you just follow along the the the top of the wisdom teeth [01:17:25] into the little fossa retromolar fossa and just go direct. You don’t have to be near the nerve. [01:17:30] We know that you can be a centimetre and a half away from the nerve. The local anaesthetic we use is so good, so [01:17:35] strong. It works. But you do need to wait ten minutes for a block to work for the optimum [01:17:40] pulpal anaesthesia, which is another reason why it’s so short.

Payman Langroudi: Ten minutes, ten minutes.

Tara Renton: And if you’re a [01:17:45] patient or a red haired patient or an anxious patient, which most of them are, could [01:17:50] take up to 20 minutes to get optimal pulpal anaesthesia from an IDB, which is why [01:17:55] they’re so rubbish.

Payman Langroudi: Why, oh why do they?

Tara Renton: Because there’s lots of theories. It [01:18:00] might be an enzyme thing. It might be laxity. Laxity of the connective tissue, a bit like in pregnancy. They [01:18:05] don’t really know. But they’ve got a really high resistance to local anaesthetic. Um [01:18:10] poor things with all the other stuff that they have to deal with.

Payman Langroudi: Yeah. Um, so in general you’re saying go a little bit higher [01:18:15] than you think.

Tara Renton: Well, the first thing was don’t give an inferior dental block [01:18:20] unless you have.

Payman Langroudi: To, unless you have to.

Tara Renton: So I would do infiltration dentistry.

Payman Langroudi: Um, so. [01:18:25] Articaine.

Tara Renton: Articaine. Buccally. Yeah. Um, the, the anterior mandible is [01:18:30] very porous, so it works brilliantly here. Don’t stick it into the mental nerve. Don’t go anywhere near nerves. [01:18:35] Mhm. Um but the, but the lingually, the mandible is very porous. So what [01:18:40] you can do is you can give your I used to say get a cartridge of articaine and do [01:18:45] in front and back of the tooth, go slightly higher up. So you blanch the lingual mucosa. [01:18:50] And then if you need to go in, if there’s still pulpal sensitive, you can give a lidocaine [01:18:55] and not know only if you’re doing extractions. Never give in to ligamental unless just [01:19:00] infiltration. Okay, but often you don’t need to do that. If you’ve got a polycytic tooth or [01:19:05] a big zit somewhere like a big acne spot or any inflammation in the trigeminal system, [01:19:10] your sodium channels will be absolutely, um, sensitised. So that’s [01:19:15] another reason why your your local anaesthetics not working. So give them ibuprofen, solubility, ibuprofen, [01:19:20] as long as they can take it about 20 minutes before the giving the local anaesthetic and that will optimise [01:19:25] your local anaesthesia because it’s basically reducing the sodium channel hyperactivity. Old [01:19:30] stuff. Ken Hargreaves, 1980s champion, Endodontist [01:19:35] pharmacist, dean of Houston dental school wow. Mega guy. It’s all out there. [01:19:40]

Payman Langroudi: Interesting.

Tara Renton: So a lot of this stuff infiltration and you’ll have much more comfort [01:19:45] for the patient. There’s much nicer injection to have. Much more effective pulpal anaesthesia. [01:19:50] And I just don’t know why we’re not doing more and more of that. And if you probably the patients you have to give [01:19:55] a block for would be a complex prosthodontics. If you’re doing long procedures, [01:20:00] you can top it up like you would in an IDB in the old days. Um and possibly [01:20:05] endo. Um, and the endodontic is actually probably the best [01:20:10] trained of all of us in managing, uh, managing postoperative [01:20:15] pain. I just operative pain.

Payman Langroudi: In general, pain in general.

Tara Renton: It’s a big part of their training [01:20:20] program. I mean, going back to that, you know, again, so many [01:20:25] things, but in vets get something like 40 hours of pain [01:20:30] training. Really medics for [01:20:35] six.

Payman Langroudi: That’s crazy. Dentists none.

Tara Renton: Half [01:20:40] an hour if you’re lucky.

Payman Langroudi: Yeah.

Tara Renton: It’s bad.

Payman Langroudi: Yeah.

Tara Renton: And it was and I hadn’t realised, you know, [01:20:45] Richard was talking about what a stressor it is for a lot of people doing DBS.

Payman Langroudi: Yeah yeah yeah yeah.

Tara Renton: Well it [01:20:50] shouldn’t be.

Payman Langroudi: I took, I took five years off when we started the company and [01:20:55] then my wife got pregnant. And then I went back part time after that. And [01:21:00] after five years of not giving an ID block, I had massive stress.

Tara Renton: I’m not surprised. [01:21:05]

Payman Langroudi: My first. But actually something had happened. I’d forgotten something that they [01:21:10] started. I was started becoming not very good at ID blocks after [01:21:15] five years off. And I.

Tara Renton: Think you’re a bit more just a bit more critical.

Payman Langroudi: Maybe. But I just [01:21:20] remember going back to my wife and saying, let’s talk about this. How do you do it? Because [01:21:25] I don’t remember having a problem before.

Tara Renton: It’s waiting. It’s waiting. That’s all it is. [01:21:30] It’s waiting.

Payman Langroudi: Yeah. So in private industry, it’s very easy to wait because I take that time to talk [01:21:35] to the patient and that’s the best thing you can do anyway. Talk to the patient in NHS. They do the other thing sometimes. [01:21:40] I don’t know if it’s still a thing. Wait in the waiting room? Yes. That used to work very well.

Tara Renton: My dad [01:21:45] did these two surgeries next.

Payman Langroudi: To each.

Tara Renton: Other.

Payman Langroudi: Yeah, that used to work very well, didn’t it? I guess that’s why [01:21:50] those patients were properly anaesthetised. Um. I can’t see being able to do [01:21:55] that in private anymore, though. No, no.

Tara Renton: No. I think it’s probably not. Not possible.

Payman Langroudi: And how [01:22:00] do you how do you manage the wrong site surgery? By putting protocols [01:22:05] in where two people are checking at a time.

Tara Renton: You know, you you can’t take the wrong brain out and you can’t take [01:22:10] the heart out. Wrong heart out. Because obviously you’ve got one of those kidneys. It’s possible, you know, [01:22:15] and limbs it’s possible and lungs it’s possible. But um, dentistry, we’ve got [01:22:20] four quadrants and we’ve got two dentitions. So honestly, it’s like tiger country. Yeah. [01:22:25] And um, as my, you know, my dear old dad used to say, shit happens. And I say that a lot [01:22:30] at work and I to my patients and to, you know, um, play with [01:22:35] fire. You’re going to get burnt sometimes. It doesn’t matter how many protocol wise.

Payman Langroudi: What do you suggest? [01:22:40] What did when you did the work and decided.

Tara Renton: Oh, I see, well, the loxp stuff. Yeah. [01:22:45] No, it’s um it’s out there. It’s a big committee. The Royal College of Surgeons and we [01:22:50] did specialist locks for each domain. So a lot of it’s around checklists and [01:22:55] just, you know, making sure that your radiograph is, is labelled correct, labelled correctly. [01:23:00] Obviously it’s on screen now so it’s less likely to happen.

Payman Langroudi: That got me. I draw the wrong side.

Tara Renton: That’s [01:23:05] you see that happens a lot. And I think one of the key things is if you’re doing the surgery, the onus is [01:23:10] to you the medical legal. Even if the anaesthetist messes up, it’s still the surgeon’s problem. So you [01:23:15] just have to plan and be clear. But also just make [01:23:20] sure, put your plan, you know, up somewhere on a piece of paper and [01:23:25] you check with your nurse and a nurse. A dental nurse twice has stopped me doing wrong site surgery [01:23:30] really. And that’s, you know, talking about having your nurses. I always say, if you’ve got a really [01:23:35] good nurse, they’re good enough to be a dentist. And they should be. I think they should [01:23:40] be able to do it, to be honest. But anyway, I just think having that team approach [01:23:45] and people being able to speak up, that’s such a good sign that, you know, my couple [01:23:50] of times Dental have said actually, um, Tara, your and you know, I’m never Tara, [01:23:55] I’m think your forceps are on the seven or the six.

