This week, Prav and Paiman get to sit down one of their dental heroes – Andrew Dawood.
Andrew talks about early challenges setting up his West End practice and his thoughts on the pros and cons of investing in pioneering tech.
The trio also talk about the virtues of independent practices and how using the highest quality implant materials doesn’t always translate to a quality experience for the patient.
These are just a few of the topics touched on in a wide-ranging conversation with a true industry pioneer and one of the most accomplished implant specialists at work in the UK today.
“We’ve tried all sorts of things in the past, but at the end of the day, keeping it simple is the way forward. Keeping teeth. That’s keeping it simple. That’s the way forward.” – Andrew Dawood
In This Episode
01.07 – Backstory
09.28 – Building the practice
16.09 – Patient journey
21.06 – On consent
24.36 – Quality vs quantity
29.56 – Pioneering, early doctors & new tech
35.25 – Synergies & leadership
39.37 – Family & practice expansion
50.41 – Next moves and past mistakes
59.56 – Work-life balance
01.02.16 – Legacy and last day on earth
About Andrew Dawood
Andrew grew up with ambitions of becoming a potter, but it was not to be. Instead, he graduated in dentistry from the Royal London Hospital in 1984 and went on to complete a Masters in conservative dentistry at Guy’s Hospital.
In 2000, Andrew was accepted onto the specialists register in both prosthodontics and periodontics. He went on to establish a reputation as one of the disciplines’ most accomplished practitioners.
Andrew was one of the first dentists to explore the potential of 3D printing in dentistry. He is founder of Digits2Widgets 3D printing and design studio for non-dental applications.
Prav: Your children are with you and you’ve got three pieces of advice you can leave them with. What would they be?
Andrew Dawood: Oh sugar. Maxine, you should have told me that it was going to be like this.
Prav: Well said.
Announcer: This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.
Payman: Well, one of the best things about my job is I sometimes get to meet a hero of mine. Really, really I mean it. So today we’ve got Andrew Dawood in the show. Andrew, thanks a lot for coming.
Andrew Dawood: Pleasure.
Payman: Thank you. You’ve got probably one of the best implant practises in the world, maybe, but definitely in the UK. One of the leading implant practises in the UK.
Andrew Dawood: Thank you.
Payman: And I’ve been following you for a long time. The first time we ever met, actually.
Andrew Dawood: Gosh. Okay.
Payman: But we’re going to start with your backstory, really. Where were you born, what were you like as a kid, why did you become a dentist, all of that.
Andrew Dawood: Oh God. I don’t think you would’ve wanted to know me as a kid. I was born in London, went to school in London, love London. Used to wander the streets picking up old electronic gadgets and trying to take them apart and put them back together again. Frizzy hair and a bit of an Afro. What can I tell you?
Payman: What kind of kid were you? Were you top of your class?
Andrew Dawood: Oh, no.
Andrew Dawood: No, no. I measured my success from the bottom. In those days, I was very much more about arts and crafts and electronics. I was a bit obsessed by electronics. I mean, not great at school. I mean, dentistry today, it’s crazy. I’d never have gotten into dentistry today.
Andrew Dawood: It’d just never have happened. I never got the greatest great and scraped through.
Payman: You too. He’s an Oxford grad. So when did you decide to become a dentist? Do you remember?
Andrew Dawood: A couple of years ago. I mean, when did I decide? So I was really into electronics and that was a possibility. My brother was a doctor so quite liked that and actually at some point, he’s quite a bit older than me, at some point he went, “Drew, you ought to do dentistry. You’re good with your hands. This [inaudible] and business is really hard work. You’re not good with hard work.” And I did a little bit of work experience with a dentist who strangely I then went on to join.
Andrew Dawood: So I realised that this was what I wanted to do because it was a nice amalgamation of the artsy crafty side, the technical side, the medical side. So it strongly appealed, but I must say that I only really settled into dentistry once I graduated.
Prav: And the dentist that you went and did some work experience for, was that prior to going to dental school I’m assuming?
Andrew Dawood: Yes. Prior to applying, even, to dental school. Incidentally, I didn’t get in anywhere. I got in a week before term started in Clearing. I mean, you know.
Payman: That makes me so happy to hear this. I’m really pleased about this. Who was he, by the way?
Andrew Dawood: He was a wonderful dentist called Laurence Levee who had done some training in the states. He was a high end prosthodontist in central London. So I was really lucky with that and I mean, that and certain other experiences made it clear to me that we wanted to be working at the top.
