Payman Langroudi: Anterior composites are an area that a lot of us have trouble with, and the [00:00:05] magic that you get from a patient where you haven’t drilled their teeth and yet [00:00:10] you’ve improved their appearance, is something that you know. The more whitening you do, the more aligners [00:00:15] you do, the more anterior composites you’ll have to do. If you’re not 100% on them, [00:00:20] get yourself on a course like Mini Smile Makeover with Dipesh Parmar. Visit Mini Smile [00:00:25] makeover.com for dates and details.

[VOICE]: This [00:00:30] is Dental Leaders. The [00:00:35] podcast where you get to go one on one with emerging leaders [00:00:40] in dentistry. Your hosts [00:00:45] Payman Langroudi and Prav Solanki.

Payman Langroudi: It gives me [00:00:50] great pleasure to welcome Ian Dunn onto the podcast. Ian is a specialist periodontist [00:00:55] um taught at Liverpool You clan, I noticed [00:01:00] and also teach GDPs on as well with the um, perio [00:01:05] courses. That’s right. Um, massive pleasure to have you, my buddy. Thanks for coming. Finally. [00:01:10] It’s been.

Payman Langroudi: A pleasure. I know we’ve been talking about this for a very long time, haven’t we?

Payman Langroudi: Definitely.

Payman Langroudi: I remember getting the message from you about a [00:01:15] couple of weeks ago saying, where are we up to with this? And yeah, the last message before that was about nine months ago, I think. So [00:01:20] somehow we got lost in the aether, didn’t we?

Payman Langroudi: And you’re a Scouser? Born and bred.

Payman Langroudi: I am, yeah, for my [00:01:25] sins. Yeah.

Payman Langroudi: So what, the University of Liverpool as well?

Payman Langroudi: No. Uh, I [00:01:30] chose I went to Leeds. Yeah. Um, but then I ended up moving straight [00:01:35] back because my girlfriend at the time was also from Liverpool. Um, and she was [00:01:40] a solicitor, so she got her first legal job there and that dragged us, dragged me back to Liverpool [00:01:45] to sort of be with her.

Payman Langroudi: That’s your wife.

Payman Langroudi: Now. Yeah. And she is now my wife, so it was a good move. [00:01:50]

Payman Langroudi: Did you meet him in university?

Payman Langroudi: No, we actually met at home. Believe it or not, she was at university [00:01:55] in Manchester. Um, we met at home. We struck up a relationship. We made it work while [00:02:00] we were both away at uni, and, uh. Yeah, it’s. We’ve all lived happily ever after.

Payman Langroudi: So [00:02:05] which which student were you?

Payman Langroudi: Um, I [00:02:10] was probably I was a bit of a work hard, play hard type person.

Payman Langroudi: Oh.

Payman Langroudi: Yeah. [00:02:15] I was certainly successful humans. Yeah. I needed [00:02:20] to work hard. I don’t think I’m naturally gifted in terms of intelligence. I’m not stupid, [00:02:25] but I’m not super academic. Um, I don’t mind telling you, I reset [00:02:30] one of my A-levels because I dipped out initially and did an extra year to go, you know, get what I [00:02:35] wanted. I do think once I got to university, I did thrive because I’d found the thing [00:02:40] that I loved and I found studying much easier than I had found my A-levels.

Payman Langroudi: Really?

Payman Langroudi: Yeah, I really did. [00:02:45]

Payman Langroudi: That’s different. Yeah, people get shocked. I got shocked in university. Biochemistry and anatomy. [00:02:50] I broke my heart.

Payman Langroudi: Don’t get me wrong, the first year was a chore. But once I hit the clinical bit, I. [00:02:55]

Payman Langroudi: Love.

Payman Langroudi: That. I loved it, I absolutely loved it. Um, and so yeah, [00:03:00] but then in, in the background, I was a swimmer and water polo player. So I captained [00:03:05] the water polo team at the university. So that was a big part of my life. And also a big part of the social, [00:03:10] the social scene. Um, and I was the first person to put my hand up for a party or, you [00:03:15] know, so I really did. Yeah. University was just.

Payman Langroudi: Which one were you? What years were you in Leeds? [00:03:20]

Payman Langroudi: 93 to 98. It’s a really good time. Leeds was changing. It went from [00:03:25] a sort of a Yorkshire city town to what was quite a sort of booming, [00:03:30] more cosmopolitan city. Harvey Nicks came to Leeds at that time.

Payman Langroudi: I remember.

Payman Langroudi: Um [00:03:35] and it was great. It was a great time to be a student in Leeds, really was.

Payman Langroudi: I was there recently for a [00:03:40] okay. And it reminded me that back when we started enlightened, obviously, [00:03:45] I used to go see dentists and stuff, and I’d been to Leeds a few times and [00:03:50] I got almost like a weird sort of a flashback of [00:03:55] because it’s that pedestrianised zone, isn’t it? And I used to carry this light activated [00:04:00] machine. Teeth whitening, teeth whitening machine in Leeds. I [00:04:05] walked into a place. Do you remember those Polaroid cameras? Yeah, they were for Dental. They [00:04:10] were?

Payman Langroudi: Oh, yes, yeah, I.

Payman Langroudi: Do. Yeah. So I walked into this practice carrying this machine [00:04:15] and a computer and all that.

Payman Langroudi: And they were huge, weren’t they?

Payman Langroudi: And the camera around my neck. And I remember [00:04:20] I pushed the button by mistake and took a photo. I was like, I took a photo. [00:04:25] It’s a joke, man. Um, so did you think [00:04:30] that you made a decision to be very good at dentistry [00:04:35] in university or after that? Because obviously this decision came [00:04:40] in at one point when you said you want to do periodontics, but years later. Right?

Payman Langroudi: Yeah. But [00:04:45] I’d like to think that that was more of an accident, if I’m being truly honest. I see a lot of young graduates who [00:04:50] are very focussed and very driven. Um, I think we’re a similar vintage when you go back. I [00:04:55] qualified in 98, and that was the year that the high street specialist list was sort.

Payman Langroudi: Of coming out. [00:05:00]

Payman Langroudi: That was the that was the year it became on the scene. So prior to that, you either were a GDP or you [00:05:05] were a hospital specialist. There wasn’t really a blurred sort of high street specialist. There was 1 [00:05:10] or 2. There was your Mike Wiser’s. And in the North West we had people like David Cohen, the Endodontist [00:05:15] and Phil Green. But it really wasn’t a thing. Um, and so none of us really, [00:05:20] at that time thought about specialisation unless you knew you wanted a career in the hospital. So [00:05:25] I enjoyed my university and I didn’t want to be rubbish, but I don’t [00:05:30] think I set myself out to be anything special. Um.

Payman Langroudi: Why didn’t you, I mean, did you have [00:05:35] dentists or medics in the family?

Payman Langroudi: I’m the first person in my family to go to university. Really? So my dad [00:05:40] was a policeman. Uh, my mum worked for, of all things master suite company. Really? [00:05:45] So, uh, sort of the reverse of Willy Wonka. So the dentist, Dad [00:05:50] and the chocolatey taste son were the other way around.

Payman Langroudi: So why dentist? How did it come about?

Payman Langroudi: Yeah, [00:05:55] that’s another story. So I did maths, physics and chemistry, with maths [00:06:00] and physics being my strong subjects. Me too. Um. Pick my A-levels with a view to being an engineer. [00:06:05] And I remember going to a careers day at Liverpool University to decide [00:06:10] on whether I was going to do chemical, electrical, mechanical. And every lecture I [00:06:15] went into, I walked out going, yeah, it’s not that one. And then I go to the next one and walk out. It’s not [00:06:20] that one. And then I got to the end and I was like, oh God, I don’t know what I’m going to do. And genuinely, [00:06:25] there was a panic. Um, so I then went to a, [00:06:30] a careers evening at my school. Um, this is at lower [00:06:35] sixth and I’ve got to make a decision by the Christmas for my Ucca form, as we called [00:06:40] it back then. Yeah. And I really didn’t have a clue because engineering was written off for [00:06:45] me. It had not no one had shown me anything that ticked the boxes. And so I.

Payman Langroudi: Went. Maths [00:06:50] in engineering isn’t it? It’s like.

Payman Langroudi: Yeah.

Payman Langroudi: Very maths heavy.

Payman Langroudi: It, maths and physics. But it was what I was good at [00:06:55] and that’s why I thought that’s what I was going to do. Yeah. Um and then I picked the [00:07:00] most eclectic bunch of uh, careers to go and listen to. I went to the [00:07:05] RAF, I went to law, I went to something in sports science [00:07:10] and I went to dentistry and a guy called George Lee from Liverpool University. He was [00:07:15] a paediatric consultant. He just he said a few things that made me think, [00:07:20] do you know what that’s that sounds all right. He sort of. He sold the fact that there was a science element. He [00:07:25] sold the fact that, you know, every day is different. He sold the fact that if you [00:07:30] like, if you like people, dentistry is a great job. Um, I think too [00:07:35] many people go into dentistry who don’t like people, I think, I think, and they found that very stressful. [00:07:40] And I remember leaving that, that careers evening, uh, and a load of us bear [00:07:45] in mind, we were lower six. We all went to the pub that night and um, we were chatting [00:07:50] about, you know, what we’d seen, what we’d listened to and people saying, you know, what are you going to do? I said, you know what [00:07:55] I think? I think I might look into dentistry.

Payman Langroudi: And everyone was flabbergasted. People called [00:08:00] me a money grubbing, all sorts. And I actually genuinely didn’t know any dentists [00:08:05] apart from my own, um, didn’t know that there was that legacy, but just [00:08:10] thought it seemed like a good job. Um, my mum walked down to the bottom of [00:08:15] our road and knocked on the the practice door at the bottom and asked if I could [00:08:20] do some work experience. Uh, and I went and did some work experience with two dentists, Clive [00:08:25] Harden and Mike Horwich. So you’ll know from Simply Endo. Yeah, well, he was just a local GDP at [00:08:30] the time really. And I went and spent a couple of days with those guys and just thought, you know what? [00:08:35] That’s it. That to me seems like a really great job. Um, if, [00:08:40] if they’ve not gone to that lecture by George Lee, I’d probably be doing something totally different. [00:08:45]

Payman Langroudi: It’s so funny, isn’t it? The sliding door.

Payman Langroudi: It is.

Payman Langroudi: It kind of.

Payman Langroudi: Feels that way, to be honest. I’ve [00:08:50] got a few of those in my career, but that was definitely one of them. Dentistry was not on the table, not [00:08:55] in the family.

Payman Langroudi: Had you gone to a comprehensive school?

Payman Langroudi: It [00:09:00] was a state school, but it was essentially a state grammar school. A bit [00:09:05] a little bit different, but selective entry. But we didn’t it wasn’t private. We didn’t pay to go. Um, [00:09:10] very good school. We did. The school does very well still. Um, [00:09:15] but yeah, just a bit of a strange. It was far from a comprehensive, equally it wasn’t [00:09:20] privately funded.

Payman Langroudi: But what was going through your head, I mean, being the first person to go to university [00:09:25] in your family. Um, I’ve heard I’ve had other people sitting where you’re sitting telling me they had like a sort [00:09:30] of inferiority complex, thinking of coming from a state school. I suppose this one was quite a quality [00:09:35] state school. It was the you see, sometimes people go [00:09:40] to private school. The. The one big difference You see, it’s like almost false confidence. [00:09:45] Your kids or something.

Payman Langroudi: No, no that’s not that’s not reasonable. I think [00:09:50] you’re right. The school environment I was in was it ran like a grammar school. [00:09:55] There were prefects. There were uniforms all the way through. There were everyone was.

Payman Langroudi: Well behaved and.

Payman Langroudi: Generally. [00:10:00] Yes, you know, as much as possible. Schools have characters. Yeah. Um but there was [00:10:05] a, there was an academic, a real academic push. If you got [00:10:10] through to your A-levels, you were, you were sort of expected to go to university though. So I think I’d sort of [00:10:15] gone through the school thinking, well, if I pass my exams, well, I’ll go from GCSEs [00:10:20] to A-levels over passed my A-levels, I’ll go from A-levels to to university. That just seemed to be natural [00:10:25] progression. The fact that my family had never done that didn’t really mind. Um, [00:10:30] and I think the only difficult bit was really I remember my dad saying to me when I was trying to decide what [00:10:35] to do, I can’t really advise you on anything because we’ve never done it. Um, and he was always [00:10:40] very honest, But I’ve got to be, to be fair, both very supportive.

Payman Langroudi: So how high [00:10:45] had your dad gone in the police?

Payman Langroudi: He was a constable all the way through to retirement.

Payman Langroudi: So reflections [00:10:50] of like the son of a policeman. Like what? What.

Payman Langroudi: Um, I [00:10:55] I’ll tell you what, my wife’s father was also a policeman. He went very senior police officer. [00:11:00] Um, but we, my wife and I both, we’ve talked about this recently. We have a very [00:11:05] strong sense of right and wrong and fairness. And that comes from [00:11:10] a law and order background. Mhm. Um, never really thought about [00:11:15] it too much, but but growing up in Liverpool in the sort of 80s, I suppose [00:11:20] Toxteth.

Payman Langroudi: Riots.

Payman Langroudi: Toxteth riots in the 80s, my dad policed the Toxteth riots.

Payman Langroudi: Did he, did he.

Payman Langroudi: Um, [00:11:25] and there was a little bit of animosity towards children of policemen amongst [00:11:30] certain people. Even though we were in a fairly middle class school, there were still some people who gave you [00:11:35] a bit of a difficult time about that. Um, deep down I was quite proud of what my dad did. It was, [00:11:40] you know, it was one of those jobs. You could say, well, it’s a right and wrong. Catching the bad guys type thing. [00:11:45] Um, but yeah, it was there were challenges, there’s no doubt about it. A few people made things a bit [00:11:50] difficult at the time.

Payman Langroudi: So you say you’ve got this sort of ethical dimension in your thinking.

Payman Langroudi: I’d [00:11:55] like to think so.

Payman Langroudi: Give me an example. I [00:12:00] mean, a nuanced one, right? Not, not an obvious one. For instance, let’s start. Let’s start [00:12:05] with, you know, what is it to be a professional? You know, in dentistry, there’s plenty of scope, isn’t there, to, [00:12:10] to go off, off piste or, you know, no one’s really [00:12:15] looking over your shoulder. No. So.

Payman Langroudi: Well, do you know you’ve already nailed it there. I’ve [00:12:20] seen this recently and I’ve, I completely agree. Being a professional is doing the right thing [00:12:25] when no one else is watching. And even when that thing that you’re doing may not be to your benefit, [00:12:30] it might be to your financial detriment, but it’s the right thing to do at the time for that [00:12:35] patient that is part of a professional approach to a clinician. [00:12:40] Um, I think there’s also elements of just general behaviour. You know, I think the way you live your [00:12:45] life, the, the way you publicise yourself to the public, [00:12:50] you know, that that upholds hopefully trust in the profession. Um, [00:12:55] and I think there’s elements of that that is being diluted. Um, uh, social media [00:13:00] does that, doesn’t it? I think people.

Payman Langroudi: Are we talking, are you thinking of, uh, private jets [00:13:05] and um, that, that whole.

Payman Langroudi: Not even just that I mean, that reinforces the stereotype [00:13:10] that dentistry is all about finance and money. And whilst for some people, I think it is, I [00:13:15] spend a lot of time, I have a lot of people come and shadow me in the practice, a lot of um, foundation dentists, a lot [00:13:20] of people who are thinking of getting into perio, so many good people in dentistry who really [00:13:25] are just in it for the patient and just want to do the right thing, that I’d love that [00:13:30] to be seen more by the public. And I don’t think it is because we’re in a world of who shouts [00:13:35] the loudest gets the most attention. Um, and I do think that to [00:13:40] a point waters down professional the profession, whether whether we say professionalism. [00:13:45] But I think deep down it’s putting the patient first, doing the right thing. [00:13:50] Um, even like, even like when you said no one’s really over your shoulder at [00:13:55] some point, those things when you’re doing the wrong thing and they’re going to come back and bite you.

Payman Langroudi: Yeah. Or not. Right. [00:14:00] But as you say, as you say, the one of the cornerstones of being a professional is that [00:14:05] I mean, it’s interesting because, you know, there’s, there are benefits to being a professional. [00:14:10] Yeah. Take it down to simple, you know, why, why do they patients come to you [00:14:15] to sign off their passports? Yeah. There’s a, there’s a, there’s an ethical dimension there. They’re not saying, go [00:14:20] to the pizza guy and sign your passport. And so with those benefits come responsibilities. [00:14:25] And I think the number one one in dentistry is that question of trust and [00:14:30] the privilege of the patient privilege of, of patient allowing you to be their [00:14:35] dentist and taking that seriously. Right. And you’re right, that conversation may not be had [00:14:40] enough on social. I think you mean social social. [00:14:45] Focusing on the wrong things.