Payman Langroudi: Goodness [01:24:00] me.

Tara Renton: It’s fantastic. Why wouldn’t you want that in your team?

Payman Langroudi: Of course. Yeah. [01:24:05] Of course. So for instance, in black box thinking that yeah, they found one of the big [01:24:10] crashes, famous ones, uh, Canary Islands. There was [01:24:15] a massive plane crash where one plane went straight into another one on the runway. And just [01:24:20] before it was it was a very famous captain. Yeah. Just before [01:24:25] he said, he said, okay, full power ahead. Yeah. And the first officer who was a junior [01:24:30] said something like, sir, are you sure there’s a plane? And then there was this muffle [01:24:35] of him saying that. Yeah. And then the plane went forward and smashed. And then they made [01:24:40] a protocol with pilots of this sort of like.

Tara Renton: Listen.

Payman Langroudi: Whistle blowing kind of [01:24:45] that if you as a junior, if you see a senior doing something there [01:24:50] and then speak up and, and, and, and, you know, he was too scared to really say it. [01:24:55]

Tara Renton: Yeah. Well, the protocol, you know, our student protocol now is you check and recheck. So you [01:25:00] make sure you’ve got the right, you know, you double check your notes, you double check you’ve got the right patient. You double check you’ve [01:25:05] written the right treatment plan up there. Um, you, um, when you’re giving the local anaesthetic you check with [01:25:10] your nurse. I’m doing the right side. Yeah. Yeah. And when with your nurse again you say right, I’m taking out the lower right [01:25:15] six and I’m putting my forceps on the lower right. Six and it’s all with your, [01:25:20] with your, with your dental nurse or your or your. So it’s a, it’s a team [01:25:25] team work. They have to have that confidence to be able to speak up.

Payman Langroudi: Tell me about teaching [01:25:30] in Kings and you’ve seen generations of, of dentists go through. Um, [01:25:35] can you tell? Pretty early on who are going to be the stars? Um.

Tara Renton: Um. [01:25:40]

Payman Langroudi: What about what about the, the teaching itself. I mean, we’re [01:25:45] about to do this event. You should come, by the way, we’re about to do an event at Ministry [01:25:50] of Sound. Oh, are you a Dental conference at Ministry of Sound?

Tara Renton: Fantastic.

Payman Langroudi: Um, [01:25:55] but where that comes from? Yes. Is that particularly post-COVID? [01:26:00] I feel like Dental education, if we’re going to get up out of our homes [01:26:05] and out of our jobs and come somewhere. Yes. That that there needs to be something about going [01:26:10] somewhere that makes that makes sense to that, you know, it’s got to be either super fun or [01:26:15] you’ve got to meet people who you’re going to network with later on, and it’s going to work. Something [01:26:20] different has to happen. I mean, you’re standing on a stage presenting a lecture. You might as well be on the on [01:26:25] the other end of a computer in California presenting a lecture, you know. Um, but what [01:26:30] are your reflections on the course, the Dental course itself. Um, and. [01:26:35]

Tara Renton: It’s, it’s a frustration because, um, like a lot of people, I, and [01:26:40] again. I’ve heard you talk about this on previous podcasts. Um, I [01:26:45] don’t think they, the Dental students come out ready cooked. I mean, there’s more and more, more and more [01:26:50] emphasis on I mean, they’re, they’re, they’re just psychologically, they’re [01:26:55] an interesting generation. Obviously, I’ve got three kids, so they’re very anxious about things, very [01:27:00] self-critical, very fearful of doing anything wrong.

Payman Langroudi: Especially this this generation, anxious, [01:27:05] high achievers, the ones because dentistry is much harder to get into now.

Tara Renton: Well, and that arguably [01:27:10] I would just say that. Are we selecting the right people? I think we need empathic listeners. [01:27:15]

Payman Langroudi: Empathic carpenters.

Tara Renton: Yes. Well, not just that, but but no, you [01:27:20] it’s the empathy is the most important thing. And I think about being patient. I mean, my [01:27:25] whole career has been patient centred and very, very patient centred. And I just think actually [01:27:30] a better qualification for people coming into healthcare would be that they volunteer or they [01:27:35] do a year, not national service, but a year working and helping in a hospital or an old people’s [01:27:40] home or kids nursery.

Payman Langroudi: It’s one of the requirements.

Tara Renton: I would love that to [01:27:45] happen. I’ve been saying that for years. I think that would tell us more and also would tell the kids more whether [01:27:50] they actually made for that particular, you know, and you need a variety [01:27:55] of people. You need a variety of people to make up a team. But dentistry, as in general, dental practice [01:28:00] is very much you and the dental nurse. Yeah. Um, whereas in other domains [01:28:05] of working in a dental team, multidisciplinary teams, you need [01:28:10] different personalities. You need someone who’s going to make sure the T’s are crossed and the i’s are dotted.

Payman Langroudi: But if [01:28:15] you, if you were queen of the world and you could redesign the dental course, which bits would [01:28:20] you take out to to include these bits that you want to put in?

Tara Renton: I think I’d take [01:28:25] out quite a lot and put a lot more.

Payman Langroudi: Um, so, so [01:28:30] the traditional, like, would you take out things like biochemistry? I would, I.

Tara Renton: Would love I, [01:28:35] I think at the element of that definitely. Yeah, I would love to see dentists. You know, one of [01:28:40] my ambitions, which never came to fruition was I’m very jealous of Richard’s new development, I have [01:28:45] to say, is.

Payman Langroudi: Is.

Tara Renton: To have like a 1012 surgery high street [01:28:50] unit that teaches students and postgrads. [01:28:55]

Payman Langroudi: Mhm.

Tara Renton: Um, and, and one day it’s pros, one day it’s oral surgery, one day [01:29:00] you can still do this.

Payman Langroudi: You could still do this.

Tara Renton: I’d love, I’d love to do I think oral surgery is so [01:29:05] stressful and so difficult for the students. That whole concept of. And it’s a horrible [01:29:10] thing to do what we do to our patients. I started saying, as dentists, you know, we’re, as [01:29:15] you say, dealing with patients who don’t want to see us. They know they’re going to get pain. [01:29:20] The trigeminal nerve basically has a one way, one ticket transfer [01:29:25] to the limbic system. So if you’re in threat of having pain to this area [01:29:30] or having painted this area. Your brain is like.

Payman Langroudi: It’s.

Tara Renton: On fire.

Payman Langroudi: Yeah.

Tara Renton: And [01:29:35] that’s what we do in dentistry. We work in the try the most difficult nerve in the whole body. That’s [01:29:40] basically amplifying all the stress and everything going on in our head related [01:29:45] to pain. And we just we do it on awake patients. I mean, [01:29:50] did that happen because of barber surgeons? Barber surgeons took out teeth. Dentists [01:29:55] invented GA and let them blooming surgeons run away with the GA. So all these fancy surgeons just [01:30:00] operate on the sleep people. I know there’s it’s changing, thank goodness. And that’s partly due to chronic pain [01:30:05] actually, because we know that a lot of the post-surgical chronic pain, neuropathic [01:30:10] pain is actually probably to do with central sensitisation. So if you get very, [01:30:15] very intense pain transmission to the brain, particularly the para ductal grace just [01:30:20] sits below the amygdala, that area sensitised. And that probably has a memory of pain. So if [01:30:25] you block it with local anaesthetic like we do in dentistry doesn’t happen. So if you go and have [01:30:30] breast surgery, limb surgery, still big enough anatomical areas, you [01:30:35] can’t block it off with local. But the anaesthetist will give strategic local anaesthetic.

Payman Langroudi: For that reason.

Tara Renton: To [01:30:40] minimise chronic pain. Isn’t that fantastic? They’re taking a lesson out of dentist. We do that for years. You [01:30:45] know, I would argue that a lot of stuff we do, patients should be sedated. I don’t think it’s [01:30:50] fair. A lot of the stuff we do that they’re awake. But going back to the, to to rearranging dentistry, [01:30:55] I think a lot of it should be like my grandpa did more of an apprenticeship. Still think you [01:31:00] need the academic knowledge, not to the extent of forays [01:31:05] or four nines or whatever it is these days. I don’t think you’re selecting the right people. I [01:31:10] did actually.