Payman: Yeah. I remember qualifying from dental school and going to the first VT interviews and just being horrified at what dental practises are like.
Andrew Dawood: Yeah.
Payman: Did you have that feeling as well?
Andrew Dawood: Well, I had a really weird experience. So when I graduated, I went to Venezuela which was a very different country to the one that it is today, right? So went to Venezuela and I worked in the jungle for three months.
Andrew Dawood: In somewhere called Amazonas on the Orinoco River and I sort of moved around in different little locations. It was the sort of Venezuelan equivalent to VT. At a couple of the locations I worked at, I was using rubber dam, I was wearing gloves actually for the first time because at dental school I wasn’t wearing gloves. Gloves, masks, and working in the way that actually I quite wanted to be working. Came back to London and oh my goodness, went to a couple of NHS practises and thought, “No, I can’t work like this” and fortunately I worked in the hospital system for a little while and that was very formative.
Andrew Dawood: So worked at TCH where I am now as well. Worked at [Guy’s] Eastman. So I was sort of sheltered from working in practise for the first couple of years and actually then did a master’s degree with Bernard Smith at Guy’s which was an amazing experience, really.
Payman: Conservative dentistry.
Andrew Dawood: Yeah, conservative dentistry in that time.
Prav: At what point did you get into implant dentistry? At what point in your career did you decide that this is the area that I want to, in air quotes, “specialise” in?
Andrew Dawood: So I graduated in 1984 and probably by 1989 I was working a little bit with implants. I wasn’t doing surgery at that time, but we just started to hear about implants and I’d go along to meetings for [Noble] Farmer at the time because it’s Noble Biocare and I had a load of grumpy older dentists sort of going, “What are you doing here?” And actually that was quite frustrating because there was lots of barriers.
Andrew Dawood: It was very much surgeon led. Even [inaudible] surgeon led. So a prosthodontist, let alone a young whipper snapper of a prosthodontist, didn’t feel very welcome at all which is definitely why Susan and I now would be very welcoming to any young dentist because I just don’t think anyone should experience that sort of, “You haven’t been doing this long enough to be investigating that.”
Prav: Do you remember placing your first implant?
Andrew Dawood: Oh, yeah. I do. I do. Lovely gentleman. Still remember him very well although he’s no longer with us, but kept him in function, smiling and looking good, for 25 years or so that I followed him up. So I remember him very well.
Payman: Did you have a mentor?
Andrew Dawood: I think I had several mentors, really. Of course there was Lawrence Levee who I…
Payman: Worked for.
Andrew Dawood: Started out working for, but I was really lucky because next door to his room was Brian O’Reardon’s room. So Brian was, I think I can call him old-fashioned in the best possible way, oral surgeon who did everything. But he was one of the first people to place implants in the sort of Branemark fashion in the UK. He used to place implants for Michael Wise, for example. So we would always be discussing cases and even better than that, he was pretty much one of the founders of the discipline of dental radiology in the UK.
Andrew Dawood: So along with Professor Seward who was quite an influence to me at dental school, he was very into the radiology, and my brother trained as a radiologist. So this was something that took me very much in the direction of radiology and eventually 3D imaging. So these were early influences. My brother to an extent, Brian certainly.
Payman: Did you meet Branemark himself?
Andrew Dawood: Yeah. In fact, Branemark consulted from our practises a couple of times.
Payman: You’re kidding.
Prav: Oh wow.
Andrew Dawood: So yes, we very much met him.
Payman: Then going forward from that, when you set up the practise, was it a classic one room situation and you grew it?
Andrew Dawood: So we started out in Cavendish Square. Susan Tanner, who’s my wife, joined the practise and eventually Lawrence Levee retired. We were in a nice flat working out of a couple of rooms. Very frustrating, very expensive rent, huge service charges, and this feeling that you could never really settle. You felt it was difficult to invest for the future, to develop the facilities you really wanted. So actually we tried to find our own place, to find somewhere where we could really imprint our own…
Prav: Did you have the classic struggles of West End dentistry where you’ve got no patients and years to build up the list and that sort of thing? Or did you have referrals from the beginning or…
Andrew Dawood: We definitely didn’t have referrals from the very beginning. I mean, that was something that was hard work and I think to an extent it still is hard work because we need to really look after our referrals. We always do try really hard to look after our referrals and their patients. It’s not something you can ever relax with, but in those days we weren’t receiving and weren’t really looking for referrals, but we did have a lot of lovely patients and many of those patients are still with us, actually. So our practise is a wonderful mixture of older patients who’ve been with us for years and years and older implant patients who we still monitor outcome for and then newer patients with all their challenges.