Payman Langroudi: I think it is. I think you know that that doing [00:14:50] the right thing for the patient is probably not talked about. It’s not celebrated enough. [00:14:55] I think plenty of people do it.

Payman Langroudi: Um Kelleher and the daughter test [00:15:00] kind of thing was in our day was was a thing wasn’t it?

Payman Langroudi: I think so. And I think [00:15:05] I do think those tests still apply. Um, I genuinely [00:15:10] think, I like to think every night when I go to bed, every patient that see me that day is [00:15:15] better off for having seen me for sure. Genuinely clinically better off. Yes, they’ve [00:15:20] paid and they’ll pay, you know, handsomely for specialist care. But, you know, it’s rare that [00:15:25] we’re doing stuff to people that they don’t benefit from. And there isn’t ultimately an underlying [00:15:30] negative to what we’ve just done. I mean, we all have mistakes. And yeah, I’m sure you might cover those [00:15:35] later on.

Payman Langroudi: We’ll be going into those.

Payman Langroudi: But yeah, I think generally I like to, you know, I put my head [00:15:40] on the pillow and think, you know what? Today I’ve helped people, uh, people are better off and haven’t been under my [00:15:45] care. And that’s quite a nice feeling. I don’t ever sit there thinking, oh, that was [00:15:50] a bit dodgy or give them a time again. I wouldn’t do that again. You know, I lie with my head on the pillow [00:15:55] because I’ve got a family and I’m happy to tell patients, no, that I won’t do stuff. You [00:16:00] know, what people want. And what I’m prepared to do is a fine balance. You know, I’ll always do what’s right. And I’ll always try and save [00:16:05] people from themselves, um, and guide them as best possible. Uh, and I [00:16:10] think.

Payman Langroudi: But that’s kind of interesting as well, right? Because, you know, the daughter test, would [00:16:15] you do this treatment on your own daughter? Yeah, yeah. It kind of ignores the consent [00:16:20] part of, of it because, you know, it’s almost like your daughter will do what she’s told by [00:16:25] you. Yeah, yeah. And it depends, man. It depends if your daughter is, uh, whatever [00:16:30] model. And she wants to drill these teeth to put [00:16:35] veneers on them, even though she’s 24. Yeah. You, as the dentist may say, I don’t [00:16:40] think that’s the right idea, but the consent point goes to once [00:16:45] you’ve given the the information to her. Yeah, it’s her decision, not [00:16:50] yours. And you know, that sort of patriarchal thing that that doctors and dentists used to know best. Yeah. [00:16:55] That’s certainly not the case anymore. Right.

Payman Langroudi: I think that’s fair as long as the consent [00:17:00] is valid. Yeah. Because we all know you use the word trust [00:17:05] before. I think we all know that you could probably sell any treatment to any patient, whether [00:17:10] it be the right or the wrong treatment, because there is that trust and you can make anything sound good, bad or indifferent. [00:17:15] Yeah. So I think it goes back to validity. Have you really given the pros and the cons and [00:17:20] and that I’m not convinced is done across the board as well as it could be. And I think ultimately, [00:17:25] at the end of the day, we can reserve the right to say to the patient, look, you can have this done, but [00:17:30] I’m not going to be the person who does it. And we do that with our patients. We especially with some of our implant [00:17:35] patients, we. One of the practice policies and people don’t always agree with this is we say to [00:17:40] patients, we don’t put implants into smokers because we get increased failures, increased call [00:17:45] out increased complications. And we we stress you can have implants. Smoking [00:17:50] does not contraindicate you, but we don’t want to accept the additional risk. And we’d ask that you seek a [00:17:55] second opinion or you stop smoking, and then we’ll open up the floodgates [00:18:00] and we’ll do the very best for you. So I think you can still apply the door to test. [00:18:05] And the patient could still choose to have the treatment that you don’t think is right. I think we still reserve [00:18:10] the right not to do it and not have the attitude, well, if someone’s going to do it, I might as well do it. I still [00:18:15] I still like to think that if I don’t think it’s right, I’m actually not going to do it. And I’m [00:18:20] lucky that my chair is always going to be full. In the north west of England. There’s so few periodontists. [00:18:25] Um. I’m drowning in work. I can afford to say to people [00:18:30] this is not a case for me. Um. And walk away from it.

Payman Langroudi: Although when [00:18:35] we think back to that professional discussion, you know, I hear you, I hear you. You’re [00:18:40] saying the motivation isn’t even there. Um, but if you’re a professional, then you’re [00:18:45] not going to do that wrong thing anyway. But but but let’s, let’s move on.

Payman Langroudi: No [00:18:50] it’s.

Payman Langroudi: Good. Tell me, how many years did you practice as a generalist? [00:18:55]

Payman Langroudi: I did about seven years as an NHS GDP. [00:19:00] Um, in that time I had started [00:19:05] teaching a day a week at Liverpool. Initially, I just got [00:19:10] a job in the sort of A&E department sort of doing any old. I just wanted to be around the [00:19:15] academic institution really and get involved. So that wasn’t actually a teaching role. And [00:19:20] then the job came up. Um, and I didn’t want to be a periodontist, I. I [00:19:25] got this.

Payman Langroudi: Off the most sexy sounding.

Payman Langroudi: But true story this. I was on the clinic. [00:19:30] Um, I was, I was consenting somebody for an extraction on the A.D department [00:19:35] and a lady came in lady called Eileen Thiel. Uh, I had never met this lady before. [00:19:40] And she walked in and she said to me, are you Ian Dunn? And I said, yes. And she said, come upstairs and [00:19:45] see me. I need to speak to you. And when she walked out, I said to my nurse, who’s that? And they said, oh, [00:19:50] Eileen Thiel, what have you done wrong? Because she had this reputation for, you know, she was one of gay [00:19:55] people, a bit of a rollicking. Um, anyway, went upstairs, spoke to her and she said, oh, you know, your name [00:20:00] has been put forward as someone who’s a good guy. Keen. Um, we’ve got an opportunity for teaching. [00:20:05] And I thought, fantastic, let’s hope it’s something sexy like endo or crown and bridge [00:20:10] or um, and she said, it’s perio. And I thought, oh God. Right. Okay. And, [00:20:15] but I thought, right, I mean, because I needed to get off the ground floor at Liverpool ground floor was like the, [00:20:20] the workhorse department upstairs was teaching. I thought, just get upstairs, get this job. [00:20:25] They’ll realise I’m a good guy. They’ll give me one of the more sexy jobs. Let’s just take the job. Take the job. [00:20:30] And and that. That was the beginning of my career. Uh, there’s [00:20:35] more to that.

Payman Langroudi: But that opportunity was there, so it wasn’t initially a period job. But you asked [00:20:40] about general dentist about 7 to 8 years as a GDP Udas [00:20:45] were coming, and I wasn’t a high grossing dentist at all. Um, [00:20:50] there’s probably a story behind that, I suppose, but it wasn’t particularly high grossing dentist. Um, and [00:20:55] so I moved towards the private sector and ran [00:21:00] that alongside my one day a week. Uh, but, but I was building perio interest. I was [00:21:05] actually focusing my postgrad on perio at this point. Um, but I was very much a general dentist probably, [00:21:10] well, 2008, ten years, at least ten years doing [00:21:15] a significant chunk of general dentistry, which is, I think, again, very different [00:21:20] to modern young specialists. Uh, you know, I do think [00:21:25] one of the things that comes across when I lecture is I’ve walked a mile in most people’s shoes. [00:21:30] Um, I have done NHS, I have worked in fairly grotty, [00:21:35] you know, fully exempt type practices. I’ve done the whole shebang. [00:21:40] Um, and I think when I then teach, I’m not coming from that ivory [00:21:45] tower, sort of never seen it, never done it. Uh, and I, and I’m told that [00:21:50] comes across so, but yeah, a long time as a GDP and I’ve never lost those GDP skills. I’ve got [00:21:55] about 40 patients who followed me over the years. As far as they’re concerned, I’m their general dentist. [00:22:00] Still see them.

Payman Langroudi: And do you still teach in the hospital?

Payman Langroudi: No, I left in 2018.

Payman Langroudi: So [00:22:05] my question is, if in 2018 you were teaching and you saw a fourth [00:22:10] year student who was taking a particular interest in perio, and [00:22:15] they said, look, Ian, a love perio, Would your advice be still, [00:22:20] go out and do general first before focusing [00:22:25] in.

Payman Langroudi: Yeah, not not even just perio. I my view is that [00:22:30] for you to be an all rounded specialist within the restorative specialities, I [00:22:35] think you’ve got to have a broad overview of how.

Payman Langroudi: Would you not get that in perio training. [00:22:40] Do they not. So I mean there must be like restorative training in period training. Right.

Payman Langroudi: They [00:22:45] do. I mean I’ve never done that mono speciality training route. And mine was a bit back to front [00:22:50] and made up as we go along a little bit. Um and I do think they, [00:22:55] you know, I listened to a couple of your podcasts, listen to Payman Minhaj. He was a Liverpool graduate from [00:23:00] when I was there.

Payman Langroudi: Oh, you know her.

Payman Langroudi: Yeah I do.

Payman Langroudi: Oh, she mentioned you.

Payman Langroudi: She’s she’s going to go on and do great things. [00:23:05] Uh, she.

Payman Langroudi: Loves gums, man.

Payman Langroudi: We all love gums.

Payman Langroudi: Periodontists do love your job. [00:23:10]

Payman Langroudi: It’s a disease of its own that we love it that much. Um, but [00:23:15] yeah, she talked about working with the people and she, you know, and I think that’s [00:23:20] there. But working in a busy general practice environment, the diagnostic skills [00:23:25] that you get from seeing the aches, the pains, the toothaches, the decision making that [00:23:30] I still use that every single day. Um, and, and I’m [00:23:35] not convinced it’s as hard wired if you’ve just done the very pure mono [00:23:40] spec programs. Don’t get me wrong, it can be everything can be learned, everything can be developed, but I do. I [00:23:45] would love to see people go into speciality training just that little bit later. It’s all [00:23:50] a bit.

Payman Langroudi: It’s kind of the British way of looking at it though. Like our friends across the pond, they kind [00:23:55] of go very quickly sometimes into specialist training. And do you see that as like maybe [00:24:00] potential blind spots that they’re getting into?

Payman Langroudi: I think I go back [00:24:05] to having walked a mile in someone’s shoes.

Payman Langroudi: And referrers.

Payman Langroudi: Shoes Referrers.

Payman Langroudi: Teaching, [00:24:10] I get.

Payman Langroudi: It’s understanding the difficulties that you refer as a facing. It’s [00:24:15] understanding that they often. Especially if you’re working in NHS practices, you’re [00:24:20] often having to work within the compromise that the systems puts on you. And actually having been there [00:24:25] and done it, you understand it, and you probably just a little bit more forgiving and tolerant [00:24:30] of what you see when other people may not be quite as, as, uh, open [00:24:35] minded about it. You know, I think if you go through that only having done everything perfect forever, [00:24:40] then it becomes a bit, well, there’s only one way to do things and that’s the right way and perfection. [00:24:45]

Payman Langroudi: Um, so you made the decision once you’d gotten a bit more exposed to, [00:24:50] you know, you’re going to, I guess, sacrifice to get [00:24:55] the training. Yeah. I mean, what was, what was your period training in the end?

Payman Langroudi: So [00:25:00] the Liverpool job was purely floor walking supervised and general dentistry. [00:25:05] Uh, the students on the perio clinic. Yeah. But I, I [00:25:10] went away because So because I had got this period job, [00:25:15] I was four years qualified. I’d done loads of courses, I’d done everything occlusion, I’d [00:25:20] done endo, I’d done crown and bridge. Had I done any perio? No, because we had a hygienist [00:25:25] and they did that and that, you know, that was NHS, that was our practice. And so [00:25:30] I thought, God, I better do some proper, I better get up to speed if I’m going to be on the clinics. And [00:25:35] so I went on a course and we can talk about that later, um, [00:25:40] to get myself up to speed. And then what I found was because I was around perio and I was teaching [00:25:45] it just only basic, you know, non-surgical therapy on the clinic. [00:25:50] And because I’d been on this course, it was a four day course. And then I’d then gone back into my [00:25:55] own practice and I was just thinking about Peri a bit more. I was then starting to get better results. [00:26:00] People in my practice were starting in the NHS saying, we’ve seen some of your patients, [00:26:05] you’re getting really good outcomes. Can we send you some of our patients? And this was this [00:26:10] was, you know, this was just brilliant because people were starting to realise I was a bit bit better than others [00:26:15] at that. Some this one, this one thing. And I just thought, you know what, in going [00:26:20] back to the northwest in back, back in the early 2000, [00:26:25] we had one periodontist in the north west of England, Philip Green in Manchester. [00:26:30]

Payman Langroudi: It’s crazy isn’t it. Wasn’t that long ago.

Payman Langroudi: Mental. Um and he had a fabulous [00:26:35] reputation. He was very helpful once I put my head above the radar. Um and, [00:26:40] but Philip was the only guy. Um and Scousers don’t like going to Manchester, [00:26:45] so they, you know, they didn’t want to be referred. And I just, I saw it as, do you know what, I [00:26:50] like this and I’m good at it. And there’s an opportunity here. I then became a complete nuisance [00:26:55] to the perio staff at the hospital. I just spent every spare minute, you [00:27:00] know. Can I have my lunch with you? Can I talk to you about this? Can I watch a case that you’re doing? And [00:27:05] then again, another one of those sliding door moments. Uh, Callum Johnson moved from Leeds to Liverpool [00:27:10] as head of restorative, and he basically got rid of the mono spec [00:27:15] clinics because everything was taught individually, period, pros, cons and he [00:27:20] made everything restorative. So all the GDPs who were teaching perio were [00:27:25] moved to restorative. And Eileen Thiel, the lady I mentioned before, she [00:27:30] said, I want to keep one general dentist, uh, in the perio team. We need one extra body. [00:27:35] And so she approached me and said, look, you, you’re clearly into this. Now, [00:27:40] do you want to come on part of the team? So it’s like, great. So now now I’m starting to do actual lectures [00:27:45] and I’m running tutorials.

Payman Langroudi: But still part time, right? Still part time, still [00:27:50] GDP.

Payman Langroudi: Gdp. Well, yeah, I haven’t even started my master’s at this point. Um, [00:27:55] but they sort of spoon fed me, they gave me some very basic stuff, [00:28:00] some very, they gave me presentations to learn and deliver. Um, and then [00:28:05] ultimately, slowly but surely made those things my own. Um, but again, goes [00:28:10] back to what we were talking about before the podcast about being in the right place at the right time. But then what was coming was [00:28:15] that there were basically two people in that Perry department, plus me, and one of them was heading to retirement, [00:28:20] and they needed someone to be able to do some of the perio [00:28:25] surgery in the hospital. So because I was part of the team, they then trained [00:28:30] me up in the hospital to do perio surgery. And it was literally I would nurse for one of [00:28:35] the periodontists and watch a procedure. And then the second the next procedure that same morning, [00:28:40] they’d nurse and I’d do the procedure. It was like, see one, do one, teach one almost. [00:28:45] Um, and we, we did that 2 or 3 weeks on the road, the same procedure, [00:28:50] the same type of treatment. And then they’d let me loose to go and do that basic [00:28:55] type of treatment. And once my hands were working better, they then say, right, you’re now ready to do some sort [00:29:00] of soft tissue grafting and we’ll show you that. And we did the.

Payman Langroudi: So the type of surgery you were doing [00:29:05] back then. I remember you kind of. If non-surgical wasn’t [00:29:10] working, then you’d say, oh, now let’s do it surgically. As far as Débridement and all of [00:29:15] that, that was the kind of work. Yeah.

Payman Langroudi: Basic sort of pocket reduction type surgery. [00:29:20] You know, old school, modified widman flap type stuff that, you know. But yeah, simple, relatively [00:29:25] simple, but very effective at the time, you know, treatment.

Payman Langroudi: But fast forward is that [00:29:30] today no longer.

Payman Langroudi: Yeah, we still I think we do a lot less surgery than we did probably 20 years ago. [00:29:35]

Payman Langroudi: Well, so what’s changed our understanding of like the patients we.

Payman Langroudi: Know how well non-surgical [00:29:40] therapy works. I think we also understand our clinical end points a bit [00:29:45] better that, you know, we used to be sort of terrified of leaving a pocket over three millimetres, [00:29:50] four millimetres. And now, you know, the BSP has come out with statements that pockets over, [00:29:55] you know, five, even maybe six millimetres that don’t bleed may not be active. And we [00:30:00] can, you know, actively monitor those cases. I think also when we do do surgery, we [00:30:05] probably do a bit more regenerative stuff. We’re trying to build build back rather than just resect. [00:30:10] So I think the surgery’s moved forwards and I think we’re also a lot less it’s a lot less [00:30:15] surgically aggressive.