Payman Langroudi: You must have been on the selection board for some time now. Um, you [01:31:15] know, getting.

Tara Renton: Specialists never, never for undergraduates. Oh, really? Yeah. Too busy teaching [01:31:20] and doing the research. I mean, the whole system is ridiculous at university because the [01:31:25] kudos and the money comes with the research. Still not with the teachings, the teachings. Always trying [01:31:30] to get the patients in, trying to deal with the NHS managers who say we can’t be arsed having the [01:31:35] dental students in. They don’t do enough work. We’re basically giving away our our salary, our [01:31:40] income. They don’t want. So you’re fighting all these levels that are running. The undergraduate program was [01:31:45] so stressful because you want more patients in. You want your students doing stuff. [01:31:50] These wonderful people who come in and give up their salary in clinical practice to come and teach our salt [01:31:55] of the earth. Not appreciated, not dealt with very well. And [01:32:00] it’s such a frustration. So I would love it that you have a nice practice [01:32:05] where people want to be there, the teachers want to be there, and then they give the kids a good [01:32:10] time, good experience, and I’d love to see that. And I don’t think that happens an awful lot. I’m [01:32:15] quite cynical or critical about the haptic stuff, and I don’t think that prepares [01:32:20] people for dealing with patients. And as nearly every one of your [01:32:25] podcasts that I’ve listened to, it’s all about the patient. It’s all about the patient relationship. If things are going to go well, [01:32:30] you know, I shouldn’t say this. You know, if your patient loves you, you can do shit dentistry. [01:32:35] But that’s not what we’re advocating.

Payman Langroudi: No, no, but it’s important. Your patient can love you and you can do brilliant.

Tara Renton: And [01:32:40] you have a better day if you have your patients, your dental nurse liking you and your patients liking you. Yeah, you’re going to have a [01:32:45] much better day.

Payman Langroudi: Yeah, exactly.

Tara Renton: So and that’s down to, you know, um.

Payman Langroudi: So, [01:32:50] so, so changing the course, you take out lots of the basic science I’m taking.

Tara Renton: I would.

Payman Langroudi: Do, you’d [01:32:55] put in a lot more on relationships.

Tara Renton: I’d put in a lot more face to face, hands on. [01:33:00]

Payman Langroudi: Work as well.

Tara Renton: Sorry.

Payman Langroudi: Communication.

Tara Renton: Absolutely. And psychology. [01:33:05]

Payman Langroudi: And I’d even say business, you know, like.

Tara Renton: Business should.

Payman Langroudi: Be the basics of business.

Tara Renton: Absolutely.

Payman Langroudi: I think it should [01:33:10] be in school, let alone dental school. Yeah. They should, they should talk. I was going through my daughter. [01:33:15] She’s she’s only at GCSE level. Yeah. Yeah. But you forget you know, GCSE maths [01:33:20] still quite hard. Like I couldn’t, I couldn’t remember how to do this stuff. I was going, yeah, [01:33:25] you know, differentiation or something. I remember the word.

Tara Renton: I gave up trying to help my kids with [01:33:30] their homework a long time ago.

Payman Langroudi: Yeah. I referred her to ChatGPT at me. But [01:33:35] but then but then this is what I’m saying, that going to quite complex mathematical sort of thing, but [01:33:40] no idea how to apply for a mortgage, like a life, like a very important.

Tara Renton: Life bank account.

Payman Langroudi: Open a bank [01:33:45] account, money in and money out, these sort of simple things, simple.

Tara Renton: Things. The education system [01:33:50] is not fit for purpose either.

Payman Langroudi: And, you know, Elon’s got an idea. I’m calling him like he’s my best [01:33:55] friend. But Elon Musk got an idea of, you know, in schools you have sets.

Tara Renton: Yes. [01:34:00]

Payman Langroudi: But he’s talking about sets that you can move within years. So, for instance, [01:34:05] this nine year old could be in 14 year old physics class. But being [01:34:10] seven year old maths, not maths.

Tara Renton: He’d probably be I would have been kindergarten English [01:34:15] and like probably if I was lucky O-level maths. But yeah, no, I [01:34:20] get that.

Payman Langroudi: So you wrote all these papers. How did you get over your English and dyslexia [01:34:25] and all that to write papers?

Tara Renton: My husband still jokes about champion, not [01:34:30] shampoo paper, what I wrote. It’s my first ever publication. Oh [01:34:35] my God, it was hard. Looking at a blank piece of paper is the most difficult thing. [01:34:40]

Payman Langroudi: Yeah.

Tara Renton: Um, and I, but I’m a massive reader now as well. I love reading, [01:34:45] which I, you know, I never did before, but I love reading.

Payman Langroudi: While we’re on it, what’s your favourite book?

Tara Renton: Uh, [01:34:50] my favourite book would be Patrick Suskind perfume.

Payman Langroudi: Which is a.

Tara Renton: Novel. [01:34:55] It’s a novel. Yeah. I do like quite dark, dark things. [01:35:00] So, um. Yeah.

Payman Langroudi: And what about your favourite Dental book?

Tara Renton: Favourite [01:35:05] Dental book? Well, I love Dental update. Oh, yeah. Not just because I’m on the editorial [01:35:10] board. Because actually, because I don’t do routine dentistry. I love reading those articles and I love [01:35:15] the editorial board meeting. They’re the best people. They’re the best and.is there as well. Such [01:35:20] talented people.

Payman Langroudi: Just.

Tara Renton: Just Leaders o. But also leaders in their fields are so [01:35:25] inspiring. So I love that because it’s just nice for me to understand, you know, it’s [01:35:30] so technical and so, so different than what I was taught.

Payman Langroudi: You on social media.

Tara Renton: Yes, I am. [01:35:35]

Payman Langroudi: Instagram and all that.

Tara Renton: I am, yeah, but not as you know me. So Instagram is [01:35:40] all stuff that I make. Oh, really creative stuff.

Payman Langroudi: Oh, really? Okay. And what do you [01:35:45] make?

Tara Renton: Oh. All sorts. I’ll make anything. I love a project. Always like a project. [01:35:50] So the last thing I made was my two mad Scottish friends who had us around for [01:35:55] New Year’s Eve dinner party. They loved dressing up and, um, [01:36:00] they have these mad selection of, of Christmas hats like turkey upside down [01:36:05] and all sorts of things. And I thought I had some fabric left over because I make these [01:36:10] really ornate Christmas stockings for gifts for people when I’m in the mood. And I had this fabric left over and [01:36:15] I thought, actually, I could make them some really good crowns. So I made these fantastic crowns for them, for Lindsay and Nigel, [01:36:20] and they were great. But anything I can make jewellery. I made my husband’s [01:36:25] wedding ring. I made cufflinks, make jewellery, make clothes, [01:36:30] pay my, pay my way through dental school, making evening dresses and party dresses for [01:36:35] the 80s.

Payman Langroudi: If Etsy was around back then, you’d be a millionaire.

Tara Renton: I would have been killed. I would have not done dentistry. I would have [01:36:40] walked away. I doubt it somehow.

Payman Langroudi: And did you ever get involved in sort of the digital [01:36:45] side of dentistry, or. I guess.

Tara Renton: I have.

Payman Langroudi: Just not.

Tara Renton: The web app is, I suppose.

Payman Langroudi: Yeah.

Tara Renton: No. [01:36:50] So yeah, my sort of chosen course would be probably, well, more psychology [01:36:55] because I love it, but um, MIT in health, I’d love to do a course sort of around [01:37:00] AI and health.

Payman Langroudi: Um, so listening to you now, I feel like just [01:37:05] endless curiosities, like a massive, massive, like [01:37:10] it’s a, it’s a prerequisite to becoming someone like you.

Tara Renton: I think it [01:37:15] helps. It makes the journey much more fun.