Prav: Just so I understand in terms of the transition, so you were in your hospital job then went to work for Lawrence, is that right?
Andrew Dawood: Yeah. So in the hospital job and started a part time MSC course over two years. So I worked the other part time in private practise.
Prav: And then was it that practise that you ended up taking over before moving on to your own?
Andrew Dawood: Exactly. Well, took it over and it became our own.
Prav: It became your own.
Andrew Dawood: Yeah. Yeah.
Prav: And so you’d purchased the practise from Lawrence? Is that right?
Andrew Dawood: Yeah. We did.
Prav: What was that like? So just in terms of you worked for him, negotiation…
Andrew Dawood: It was stressful. It was something that happened organically over a period because we were together for five years and we did more, he did less, and it was organic and…
Prav: Just transitioned.
Andrew Dawood: And the patients stayed, mostly stayed, and indeed I think many patients brought more of their family in and we got quite lucky there, I think.
Prav: And then from there you went on to, I guess you weren’t happy with the facility or the building or whatever it was, to put your own stamp on it and so is that when you decided…
Andrew Dawood: I very much wanted something of an operating theatre type environment.
Andrew Dawood: For one thing, we wanted some space for education. We wanted to develop the multidisciplinary side. I mean, nowadays multidisciplinary practise is very much an every day thing. There are loads of multidisciplinary so called centres of excellence, right? But in those days, there weren’t even… God damn. It’s making me sound like a dinosaur, but there weren’t even dental specialists as such and that’s exactly the environment we wanted to create.
Andrew Dawood: So eventually MRD and specialisation, registered specialisation, appeared and that’s exactly when we moved and started in Wimpole Street which is where we are now.
Prav: And what was that process like? Just trying to find a place, the building, costing up things. Were there scary moments at that time where you felt, “If I make this move…”
Andrew Dawood: Well, there were very scary moments.
Andrew Dawood: Because we didn’t really plan it very well. We sort of just did it and hoped for the best. I wouldn’t recommend that. We had no idea what we were getting ourselves into. So when we first made this move, we actually lived on the premises. On the two floors above. So I can remember, oh God, I don’t know what CQC would do nowadays, but I can remember treating a patient, in the midst of a full mouth rehabilitation during that move, where the surgery was fine, but there were no lights in the hallway, no lights in the bathroom, and it was winter time and she had to be escorted. Oh God. Maybe I shouldn’t go there. It was a really challenging few months as we made the move and of course, we hugely underestimated the costs.
Prav: Of course.
Andrew Dawood: Took a long time to recover. Would I do it again? Yes, definitely.
Prav: What was the biggest mistake you made during that time, do you think?
Andrew Dawood: So when we made the move, we kept ourselves to a small number of rooms. I mean, more rooms than small, but I think I would’ve tried to create the team we wanted to be earlier on in that move. So things grew slowly. It wasn’t a mistake, I just wish we’d…
Prav: Scaled quicker or…
Andrew Dawood: Yeah. Right.
Prav: Invested in the team earlier on.
Andrew Dawood: Yeah. Exactly. Not a mistake, but just looking back I wish we’d had the courage to do that a little sooner, but it happened soon enough and we’ve got a fantastic team so I’m really not complaining and actually generally speaking, the people who joined us stayed with us and…
Prav: Who’s your longest standing team member and how long has that person been…
Andrew Dawood: Probably Shannon Patel.
Payman: Who I went to school with.
Andrew Dawood: You went to school with her?
Andrew Dawood: So if I said 20 years, would that sound about right?
Andrew Dawood: I think she’s been with us about 20 years.
Payman: I qualified 25 years ago so then he was one year above me, but I don’t remember how soon he came to be.
Andrew Dawood: So I’m saying being with us. I don’t really see it that way. I think we’ve been together which is different. [inaudible] the lead periodontist.
Payman: How many specialists work there now? How many humans?
Andrew Dawood: I think there are 15 or 17 dentists. Something like that. Yeah, and there are probably about 50 of us in the building or something like that.
Payman: Whoa. So how many operatries?
Andrew Dawood: 17.
Payman: 17 operatries. Wow.
Prav: What’s the structure like? So in terms of clinicians, support team, reception team, concierge. Just give us an overview of someone who looks after the patient.
Payman: That’s the new buzz…
Prav: Implant coordinator, concierge, the people call it or person who…
Andrew Dawood: Right.
Prav: Looks after the patient journey.