Payman Langroudi: So it’s more minimally invasive.

Payman Langroudi: I’d like to think so.

Payman Langroudi: And you’re working more towards reattachment. [00:30:20] Is that right?

Payman Langroudi: Reattachment. And where we can rebuilding of the periodontal apparatus, [00:30:25] the the bone, the periodontal ligament with the regenerative techniques. But that’s there are limitations [00:30:30] with that. Um, but, but that’s developing all the time. It’s exciting where that [00:30:35] can go. But that was my hospital background. I was essentially then working as a staff grade, uh, [00:30:40] one day a week and I was still in NHS GDP, but it was off the [00:30:45] back of that, that I then realised I, I could do it, but I didn’t actually know the literature. [00:30:50] I didn’t know why I was doing the stuff sometimes. And that’s when I went off and thought, [00:30:55] right, I need to go and do a master’s now. And, and that’s, that’s what I did. And so my.

Payman Langroudi: Time.

Payman Langroudi: Yeah, part [00:31:00] time.

Payman Langroudi: For four year.

Payman Langroudi: For three years with it wasn’t the full sort of [00:31:05] M Clin dent down here. I went up to. Yeah, yeah. Because I was, I was I had the clinical [00:31:10] components. I was doing that sort of over the shoulder stuff for about four years or [00:31:15] more really. Um, and eventually running my own list in the hospital being referred [00:31:20] stuff from the consultants, the sort of the prosthodontists and the endodontists to do surgical [00:31:25] perio. Um, and so I had all of that sort of over the [00:31:30] shoulder hospital training, but I just needed the academic component to fill in the gaps. And that even [00:31:35] that was for my own benefit really, because I was doing the job and I was good at it, but [00:31:40] I just felt the need to almost validate myself academically and just.

Payman Langroudi: And so was it worth it [00:31:45] in terms of do you think it was it was just an itch you had to scratch or did you actually learn [00:31:50] a lot?

Payman Langroudi: Um, I just I loved every minute of it. Did [00:31:55] you. Yeah, I was.

Payman Langroudi: Just deep dive into it.

Payman Langroudi: I decided that I love Perrier [00:32:00] and just.

Payman Langroudi: Wanted as much as.

Payman Langroudi: Possible. So it was like, tell me as much as you can. Tell me. Tell me why we [00:32:05] know this and tell me, tell me about all the classic studies and tell, you know, we I was lucky at the [00:32:10] time to be taught by um, Jose Zurdo and Cristina Romano, husband and wife team from based [00:32:15] up in the Midlands at the Carisbrook. Um, and they were, they’d been trained in Gothenburg by Jan [00:32:20] Lindhe and all like the perio gods. So I just loved every minute of spending time [00:32:25] in their company. They’re still good friends. Um, I was going back to the university [00:32:30] with all this new knowledge and annoying the periodontist there with just my enthusiasm. [00:32:35] Um, but yeah, I got, I got loads out of it. Did it make me better?

Payman Langroudi: I mean, [00:32:40] which aspect of perio at that point turned you on because you couldn’t go deep [00:32:45] into the whole autoimmune cellular level? No perio. Or you can obviously [00:32:50] go into the surgical side. You can go.

Payman Langroudi: Let’s be honest, as a youngster, you just love to do surgery, don’t [00:32:55] you? You just.

Payman Langroudi: Oh, is that it?

Payman Langroudi: You know, it was that sort of, I can do something that other people can’t do and [00:33:00] I can I can take something. You know, it. You felt different. You there was an element of [00:33:05] this is exciting. You know, surgery is exciting. I think one of the one of the running jokes, often [00:33:10] in specialist training is they can teach you surgery in three months, but it then takes three years to teach you when [00:33:15] not to do it. Um, and that’s one of the things as you, as personally as I think, [00:33:20] as we get older and more experienced, I’m less surgically aggressive than I used to [00:33:25] be. Um, just again, comes with experience and it comes from complications. [00:33:30] It comes from all sorts.

Payman Langroudi: And much less predictable than hard tissue work, [00:33:35] isn’t it? I mean, in so much, as you know, you put the gum back on that day, it looks [00:33:40] completely wrong. And then you have to sort of do it correctly so it matures into [00:33:45] the correct situation.

Payman Langroudi: I think that’s very fair. And I think you [00:33:50] ask any of the implant guys who, you know, drill holes in bone, they once [00:33:55] they’ve got that skill, they. They know that’s not the skill. It’s the manipulation. Manipulation of the soft [00:34:00] tissues, the making, the making the implant look like a tooth. And not just a not just a [00:34:05] screw in bone. Um, and you look at, you know, the guys who [00:34:10] are very, very good at their implant and their soft, their plastic surgery [00:34:15] is, is as good as anyone in the country, if not the world. Um, so yeah, it’s soft tissue [00:34:20] is very, everything heals eventually, but it can also be very unforgiving. And you know, [00:34:25] when you, when you cut something hard, like a tooth or bone tends to do as it’s told. Yeah. [00:34:30] And soft tissue, you’ve got to really know how to handle Palmer.

Payman Langroudi: Yeah. He, he’s now going [00:34:35] quite deep into plastic surgery. And he was telling me that the rate of improvement [00:34:40] is so much slower than composite. Yeah. Because it’s so unpredictable. [00:34:45] It is, it is.

Payman Langroudi: It’s interesting that he’s going into that. I always say deep down everyone loves [00:34:50] Perrier. They just don’t know it yet. It’s a sign of maturity when you realise that perio is everything. [00:34:55] But, um. So tell him. Well done. It’s not too late.

Payman Langroudi: Yeah, I know, [00:35:00] he’s super interested in it. He’s even got a periodontist. Well, someone with a special interest work in the practice, but. [00:35:05] So I said to her, why are you bothering with this guy? Could do it. And he said, it’s just super interesting. Yeah.

Payman Langroudi: But then do [00:35:10] you know what? That it doesn’t matter what. When you find something you love, you [00:35:15] just want to dive into it as much as you can, don’t you? And I see that with, you know, I work with a couple of really good endo nerds [00:35:20] and, and they’re brilliant and they, they just love every aspect. I couldn’t wait to stop doing [00:35:25] endo.

Payman Langroudi: But do you think my thesis is wrong? You must have heard my. I’ve said it so many times. The notion of you [00:35:30] love whatever you’re good at.

Payman Langroudi: Yeah.

Payman Langroudi: I don’t really. There isn’t. There [00:35:35] isn’t a thing in your brain that makes you more loving of gums than endo. [00:35:40]

Payman Langroudi: I think there’s. Oh, well. But then I would also say, I would argue that different [00:35:45] personalities are going to be good at different things, because perio has a huge chunk of psychology [00:35:50] and, and patient behaviour and communication, whereas [00:35:55] endo rubber dam on don’t speak to me just, you know, no disrespect to my endo friends [00:36:00] by the way. That’s true. But you know, it’s it’s a bit more, although when I say surgical, [00:36:05] it’s a bit more, I’m going to do this to you and it’s going to be fine perio, [00:36:10] the psychology and the behaviour of the patients and that that winning [00:36:15] them round and getting them on board, that is something I love that I don’t know that I’d get from [00:36:20] Endo. So I think there’s.

Payman Langroudi: More to it than that question, she said. By the time they get to me, behaviour [00:36:25] change has already been sorted. Is that not correct?

Payman Langroudi: We get a self-selecting [00:36:30] group of patients, but then we also get a group of patients who, um, [00:36:35] think they can throw money at a problem and don’t have to change their behaviour. Yeah. I mean, I’ve [00:36:40] treated people who high up in the Sunday Times rich list who just think they can just throw money [00:36:45] at me and make I’ll make everything go away. But their lifestyle is chaos. Mhm. Um. [00:36:50] It’s, you know, there is a huge amount of psychology and kid [00:36:55] ology, but you are right. We have as a, as a specialist, you, you’re, [00:37:00] you’re consult fee and even just travelling to see someone is a, is a [00:37:05] barrier. And so when a patient chooses to go over that obstacle, [00:37:10] you’ve already got a self-selecting patient. You’re already halfway there. So I don’t think that’s unreasonable. [00:37:15]

Payman Langroudi: And some periodontists then kind of move very seamlessly into [00:37:20] implants. You’re one of them, right?

Payman Langroudi: No, not oh well, I did, I dabbled. [00:37:25]

Payman Langroudi: Oh you didn’t really.

Payman Langroudi: Did not love it. Oh, really didn’t excite me as much as the perio excited [00:37:30] me. Um, why do you know? I don’t know, because the surgery [00:37:35] is is not dissimilar. Yeah. Um, I, I honestly, um, [00:37:40] Payman I can’t can’t put my finger on it, but I didn’t love it. I didn’t hate [00:37:45] it. Uh, but I did have to make a decision because again, and this has come up on a few [00:37:50] of the podcasts I’ve listened to of yours, you do have to go all in with that stuff. Yeah. The days [00:37:55] of dabbling in implants have gone, you know, placing a.

Payman Langroudi: Massive field now, [00:38:00] isn’t.

Payman Langroudi: It huge? It’s a speciality on its own. And everyone accepts that, even though it’s not a specialist list thing. Um, [00:38:05] we all know who the people who are fully invested in it are. Um, [00:38:10] and for me, there was a decision. Do I go all in and, or do I not? And [00:38:15] I worked in a, I work still in a practice now with a guy called Paul Swanson who big [00:38:20] implant placer. He was part of the FDP diploma and he just did it better than [00:38:25] me. They were. When I restored his implants, they restored them my own. My [00:38:30] hourly rate would drop when I did implant work because it wasn’t something I was doing all [00:38:35] the time. And my rate.

Payman Langroudi: Was. Is there something about, uh, the disposition [00:38:40] of an implant surgeon is more like an orthopaedic surgeon. Sort of. Get [00:38:45] in there. And the disposition of a surgeon is more like what? Like a vascular [00:38:50] surgeon. Like, what would you say?

Payman Langroudi: I think you know what I’m. I’m going to annoy [00:38:55] lots of my my my implant colleagues and friends because a lot of them are very plastic aware. [00:39:00] Um, but there is I mean, Paul wouldn’t wouldn’t criticise me for [00:39:05] saying it. Paul Swanson is all about the surgery, loves it, loves the the, the [00:39:10] stress that goes with it, the complex, the complexity of the cases and is happy to have [00:39:15] all of the restorative work done by somebody else. And and he’s, he’s in doing bits of plastics, [00:39:20] but other stuff he’ll send to me to do. Um, but [00:39:25] I think there is, there is definitely a cohort of almost orthopaedic style implant guys [00:39:30] with perio plastic skills without any shadow of a doubt.

Payman Langroudi: I mean, still not many women going [00:39:35] into Implantology.

Payman Langroudi: No, I do, I think the a D are doing well on that though. I think they [00:39:40] really are pushing it. You look at a few people over the last few years that we’ve had female ID presidents [00:39:45] and and I think they are very conscious of that and looking to support women [00:39:50] in Implantology. Again, that you ask yourself, why is it a testosterone [00:39:55] thing where it’s very male driven? Is it that because of that all or nothing nature [00:40:00] and family commitments, that it’s not something that people go into? I don’t know, but certainly [00:40:05] in the northwest we’ve got some very, very good. Shahzad Jeffreys, a superb Implantologist [00:40:10] who works in the northwest. She was mentored by Paul in our practice.

Payman Langroudi: I come across much more nowadays, [00:40:15] but still it’s it’s interesting.

Payman Langroudi: It’s a male dominated, male dominated. [00:40:20]

Payman Langroudi: Whereas Peri, I don’t think is or.

Payman Langroudi: No, I don’t think. I think historically dentistry was probably [00:40:25] male dominated, but that those days have been long gone. Yeah. Um and I think perio [00:40:30] probably yeah, we definitely, I can think about the, the cohort that’s just graduated from [00:40:35] King’s, I think in, in fact, I think they were all female. I think I may [00:40:40] be wrong in that, so I apologise if I’ve ostracised somebody. But yeah, the very [00:40:45] female heavy cohort. So, um.

Payman Langroudi: Let’s get to you a bit of [00:40:50] Peru.

Payman Langroudi: Okay.

Payman Langroudi: I know we were talking about, but but clinically I stopped practising years [00:40:55] ago, 2012, and I stopped learning about perio after [00:41:00] my house job. So years ago, what’s changed? I mean, the you [00:41:05] said you alluded to the more minimally invasive approach. Um, people [00:41:10] talk about things like laser perio, bony infill that [00:41:15] we used to think that was impossible before. Is it still a little, um, what’s, what’s, [00:41:20] what’s, what’s new other than classifications? Because you guys.

Payman Langroudi: We’re going to change [00:41:25] that next.

Payman Langroudi: Week. Like you guys like changing classification.

Payman Langroudi: Because we need something new. [00:41:30] Yeah. Um what’s changed. Um.

Payman Langroudi: I mean, you know, the mouth body connection [00:41:35] thing were you, are you guys fully onto that? Yeah. Because because it’s not taught very well in undergrad. [00:41:40]

Payman Langroudi: I think we’ve been on that for at least probably 20 years.

Payman Langroudi: But it’s not really taught very well in undergrad, is [00:41:45] it? In undergrad, you’ve got this patient in front of you who’s got gum disease. You don’t you got to take a medical history. [00:41:50] If there’s diabetes in there, you kind of think, well, maybe that’s affecting. It is affecting [00:41:55] things, but not really making a connection in undergrad. So in [00:42:00] postgrad.

Payman Langroudi: I think it’s I think it’s the awareness is significantly better, I think. You know, we’ve got so many [00:42:05] consensus groups where you’ve got organisations like the BSP or the EFP [00:42:10] working with endocrinology and cardiology and producing consensus reports. I think I think [00:42:15] it’s better. And that will filter down much better than it did when you and I were at university, because it wasn’t really [00:42:20] a thing then. It was. And you know, it’s a cheesy sentence, [00:42:25] isn’t it? But for too long, dentistry and the mouth has been outside of medicine, [00:42:30] outside of the body. And it’s mental to think that they’re not connected. Um, [00:42:35] and we’ve, you know, we’ve known since you and I were undergrads about the diabetes link, but we’ve now [00:42:40] got all of the arthritis links the Alzheimer’s, cardiovascular, [00:42:45] kidney disease. Lots of associations and, you know, very [00:42:50] plausible linkages. So I think it’s important. I’ve got to be honest, I don’t [00:42:55] I don’t labour that with patients. I don’t like to scaremonger patients with that because I always just think you’re treating period [00:43:00] to save your teeth. And as an adjunctive benefit is that your systemic health will be better. [00:43:05] But I don’t I try not to sort of go down the floss or die route with my patients. [00:43:10]

Payman Langroudi: Oh, I get it, I get it, but but but the notion that you’ve now suddenly got a period [00:43:15] of period breakdown, is there something going on systemically that [00:43:20] we don’t know about? Yeah. Like like a period referral to a GDP, you know.

Payman Langroudi: Gmp [00:43:25] that’s not happening. And the, the, I think the medical awareness is [00:43:30] bad. I think we as a profession are reasonably good at knowing about this stuff. I [00:43:35] had a, a diabetic specialist nurse referred to me for perio treatment, [00:43:40] and I didn’t know she was a diabetic specialist nurse. And we talked about the major risk factors [00:43:45] smoking, unstable diabetes, stress. Um, and she said diabetes. [00:43:50] What? What do you mean? No way. I was like, you’re. And then so when I told her, she was like, where [00:43:55] have you read that? And I said, I said, why are you asking that?

Payman Langroudi: She said recently, yeah.

Payman Langroudi: In the last, [00:44:00] uh, the other side of Christmas. And she said, where have you read that? I said, well, [00:44:05] we’ve known about it for 30, 40 years. We’ve got international consensus. [00:44:10] Why? I said, why are you asking that? She said, well, I’m a diabetic nurse. I’ve never heard of it. Wow. [00:44:15] That’s a massive problem.

Payman Langroudi: It’s an interesting thing. I mean, as a profession, we didn’t get through [00:44:20] to the public that the frequency of sugar. Yeah. It’s [00:44:25] interesting. We never got that through. But everyone knows sugar. Yeah, but no one knows that frequency [00:44:30] of sugar. Yeah. But this bit of information. My goodness me.

Payman Langroudi: It’s frightening.

Payman Langroudi: It’s [00:44:35] really it really bad. It is. It’s pretty bad.