Payman Langroudi: Yeah.

Tara Renton: Um, yeah. No, [01:37:20] I think it’s a very, very cool thing I would say actually, and just interested in lots of things. And I [01:37:25] belong to the RSPB. I’ve just been to India. My husband’s involved in tiger conservation. [01:37:30] So big animal lovers and um, love nature. [01:37:35] I cycle every morning in Richmond Park when I can, so I have my own safari every morning. All [01:37:40] the birds.

Payman Langroudi: Beautiful.

Tara Renton: Took a video of the stags this morning, crossing the road in front of me.

Payman Langroudi: And [01:37:45] what did you say was the lowest point? Was it this bullying part incident, like [01:37:50] in this 40 year journey?

Tara Renton: Yes. Um, I was sexually [01:37:55] abused. 11. That was pretty tough. Didn’t tell my mum until about five years [01:38:00] ago. That was horrible. And that’s probably part of my personality as well, just [01:38:05] digging my way out of that. So that was pretty awful. Um, and [01:38:10] then yeah, the bullying at at that, that particular job was tough actually.

Payman Langroudi: Did you feel [01:38:15] like one mirrored the other? Like in your head?

Tara Renton: Uh.

Payman Langroudi: Sometimes [01:38:20] does, you know, like sometimes.

Tara Renton: The one I wasn’t there out of choice. And the second [01:38:25] one, the bullying scenario I was going to into work every day. So some submissive, [01:38:30] you know, submitting to this horrible behaviour. So that’s slightly different. And that [01:38:35] made it harder in a way. Um, yeah. So yeah, no sort [01:38:40] of character building as my mom says, tough, tough love.

Payman Langroudi: If you like. So [01:38:45] then now going forward, basically retired, but [01:38:50] you’re working. You’re working. Yeah. On, on the legal side and.

Tara Renton: Uh, not doing much. I’d [01:38:55] love to do more. I’d love to do more medical legal actually. So I’m just, um, um, [01:39:00] involved in writing an opinion paper, uh, for the BDJ [01:39:05] on the, uh, Winterbottom case. Yeah, yeah. Um, and I’ve got [01:39:10] Irish is involved and he honestly, he’s been through the wringer and he. It’s completely. [01:39:15] Judgement seems very odd. Doesn’t seem right. So [01:39:20] I’m very, very interested in exploring that from a clinical and legal perspective. [01:39:25] So Linda Cruz is doing that with us. Excellent. That’s something I want to pursue. Again, I’d love [01:39:30] when I retired I thought I might do a law degree actually. Really. I don’t I’m not I’m [01:39:35] not a thing. I’m going to do that.

Payman Langroudi: There’s that course at Cardiff that’s like law for doctors or [01:39:40] something like that.

Tara Renton: I might look into that.

Payman Langroudi: Yeah.

Tara Renton: I find it fascinating because they think in such a different way. [01:39:45] Yeah, yeah. Totally different way. So I’m not sure I get.

Payman Langroudi: Some of the most impressive professionals I’ve come across are lawyers. [01:39:50]

Tara Renton: Yeah.

Payman Langroudi: Yeah. Some of the most annoying as well. Yeah. Some of the most impressive.

Tara Renton: Yeah, yeah.

Payman Langroudi: Yeah. Um, [01:39:55] yeah, I’ve noticed that along the way. Yeah. So do you, do you miss the rough [01:40:00] and tumble or are you.

Tara Renton: I miss the I miss my team at work. Yeah. Not seeing them, I [01:40:05] miss operating. Yeah. Um. I’m still seeing patients. That’s still a challenge. I’m [01:40:10] still Invited all over the world to. Lecture won’t be going on for much longer because I won’t be [01:40:15] current for much longer. Um. I’m still. I’m writing a paper for [01:40:20] BMJ Practical Neurology. So breaking down the silos around facial [01:40:25] pain, teaching neurologists about toothache, basically. Um, I’ve [01:40:30] got a load of I help still. I’ve got two clinical fellows who want to do PhDs. [01:40:35] I can’t supervise them, sadly. Crazy thing. Retire, return [01:40:40] only you’re only allowed to return for two years at King’s. I mean, the different universities have different [01:40:45] regulations. I’d love to be doing more. You know, I wouldn’t be charging them anything like free [01:40:50] pro-bono. No, no.

Payman Langroudi: No, not even that.

Tara Renton: No, no. Can’t do [01:40:55] it. I don’t know the regulations.

Payman Langroudi: People like.

Tara Renton: I don’t I obviously don’t want people hanging around [01:41:00] like a bad smell. And I’m very aware of that. I don’t want to do that either. You know, I really don’t. I want to [01:41:05] not hang around and be one of those people in the room think, oh God, he’s still here.

Payman Langroudi: What comes [01:41:10] to mind if I ask you? Like, what was the lecture? Or a lecturer? Yes, that [01:41:15] that blew you away.

Tara Renton: Um. Probably two. So when I was a dental [01:41:20] student, um, we had, uh, Mark Ferguson, I think it was who did the, um, [01:41:25] discovered that crocodiles in utero didn’t scar when they repaired their cleft lip and palate. [01:41:30] I know it’s weird, but I love that. Yeah. And then my probably seminal lecture was [01:41:35] listening to Irene Tracy, who’s now provost or vice provost at Oxford [01:41:40] University. She is a pharmacist, but did some of the seminal work around [01:41:45] pain perception using MRIs, which is where I ended up. I was hoping to work with her, [01:41:50] but she never came to London and we nearly did. Um, but I’ve done a huge amount of MRI work, [01:41:55] and on that front, I’m very much involved in developing MRI neurography. [01:42:00] So we can see nerves for the first time in imaging, which is very exciting.

Payman Langroudi: How does [01:42:05] that work?

Tara Renton: It’s basically clever mathematicians. So basically you have an MRI. [01:42:10] Um, just a normal MRI, which is fantastic. But what you do is you have a [01:42:15] specific coil that actually, um, accentuates the concentration [01:42:20] of the, of the MRI in those areas. And um, Frederick van [01:42:25] de Crusnes, one of my star PhD students, I’ve had 14 PhD students over the years. They’re all my work [01:42:30] babies. They’re amazing. He, he developed this. And you can actually see all the cranial [01:42:35] nerves on an image. So and you can see if the, for example, lingual nerve is broken, if [01:42:40] it’s swollen, if it’s hyperintensive inflamed. So we’re just developing that first in Manhattan [01:42:45] at King’s at the moment. So they’ve got it up and running in a few centres in the in the US [01:42:50] and a couple of centres in Belgium. But first here, which is really exciting. [01:42:55] So that’s a project that I will not let go because I just think it’s fascinating. It’s going to be a whole new science. [01:43:00] And we’ve never looked at nerves before, never been able to do ophthalmologists, headache [01:43:05] neurologists. They are gagging for this stuff.

Payman Langroudi: So it’s.

Tara Renton: Fantastic. Cancer surgery [01:43:10] planning. It’s amazing. Um, and what the clever guys. So so basically [01:43:15] the and we also use contrast. So gadolinium, which helps obviously [01:43:20] visualise the nerves. Um, so what you can see is and what they’ve done is they’ve basically sort of refined [01:43:25] the, the mathematical algorithms. So you can actually differentiate nerve tissue from fat. Um, [01:43:30] and obviously water content for other arteries and bits and pieces. So the scans [01:43:35] are developing that I’m working with the team at um Slam or um, IOP [01:43:40] in the Institute of Psychiatry Psychology. They’ve got a big central neuroscience neuroscience imaging [01:43:45] centre there, which is where I’ve done most of my research. So blessed, such interesting people, [01:43:50] so clever. And they’re basically developing an MRI scan that could do [01:43:55] bone arteries and nerve. So it’s really super exciting. So that’s one of the projects. My web app [01:44:00] is a big project. Um, I’d love to commercialise that. So it can actually be just take [01:44:05] a psych assessment of patients before you see them. Um.

Payman Langroudi: Should do that. [01:44:10]

Tara Renton: I’d love to do that.