Andrew Dawood: Yeah. I mean, we have a fantastic reception team. That’s always a challenge. We have four or five therapists or hygienists. We do have treatment coordinators who sort of liaise with some of our more complicated treatment plans. What else? I mean, we have a couple of people in sterilisation.
Prav: I’m a patient. I want treatment at your practise. I send an email through your website. What’s my journey?
Andrew Dawood: So the email will probably be picked up by one of our treatment coordinators who would try and make something of an assessment of the kind of treatment you actually need. I mean, that can be quite challenging. One loose tooth can translate into a mouth full of periodontal disease and they could be salvageable or un-salvageable. So it could be pain. So pain is likely to end up with the endodontist. Sense of gum problems is likely to end up with the periodontist and so they will go to see the dentist. They’ll go to see the clinician. We don’t have system where a non clinical member of staff, which actually happens in quite a few practises…
Prav: It does.
Andrew Dawood: And is decidedly dodgy, I think.
Prav: Okay. So I take the first step. I liaise with your treatment coordinator or receptionist by email or by phone and then they invite me in to have a assessment with a dentist?
Andrew Dawood: Yes. Absolutely.
Prav: Triage me based on what they feel my needs would be.
Andrew Dawood: Exactly. Exactly.
Prav: And then that’s a full thorough clinical assessment?
Andrew Dawood: Yeah. I want to see every patient carefully and meticulously reviewed in a consultation.
Prav: And what would that sort of…
Andrew Dawood: Which can be very frustrating sometimes.
Prav: So I come and have a consultation with yourself. Just talk me through that process. I know it might seem very simple, but…
Payman: How thorough?
Prav: How thorough is that? How long is the appointment? What happens during that appointment?
Andrew Dawood: So I would schedule a 30 minute appointment. I think you can get through a huge amount in 30 minutes and I really do try to assess them in every way. So I suppose I have a restorative background, a prosthodontic background, and so just presumably we’re talking about an implant patient if they’re coming in my direction, but I’ll very much be looking at the general state of their dentician, their periodontal state. I’m fascinated by medical histories.
Andrew Dawood: I get really engaged with the forensics of how did they get to be in the state they’re in. I think that’s hugely important when we’re looking to the future. We want to know what took them to this point whether it’s high blood pressure, they’re on a casein channel blocker, they’re taking [Amlodipine] and actually before we know it, they’ve got a periodontal situation and actually did their doctor know that this drug that they’ve been taking for 5 or 10 years may be one of the factors in causing the problems that have bought them to my door.
Andrew Dawood: So I think that sort of forensic approach is interesting. There are so many drugs now that are going to affect the outcome of treatment. Bisphosphonate. We’re giving a little bit of guidance on anti-resorptive agents. So a lot of our patients are smokers. So I find that actually fascinating. We will very often work with a panoramic radiograph although people always associated us, I think, with CBCT. I mean, we reserve that until we know where and what we’re doing. So that might be something that we will do later on in the process, but it’s seldom the first thing.
Andrew Dawood: So I always laugh when you see adverts. “Free CBCT scan for your new patient.” I mean, that’s an extraordinary thing to do and it’s a huge responsibility as well because that’s a huge volume of data that you need to be thinking about and reporting if you’re going to go that far with a patient. So I try and get a general idea of where we’re going. If it’s a small, distinct issue then I will write and give a comprehensive plan. A quotation, of course. If there’s much more to it, then it may be we’re going to move to a second consultation with more in depth record taking or it might be that we’re going to carry out some initial periodontal therapy to just see what scope there is for improvement before we make a definitive plan.
Prav: And treatment plan sort of a week or so later or at that appointment?
Andrew Dawood: I try very hard to dictate on the day.
Andrew Dawood: It might take longer to edit and send out a letter.
Prav: And then what happens? Do they come back to you to have that presented to them or does that go out in the post?
Andrew Dawood: It will generally go out in the post and one of our treatment coordinators will be there to follow up, but I’m always happy to pick up the phone.
Andrew Dawood: Whether it’s a referring dentist or a patient, I’m always happy to pick up the phone. I mean, I think one of the hot topics at the moment is consent.
Andrew Dawood: And I think that consent process starts the moment the patient walks through the door.
Prav: Are you writing long essays now with the litigation that’s going on?
Andrew Dawood: So you see, you can write a long essay and the patient will walk through the door and go, “I didn’t read any of that.” So what do you do actually in those circumstances? What do you do? [crosstalk]
Payman: It’s still your fault, right?
Andrew Dawood: They’ve just told you that they haven’t read anything, that they actually haven’t taken notes of anything that you’ve put on paper, so what do you do?