Payman Langroudi: I mean, to be fair to people like Ian [00:44:40] Chappell, he’s written articles in editorials in The Lancet to try and make [00:44:45] people aware. We’ve had a few initiatives as part. I’m part of the British society. Um, [00:44:50] we’ve had a few initiatives where we try and push and. But you, [00:44:55] you know, your GP is so busy. Diabetes [00:45:00] is one disease that they have to look for. You can’t expect them to be on top of everything, especially what they [00:45:05] would see as maybe a, a nuanced small area. But we know it’s huge. We know, [00:45:10] you know, we know that if you stabilise perio, it’s the it’s the equivalent of the patient having one [00:45:15] additional drug. Wow. That’s the power of stabilising perio. So when you explain [00:45:20] that to a GP and they think, well, blimey, actually, you know, think about the cost impact on the health service [00:45:25] of that additional drug, not to mention the complexities of polypharmacy of multiple medications [00:45:30] just by switching off their perio inflammation. It’s like them having another [00:45:35] drug, not only, but you’ve also switched off other inflammation elsewhere. Um, we do [00:45:40] need to do a better job of educating other professions. Um, but we’re working on [00:45:45] it a bit slow. And like I say, they have other things that where everyone wants a slice of them and it’s [00:45:50] difficult. It’s difficult for a general dentist to stay on top of all aspects of everything. So the same [00:45:55] goes for our GPS, of course.

Payman Langroudi: What else? What else has changed? I mean, you must have had [00:46:00] in your career things come and go. I remember when I was a young dentist putting [00:46:05] putting little antibiotic. What was that called? Periochip.

Payman Langroudi: Yeah. Periochip. And putting dentomycin. [00:46:10] Yeah.

Payman Langroudi: Dentomycin. Yeah, I used to charge extra for that. It was like a, it was like a money maker for me. [00:46:15] I was like, oh, yeah, this makes a lot of sense. Um.

Payman Langroudi: That’s definitely changed.

Payman Langroudi: Stuff [00:46:20] is just stuff. Stuff comes along that claims to solve everything and then not much of it [00:46:25] does. I worry though, yeah, that let’s imagine I come up with a breakthrough. Yeah, [00:46:30] it’d be 30 years before I convinced Periodontists. [00:46:35] Because you guys are so fully like like like think that no, [00:46:40] it’s all the same problem and you’ve been lied to so many times, I think.

Payman Langroudi: Yeah, yeah, I think that’s [00:46:45] fair. I think, um, I mean, you ask what’s changed? Yeah. [00:46:50] The you just the example you gave of the local delivery systems [00:46:55] that went with the thinking at the time of how we understood the disease worked so late, late, [00:47:00] early, late 80s, early 90s, all the socransky stuff. Um, and so we were [00:47:05] almost treating it like an infection and the periopathogens. So that’s where all the antibiotics [00:47:10] came from. Um, and then we realised that actually not, that’s not quite specifically [00:47:15] how these things work. And so I think our treatments develop as we in [00:47:20] every medical speciality, as we understand more, we are definitely less chemically [00:47:25] driven than we used to be. Antibiotics, antiseptics.

Payman Langroudi: Is it not a role for systemic antibiotics. [00:47:30] In some situations.

Payman Langroudi: There is without any.

Payman Langroudi: Situation.

Payman Langroudi: Young patients with what you [00:47:35] and I would have called aggressive periodontitis. That is certainly an indication. There are some more [00:47:40] controversial indications. Um some people will advocate using them in [00:47:45] long standing non-responding chronic periodontitis. I’m using [00:47:50] old definitions now, but some people.

Payman Langroudi: Did it for me.

Payman Langroudi: I’m here for you, [00:47:55] Payman. Um, no, but we sort of. That’s quite controversial [00:48:00] whether you use them or not. Uh, I think certainly in general practice, the BSP have been very clear. If you’re thinking [00:48:05] of writing a prescription for a patient, you should really write a referral. They don’t want prescriptions [00:48:10] written for perio in general practice because it’s inappropriate. Those patients really need to be managed [00:48:15] at a specialist level. And a lot of the stuff that gets sent to me where it’s suspected they might [00:48:20] need something else, they just need treatment done, done better, or the patient needs to have their bar [00:48:25] raised a bit or there’s something being missed. So we we really do restrict [00:48:30] and limit them. But my I work in a practice where we’re so busy. I’ve got a couple of dentists [00:48:35] with special interests who work with me. So my we triage the patients. [00:48:40] I tend to see most of the youngsters. I tend to see most of the mucogingival, most [00:48:45] of the failing implant stuff. Um, and because my patient base is skewed towards that younger, [00:48:50] more aggressive style periodontitis, I will write prescriptions fairly frequently for [00:48:55] perio. But my my day list is not normal. Um, [00:49:00] so there’s a role, but yeah, it’s still very, very limited. And most people shouldn’t need them to be able to get on top of [00:49:05] their disease. Um, what has changed? Regenerative stuff [00:49:10] is getting more predictable. So growing bone back in vertical bone defects that we’re [00:49:15] still using a lot of the same materials, but how we use them has changed. Um, you know, your end [00:49:20] gains, your bio-oss and bio guides. I think we’re just, we’re more, more, um. [00:49:25]

Payman Langroudi: Refined.

Payman Langroudi: With slicker at using them. We know why things work and when to use which product, when. [00:49:30] Um, I think we’ve talked about plastics that is, that’s [00:49:35] just constantly evolving. And like you said, it’s getting better. You look at the Italians [00:49:40] and probably the Germans who just drive that that world.

Payman Langroudi: Is it driven by cosmetics?

Payman Langroudi: Yeah, [00:49:45] plastics very much. That is much less about health.

Payman Langroudi: It’s [00:49:50] not it’s not like is it predictable that you can reduce sensitivity with plastics or not? Is it not [00:49:55] predictable?

Payman Langroudi: I would hate to sell that as a primary outcome because if I if I do [00:50:00] a root coverage on, let’s say, a tooth that’s got eight millimetres of recession and [00:50:05] I cover seven millimetres of it, that’s a good outcome.

Payman Langroudi: Yeah.

Payman Langroudi: But if that one millimetre [00:50:10] has still got dentine hypersensitivity, I’ve failed. I would, I would never do that. I would never [00:50:15] sell it. And ultimately if your problem is sensitivity. Colgate Pro relief or [00:50:20] you know, some sort of desensitising toothpaste would be my go to. Um. A secondary [00:50:25] benefit of covering up roots is usually that you reduce sensitivity. But I’m always [00:50:30] I do hear people selling it. You’ve got to be so confident you are going to achieve 100%. And [00:50:35] whilst we’d like to think we are, like we’ve already said, soft tissue doesn’t [00:50:40] always do as it’s sold. So, uh, yeah.

Payman Langroudi: I think and when you’re referred [00:50:45] a patient by someone planning to do a big whatever it is, [00:50:50] whether it’s a restorative plan or an implant plan or whatever, that [00:50:55] people, patients don’t seem to sort of understand that the period [00:51:00] like, you know, people think how much is an implant? Yeah. And, and the nuance [00:51:05] of explaining to that patient, like, you know, the implant that looks like a tooth or an implant doesn’t look like a tooth. Is [00:51:10] that something that’s left to you by the referral? Oh, without a doubt. Is that one of your jobs?

Payman Langroudi: I think without a doubt. [00:51:15] And I think one of the hardest things, I think as a general dentist or hygienist therapist [00:51:20] is getting patients to understand why they need to go see the specialist. You know the common. I get asked all [00:51:25] the time. What do I say when a patient says, what are they going to do that you can’t do? Because they just think we’re [00:51:30] just, you know, going to do more of the same, but charge them more. Yeah. Um, sometimes we [00:51:35] are, sometimes we’re going to do more of the same, but do it better or do it differently or elevate the status of the patient. [00:51:40] But I think most of the time it is. But you’re so right. People will pay. People will [00:51:45] pay £900 for a specialist endo because it gets them out of pain. People [00:51:50] will pay £3,000 for an implant because the tooth is no longer there and they want something fixed, but [00:51:55] they’ve got a disease that isn’t painful and they don’t perceive there to be a problem. And why should [00:52:00] they pay a few thousand pounds to stabilise my perio? And there is the education phase [00:52:05] of that is huge. Um, I remember listening to again, Philip Green, [00:52:10] I’ve mentioned him already when he was BSP president quite a long time ago now. He [00:52:15] was asked the question, what would you do to make Peri make people take Perrier [00:52:20] more seriously. And his answer was, I’d make it painful. Yeah, because.

Payman Langroudi: It’s [00:52:25] a good point.

Payman Langroudi: If if if you know because because it’s inflammation. If Perry was painful, your [00:52:30] patients would be there knocking on the door going, get this sorted. The fact that it’s this silent disease, [00:52:35] they don’t know it’s happening until it’s too late. Um, is a problem. Um, and then, you [00:52:40] know, we’re having to educate them as to why they’ve got to do all this behaviour change, why they’ve got to change their lifestyle, [00:52:45] why we’ve got to do all these treatments. It is, uh, a sales pitch it, [00:52:50] but selling health ultimately. Yeah.

Payman Langroudi: You [00:52:55] think that the difference between what would you say good periodontist, [00:53:00] great periodontist. What’s the difference?

Payman Langroudi: Um, I think [00:53:05] there’s probably two definitions. There’s there’s great hands and some people are just gifted. [00:53:10] Um, again I’ve mentioned Rob, although he’s not periodontist I would, [00:53:15] he’s got the skills of, of any of the best presidents in the, in the country, if not the world. Um. [00:53:20] I think communication, being able to, you know, [00:53:25] you know, yourself and one of our, one of the challenges of our job is, [00:53:30] is the management of the individual, the dentistry relatively simple, even the complex [00:53:35] stuff when you, when you’re doing it all the time, it’s relatively simple. It’s managing the patient who’s attached to that dentistry. [00:53:40] Um, and so I think communication is just everything because we’re [00:53:45] often sent patients who are quite late presenting and we’re often having to give [00:53:50] difficult news and then talk to them about difficult conversations about where they go next. And so [00:53:55] I would say, and I said it before, you’ve got to like people and you’ve got to be good with [00:54:00] people, and you’ve got to be able to work with all of those personality types. And I [00:54:05] think empathy, empathy, and dentistry full stop, is.

Payman Langroudi: Humanity of that moment, right? When you’re telling someone [00:54:10] he’s got to lose lots of teeth. Yeah, it’s an important point. It’s a funny man with [00:54:15] the enlightened. We talk about or ask people whether they want teeth whitening. [00:54:20] Yeah. And then a lot of them worry about that, right? They don’t want to embarrass their patient. They don’t want to [00:54:25] annoy them. And I tell them, look, do you know how embarrassing it is to be told [00:54:30] you’re not brushing your teeth properly? Yeah. Like by someone younger than you? Yeah. You know, if I, if I [00:54:35] was a I am a 50 year old guy and some 28 year old hygienist says you’re [00:54:40] not brushing your teeth properly. It’s massively embarrassing. Yeah. Massively embarrassing.

Payman Langroudi: It’s also a [00:54:45] barrier to behaviour change. What comes next?

Payman Langroudi: Yeah, yeah.

Payman Langroudi: That patient thinks that you think that they’re dirty. [00:54:50]

Payman Langroudi: Yeah yeah yeah yeah.

Payman Langroudi: It’s huge.

Payman Langroudi: And it’s it’s such a we’re so in it that we don’t [00:54:55] see that. Right. But it’s a really important nuance.

Payman Langroudi: We talk about that a lot in our [00:55:00] courses. Yeah, we really do.

Payman Langroudi: Yeah. Interesting.

Payman Langroudi: Because there’s a there’s a really good video [00:55:05] that was put out by the, um, European Federation of Periodontology a few years ago called The Sand [00:55:10] of Periodontitis. And they interviewed three patients. And in the first scene they [00:55:15] talk to a lady called Angela. Um, and they ask her how she felt about her diagnosis and she talked [00:55:20] about, um, she felt ashamed. She felt that she couldn’t talk about it to her friends. [00:55:25] She talks about, um, she could talk about her cancer diagnosis to her friends, but not her diagnosis [00:55:30] because she was embarrassed because it was her fault, because she was dirty. And I, we [00:55:35] play that on every single course that I run to remind people, because we do get into a conveyor [00:55:40] belt of another patient, another disease, another patient, just it’s it’s all day, every day. [00:55:45] Just we’re used to just dealing with this stuff and we process people in and out. And I say to [00:55:50] my delegates, when you diagnose perio, patients are going to have a. Some patients are going [00:55:55] to have a bit of a moment. They’re going to think that you think they’re dirty, they’re going to have a shameful, God, this [00:56:00] is all my fault. And you have to remember that human side of this disease. It’s a [00:56:05] bit different to you’ve got a hole that needs filling. Perio has a bit of stigma attached to it. [00:56:10] And while sometimes that stigma is appropriate because a lot of the time there is lifestyle and [00:56:15] behaviour. There’s also all the other stuff that goes with it, you know, genetics and stress [00:56:20] and, you know, medical conditions. It’s not as simple as you’ve not cleaned your teeth properly. And we have to just, [00:56:25] we have to work with patients to make them understand that and downregulate that shame. It’s really important. [00:56:30] I mean, really important.

Payman Langroudi: One thing that comes to mind is you must be at [00:56:35] the stage you’re at, you must be in touch with the manufacturers, right? The toothpaste [00:56:40] manufacturers, the toothbrush manufacturers, some of the biggest companies in the world. Yeah. [00:56:45] I mean, you know, we think of our biggest companies in dentistry might be align [00:56:50] and Henry Schein, but Colgate and GSK.

Payman Langroudi: And. [00:56:55]

Payman Langroudi: Oral-b, they are ten times the size of of those companies. [00:57:00] So those massive budgets and on our screens all the time, there must be an element [00:57:05] of education that needs to happen from them. And it’s a weird thing. Yeah. Because [00:57:10] you know, the guy selling this microphone isn’t. We’re not asking him to educate anyone. Yeah. You know, you might do [00:57:15] if you’re into it, you might say, oh, conversations are important or whatever, but are you I [00:57:20] mean, you’re in touch with these guys, right? You must be.

Payman Langroudi: Do you personally, I work with some [00:57:25] of them in terms of lectures, lecture opportunities. Um, and I think through, through some [00:57:30] of the work I do with the BSP, we work with some of these organisations. Um, I [00:57:35] think, I think we’d like to think that they could do [00:57:40] a bit more. I think some of the companies, what you don’t always see behind the scenes, um, certainly [00:57:45] people like GSK, Haleon. Um. Johnson [00:57:50] and Johnson, they, they support the BSP with sort of like non restricted [00:57:55] grants. So they don’t, they don’t get anything back, but they support the work that we do and the promotion. So that [00:58:00] is a good thing. But they’re relying on us to do the physical promotion there. I think I would love to see [00:58:05] some of these companies do more publicly because you’re [00:58:10] right. You know, the the BSP or Ian Dunn is never going to put an advert in between Coronation [00:58:15] Street and the adverts because it’s just too big a campaign.

Payman Langroudi: I mean, from their perspective, I say, well, [00:58:20] you know, we’re paying millions for those ads, so screw you.

Payman Langroudi: But it’s a missed opportunity.

Payman Langroudi: My [00:58:25] friend was playing golf with the CEO of Colgate okay, in the US. And [00:58:30] um, you know what he said? He said um Colgate is in more households [00:58:35] than any other product in the world.

Payman Langroudi: I can believe that.

Payman Langroudi: Yeah. So something like 65% [00:58:40] of all global households have Colgate Palmolive product [00:58:45] in them. And the way he, he was talking to him was, well, you know, like [00:58:50] almost like in a conservative way, they’ve won. So they just want to keep everything the same. Yeah, [00:58:55] yeah, I get that, I get that. But but, you know, if you’ve got access to 65% [00:59:00] of households in the world.

Payman Langroudi: You’d like to think there. [00:59:05]

Payman Langroudi: Should be a.

Payman Langroudi: Big corporate responsibility.

Payman Langroudi: That’s right.

Payman Langroudi: That’s sort of what you’re asking me. Yeah. And [00:59:10] I would like to think that that there was a bit more of that. I think at the end of the day, a [00:59:15] lot of the especially I mean, you’ve mentioned sort of the toothpaste mouthwashes. That’s almost farmer type [00:59:20] stuff. Yeah. And they are in sales. And we have to remember that, don’t we? Yeah. But I do think [00:59:25] I do think they could do more. Um, there’s no two ways about it. I’d love to see them take [00:59:30] a slightly more bigger picture view because I don’t think they’d sell any less product.

Payman Langroudi: Exactly. [00:59:35] And the other thing is, I used to think when I used to think about this when I was younger, I used [00:59:40] to think, well, the end of the day it’s just teeth. But then when even today, [00:59:45] today, right now, the biggest cause of GA in children is teeth. It’s [00:59:50] amazing. 2026. That’s the case.