Payman Langroudi: If it works, then the next step to do that I’d love to do that.

Tara Renton: And [01:44:15] then because I, one of my heartbreaking things around seeing patients for these many, many [01:44:20] years is delayed or wrong diagnosis. So many patients sit around some [01:44:25] unfortunately, with cancer, not too many, thank God. But then people, you know, they’ve had [01:44:30] all this dental work and they’ve actually got a migraine of v3 mandibular branch or maxillary [01:44:35] branch, or they’ve got a cluster headache type thing going on. Um. [01:44:40]

Payman Langroudi: Yeah, I spoke to someone.

Tara Renton: So many patients.

Payman Langroudi: Who said, you’re a dentist. I said, yeah, and [01:44:45] he said, I’ve got to ask you about this thing. Uh, trigeminal neuralgia.

Tara Renton: Everyone knows about neuralgia. [01:44:50] It’s the least common facial pain.

Payman Langroudi: So I said, yeah, what do you want to know? And he said, [01:44:55] I went through 12 years of going through different doctors until [01:45:00] someone said, this is what it is.

Tara Renton: And it was.

Payman Langroudi: Ten. It was ten, [01:45:05] and it had an operation to resect MVD.

Tara Renton: But [01:45:10] one of the few indications for surgery and.

Payman Langroudi: A tear came to his eye when he mentioned the name of the guy [01:45:15] who finally figured it out, you know. Yeah, yeah.

Tara Renton: No TN is we do see [01:45:20] it’s the least common diagnosis that we make very, very life impactful for [01:45:25] patients.

Payman Langroudi: Because the pain is severe. Right?

Tara Renton: Well, the pain is severe. You get either elicited or spontaneous. [01:45:30] Often around this area. It’s probably sodium. It’s inherited and [01:45:35] 18% of patients really onset spontaneous starts, usually 5060 year [01:45:40] olds. Yeah. Sort of almost equal distribution men and women. Um, and [01:45:45] uh, haven’t found the cause yet. Mvd basically peels of an artery [01:45:50] or a, or a vein off the stem of the nerve as it comes out, but still, we don’t really [01:45:55] understand how that works. But it’s the most effective treatment after medical treatment initially. Mhm. But if [01:46:00] you’re a pilot or a HGV driver. You can’t tolerate the medications because they just slow you down, slow [01:46:05] your responses. So but that’s I think that’s pretty well treated. There’s a guy called Cruccu [01:46:10] in Italy who’s the lead. He’s done some exceptional work around TN. So I think it’d [01:46:15] be unusual now. I mean all medics know about TN because they remember the trigeminal neuralgia case on their neurosurgery [01:46:20] ward round. So that’s the only oral facial pain that most medics know about. They all know about it. [01:46:25] And that’s frustrating to me because all that gets it’s always TNTNTN. But actually toothache [01:46:30] can mimic migraines, can mimic TN, can mimic all sorts of different conditions. [01:46:35] And then obviously post-traumatic neuropathy, nerve injuries is a biggie. Much bigger and [01:46:40] bigger than TN because you have you touch it, you get electric shock, you get mechanical allodynia or [01:46:45] thermal allodynia, which is a feature of that, of that condition. So that’s often misdiagnosed [01:46:50] as well. What about. So that’s what the web apps come about, is to try and develop a sort [01:46:55] of diagnostic app that will direct patients either to neurologists or to a dentist [01:47:00] or to ENT so they don’t end up going to an ENT surgeon having sinus washout and septal [01:47:05] deviation correction, and then being told that they’ve got, you know, cluster headache or going to [01:47:10] the neurologist and having five years of, of headache medication when they’ve actually got, you [01:47:15] know, tooth or embedded carious wisdom tooth that no one’s picked up on and [01:47:20] a long cone periapical.

Payman Langroudi: So is the least common. What’s the most common migraine?

Tara Renton: Migraine [01:47:25] is very, very common. So and migraine always generally in [01:47:30] most patients affects v1, v2, v3.

Payman Langroudi: All the way down.

Tara Renton: It does. And we forget that. [01:47:35] And there’s an increasing number of patients now that come to us who’ve got misdiagnosed pain. And actually [01:47:40] it’s migraine. So you can actually screen that’s part of our screening. It’s hit six. You can screen out migraines [01:47:45] very, very easily and find out if there are migraine.

Payman Langroudi: And has has bruxism increased. [01:47:50] And TMJ.

Tara Renton: Is not a pain condition and bruxism.

Payman Langroudi: Is not.

Tara Renton: There’s really good evidence [01:47:55] now that bruxism does not drive muscle pain and.

Payman Langroudi: Oh, really, really, really.

Tara Renton: So, you know, we’ve had patients [01:48:00] where they’ve got no teeth, like one millimetre of tooth tissue above their gingival level. Yeah. [01:48:05] No pain.

Payman Langroudi: Okay.

Tara Renton: So bruxism, there’s two there’s awake and sleep, bruxism, sleep [01:48:10] bruxism. Nocturnal bruxism, bruxism. Increasingly. Another inspirational lecture. [01:48:15] Danny. Danny Eccles. He’s a sleep [01:48:20] physician researcher. Adelaide. Incredible. And [01:48:25] um, his work is international based but they basically [01:48:30] showing that actually nocturnal bruxism is an activity that coincides with periodic [01:48:35] limb movements. So restless leg syndrome at night. Yeah. And actually it’s all to do with the arousal [01:48:40] phase of sleep. So it’s a neuromuscular phenomenon. It’s not stress. [01:48:45] Oh really? Yeah. And actually what you need to do, how you I mean stopping [01:48:50] restless leg syndrome. It’s the same old drugs we use for a lot of chronic pain conditions, relaxant, muscle relaxant drugs. [01:48:55] But actually you just need to protect the teeth and reassure the patient. Daytime [01:49:00] I definitely clench is probably stress related, but it doesn’t drive [01:49:05] pain.

Payman Langroudi: So to that, that bit of information that I have is, I guess, old information. [01:49:10]

Tara Renton: It is. I think it’s coming through. I mean, the other thing that’s very interesting as well, that I’ve published quite [01:49:15] a bit on recently is myogenous TMD. So muscle based jaw joint pain, a [01:49:20] lot of that is migraine.

Payman Langroudi: Oh really?

Tara Renton: So you need to and again, [01:49:25] it’s something dentists should be doing routinely is if the patients presenting with a pain [01:49:30] just say, do you get headaches? Do you get migraines? And they know most patients will know [01:49:35] if they have a history or they currently get intermittent migraines.

Payman Langroudi: So much of it is going into that [01:49:40] functional medicine kind of that’s.

Tara Renton: Where.

Payman Langroudi: We should be interaction. That’s where we should be. Mouth body connection. [01:49:45] I wouldn’t expect that from someone coming from, you know, oral surgery, you know, but [01:49:50] you’re very much everything you’ve said is in that sort of.

Tara Renton: It is that’s where we need to be. [01:49:55] That’s the whole place we need to be to optimise the treatment for our patients. And [01:50:00] and that’s not what’s being taught, sadly. And it’s so much more interesting.

Payman Langroudi: Yeah, [01:50:05] it’s very interesting. It’s very interesting. It’s been a massive pleasure to have you, professor. [01:50:10] Stay awake. Dame. Stop it. Please [01:50:15] don’t do that. Can I can I finish off with the usual questions where you ask the fantasy [01:50:20] dinner party? Three guests, dead or alive. Who are you having?

Tara Renton: Um, [01:50:25] I’ve got no name. Uh, so, um, [01:50:30] Atul Gawande, who’s the medic? The Indian American medic who was Obama’s medical [01:50:35] adviser, who’s done a huge amount around lots and lots of areas, [01:50:40] but he was Mr. Checklist. He was one of the first people to introduce the W.H.O. [01:50:45] checklist, which is now surpassed. But it’s I think it’s entered the culture of most.

Payman Langroudi: It speaks very [01:50:50] well as well.

Tara Renton: He’s a fantastic speaker. Yeah. Um, I think he was on, um, [01:50:55] Rory Stewart, wasn’t he? Uh, Campbell and Stewart.

Payman Langroudi: Yeah. That’s right, that’s right, that’s right. Politics. [01:51:00] Politics. Leading. Leading. Yeah.

Tara Renton: He’s really good. Um. And then [01:51:05] I wrote an actress name down and I’ve had a mental block now.

Payman Langroudi: Um, what was she in? [01:51:10]

Tara Renton: She was a jungle queen. Um, she was a sort of kick [01:51:15] ass woman. Didn’t take any prisoners. We were going back to the 1950s movies. I grew [01:51:20] up, my dad was a great movie buff. Um, Katharine Hepburn.

Payman Langroudi: Katharine Hepburn loved her. Okay.

Tara Renton: Trousers. [01:51:25]

Payman Langroudi: Yeah, yeah, yeah.

Tara Renton: Did her own thing, but in a nice way. Um, and [01:51:30] then, um, who else would I invite? [01:51:35] I mean, I don’t think Elon Musk would be. He is phenomenal. I don’t like him. He’s [01:51:40] not a nice person, but he’s phenomenal.

Payman Langroudi: He is I think on the net net you have to say he’s an asset. I [01:51:45] mean.

Tara Renton: Yeah I think I’d agree.

Payman Langroudi: With you. He could be a Nazi whatever whatever he is a right winger, [01:51:50] whatever he is. But if you look at what he’s done, you’ve got to say it’s so impressive. [01:51:55] Humanity’s moved forward. Yeah.

Tara Renton: It’s so impressive. And he talks about his busy. [01:52:00] I have a busy brain, which is why, you know, I don’t I have I don’t have when someone, a couple of people [01:52:05] have asked me if I have therapy and I’ve never done that, but I say my bicycles, my therapy. And [01:52:10] I learned that, you know, with long time back when really busy family [01:52:15] look back, I just can’t believe what we did, you know, spinning all those plates and doing everything. But [01:52:20] the one thing I did was I bought a second hand Brompton bike on eBay because [01:52:25] I was frustrated. I was getting no exercise. And it basically meant I could take it [01:52:30] everywhere and I could cycle between meetings, cycle to work as much as I could cycle home. And honestly, [01:52:35] I could have the shittiest day from hell. Want to kill everyone? Get on [01:52:40] the bike. Five minutes cycling from Denmark Hill to Vauxhall.

Payman Langroudi: Solve [01:52:45] it.

Tara Renton: And that’s what I learned. Actually. That’s probably.

Payman Langroudi: Some [01:52:50] lime bikes for that, but.

Tara Renton: No lime bikes.

Payman Langroudi: Even though there’s not much work going on. No, no. The [01:52:55] speed of acceleration. Yeah. No, but you’re right. And in winter it’s [01:53:00] harder, isn’t it? Yeah. In winter I don’t use them as much. No. And actually feel it, [01:53:05] you know. Oh do you. And somehow I make a point. You use 2 or 3 a day. Yeah. I’ll cycle here. [01:53:10] Cycle back, cycle wherever. I should make.

Tara Renton: A point of doing it more.

Payman Langroudi: Yeah.

Tara Renton: As I say in Norway, it’s not the [01:53:15] wrong weather. It’s the.

Payman Langroudi: Wrong place. Exactly. Yeah, exactly.

Tara Renton: Very much. I cycle snow, rain, everything. [01:53:20]

Payman Langroudi: You do, you.

Tara Renton: Get out. I love it, it just makes me feel.

Payman Langroudi: Yeah, yeah. There is something.

Tara Renton: A dose of mindfulness. [01:53:25] Nature. Get home and I’m ready for the rest of the day. I love it so I don’t [01:53:30] I think Elon needs to do probably more cycling. I don’t know. He’d be less productive if he does more cycling. But it’d [01:53:35] be interesting to sit next to someone with that much of a busy brain, or maybe a bit of a misogynist, I don’t [01:53:40] know. I’ve had enough of those in my life, but.

Payman Langroudi: I’ve got a deathbed question.

Tara Renton: Oh, yeah.

Payman Langroudi: Lying [01:53:45] on your deathbed, surrounded by your dearest and [01:53:50] nearest and dearest many years from now. What three pieces of advice would you [01:53:55] leave for them and for the world?

Tara Renton: Stay curious. Probably? Absolutely.

Payman Langroudi: That [01:54:00] seems.

Tara Renton: Clear. That’s my biggest joy. Um. Priorities. [01:54:05] Prioritise your friends and family. I’ve got eight girlfriends. [01:54:10] I wouldn’t be here sitting here now without my amazing husband. Three [01:54:15] kids. I’m incredibly proud of that. I haven’t fucked up completely. Um, [01:54:20] and the girlfriends we’ve seen each other through.

Payman Langroudi: Which era are they from? From [01:54:25] school, university, or.

Tara Renton: A couple I’ve known for 40 years.

Payman Langroudi: Uh huh.

Tara Renton: Um. Uh, [01:54:30] yeah, about half over half of them I’ve known for 38, [01:54:35] 40 years. And then there’s a few new add ons that we met at antenatal [01:54:40] with our Firstborn’s 33, 33 years. I can’t believe I’m saying [01:54:45] that.

Payman Langroudi: There’s nothing like old friends. Nothing like old friends.

Tara Renton: So friends and family, I think, are really, [01:54:50] really up there. Curiosity. And I would say, stick to your guns. [01:54:55] If there’s if you’re principled, if I look back and think, I could have made some really dumb [01:55:00] decisions, like not doing medicine, I didn’t do it. I was right, I was very lucky because [01:55:05] oral surgery came in, you know, and then I. Yeah, no, stick to your [01:55:10] guns, you know, you know, know who you are. And, and if you have a goal, [01:55:15] just, just keep at it. And if you keep hitting a brick wall, just walk around that wall. Find a way [01:55:20] around that wall.

Payman Langroudi: What do you wish you were more like.

Tara Renton: Uh, [01:55:25] my husband.

Payman Langroudi: In what sense?

Tara Renton: Calm. Kind. [01:55:30]

Payman Langroudi: You seem calm.

Tara Renton: I am calm.

Payman Langroudi: You seem kind.

Tara Renton: I am kind.

Payman Langroudi: Um. [01:55:35] What is it? What is it you’re bad at? You know. That’s what I’m getting at.

Tara Renton: I think I, I have [01:55:40] I can have the element of irritating people. I don’t mean hating people. Yeah.

Payman Langroudi: In [01:55:45] what sense?

Tara Renton: Um, there’s a family joke really that I, you know, I’m ADHD [01:55:50] and. Yeah, I’m a bit busy. Mrs. [01:55:55] McHenry.

Payman Langroudi: From.

Tara Renton: Magic Roundabout. So yeah, probably. But [01:56:00] then that’s part of my charm, I guess. A lot of people tell me, I don’t know.

Payman Langroudi: I mean, the [01:56:05] thing is, you could say I wish I was better at politicking in I guess. Yeah, [01:56:10] but but but the charm of it is that you’re not.

Tara Renton: Yeah, I guess so. Well, it’s it’s not [01:56:15] served me too badly.

Payman Langroudi: Yeah.

Tara Renton: And I’d be a very different person if I was better at that kind [01:56:20] of stuff.

Payman Langroudi: Exactly, exactly.

Tara Renton: Probably be nice just to have a little tiny bit of commercial [01:56:25] DNA.

Payman Langroudi: Yeah yeah.

Tara Renton: Yeah, yeah. Because I really haven’t.

Payman Langroudi: That sounds like your husband’s got that [01:56:30] in spades.

Tara Renton: He. Yes. He has.

Payman Langroudi: So you should do a project together. You should do this teaching centre.