Payman Langroudi: Alder hey and Liverpool spend £1 [00:59:55] million a year on paediatric GA extractions. £1 million [01:00:00] a year.

Payman Langroudi: I thought it’d be more than that.

Payman Langroudi: It’s devastating. That’s probably an eight year old figure.

Payman Langroudi: Actually, it’s probably [01:00:05] more. Yeah.

Payman Langroudi: And they probably could do it. They probably just can’t get through anymore. Um. It’s huge. [01:00:10] And that’s just one city. You know, that’s going to be that’s going to you multiply that by, you know, your [01:00:15] Manchester’s your Birmingham’s. They’ve all got bigger populations.

Payman Langroudi: In a preventable disease. That’s that’s the key point. Right. [01:00:20]

Payman Langroudi: Key point.

Payman Langroudi: Um what grinds your gears about [01:00:25] dentistry. The market. Let’s let’s let’s start [01:00:30] let’s start before you worry yourself about. No, no. Let’s start with with relation to [01:00:35] in relation to perio. Like what do most generalists not know about perio that they really [01:00:40] should.

Payman Langroudi: I wouldn’t say it’s that they’re not know I don’t.

Payman Langroudi: Well not acting [01:00:45] whatever.

Payman Langroudi: What people don’t remember is actually the power [01:00:50] that the patient has to control the disease. I think we’re so ingrained as [01:00:55] a profession that our only value is perceived when we’re physically doing something to the patient.

Payman Langroudi: Treatment. [01:01:00]

Payman Langroudi: I’m either diagnosing or I’m scaling, or I’m drilling or I’m extracting. And when you’re doing [01:01:05] something, that’s my value and I can charge you for that. And I think we forget and [01:01:10] the the S3 period guidelines that came out a few years ago have changed the way we’re [01:01:15] trying to get people to think about this, telling the patient, do more, but physically, properly [01:01:20] sitting with them and educating them on oral hygiene and not just paying lip [01:01:25] service that can produce similar clinical outcomes to you or I do in a clinical [01:01:30] intervention. And if patients, if you’re working in an environment where patients can’t afford expensive care, [01:01:35] educating them to help themselves is the bit that we fail on. We really [01:01:40] do fail on that. Um, I also see with some dentists, [01:01:45] some of my referrers, they don’t always believe in perio that it [01:01:50] actually works. Now, if you believe that, then you’re right, it won’t work. But [01:01:55] I’ve had I had a referral from me a couple of weeks ago, and it was a strange phone call because [01:02:00] he said, I just needed to ring you to see What was it you did that achieved such an amazing result? And [01:02:05] I couldn’t remember the patient. So I had to go open the computer up and have a look and and all [01:02:10] we’d done was we’d actually treated the case from start to finish. Non-surgically. But the case [01:02:15] was a disaster when he walked in.

Payman Langroudi: By the way, is that you physically.

Payman Langroudi: That [01:02:20] depends on the patient. So we I have some great hygienists that I work with. So I, [01:02:25] we do a lot of, um, we give a lot of that to the hygiene team. There [01:02:30] are certain patients when I’m treating youngsters with aggressive disease and I’m prescribing antibiotics, [01:02:35] I will often do that myself. Um we have some patients who will say, you know, I’ve seen a hygienist [01:02:40] before in other practice, I want to see you. Um, and I explain that it will be more cost [01:02:45] effective and equally just as good if they see one of our hygiene team and some people say, no, no, I’m here [01:02:50] now. You’re the guy who I’m putting my trust in. And so they, they pay for me to do that work. And I [01:02:55] don’t I don’t dislike that work. It was interesting. I listen to Payman and she said [01:03:00] she couldn’t wait to get rid of that and just wants to do surgery. But but I also think that also comes with that stage [01:03:05] of career where, you know, I’ve trained to be special. So I want to do special stuff all the time. [01:03:10] I really don’t mind doing the scope of practice that is required for the patient that’s in front of [01:03:15] me.

Payman Langroudi: But the value add of you doing it with the hygienist. Do you think it’s anatomy? [01:03:20] Like literally that’s what it is. You’re literally kind of more aware of [01:03:25] what needs.

Payman Langroudi: I think in terms of non surgical outcomes, the. [01:03:30] There’s two hygienists in our team that do a lot of my work for me because I work [01:03:35] in a mixed practice. As in I say mixed. It’s all private, but it’s general and specialist. So um, [01:03:40] we have quite a big team, 17 surgeries. It’s a beast of a practice. Beast of a. [01:03:45]

Payman Langroudi: What’s that called?

Payman Langroudi: Uh, Rose Lane dental practice. Uh where’s.

Payman Langroudi: That.

Payman Langroudi: Liverpool. Liverpool. South. [01:03:50] Liverpool.

Payman Langroudi: Oh.

Payman Langroudi: South towards down the airport end. Yeah. Um. Now I know [01:03:55] that if Helen or Yvonne do a case for me that they’ll get the same outcomes [01:04:00] because they think like I do. They treat the same same treatment philosophy. They will. So they’ll get [01:04:05] great outcomes as well. Um, some patients just yeah, the added value [01:04:10] of I’m a bit greyer, I’m a bit older. I’ve got that badge that says I’m a specialist. [01:04:15] I’m charging a bit more for that. Does add value to some patients. Yeah. Um, but [01:04:20] yeah, I don’t mind doing those bits myself, but I think going back to the question you were saying, [01:04:25] we seem to have this thing where our only value is when we physically do something. And [01:04:30] actually in perio and also, I mean, if you boil it down to everything, the prevention [01:04:35] in all dentistry comes down to communication, but we’re not getting paid to do it. So we don’t do it. Um, [01:04:40] that grinds my gears, I suppose a bit because that was the, you know, I [01:04:45] think we could, we could achieve so much more for so less input if [01:04:50] we really did have a true preventative model. Um, it’s one of the [01:04:55] things in dentistry that grind grammar.

Payman Langroudi: School and tell me a few others. You alluded to the social media [01:05:00] thing.

Payman Langroudi: I don’t mind social media. We’ve got to accept it’s it’s a, it’s a, it’s a, a [01:05:05] modern beast. It’s how people communicate. I’ve got grown up. I’ve got my, my youngest daughter’s [01:05:10] 19 at the weekend, my eldest, 23. So they’re, they’re in that world. And that’s how they live their lives. So [01:05:15] I understand how we have to operate in there. Um, and I think [01:05:20] social media has been brilliant from a resource point of view for us being connected. Yeah. Uh, [01:05:25] I also think that drives, um, anxiety amongst the profession. They [01:05:30] sort of the, the comparison envy that people think, oh, I’m not, I’m not successful because I’m not, [01:05:35] you know, not that person. I’ve not done that. So I think that, that annoys me because I don’t think a lot of that is real. [01:05:40] Um, I think some of the stuff that I see on social media, you [01:05:45] know, if my principal said to me, look, we’re going to do a TikTok video or we’re going to do some [01:05:50] crazy dancing reception, I’m gone. I’m out of that practice. I’m leaving because [01:05:55] that’s just not for me. Um, and that I just think sometimes is a bit demeaning, but equally, I understand [01:06:00] that that’s the market that some people are appealing to, and that’s not going to be so that what I said [01:06:05] that grinds my gears. Probably not. I just scroll past it and let it wash over me. Um, I [01:06:10] would, you know, I genuinely would love to see CPD better [01:06:15] regulated than it is. Um, I feel like when we qualified, [01:06:20] you would look around the country and you, you knew who the good guys were, you knew who. [01:06:25]

Payman Langroudi: Now there’s so much of it.

Payman Langroudi: There’s just volume. And I’m not convinced [01:06:30] that all of that volume is as good as it could be. Um, you know, I really enjoyed listening to Nick Sethi’s [01:06:35] podcast the other week and what the work that they do. I know Nick through tubules, great [01:06:40] guy, uh, good mates with Riaz. We worked at Liverpool in the hospital together. You know, there [01:06:45] are people who are doing great stuff. I’m down here teaching with monarch for tomorrow, people who are [01:06:50] doing high level really well. Cpd type stuff, but then [01:06:55] I just see some people who just churning out quick fix short but but [01:07:00] dressed up diplomas and I sort of wonder just how much can you learn [01:07:05] in that short space of time? I’ve got no problem with short courses, but don’t dress it up as [01:07:10] anything more than a short course. It’s, you know, a five day course is not a diploma. Um, [01:07:15] and I think the.

Payman Langroudi: Diploma kind of is whatever you want to call it, right. It’s a funny thing. [01:07:20] I think it.

Payman Langroudi: Is.

Payman Langroudi: Nowadays. Yeah.

Payman Langroudi: I think there was a time though, you know, when a certificate was [01:07:25] a year course, a diploma was a two year course. Masters was a third year course.

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

Payman Langroudi: And I think so. [01:07:30] It means very different things to different generations. Um and I do [01:07:35] worry that.

Payman Langroudi: But what else? What else should go on. I’ll tell you some of mine. [01:07:40] Um, I don’t like, uh, people who call themselves [01:07:45] professor when, when they’re not, when they’re not professor. I don’t like that. Um, [01:07:50] Because it’s a funny thing. It’s a it’s a foreign university thing. Often, [01:07:55] I think like if you’re, if you’re teaching a university in France, Italy, Spain, or [01:08:00] many places, America, all teachers in university are called. Professor. Yeah, yeah, yeah. [01:08:05] But here it’s the.

Payman Langroudi: Associate professor.

Payman Langroudi: The top guy in the department. So [01:08:10] to use it here just seems so, so disingenuous. Yeah. I think that’s that’s not, not [01:08:15] unreasonable.

Payman Langroudi: Um, yeah.

Payman Langroudi: What about awards? I bet you don’t like awards. Do you like awards? [01:08:20]

Payman Langroudi: No, I really don’t like awards.

Payman Langroudi: Go on, go on, go on. Articulate what you don’t like. Because the younger [01:08:25] generation can’t even understand it. And I have to. I have to get them to to tell me what they think [01:08:30] it is. What is it for you? The crux of awards that you don’t like?

Payman Langroudi: Um, [01:08:35] I don’t like the idea that, you know, there can be 7 or 8 best young dentists [01:08:40] this and 12 best old dentists that. And because even [01:08:45] though I’m good at what I do, I’m, I am I the best? How do you measure that [01:08:50] best? And does that best give you an advantage? When do you deserve that advantage? [01:08:55] I just I find that sort of I find it all a little bit crass, not professional.

Payman Langroudi: Right back to [01:09:00] that.

Payman Langroudi: It goes back to professionalism.

Payman Langroudi: Professionalism.

Payman Langroudi: That also goes back to me being old. If I’m being, you know, and [01:09:05] just probably, you know, grey old grumpy, um, it’s [01:09:10] just not what we did. And I just find it all.

Payman Langroudi: At the, at [01:09:15] the same time. Do you recognise what I’m saying about like Ken? Ken Finley is a good, good [01:09:20] friend of mine and I remember when they started, it was them, it was, it was FMC that [01:09:25] really pushed all of this awards, uh, top 50 at the time [01:09:30] you had the BJ that wasn’t you weren’t allowed to put a photograph or do you [01:09:35] remember you couldn’t even put any image in a BJ article? Maybe a graph. [01:09:40] Yeah, but nothing else. That’s where we were at. And Ken comes along and [01:09:45] says, well, let me do the sun And it was a good thing, you know, like it opened [01:09:50] up.

Payman Langroudi: We couldn’t advertise, could we? When we first.

Payman Langroudi: Arrived.

Payman Langroudi: We couldn’t advertise. And then that changed. And that was [01:09:55] the beginning of this opening up of, you know, the marketing and everything that we’ve now got. Um, [01:10:00] I’ve got to be honest, I don’t, I don’t, I would never think less [01:10:05] of somebody who does the awards. And I know people who are part of that industry. And [01:10:10] if you’re going to enter the awards, you are practising to a very high standard because [01:10:15] you have to to be.

Payman Langroudi: Approved to do it.

Payman Langroudi: And you’ve photographed your work, you’ve shown good [01:10:20] thinking. So, you know, there was elements of that. I think my validation [01:10:25] would come from other places. So you just listen to Nick talk and you [01:10:30] talk about Bard, you know, and you’ve got like Bard accreditation. And you know, if you, [01:10:35] if you’re accredited by Bard, you know, your stuff, you are the bee’s [01:10:40] knees, you know, and even the best people who are going through that process will be stood there [01:10:45] nervous at the front. You know, it doesn’t matter whether you’re Finley Sutton or whether you’re you know, you’re going to be [01:10:50] grilled.

Payman Langroudi: By everyone on it.

Payman Langroudi: And you’re going to be. And and you’ll know your stuff and you’re [01:10:55] going, I’m going to get through this. But that to me is sort of. That’s the sort of validation [01:11:00] I would seek or I want someone to say to, you know, that, you know, someone I respect, like, [01:11:05] I don’t know, like an academic like Ian Chappell or somebody go, yeah, that Ian Dunn’s a good guy. That’s sort [01:11:10] of what I that that to me would be better than any piece of plastic that is voted, you know, that I’ve entered and [01:11:15] been, you know, um, do I think less of people for doing that? No, not at all. I [01:11:20] think if you abuse that and, you know, and actually start to believe that you are [01:11:25] better, that’s probably a bit of an issue.

Payman Langroudi: But I mean, people use it in their marketing, don’t they? So do you find [01:11:30] that distasteful?

Payman Langroudi: Not necessarily distasteful. I think if you’ve done it, it’s like I say, it [01:11:35] shows a commitment to, to, to a high standard because [01:11:40] I’ve yet to see any of those winning cases where I thought, God, that’s rubbish that you are. [01:11:45] You are working at a high level if you’ve won those awards.

Payman Langroudi: So I guess the funny thing, I’m no longer in [01:11:50] it, right? So it doesn’t bother me at all. But I can imagine if [01:11:55] I was working in Liverpool and some dude won [01:12:00] Best Dentist Liverpool. Yeah. And if I was really good at dentistry, by the way, if I was really good at dentistry [01:12:05] and some dude wins best dentist Liverpool and I’ve not even applied, [01:12:10] I can imagine how that might grind my gears. Yeah, I can see it. I can see it. [01:12:15]

Payman Langroudi: I work with, um, I work with a specialist prosthodontist guy called Steve Barber, one [01:12:20] of the best dentists I’ve ever worked with. I mean, his work is just second to none. You’ve never [01:12:25] heard of him because he’s so under the radar. Um, and I see people [01:12:30] winning awards locally and, and yeah, that works okay. It’s good. It’s not as good as Steve’s. It’s [01:12:35] just, you know. And do I feel sorry for him? No, because he’s busy. People who [01:12:40] refer to him know he’s great. There was a time. There was definitely a time. [01:12:45] And you’ll have seen me on social media do it where I was like I was. I felt like the police. I wanted to [01:12:50] argue with everyone. And you’re wrong.

Payman Langroudi: The Facebook.

Payman Langroudi: Yeah, social media platforms. [01:12:55] And, you know, and I’m at the point now where I sort of think I can only treat who’s in front [01:13:00] of me. I can only teach who turns up to my courses and I can’t control anything [01:13:05] else. And so why should I bother? And maybe I’m maturing. Maybe I’m getting [01:13:10] more laid back. But you know, I chat to people like you. He’s a good friend of yours, Drew Shah. [01:13:15] I know Drew’s not a fan of that sort of that sort of. Oh, he hates it with [01:13:20] a passion. I think him and I are equally paralleled in grumpiness when it comes to [01:13:25] comes to those things. So um, but yeah, we see we. It [01:13:30] goes back to that comparison envy and the comparison. That same [01:13:35] comparison is a thief of joy. One of my favourite expressions. And I see people who I [01:13:40] mentioned before, people who come and spend days with me and they’re saying to me, you know, I’m [01:13:45] looking after my patients and I care, and I spend too much time on this, and I’m not earning very much money that and [01:13:50] I’m not winning awards and I’m not driving a Ferrari and I’m and I’m saying, yeah, but you’ve just [01:13:55] told me that you’re looking after your patients and you’re doing good work and you’re only three years qualified, relaxed, [01:14:00] just relax. You’re doing all the right things. All that will come if you keep [01:14:05] doing the right thing. I suppose that side of the awards and that I’m [01:14:10] not there and I’m, I’m not successful until I’m that I think people [01:14:15] need to look at how they measure success because success could be you could be going work in community [01:14:20] dentistry on a salary. And you could be treating all that special care type patient group [01:14:25] that that success, if that’s what you love and you’re doing a great service, don’t [01:14:30] measure success in bank balances or cars or, you know, that’s.