Tara Renton: I’d [01:56:35] love to do it together. Well, I was just. I ring up Richard Porter and just say, [01:56:40] do you want your oral surgery or a facial pain I love. I’d [01:56:45] love to train oral facial pain. Do you know, I get a lot of people asking me about doing special. There’s [01:56:50] no speciality in oral facial pain. Yeah, but I think it would be a fantastic thing if certain dentists are interested. [01:56:55] I think you do your dentistry for 4 or 5 days a week, and then you do one day speciality, [01:57:00] and that would be make an awful lot of sense for for, you know, maintaining interest. [01:57:05]

Payman Langroudi: So this is something I want to go into at this thing at ministry, right? Is the question of [01:57:10] should I specialise or should I go on Richard Porter’s course? Yes. [01:57:15] Or for the sake of the argument, Frank spear or yes or whatever. [01:57:20] But you know, should I specialise? And the other question, which speciality should I do? [01:57:25] Because I think oral surgery. I say all surgeries, one on its own in a way. [01:57:30] But for me, when I when a young dentist ask me which, which one should I do? I’m [01:57:35] not sure which one I like the most. I’m going to do whichever one. Yeah. Like get very good at anything. [01:57:40] Yeah. And you’ll enjoy it. Outside of. Also, I’d say all surgery and max facts and blood [01:57:45] and flaps and bone. Some people are made for that, and some people just don’t want to [01:57:50] go anywhere near that.

Tara Renton: And I understand that.

Payman Langroudi: Yeah. But whether it’s.

Tara Renton: A lot of people do.

Payman Langroudi: Yeah. A lot of people [01:57:55] do. A lot of people do.

Tara Renton: And it’s incredibly rewarding.

Payman Langroudi: I mean, the thing we don’t have anymore is that, you know, the failed [01:58:00] medic syndrome. Yes. Because it’s just as hard to get into dentistry as to get into medicine.

Tara Renton: Well, it’s. [01:58:05]

Payman Langroudi: Harder. It’s harder in my day that that was the thing. Yeah. It was you couldn’t quite get into [01:58:10] medicine then that you came to dentistry. And then then and then those guys end up becoming Max fac surgeons because [01:58:15] they wanted to be doctors. For me, you said it for me.

Tara Renton: I was biting my tongue, which is very [01:58:20] unusual, which is not a great that’s not a great solution. No, it’s [01:58:25] not a great professional way to select your future career. Yeah. No, I think and it’s not. And, [01:58:30] you know, saying that now it’s and [01:58:35] the part of the reason I originally chose dentistry is I know that I, I knew that I could work [01:58:40] in a practice for one or 2 or 3 days a week and do whatever I wanted to do. The other [01:58:45] time. So I think there’s that pressure of I think the kids put themselves under a lot of pressure. [01:58:50] They want to be Instagram influencers. They want to be this. They probably want to prefer to be that than actually [01:58:55] doing a lot of the dentistry, to be fair, which is a shame for the patients. Um, [01:59:00] but I think it’s not just about pleasing. [01:59:05] I think there’s so much out there, like, well, like orofacial pain, there’s no speciality in orofacial pain. [01:59:10] There’s no speciality in lots of aspects of teeth whitening.

Payman Langroudi: Yeah.

Tara Renton: No implants. Implants.

Payman Langroudi: Not going [01:59:15] with that. Should I specialise, should I go on a course? Should there be some sort of hybrid? Yeah. Which [01:59:20] is what you’re suggesting.

Tara Renton: I think it would be great.

Payman Langroudi: Like even even at one from institutions, you know, like [01:59:25] it could be that you could go. And I know it’s like a part time MSc. They have these things, right? [01:59:30] But but something where people could, could follow an interest.

Tara Renton: And have [01:59:35] a network, a supportive network.

Payman Langroudi: Yeah.

Tara Renton: And that would be a UK wide. I mean, another [01:59:40] going back to undergraduate. Why don’t we have national curricula in orofacial pain? [01:59:45] You know, I heard you saying one of your podcasts about when you first qualified from Cardiff, [01:59:50] you went into BT and you had you could see that some people were really good at this, and [01:59:55] some people were really good at that and, you know, identified some of the weaknesses in your own training. Yeah. [02:00:00] I just think, actually, why aren’t we just. And that’s an argument for even the NHS as well, [02:00:05] when there’s all this good stuff happening, why aren’t we harnessing that and spreading the love? [02:00:10]

Payman Langroudi: Because we’re very slow to change. We’re very slow to change. But you’re form of the system, [02:00:15] right? Can you can you understand why we’re so slow to change?

Tara Renton: Well, I think one of the [02:00:20] problems, like talking about ID blocks and, and, and diagnosing TN, we’re [02:00:25] still doing the same stuff we were taught at dental school.

Payman Langroudi: Yeah, but look, your kids are in, you know, it [02:00:30] data science, AI changing weekly.

Tara Renton: Yes, but I’m just.

Payman Langroudi: Saying those industries [02:00:35] are very quick to change, but Dental medical.

Tara Renton: But they’re still teaching the same stuff I was taught [02:00:40] at dental school and that’s wrong. It’s mad and it’s wrong. It’s completely wrong and it’s not [02:00:45] fit for purpose. And I feel sorry for the kids for that because they’re already predisposed to anxiety. [02:00:50] They don’t have their confidence is not built up enough, I think, [02:00:55] and their interpersonal skills, they don’t know who they are.

Payman Langroudi: How have you managed to navigate all [02:01:00] of this and keep such a like, smile on your face? Because [02:01:05] that’s I’d say that’s the the biggest success of your sort of career. Like we like meeting [02:01:10] you properly is that, you know, you know, a lot of people get jaded and [02:01:15] lost.

Tara Renton: I’m always well, it’s the curiosity and I’m always hoping for. I [02:01:20] feel most sorry for people that go to work and do the same thing over [02:01:25] and over again. Never question, never think about how they can make things better [02:01:30] for the patient. Go home and have dinner.

Payman Langroudi: Mhm.

Tara Renton: That would be, for me, the worst possible [02:01:35] work life environment I would have. Yeah I [02:01:40] am. I have managed with grit and determination, [02:01:45] but mostly curiosity and energy to, you [02:01:50] know, identify something that seems like a really good idea. Changing practices impossible. [02:01:55] Like the guidelines and everything. You just get all these, you know, depending on their different personality disorders. [02:02:00] Yeah. And we can’t do this because of that. And we can’t do that. You know, the, the negative this and but yeah, [02:02:05] I think, I think if you’re patient centred, then that that is obvious. The choice [02:02:10] is obvious that actually that’s the right direction, the right factor. We go in.

Payman Langroudi: You know, [02:02:15] and you’ve, you’ve lectured all over the world. Are there different research [02:02:20] cultures.

Tara Renton: Oh my goodness. Different Dental cultures. Yeah. Different conference cultures.

Payman Langroudi: So for [02:02:25] instance, one, one thing I heard that the, the Chinese research is much more [02:02:30] centralised. And so much as they look at a big problem and direct all [02:02:35] the resources towards these big problems in university.

Tara Renton: Well, that’s what they do in [02:02:40] corporates and R&D and corporates. Yeah, exactly. It’s exactly the same process. It’s much more commercial.

Payman Langroudi: So where we’re [02:02:45] at with with universities is almost it’s almost like a passion projects of [02:02:50] or of course, there’s the, the funding side of it as well. Yeah, [02:02:55] I think the passion is an important part of it. Right. But do you think there should be more coordination like [02:03:00] UK wide, wide. We should coordinate research.

Tara Renton: Should be much less barriers, much less [02:03:05] silos. Yeah. And much more collaboration. Yeah. And I think that’s something [02:03:10] that’s probably one of my other skills. I was never frightened to Praveen Anand, [02:03:15] who’s a is a fantastic, godlike neurologist at [02:03:20] Hammersmith Hospital. He led the whole research into nerve growth factor [02:03:25] in diabetic neuropathy. Mega brain. I wanted to as part of my PhD, [02:03:30] I wanted to use this equipment. It’s called medic and it basically is quantitative sensory testing. [02:03:35] So you have, um, hot and cold and you look at different fibre types A-delta C fibre [02:03:40] and how they react and pick up the different thresholds. Anyway, this really [02:03:45] expensive machinery and the rep was really lovely penny. And she said, oh well Prof Adnan’s [02:03:50] got that at Hammersmith Hospital. And I said, well you know, she said, oh I’m [02:03:55] sure, I’m sure he’d let you see the equipment. So there’s me [02:04:00] and I, you know, I’ve never been backwards and coming forward, I will front up and take a [02:04:05] challenge. Um, and I, you know, I remember going to his clinic and I honestly, it felt [02:04:10] like I was in hyperspace. There was him, there was a very bright Peter [02:04:15] neurophysiologist from Queen’s Square. There was Rolf Birch, really famous orthopaedic [02:04:20] surgeon who first talked about brachial plexus syndrome and pain after orthopaedic surgery. He [02:04:25] used to wear a Deerstalker and a pipe. I was in this clinic. It was like surreal. [02:04:30] And I really probably fundamentally understood less than 2% [02:04:35] of the conversation. It’s like dumb blonde, you know? And I just but it [02:04:40] didn’t stop me, you know? And he was brilliant. He let me he persuaded [02:04:45] the company to lend me a machine for one of my PhD chapters. That’s that’s how [02:04:50] to be is not afraid to if you’re that curious in something and you’ve [02:04:55] got the energy and the drive, things are going to happen.

Payman Langroudi: Oh, [02:05:00] it reminds me of one of my school friends. He’s become a world expert [02:05:05] at, uh, psychology.

Tara Renton: Oh, interesting.

Payman Langroudi: Fungus disease. [02:05:10] That he’s a doctor, but he’s become a real top guy in that. And he invited me to his professorial [02:05:15] lecture. And, um, honestly, slide two. [02:05:20] I was completely lost. Completely lost. And I thought I knew it. You know, I [02:05:25] thought I’d understand a few medical terms or.

Tara Renton: I’ve had so many.

Payman Langroudi: Experiences. Like I told [02:05:30] him. Slide two. I was I just couldn’t keep up. And he goes two. I [02:05:35] was like, and you know, when they’re in their own world, aren’t they for them? And there’s [02:05:40] other people in the room that they’re trying to impress or whatever they’re talking. He was talking so matter of fact [02:05:45] ish and I literally couldn’t keep up after slide two.

Tara Renton: And I’ll tell you the worst scenarios that you have [02:05:50] someone like that lecturing before you get up to lecture after them. Even worse. I felt like the village idiot [02:05:55] quite a few conferences. Like I’m obviously just there for the entertainment. I’m not really there for any kind of the [02:06:00] intellectual knowledge base.

Payman Langroudi: Place you’ve been.

Tara Renton: Oh golly, I’ve just been to the Andaman [02:06:05] Islands, which is very. The Andaman Islands are an archipelago [02:06:10] of islands, uh, east of India and west of Myanmar. [02:06:15] Oh, so they’re like. And if you follow the archipelago down, it becomes the Philippines. [02:06:20]

Payman Langroudi: Was it beautiful or Indonesia?

Tara Renton: Indonesia. Indonesia. Absolutely. Stunningly beautiful. [02:06:25] Impossibly difficult to get to.

Payman Langroudi: Yeah. How’d you get there?

Tara Renton: By boat. Hardly [02:06:30] any European. You do? By boat, by plane, by plane, by plane, by boat. Um, [02:06:35] but absolutely, absolutely beautiful. Um, [02:06:40] did a bit of diving, which I haven’t done for ages.

Payman Langroudi: Beautiful in the sort of the yellow sand, kind of beautiful. [02:06:45]

Tara Renton: Beautiful beach something. We lived in Australia for five years and I go back a lot. My kids have been based in Australia [02:06:50] on and off for eight years. So beautiful beaches, beautiful beaches, a beautiful beach. But [02:06:55] um, the you land there basically. Um, the north Andaman is [02:07:00] basically there’s over 300 islands and only um 23 are [02:07:05] inhabited and only three of the islands have tourists on. Oh, and when [02:07:10] you fly over it’s this dense tropical forest.

Payman Langroudi: Forest.

Tara Renton: And [02:07:15] most of these lovely islands you go to is like the Maldives. It’s like pretty flat. And they’ve got these beautiful [02:07:20] hills. But when you go and go into the forest, I’m not kidding you. It’s like something out of [02:07:25] Games of Thrones. These trees are like Norfolk pines [02:07:30] and thick trunks. Beautiful. They go up 20m [02:07:35] at least.

Payman Langroudi: So would you get on a boat and and go to these different islands? [02:07:40]

Tara Renton: You can you can visit different islands or you just stay on one of them. We were on Havelock Island. They’re [02:07:45] all named after old British officers. Um and um [02:07:50] I think they’re trying to change the names, but they haven’t got around to it yet.

Payman Langroudi: So they call the Andaman.

Tara Renton: Called the Andaman.

Payman Langroudi: Andaman [02:07:55] Islands.

Tara Renton: Andaman Islands. Yeah. So that’s probably and [02:08:00] it was on the back of going to one of Tony’s Tiger annual Tiger conference. So he’s involved [02:08:05] in tiger conservation. So it just combines all that lovely thing that he does, which is I’m [02:08:10] really proud of him that he does that. So that was a very, very special trip. Yeah. But [02:08:15] I mean I love Cornwall, so I spent my first few years in Cornwall. So probably [02:08:20] my favourite place on earth is Cool Sand beach.

Payman Langroudi: Oh, really?

Tara Renton: Yeah, that’s where my [02:08:25] ashes are going to be.

Payman Langroudi: Doesn’t feel like the rest of the UK, does it? It just feels like a different country.

Tara Renton: Where the people are [02:08:30] very different.

Payman Langroudi: People are different. It’s just different. Everything different. Different landscapes, different hilliness. [02:08:35] Yeah.

Tara Renton: I love it.

Payman Langroudi: There it is cool.

Tara Renton: The walks are great. The sea. Just [02:08:40] being in. I swim every day.

Payman Langroudi: Have you got a place there?

Tara Renton: My mum’s my mum’s house. Oh, your mum’s on the beach.

Payman Langroudi: Okay. [02:08:45]

Tara Renton: The pub’s five foot outside the front door.

Payman Langroudi: And.

Tara Renton: The back, back gate goes onto [02:08:50] the beach. I don’t think there’s a better place on earth. I love it there.

Payman Langroudi: Good food and stuff as well. [02:08:55]

Tara Renton: Uh, it can be, it can be variable. But yeah, no, generally pretty good food. Excellent. Yeah. [02:09:00]

Payman Langroudi: It’s been such a massive pleasure and a real privilege to have you. So thank you so much for coming [02:09:05] all the way.

Tara Renton: My pleasure.

Payman Langroudi: Really, really enjoyed that and learned so much from you. I don’t your [02:09:10] mindset particularly is just such a such a beautiful way of looking at things, you know, like curious, [02:09:15] positive, um, uh, I always thought that was a young person’s [02:09:20] outlook, but it’s lovely to see someone continuous to be continuing to be that [02:09:25] way, you know, post retiring from all of your jobs.

Tara Renton: I think the family would like me just to kick off [02:09:30] the shoes. It’s never going to happen.

Payman Langroudi: Thank you so much for doing this.

Tara Renton: My absolute pleasure. Payman. [02:09:35] Thank you for the invitation.

Payman Langroudi: Pleasure.

[VOICE]: This is Dental Leaders, [02:09:40] the podcast where you get to go one on one with emerging leaders [02:09:45] in dentistry. Your hosts Payman [02:09:50] Langroudi and Prav Solanki.

Prav Solanki: Thanks for listening guys. [02:09:55] If you got this far, you must have listened to the whole thing. And just a huge thank you both [02:10:00] from me and pay for actually sticking through and listening to what we’ve had to say and what our guest [02:10:05] has had to say, because I’m assuming you got some value out of it.

Payman Langroudi: If you did get some value out of it, [02:10:10] think about subscribing. And if you would share this with a friend who you think [02:10:15] might get some value out of it too. Thank you so, so, so much for listening. Thanks.

Prav Solanki: And don’t forget our six [02:10:20] star rating.