Payman Langroudi: Success [01:14:35] could be working two days a week and taking the kids to school the other three days, you know, like. [01:14:40]

Payman Langroudi: Spending.

Payman Langroudi: Your life, that’s what.

Payman Langroudi: You’re walking the hills in the Lake District and, you know, having to schlep into work and [01:14:45] do those two days so you can have the five days off. You’ve got to measure, you’ve got to decide what success looks like [01:14:50] for you and not measure it by other people’s yardsticks. It’s, um.

Payman Langroudi: All [01:14:55] that said, you’re one of the more kind of famous guys [01:15:00] about between between generalists. [01:15:05] Right?

Payman Langroudi: Okay.

Payman Langroudi: General dentists up north, who can we think of? Who are the guys? [01:15:10] You. I mean, maybe it’s because of teaching. Yeah. Yeah, it probably is because of.

Payman Langroudi: Teaching probably.

Payman Langroudi: Is. Um, and [01:15:15] if you’re going to be a teacher, you’re going to have to tell your story and people need to come and come and come on your course [01:15:20] and all of that. Yeah. Um, do you find that your, it doesn’t come naturally to you [01:15:25] sort of self promotion and whatever it takes to fill these courses, what does it take to fill these [01:15:30] courses? I mean.

Payman Langroudi: Yeah, that’s got really difficult. The last few years has become increasingly difficult. [01:15:35] Yeah. I think as as undergraduates, I was chatting to a couple of foundation the other [01:15:40] day and they were saying how many of their lectures were delivered via video, pre-recorded on [01:15:45] demand. So they’re not even understanding the value of face to face teaching at their undergraduate [01:15:50] level. So trying to get them to come on courses and part with money is, is increasingly [01:15:55] difficult. Um, I do find self promotion difficult. I, [01:16:00] my, my former self promotion is just being out there and being available to people. I, [01:16:05] I’ve been on the train coming down here today. I’ve answered five Facebook private messages from people [01:16:10] who don’t know me and I’ve never met them before, not even been on my courses. Hi. Can I ask you a [01:16:15] question? And my answer is always yes. I’ll answer that question when I get a minute. I’ll answer it. And [01:16:20] I always put myself out there on social media platforms as someone who’s knowledgeable and approachable. That’s [01:16:25] my promotion. But I’m not going to stand there going, I’m the biggest. I’m the best, maybe to my detriment. [01:16:30] Um.

Payman Langroudi: One thing I really like about your content or Intensol was um, [01:16:35] the way you the, the way you talk about hygienists [01:16:40] and therapists as a, as equals. Um, and [01:16:45] that’s, I think it’s such an important thing. Yeah. Because, you know, Perry is a team sport. [01:16:50] Yeah. And dentistry’s a team sport.

Payman Langroudi: Yeah, absolutely.

Payman Langroudi: And too many practices [01:16:55] have too much hierarchy going through them.

Payman Langroudi: The profession has too much hierarchy going through it.

Payman Langroudi: Yeah. [01:17:00] But practices.

Payman Langroudi: You’re right. You know, you’re right.

Payman Langroudi: The thing about practice is, you know, there’s a king of that castle and [01:17:05] then too many the stories you hear from hygienists. Yeah. Because [01:17:10] they’re only like one day here, one day there, they’re not treated as staff members. And I [01:17:15] just remember your the way you write about hygienists and therapists. Yeah. [01:17:20] It’s with a sort of respect that you don’t often see.

Payman Langroudi: So [01:17:25] there’s multiple streams to that though, because, well, I want to believe it, you [01:17:30] know, and there are good dentists and bad dentist. There are good hygienists and bad hygienists and therapists [01:17:35] and you. So and I’ve been lucky enough to work with some great hygienists, um, who’ve [01:17:40] made me look very good. Um, let’s be honest. You they’ve made me [01:17:45] look very, very good. Um, so some patients will come in, see me for a consult, go to one [01:17:50] of the hygiene team, come back to me and I discharge them because they’re fixed and I get [01:17:55] all the glory and they’ve done all the hard work. So it would [01:18:00] be disingenuous of me not to acknowledge that and also not to stand up for that. [01:18:05] Um, you have to look at, you know, most let’s, let’s [01:18:10] just say the, I don’t know whether what’s true about this, but let’s say the average size of practices for [01:18:15] surgeries, let’s say there’ll be three dentist surgeries and one hygienist surgery. And then if [01:18:20] you go to the staff room, the dentist won’t be in there half the time. And the dentists are all together having their butties, [01:18:25] and then the nurses will all be in the staff room and the hygienist is in this no man’s.

Payman Langroudi: Land isolated role. [01:18:30]

Payman Langroudi: Really isolated and that’s where their organisations are really helpful. The best. And [01:18:35] BADT to to give them that that outlet. Um but I think, [01:18:40] you know, with I don’t know whether, you know, I, I’m admin, one of the biggest hygienists and [01:18:45] therapist forums on Facebook for the UK. Um, and it’s just [01:18:50] a release valve for them to know.

Payman Langroudi: What I’m reading the stories.

Payman Langroudi: They’re not that their [01:18:55] experiences are not unique and it’s a bit like dentists for dentists for us, you know, that it’s [01:19:00] somewhere where you can go and speak and know that there’s going to be support, know that you’re not alone. And [01:19:05] so for me, you know, I’ve been very lucky now to get myself into a position where, [01:19:10] as you say, people know who I am. And through my work with the BSP and the [01:19:15] teaching and all the different things, I sort of owe it to them to support them because [01:19:20] that, yeah, there are a lot of Periodontists one, two [01:19:25] dentists don’t want to do perio per se. So three give it to the people who do want [01:19:30] to do it and are pretty good at it. And don’t don’t treat them as a second class citizen. [01:19:35] Um.

Payman Langroudi: Not to mention the way it’s looking. Therapists are going to be a major part of the future. [01:19:40]

Payman Langroudi: Huge. I listened to Amber Alpin’s podcast. Amazing, [01:19:45] brilliant. What a great setup.

Payman Langroudi: Amazing.

Payman Langroudi: And there’s loads of them in the northwest. We’ve got a handful [01:19:50] of hygiene and therapy owned and LED practices. And why [01:19:55] not? They’re making a great go of it. They’re doing great work. There’s a lady on the [01:20:00] Wirral, Jules Fisher, who runs at the Hygienist Only Centre and is [01:20:05] one of my best referrers. You know, she she takes patients as far as they can and then she knows when to [01:20:10] pass them on. And it’s a great model and the patients get great care. Yeah. Um, we [01:20:15] just, we’ve got to get rid of this protectionism element because there’s, we’re not going to run [01:20:20] out of work.

Payman Langroudi: One of the biggest uses is owned by a nurse ex nurse. [01:20:25] Okay. Um I want to get on to Liverpool because it’s such an [01:20:30] interesting town. Um, again, enlightened biggest users have always [01:20:35] come from Liverpool. From the beginning.

Payman Langroudi: I was going to say Liverpool or Kent, I would have thought would be your two big. [01:20:40]

Payman Langroudi: Well no. Essex. You’re thinking. Sorry but no, it’s more Liverpool or Newcastle, more North northwest [01:20:45] or northeast. Newcastle. Sunderland?

Payman Langroudi: Yeah.

Payman Langroudi: The people up there just want white teeth, man. Yeah [01:20:50] yeah yeah. Um but Liverpool as a town, I’ve been going there for years now [01:20:55] and what a change. Yeah. The people are amazing. [01:21:00] Everyone’s a comedian and, and funny and [01:21:05] just, just, just like real salt of the earth. I always think of Liverpool Manchester [01:21:10] as like complete opposites in so much as in Manchester. Everyone looks quite polished. Okay, but you’re not [01:21:15] sure what to think about it. But in Liverpool they’re quite raw. But everyone’s cool. Everyone’s [01:21:20] everyone’s just like, uh, worth talking to. Um, but the change in [01:21:25] that town.

Payman Langroudi: Yeah. It’s huge. But you know what? That really makes me feel quite proud that [01:21:30] you’ve just said that. I hear it all the time.

Payman Langroudi: Love that.

Payman Langroudi: City. And there is such a stereotype about [01:21:35] Liverpool that that once people have been, they realise that it’s not what it was, I think. You know, you [01:21:40] mentioned when my dad and the police and Toxteth riots, there is such a stigma and Harry Enfield and the [01:21:45] Scousers and all that, you know, shell suits and trackies and calmed down and all that stuff. There is that stereotype. [01:21:50] Um, Liverpool has had its difficult times. You know, the 80s, [01:21:55] even into the early noughties when I went when I left Liverpool to go to university, Liverpool had [01:22:00] big problems. Um 2008 we got all that capital of culture money [01:22:05] and it absolutely transformed the city. I mean, I was back [01:22:10] living there at the time. I was living in the docks, um, in sort of warehouse living type [01:22:15] stuff. And it was just a great time. But that, that the city transformed and it is [01:22:20] an absolutely fantastic city to live in. And like every city, it’s got issues and [01:22:25] it’s got idiots. But the majority are, like you said, up for a laugh.

Payman Langroudi: The people [01:22:30] are so unique.

Payman Langroudi: Man cannot wait to chat to you.

Payman Langroudi: Yeah yeah.

Payman Langroudi: Yeah. I ran a course last week. Uh, [01:22:35] we had 16 hygienists therapists come over for a two day course. Um, [01:22:40] from all over the country and the WhatsApp group the night before, because they were all coming in on the Wednesday night. We were teaching [01:22:45] Thursday and Friday was, oh my God, Liverpool is so friendly. I’ve had so many random conversations. [01:22:50] And my teaching colleague Helen Maria teaching us, we were just texting each other going [01:22:55] makes me feel quite proud about that. It’s good. Yeah, I am born and bred in Liverpool. I’ve [01:23:00] escaped for a bit and moved back and uh, it’s it’s a great place to be.

Payman Langroudi: Great restaurants, [01:23:05] great shopping that Liverpool won the Duke of Westminster project. Yeah, yeah. Liverpool [01:23:10] won like I find really good places there.

Payman Langroudi: Yeah. Good culture. We’ve got multiple theatres, [01:23:15] comedy scene, live music.

Payman Langroudi: What I love is that kind of city that’s [01:23:20] big enough that you can go and find yourself a Wagyu steak if you really want one, but small enough [01:23:25] that everyone kind of knows each other kind of bumping into each other. And then with Liverpool [01:23:30] as well, like, you know, it was at one point it was one of the richest cities in Britain, the richest city in Britain. [01:23:35] At one point when the slave trade. Yeah, I’m not sure. I’m not sure.

Payman Langroudi: No, no, it was [01:23:40] built on that.

Payman Langroudi: But those, those massive buildings, not not just the warehouse, the [01:23:45] massive bank like buildings, you know, they’re really special. You don’t get [01:23:50] that in many places.

Payman Langroudi: But we’ve got more royal liver.

Payman Langroudi: Yeah. Craziness.

Payman Langroudi: We’ve got more grade [01:23:55] two listed buildings than any other city outside of London.

Payman Langroudi: Is that right?

Payman Langroudi: Because it was bombed in [01:24:00] the war.

Payman Langroudi: Oh. Too far.

Payman Langroudi: So I think it wasn’t deemed to be strategically important. So the architecture [01:24:05] is phenomenal. And if you if you walk around with your head up and look around. Yeah. [01:24:10] You’re right. It’s, uh, it’s, it’s architecturally beautiful in [01:24:15] parts. Um.

Payman Langroudi: Let’s get to the darker part of the pod.

Payman Langroudi: Okay.

Payman Langroudi: Let’s talk about [01:24:20] mistakes. Clinical errors that you’ve made that the rest [01:24:25] of us can learn from.

Payman Langroudi: Um. I [01:24:30] can think, well, maybe whether other people can learn from it, I don’t know. But [01:24:35] arrogant sort of the arrogance of youth. You know, I was, I was doing [01:24:40] my perio surgery stuff and I was generally pretty good at it. And I had a patient [01:24:45] who was referred, I mean, just this, just the horror. It’s more of a is it a mistake? It was a bad [01:24:50] clinical outcome. She came to me with an an upper right central incisor that was root filled [01:24:55] and dark with a little bit of recession on it. And I was asked to cover the root up and also thicken [01:25:00] the tissue so the dark root didn’t show through. Done it a few times, multiple times before at this [01:25:05] point. Um, yeah. No problem. Uh, but the tooth was root filled. It was a protected there was [01:25:10] scar tissue. The surgery was a complete nightmare. I got really good coverage that it [01:25:15] seemed to go okay, but it was difficult. Um, she got really bad healing. She got, [01:25:20] she went from having two meals, a recession to six mils of recession. I’d caused it. My, [01:25:25] my, my healing response was horrendous. Um, she’d gone through two [01:25:30] and a half years of ortho, by the way, to get to that point. And I was the, I was the penultimate bit [01:25:35] before they replaced the crown on this tooth. Um, that was pretty bad. Uh, [01:25:40] what.

Payman Langroudi: Happened?

Payman Langroudi: I just had to, I, I had to own it and I just had to, I redid [01:25:45] it. Um, I can’t say I did anything massively differently and we got a really good outcome the second [01:25:50] time. Um, but it was you then working with the patients who is [01:25:55] doubting you and yeah, there’s a trust issue now. And actually she’s gone from a two mil [01:26:00] recession to a six mil recession on a tooth that is dark. Um, it was a difficult, [01:26:05] difficult period.

Payman Langroudi: What’s the learning outcome from that?

Payman Langroudi: Um, [01:26:10] what was.

Payman Langroudi: There was an error. What was the era? Was it a communication error? I mean, I suppose.

Payman Langroudi: You did ask [01:26:15] me about it. Could I say there was an error? Maybe.

Payman Langroudi: You said. You said you wouldn’t have done it any differently.

Payman Langroudi: I don’t think I would have [01:26:20] done it any differently. So maybe it wasn’t. Or maybe it was just like we said that sometimes you just don’t get the healing you want. Not [01:26:25] all soft tissue.

Payman Langroudi: Is consent error.

Payman Langroudi: I think thankfully we consent for all sorts [01:26:30] of problems.

Payman Langroudi: Did you tell them that that could have happened? Yeah, possibly.

Payman Langroudi: Graphs can fail. Things can heal [01:26:35] unfavourably. So yeah, I think we always have thorough conversations. So whether that was a dark [01:26:40] time, it was a stressful time because of the I mean, the other thing I would say that.

Payman Langroudi: The patient [01:26:45] didn’t do anything right.

Payman Langroudi: Didn’t know patient trusted me. We we’re she [01:26:50] has to wait 3 to 4 months for that site to mature before we can go back in. Walking [01:26:55] around with a front tooth that’s like now got more recession. She was, with [01:27:00] hindsight, incredibly tolerant. Um, and the one thing I would always [01:27:05] say to people, if you’ve got a problem, just own it, be all over it and, you know, smother the patient in [01:27:10] kindness and, um, don’t try and quick fix, don’t try and distance yourself. Don’t you know? [01:27:15] Um, I think the only time to say distance. The only time if you if you can’t [01:27:20] fix it, if you’re not the guy, make sure that they end up in front of the guy or the girl who can [01:27:25] fix it. You know, do whatever it takes to make this right for that patient. Um.

Payman Langroudi: And [01:27:30] give money back straight away, man. I mean, even don’t even ponder on it, although not as easy [01:27:35] as you think. Sometimes you work for a corporate, it has to go up the up the ladder and back down. Um, [01:27:40] what’s, what’s been what, what comes to mind if I ask you what’s been your darkest day [01:27:45] professionally?

Payman Langroudi: Uh, the day I got my GDC letter. [01:27:50]

Payman Langroudi: From a patient.

Payman Langroudi: From a. Yeah. So, um, long story [01:27:55] short, I was, I was still a GDP, but only just at this point, I was very [01:28:00] much perio trained and MSC nearly finished. And um.

Payman Langroudi: Was [01:28:05] it during that peak, GDC 2015, 2016 time?

Payman Langroudi: Yeah, probably.

Payman Langroudi: Every single [01:28:10] dentist was.

Payman Langroudi: A little bit.

Payman Langroudi: Earlier. Okay.

Payman Langroudi: Probably about probably about 2008. Oh, can’t quite remember. [01:28:15] But it was it was peak. It was.

Payman Langroudi: It was.

Payman Langroudi: Peak time of a type of severe distrust [01:28:20] with the profession. Yeah. Um, and I had a guy who knew patient consult, I treated his [01:28:25] family, uh, and he came in with a lesion lower right on his soft tissue on his gingiva [01:28:30] in his attached gingiva. Didn’t look great, but he said to me, oh, I’ve had this before. [01:28:35] And I said, what was it? And he said, I don’t know. I said, what do they do? He said, oh, I was up [01:28:40] in Glasgow. They lasered it off and you know, I said, well yeah, but what did they tell you? It was, [01:28:45] I can’t remember. And I said, well and I again, to add value to the story, it [01:28:50] was the 21st of December. So I said to him, look, doesn’t look great, [01:28:55] but you know, don’t know what it is. Um, let’s get it checked. And [01:29:00] I said, but you know, try not to worry about it because you’ve had it before. It was nothing. You’ve got it [01:29:05] again. It’ll probably be nothing. Don’t worry about it. Um and his [01:29:10] wife said for the consultation with him, uh, so off he goes. I write the [01:29:15] letter to oral surgery to oral medicine, and we start [01:29:20] over from a.

Payman Langroudi: Good old days.

Payman Langroudi: Yeah. We fax it over and we actually ring oral medicine. [01:29:25] Say, have you got the facts? They said yes, because I did it as a two week, uh, referral. So [01:29:30] he then gets an appointment for the 3rd of January to go and see [01:29:35] them, bearing in mind how many bank holidays we’ve got in that period. So we’re doing all right. And then [01:29:40] on that day, there was a massive snowfall in Liverpool and his appointment got cancelled and [01:29:45] put back two weeks. And in that two weeks he comes in to see me again. Because now he’s he’s actually [01:29:50] in a lot of pain and he opens his mouth and everything’s changed and it’s clearly something very [01:29:55] horrible. Um, and so, but at this point I’m working at the hospital. [01:30:00] So I take a photo and I go in and speak to the head of oral medicine and say, look, [01:30:05] this guy was doing last week. He’s not coming in for another, you know, have a [01:30:10] look at this further. Two weeks and straight away they said, oh God that’s clearly a squamous cell [01:30:15] carcinoma. So I so they said, you know, we more than [01:30:20] just a concert. I will know when he’s coming in. We’ll have it all ready.

Payman Langroudi: We’ll do the biopsies. We’ll just, we’ll run the case. [01:30:25] And so, so I’m thinking this is this is great service that’s doing really [01:30:30] well. And then um, about the Easter, I get [01:30:35] the, the letter that or the book, the, the, the case booklet from the GDC [01:30:40] because this patient’s now going after everybody, uh, he’s going after the hospital for delaying [01:30:45] his care. He went after the Maxfax team for, you know, and they, they [01:30:50] just threw the hospital’s lawyers behind it. No one had done anything wrong. It was it was it was a desperately sad [01:30:55] case. He was lashing out. Um, there were no winners. No winners at all in this scenario. [01:31:00] But he went after me for failing to diagnose and failing to [01:31:05] treat his problem. And now you and I would hope that a GDC [01:31:10] caseworker would have looked at that and made it just go, you know, quick letter, [01:31:15] dear. You know, dear patient, this dentist has done everything he’s done more than everything, [01:31:20] you know, taking photos. I’d gone in and spoke to oral medicine because I had the luxury of that, that, that access, [01:31:25] um, that took 11 months for that to go away.

Payman Langroudi: 11 [01:31:30] months of back and forth as well.

Payman Langroudi: Yeah. Back and forth. Um, [01:31:35] it was such a difficult time. I, I was working at the hospital, [01:31:40] uh, and I remember going to speak to Callum Johnson and I said, look, I’ve got this problem. And I [01:31:45] said, look, if I don’t want to bring any shame on the hospital. And he said, you’ve done nothing wrong. Don’t worry about [01:31:50] it. I just started working with Amin up at clinic three, three, four.

Payman Langroudi: Yeah, yeah, [01:31:55] I love that guy.

Payman Langroudi: Yeah. Well, we we’ve worked together for 12 years, but I just started there with him. And [01:32:00] I approached him and I said, look, I don’t want to bring any embarrassment on the clinic, you know, because [01:32:05] my my back in the days we’d get the GDC booklet like once a month and [01:32:10] the case hearings would be in there. I thought, I’m going to be on there. I’m just building my reputation [01:32:15] at this point. I’m like ten years in, I’m just, I’m just just about building a name. I was [01:32:20] just started teaching with Phil. I said to Phil, look, I’ll stand back and I don’t want to bring any shame on your [01:32:25] great reputation. And I look back at all of them, said, you’ve done nothing wrong. [01:32:30] This is going to go away. Just you keep working with us, no problem. [01:32:35] But at the time, there was such a distrust of the GDC that [01:32:40] I doubted. I knew I’d done nothing wrong. I can tell a story now, and I know that given [01:32:45] my time again, I couldn’t have behaved any better. And everything was, you know, um, and [01:32:50] it, but it was a dark time. That was because I, you just constantly doubt yourself. [01:32:55]

Payman Langroudi: Everyone around you is telling you you’ve nothing to worry about. I remember coming down to London. Um, I [01:33:00] was with I’m with Dental protection and Jane Merivale, who’s now I think with BDA, was my [01:33:05] liaison. She was brilliant. She was. The support I got from from them was brilliant. And they brought in [01:33:10] external counsel because it was such a serious claim that if it was proven, the [01:33:15] consequences were going to be enormous, even though there was nothing to prove. But they brought in external [01:33:20] counsel. And I remember being in London, I had this meeting for about an hour, and I [01:33:25] felt totally reassured that everything was great. And they and they got to the end. She said, look, [01:33:30] don’t worry about this. Go away. Don’t worry. This is the easiest case that we’ve got to deal with at the moment. That [01:33:35] said, we don’t have a lot of faith in the GDC at the moment, and all of that hour of positivity [01:33:40] was undone and that’s how I slept. I didn’t sleep that night with that last sentence. Um, [01:33:45] that was dark and I was I was horrible to live with. [01:33:50] You know, I had young kids, um, I wasn’t present.

Payman Langroudi: What [01:33:55] was the emotion?

Payman Langroudi: Um.

Payman Langroudi: Is it fear?

Payman Langroudi: Do you know what it was? [01:34:00] There was a fear of a. With hindsight, it’s ridiculous.

Payman Langroudi: And if anyone’s [01:34:05] losing your. Your.

Payman Langroudi: Yeah, the profession and my one way of earning a living for my family and [01:34:10] my children. Um, we had not long moved home [01:34:15] house to the house we’re in now. We bought a doer upper. So the house was battered. Um, it [01:34:20] was our forever house in the project. And I thought, you know, how are we going to ever afford to run this and [01:34:25] make this work? There were visions of, you know, what else am I trained for? I mean, [01:34:30] we hear that in our profession all the time. What else can we do? And we can do a lot because we’ve got a lot of skill sets. [01:34:35] Yeah. Um, but just just a oh my God. You know, I’m going to embarrass [01:34:40] I’m in, I’m going to embarrass Phil. I’m going to let my family down. And [01:34:45] nobody could get through to me. You’ve actually done nothing wrong. This is going to be okay. [01:34:50] I just I knew it and I nodded and I just didn’t believe it until I got the letter [01:34:55] that.

Payman Langroudi: It was a funny time with the GDC at that point. It was really. It was an unknown entity. Yeah. Like [01:35:00] what was going to happen next?

Payman Langroudi: I think it was pre caseworkers as well. I think it didn’t it didn’t [01:35:05] go to a full hearing, but it went close to.

Payman Langroudi: You know it’s really interesting. It took 11 months [01:35:10] and you’ve done nothing wrong. Imagine you’d done something wrong. I mean you know like in [01:35:15] a career, sometimes you miss stuff. Sometimes you, you know, you make a mistake.

Payman Langroudi: All day long. [01:35:20]

Payman Langroudi: Yeah. It’s it’s the humanity side of that should be there too. But imagine now [01:35:25] you’ve done something wrong. Yeah. And you’re 11 months in.

Payman Langroudi: I genuinely don’t know how to cope with that.

Payman Langroudi: Yeah. [01:35:30] And and concerned. You’re not going to be able to pay your kids school or your whatever it is, your mortgage or, [01:35:35] or whatever.

Payman Langroudi: I’d like to think we’re they’re better. I would like to think [01:35:40] they’re better. And I hear from people that they are.

Payman Langroudi: Improving, I think. Yeah.

Payman Langroudi: I still think we’ve got a way to go [01:35:45] because we you and I still see it on the forums. Yeah. The fear of of being [01:35:50] struck off. And I’ve said it before on, on forums, I actually think it’s relatively difficult to be [01:35:55] struck off. You’ve got to be a real idiot. And you’ve also, even if you make a mistake, the GDC don’t mind mistakes [01:36:00] as long as you show us how it’s not going to happen again. Show us that you’ve done some training. Show [01:36:05] us that you’ve. You know, I think, you know, I think the it is a better environment, [01:36:10] but I still think there’s a way to go. Um, but that was dark.

Payman Langroudi: It’s a funny thing because it’s [01:36:15] an irrational fear in some ways. Yeah. But, but at the same time, you go back [01:36:20] to that. What is it to be a professional? Yeah. One of the things is to be a professional is to be regulated. [01:36:25] Yeah. Yeah, absolutely. You’ll know from your wife that it’s the with lawyers, it’s the [01:36:30] same organisation that’s there, BDA and their GDC. Yeah. So, [01:36:35] so that that kind of goes to shows the point that it understands both sides. It understands [01:36:40] regulation and it sounds practice. But with us, there’s this sort of walled off, you [01:36:45] know, the BDA is like your friend, GDC is your enemy sort of thing.

Payman Langroudi: Yeah, I think there was [01:36:50] definitely that mindset. And I also think, you know, thankfully, my wife never had any regulatory [01:36:55] issues that she had to deal with of her own. But I always saw with things like the Law Society [01:37:00] that there was an element of, we’re going to back our own and protect them. But if you prove that there that [01:37:05] this person’s a baddie, then obviously we’ll sort this out. And I think the one thing that we always [01:37:10] used to see with the GDC was that there was the fear that we were guilty until proven innocent. [01:37:15] You had to prove your innocence, not the other way. Not they didn’t have to prove your guilt. And [01:37:20] I think that was a fear, um, that we had, whether it was rational.

Payman Langroudi: Lawyers have one for [01:37:25] sure, dude. Yeah. Because notes have become this complete like, like you could have been the best [01:37:30] dentist in the world, but if you forgot to write that thing in the notes, that could be, you know, something [01:37:35] they get you on. Um, not to mention what’s it called? Dental law partnership. [01:37:40] Uh, they buy, they buy a case, you know about that. They go out there [01:37:45] and buy cases from all the other lawyers. Oh, your wife’s a lawyer. So you know how these.

Payman Langroudi: Ex-lawyer.

Payman Langroudi: Now, these sort of things work? Yeah. [01:37:50] Um, I feel like it needs to be an issue. Every dentist must have at some back [01:37:55] of his head something about standards and regulations, but not the number one, two, three, [01:38:00] four, five. Most important thing he’s thinking about, you know, number one, two and three should be [01:38:05] all around the patient. Yeah. You know, maybe then your team. Yeah. All of that then. Number 11. Yes. [01:38:10] Don’t be an idiot. Yeah.

Payman Langroudi: And you know, it’s interesting because I do a little bit [01:38:15] of teaching with, um, Leo Briggs from MD. You. Yeah. Um, he supports some of the [01:38:20] courses that we do and, and he, his view and I don’t want to put words in his mouth, but is [01:38:25] that we write too many notes. Yeah. And you actually, and I see it with some of the younger colleagues [01:38:30] I’m working with. When I get one of their patients referred in house, I can’t [01:38:35] actually find the pertinent information that I need because there’s all this noise. Yeah. And [01:38:40] our notes were always meant to be for us. You were supposed to be able to pick up someone else’s notes, know what [01:38:45] was done last time, know what’s supposed to be done next time. And it was, it was that. And obviously [01:38:50] if something bad happened, You. You told the story in the notes, but you didn’t record every [01:38:55] ounce of every conversation. And actually, you now look at people’s notes and you think, there’s [01:39:00] no way all those conversations actually happened.

Payman Langroudi: It’s a disease of the West, man.

Payman Langroudi: Yeah.

Payman Langroudi: Did you know [01:39:05] about this? Like in China, the last three Leaders Xie and Dong Xiaoping and whatever [01:39:10] they were, all of them were engineers. Okay. That’s why when they build skyscrapers, it goes up quickly [01:39:15] and all that. Okay. Over on this side, lawyers are in charge. Yeah. Lawyers are in charge. And it’s [01:39:20] like when you put lawyers in charge and lawyers win. I feel like they have in in Dental. Yeah. Then [01:39:25] then regulatory becomes over important and stuff like this happens. [01:39:30] You know what you’re saying there is very pertinent, right? Patient outcomes are getting worse [01:39:35] because you can’t find the important bits of the notes, let alone you’ve got to spend the time writing [01:39:40] those essays. Patient outcomes are getting worse. But lawyers have won.

Payman Langroudi: Yeah. [01:39:45] It’s quite.

Payman Langroudi: Crazy. It’s crazy.

Payman Langroudi: Can we do the grind the gears question again? Yeah. [01:39:50]

Payman Langroudi: Does your wife not practice anymore?

Payman Langroudi: No. [01:39:55] She left law a long time ago. She had a couple of careers over the years. Um, she did about ten years as a [01:40:00] property lawyer, but she’s done a few things since.

Payman Langroudi: Are you gonna do your own place, [01:40:05] or do you feel like you’re an associate?

Payman Langroudi: No, no. Um, I’ve nearly bought a practice twice. [01:40:10]

Payman Langroudi: Oh, really?

Payman Langroudi: Um, nearly bought a practice many years ago, um, and got a bit shafted [01:40:15] at the 11th hour. Um, I had the option to buy into Rose Lane, um, a few years [01:40:20] back, but it would have meant, um dropping everything else. I did all my [01:40:25] teaching, my other clinics, my hospital at the time, because the only way to make it work was to be there [01:40:30] four and a half days a week. And I was only there three days a week. Um, and I made a conscious [01:40:35] decision. My wife and I made a conscious decision to that. We didn’t want to do that. I [01:40:40] loved teaching, I genuinely love teaching. Uh, it’s great fun. It’s [01:40:45] a, it’s a privilege. Um, And so I just thought, you know what? It’s not for me. And [01:40:50] with hindsight, I don’t for a minute regret it that I’ve not bought a practice and done it. I think [01:40:55] specialist practice, the goodwill is not worth the same as a general practice anyway. Um, I don’t [01:41:00] know that I’d, I’d have been a nice employer, but nice employers are not always the best, you know, [01:41:05] not the best business people.

Payman Langroudi: Um, and specialist associate is quite an interesting position isn’t it. Because [01:41:10] you get better, better um splits than generalists. Yeah. [01:41:15] I think plus the prices are higher. Yeah. So from the business perspective that’s cool. And [01:41:20] isn’t that a happy associate is one of the happiest jobs in the world. [01:41:25] Yeah. Yeah. You know, if you can, if you can do as a specialist, no one’s going to get in your way and tell you what to do. So you can [01:41:30] do what you want to do. All you need is patience, basically. That’s it. Yeah. End of no, [01:41:35] I would agree.

Payman Langroudi: I think all of those things that you’ve said, I, I, you know, yeah, you can command [01:41:40] a slightly better sort of split. You are working on a better split of a higher [01:41:45] fee. Um, you don’t need to be there five days a week because you’re not their general dentist, [01:41:50] you’re not there, you’re not there for the cement crowns. So you can do piecemeal work. The [01:41:55] peripatetic sort of work. Um, the only thing I’d say to [01:42:00] any associate listening is you’ve got to, you’ve got to understand the business [01:42:05] side of a practice though having nearly bought a couple of practices over the years, nearly done that. Yeah. [01:42:10] I, when I go to a practice and I’d hope that anyone I’ve worked with will testify [01:42:15] to this, I’m all in. It’s all it’s about me and I want the best for me. But actually, [01:42:20] I also want the best for the practice. And I’ve always done everything I can to promote the practice and [01:42:25] also promote my colleagues in the practice, because we we all benefit [01:42:30] when we all pull together.

Payman Langroudi: Absolutely. Right. I mean, when I was an associate, I used to make an [01:42:35] absolute point of defending the principle amongst the nurses. Yeah. You know, like that [01:42:40] us and them thing that can go on. Um, number one, but number two I see it on mini [01:42:45] smile maker on our um composite course you get some associates come and [01:42:50] there’s a, there’s a friction between them and their boss that they 100% [01:42:55] will not buy a goddamn thing. Yeah, yeah, I get it. By the way, I [01:43:00] get it. If your boss keeps on changing your percentage and treating you like terribly, you [01:43:05] start to think, well, why should I put my hand in my pocket? But then you get the other side. You get these super [01:43:10] associates, whatever they call it. The guys bought his own scanner. He’s come he’s [01:43:15] buying everything from us, you know, and and he’s very happy. I mean, he I guess again, [01:43:20] you know, it’s a winner you’re talking about, right? Someone who’s managing to bring his own patients [01:43:25] in and all that.

Payman Langroudi: Exactly.

Payman Langroudi: But then but then everything in between as well. But your [01:43:30] point is excellent because the associates job is, is much more than take [01:43:35] care of these patients. If you’re going to be someone who’s going to, you know, enjoy your work, right? [01:43:40] Enjoy your work, Understand that running a business is tough, and [01:43:45] the number of associates who don’t even realise they’re making a loss for their practice. A number of principals don’t [01:43:50] realise associates are making a loss for their practice. There’s a good amount you have to earn as an associate just [01:43:55] to be cash flow positive for the practice.

Payman Langroudi: Yeah, absolutely. I couldn’t agree more. Um, [01:44:00] I see as you see on some of the platforms on social media, you know, I’m an associate. I pay my [01:44:05] X percent. I want this, this and this. It’s all very, it’s all very me, me, myself [01:44:10] and I.

Payman Langroudi: Entitled.

Payman Langroudi: And yes, you are your own business. And yes, you’ve got to look after yourself. But [01:44:15] at the same time, you know, you are a business within a business and that your business is only going [01:44:20] to survive if that business does well. And it, I don’t know, I’ve been at Rose Lane now [01:44:25] for 15 years in.

Payman Langroudi: A happy place.

Payman Langroudi: Yeah, it’s a really good place.

Payman Langroudi: You’re blessed [01:44:30] man.

Payman Langroudi: You’re blessed that every now and then there are issues a 17 [01:44:35] surgeries we’ve just moved to. It’s so.

Payman Langroudi: Amazing.

Payman Langroudi: Just expanded. It’s a great 17 [01:44:40] surgeries for floor. Fully digital in the house lab practice in the practice in-house.

Payman Langroudi: All [01:44:45] the specialities as well.

Payman Langroudi: Every everything apart from maxfax. Um so yeah, perio. [01:44:50]

Payman Langroudi: Who’s the who’s the principal.

Payman Langroudi: Guy called Paul Swanson.

Payman Langroudi: Oh. Paul Swanson.

Payman Langroudi: Yeah, he’s done really well. He’s [01:44:55] a good guy.

Payman Langroudi: What a hero.

Payman Langroudi: Do you know what the one thing about Paul, he’s never, never [01:45:00] over promised anything and not delivered.

Payman Langroudi: To.

Payman Langroudi: You. To me, I’d say, um. But equally, [01:45:05] if I if I want something, I can’t have it, he’ll tell me why. Um, he’s also [01:45:10] whenever, if ever there was a time where there was a, you know, a split where it [01:45:15] could go 51% in my favour and 49% of his, that’s what he’d take that because it was like, [01:45:20] well, I don’t need that 1% makes no difference. But Ian will be happier. He’s just got he’s had a bigger picture [01:45:25] attitude about not the next six weeks, but the next six years or 20 years. [01:45:30] And you know, I’ll I won’t leave that practice. I’ll retire from there. I’m there three days a week. [01:45:35] I’m a high grossing associate. He knows I look after the patients well. My perio [01:45:40] feeds his implant work because I get sent stuff that Harry Potter couldn’t fix. You [01:45:45] know? So it’s a win win.

Payman Langroudi: How old is he?

Payman Langroudi: He’s actually. He’s [01:45:50] younger than me now. He’s 49.

Payman Langroudi: Oh, amazing. Amazing. So you really will be there for the rest [01:45:55] of your career? Yeah. He’s a good guy. Yeah.

Payman Langroudi: He’s. He’s been a good guy to work with. He’s a good friend. And yeah, [01:46:00] a lot of respect. And what he’s built is, is quite incredible. Yeah. Good on him.

Payman Langroudi: We [01:46:05] come to the end of our time. I’m going to end with the usual questions. Um, some quick fire ones. What stands [01:46:10] out to you as one of the best lectures you’ve ever been to? Or a course lecture? I like lecture I’m quite [01:46:15] interested in.

Payman Langroudi: I’m going to give you two, if you don’t mind.

Payman Langroudi: Yeah. Of course.

Payman Langroudi: So in terms of inspirational, [01:46:20] like blow Your Mind lectures, you’re looking at people for me, like Otto Zur in Germany, [01:46:25] the plastics guy. Um, okay. So while [01:46:30] some of the Italians are truly inspirational, they also often come with big egos. And Otto [01:46:35] is someone who is is quite humble considering how skilled he is. And I’ve spent time with him and [01:46:40] he wants to talk more about Bayern Munich and Liverpool Football Club than just about plastics. [01:46:45] And I’ve spent time over there and they. That blew my mind. What they can achieve and the evidence [01:46:50] base that the way he teaches it was phenomenal. Um, I’ll go back to fill our [01:46:55] though it was 2002 when I got Liverpool job and I [01:47:00] thought, I need to go and do a course and I went and did a four day section 63 [01:47:05] NHS, I think it was three I think Aintree Hospital. And [01:47:10] that blew my mind. I just it was like for all the training [01:47:15] we’d had at undergraduate level, I didn’t really understand anything. We just scraped stuff off teeth [01:47:20] and then we did it again six months later and they just like the. The clouds parted [01:47:25] and just there was clarity and everything made sense off the back of it. And I remember [01:47:30] leaving thinking, is it really that simple? You know, yes, perio can be very complicated, but [01:47:35] actually most of it is very simple fundamentals, doing the basics really well. And [01:47:40] that probably goes for tooth whitening and you know, do the basics really well and you’ll get good [01:47:45] results. And that that, you know, Arlene Thiel well, she changed my life because she [01:47:50] gave me the job that I didn’t really think I wanted. But then fill hour was the one who lit the little fire underneath [01:47:55] me because within, within four years of me going on that NHS [01:48:00] section 63 course, 2006, I went to Madrid to my first Euro perio. [01:48:05]

Payman Langroudi: You guys love that, don’t you? It’s like.

Payman Langroudi: Perio Olympics.

Payman Langroudi: Glastonbury, it’s the.

Payman Langroudi: Olympics. [01:48:10] Every three years in a major European city. 10,000 people, 10,000 [01:48:15] people.

Payman Langroudi: How many? 30 stages or something?

Payman Langroudi: Yeah, you’ve usually got at least ten stages [01:48:20] at any one time. The main auditorium is normally about six, 5 to 6000 people. They’re big.

Payman Langroudi: So [01:48:25] interesting.

Payman Langroudi: That’s great. And it’s not all perio. A lot of implant stuff, a lot of research stuff. It’s [01:48:30] it’s. Yeah. And every three years we’re all we’re all going to Munich in 2028. It’ll be great.

Payman Langroudi: Nice. [01:48:35]

Payman Langroudi: So yeah. So. So yeah, the flower thing probably for me was the [01:48:40] career changing lecture. And it wasn’t a lecture, it was a course, but it really did.

Payman Langroudi: What about [01:48:45] if there was no time or money constraints. What course would you jump into tomorrow?

Payman Langroudi: I [01:48:50] would go and do the whole [01:48:55] Otto and Marcus Hertzler talk. The whole program. You look, it’s about [01:49:00] it’s about 30, 40 grand a year. So it’s almost like a mini masters, but it’s it’s [01:49:05] more just the hands on stuff. Um, those guys are gods. It doesn’t matter who you are, you’re [01:49:10] going to be able to learn something from them. I went over and did something just before the pandemic. Um, and [01:49:15] just, you know, remember feeling like I actually knew nothing about anything. And because I’d [01:49:20] had a couple of difficult, I’d had a couple of cases not go perfectly well. And I thought, you know what, even though I was teaching [01:49:25] some of this stuff, I thought, I need to just go back and have a refresh. You know, everyone should do that. You know, [01:49:30] no one’s too big to go on a course. And every time you go on a course, you learn something new anyway. [01:49:35] And so I went over to Munich, spent three days with with the two of them, um, and [01:49:40] just just tweaked everything and came back and then everything started working again.

Payman Langroudi: I got [01:49:45] massive respect for teachers who go on courses, man, you know, like a, it might be [01:49:50] difficult, you know, like for socially difficult to turn up as a delegate. Um, [01:49:55] but it’s.

Payman Langroudi: A bit of humility though.

Payman Langroudi: You know. Yeah.

Payman Langroudi: You don’t know it all. You never [01:50:00] will know it all. Yeah. You know, you can learn from monarch. Monarch [01:50:05] can learn from someone else or learn from it. It’s just no [01:50:10] one’s got all the answers. And so, you know.

Payman Langroudi: Very true.

Payman Langroudi: Yeah. I actually think it’s almost [01:50:15] wrong to have a guru. You know, I always think you should if you if you your world is composite, you [01:50:20] should hear the gospel according to 3 or 4 different people. Gallup or, you know, [01:50:25] I think we had D-Day over at the weekend and we were Gulfport, D.J.. You know, [01:50:30] you should go and listen to other people and think, right, whose philosophy fits with me? And that’s the same for perio. So [01:50:35] for us, is it Otto? Is it Zucchelli? Is it Amit Patel? Is it me? Is [01:50:40] it who is it? You know, um, the the Peri Academy. Who is it? Go [01:50:45] and listen to people and decide who do I fit with? Um, because we don’t know. [01:50:50] No one knows it all.

Payman Langroudi: So what comes to mind when I ask what’s your favourite resource? What’s your favourite [01:50:55] book?

Payman Langroudi: Uh, the, the Perry Bible, I [01:51:00] suppose is the, the Lindy textbook. It’s like double volume. Don’t really go to [01:51:05] that much anymore. That was my go to book when I was studying. Um, again, I [01:51:10] keep I’m going to get sponsored by these guys, but Otto’s uh, has, has the big pink book that everyone [01:51:15] talks about the Perry plastic surgery. Yeah. So teeth and implants, that’s just one of the most [01:51:20] beautifully photographed and put together Bibles on the planet. You know, it’s just amazing. [01:51:25]

Payman Langroudi: Love in your face when you say it.

Payman Langroudi: It’s just it’s just Kool and the gang stuff.

Payman Langroudi: Um, what about [01:51:30] resource like maybe website, uh, blog, uh, Instagram page or [01:51:35] whatever it is.

Payman Langroudi: Do you know, I’ve got to be honest from a point of view, I don’t follow [01:51:40] many. Um, I tend to follow people. Lecture wise, I’ll go to conferences [01:51:45] because they’re there. Um, I prefer live in, [01:51:50] in event type learning. Um, I think in terms of keeping [01:51:55] in touch with the profession, you know, for dentists by dentists is the biggest platform. [01:52:00] Um, and I’m on there and I contribute and I listen and you [01:52:05] take stuff in. Um, and in terms of personal resource, if I, if I’m [01:52:10] struggling with something, I’m very lucky that through my work over the years with people like the [01:52:15] BSP, I’m quite well connected. I can, I can send Ian Chappell or Philip Preece or a [01:52:20] WhatsApp and, and just have that back up that I’ve, I got this [01:52:25] right Or am I.

Payman Langroudi: Doing this wrong that we all need that.

Payman Langroudi: Mentors or peer support? You know you’ve [01:52:30] got to do it was Nick, wasn’t it? The network effect. Build [01:52:35] your network. Yeah. Whatever world you’re in, build a network, build people that you can, you [01:52:40] can just go, I need a favour or can I ask you this? Or, you know, we [01:52:45] I think we do it. We do it all the time and people do it to me. And I think, you know, when [01:52:50] you’re lucky enough to be part of other people’s network, be there and be be present and [01:52:55] give your time. Because we’ve all had a hand up, haven’t we?

Payman Langroudi: Yeah. So I was going to say, you must [01:53:00] have that now with mentees, right. Huge, you know, getting people excited about, [01:53:05] you know, people did that for you. Yeah.

Payman Langroudi: Well, even if it’s just a couple of people coming in and [01:53:10] watching me in the clinic or, you know, coming on the course or wanting some mentorship or just some just a Facebook [01:53:15] message and advice, you always, I always just think, well, I had this support, so you [01:53:20] got to pay it back, haven’t you? Yeah. For sure. It’s, um, I think people need to remember [01:53:25] that.

Payman Langroudi: Final question. Yeah, it’s a fantasy dinner party. Three [01:53:30] guests, dead or alive. Who are you having?

Payman Langroudi: Um, [01:53:35] so I did think about this one because I knew I hear the song, all you podcasts. [01:53:40] I’m sort of going to go with a bit of a musical theme. So [01:53:45] it’s not it’s not that musical, but you’ll get it when I explain. So my grandad, my mum’s [01:53:50] dad, um, he passed away before I was 18. Uh, [01:53:55] he never knew I went to dental school. I’d loved to have. I’d loved him to see where I’m. What I’m doing [01:54:00] now. Um, he had a real passion for music. So my musical [01:54:05] tastes are very weird and wonderful. Quite eclectic. One of his things was he [01:54:10] bought every number one single, whether he liked it or not, on on seven inch for about 8 [01:54:15] or 9 years. It’s a collection. Every single one. So whether you know, um, and [01:54:20] he always taught me that a good song is a good song, whether it’s hip hop, R&B, country [01:54:25] and Western rap. You know, just.

Payman Langroudi: I think that I think I agree with that, with the foreign, you know, like sometimes I don’t understand [01:54:30] a word of what’s being said, but it’s good music. Yeah, it’s a good song.

Payman Langroudi: If it’s a bassline or a riff [01:54:35] or something. So my granddad for that reason, and he was a good [01:54:40] guy. One of the people, he was the life and soul of a party. So he’d be great to have a dinner party. Um, [01:54:45] next one’s a bit weird, but I was chatting to my wife about this, but I. Chris [01:54:50] Evans is someone I really like, the radio presenter, Chris Evans.

Payman Langroudi: Yeah, I know Chris Evans because he. [01:54:55]

Payman Langroudi: I just think.

Payman Langroudi: Back in our day he was on fire. Do you remember.

Payman Langroudi: Well, there was TFI and there was [01:55:00] don’t forget your toothbrush. And he was living quite a wild hedonistic life wasn’t he? Yeah, yeah. [01:55:05]

Payman Langroudi: Um what’s he up to now?

Payman Langroudi: I think he’d have great stories. I think so. He’s [01:55:10] now on. Well he was on radio two for years and now he hosts Virgin. And he’s he’s [01:55:15] totally different to who he was. He’s now teetotal and he’s he’s into running. But he’s actually [01:55:20] incredibly positive. And some people will hate that. Some people don’t. You know, it’s just too annoyingly [01:55:25] positive and upbeat all the time. Driving into work every morning. I quite like the [01:55:30] start to the day. Yeah. And I just think he I like his outlook on life and I like [01:55:35] and, and also he’s got that music background. He’s interviewed, he’s, he’s interviewed and partied with [01:55:40] some of the big, big names. Yeah, for sure. So he’d be good. Um, and my [01:55:45] last one is probably a sort of a musical sort of sort of hero would be Billy Joel. Oh, [01:55:50] um, another guy who’s probably been a bit of a hellraiser in his time and would have some good stories. My granddad [01:55:55] wouldn’t fit in because he was almost teetotal, but he’d fit in with Chris Evans new model. Um, but [01:56:00] yeah, Billy Joel, he’s, he’s someone who I’ve only seen live once. Um, but it was someone that my [01:56:05] granddad got me listening to. Um, and yeah, I think that would make [01:56:10] for an interesting evening. Um, but yeah.

Payman Langroudi: Last question is a deathbed question. Three [01:56:15] pieces of advice for your loved ones on your deathbed.

Payman Langroudi: Um. [01:56:20]

Payman Langroudi: You know what? You know what? Let’s skip that. Let’s skip that, because the chances of that seem [01:56:25] to be very similar every time I ask them. Okay, like another one. Um, how would you like to be remembered? [01:56:30]

Payman Langroudi: As a nice guy who doesn’t [01:56:35] take himself too seriously and will always help if you [01:56:40] ask, that would do.

Payman Langroudi: Love that. Perfect.

Payman Langroudi: Yeah, that’s [01:56:45] that’s.

Payman Langroudi: Me. That’s someone who’s not taking himself too seriously. Yeah. No, that’s a perfect answer. [01:56:50] Good. It’s been amazing, man. Thank you so much. Thank you.

Payman Langroudi: It’s been good fun.

Prav Solanki: Thanks for listening, guys. [01:56:55] Hope you enjoyed today’s episode. Make sure you tune in for future episodes. Hit [01:57:00] subscribe in iTunes or Google Play or whatever platform it is. And [01:57:05] you know, we really, really appreciate it. If you would, um.

Payman Langroudi: Give us a six star rating.

Prav Solanki: Six star [01:57:10] rating. That’s what I always leave my Uber driver.

Payman Langroudi: Thanks [01:57:15] a lot, guys.

Prav Solanki: Bye.