Payman: Yeah, that’s difficult.
Andrew Dawood: So long essays, I don’t think are enough or maybe they’re too much, and what certainly isn’t appropriate is a signature on a form which says basically if the world falls apart, you know that could happen and it’s a lot of responsibility. That sort of thing signed 30 seconds before you start an invasive treatment. In the case of implants, you’re putting in something that hopefully is going to be there for a lifetime or taking out teeth that may have some more scope to last a bit longer and putting in implants which are hopefully going to be there for a lifetime and that’s not a decision you can make on the day of surgery.
Andrew Dawood: I mean, one of the trends that’s out there is you see a lot of itinerant dentists who are going into practises, putting in implants, and they have not met the patients before they do the treatment and that’s just not acceptable in any way, shape, or form and we have a number of patients who come through our door who have been sent to us for various medical legal reasons and for advice and this is something that is a real problem. They say, “We did not understand. We did not consent to this.”
Andrew Dawood: So I think how do you get good consent? By recording the fact that you’ve had good communication throughout the process and yes, the letter of course is important. It is.
Prav: And do you have a unique consent process? Do you ever get the patients to write down the risks themselves? I’ve heard different dentists do it different ways. So some of them say if they ask the patient to write the risk down then at least they’ve understood it. What was your take on that?
Andrew Dawood: Well, we don’t give them a multiple choice type… We don’t do that, but we do go into detail and I think that by and large, the more you discuss the potential issues, the potential problems, actually there is a concern out there that you’re going to drive the patient away by telling them what all the problems are, but in fact I think what the patient sees is someone who’s wise, someone who’s been around the block and understands what can happen, and I think it’s increasing confidence in you, the clinician, rather than decreasing confidence in the process.
Andrew Dawood: So you’re bringing people down to earth and that’s really useful and really important, but it means we’re all on the same side and actually if the patients don’t like that, then maybe you’re better off without them.
Prav: Sure, and in terms of being one of the leading implant clinics in the UK, in terms of pricing and level of investment, where do you sit? I’m assuming at the top end of the market.
Andrew Dawood: We are an absolute bargain. No, I’m actually being…
Payman: Love that.
Andrew Dawood: Completely serious.
Payman: Love that.
Andrew Dawood: We’re being completely serious. Okay, look. You’re talking about us as an implant clinic and actually we’re not an implant clinic. We’re a specialist practise. We’re a practise with many specialists in it, actually. We’re not all specialists, but we’re a practise where if it is appropriate that a patient has a root filling, they’ll have a root filling. If it’s appropriate that they’ll have a difficult reconstruction on teeth, then that’s what they’re going to have.
Andrew Dawood: Yes, I do implants, almost exclusively implants, but what is an implant clinic? I mean, maybe that shouldn’t really be there. I didn’t think a specialist implant, you know we talk about should there be a specialism in implant dentistry, I don’t really think there should be because it’s actually about restoring denticians and we need that overall perspective.
Andrew Dawood: So we are a bargain. Coming back to your point, we’re a bargain because we’re hyper efficient. I think we’re extremely efficient at what we do. We’ve been doing it a very long time. We use well known, highly regarded implant systems and we do that from the ground up. So our implant system is something that’s highly regarded and well known, but the components that we put on top of it are also of that system. So I think something that people don’t really get is that what you put on top of the implants is as important as the implants and a lot of patients will say, “They used that implant. It’s a really good implant”, but then you see that what’s been put on it just doesn’t fit at all and they’ve used…
Payman: Cheap stuff.
Andrew Dawood: Cheap stuff on top and that’s a great way to cause perisplanchnitis, for example. So the implant fails because of the restorative work that’s done. So when we work with referrers, we work very closely with them to make sure that what goes on the implant is the right thing. Now if you’re going to do it right, it is going to cost a bit more. I think I’m actually going to name something that’s happening at the moment because you’re laughing, I think you know what I’m going to tell you.
Andrew Dawood: So there’s a dental company called Finest Dental which has just recently, I understand, gone bankrupt or something like that and there are patients out there who have just been left in the most appalling state and some of them have found their way to our practise and it’s just mind boggling. I mean, they have had implants provided from a well known manufacturer, but in the patients I’ve seen, the implants look like they’ve been shot in. Far more of them than there should be. Far more implants.
Andrew Dawood: So they’ve paid very little, I believe they’ve paid very little, but for twice as many implants as they needed. Then what’s been put on top just [inaudible] belief. No thought to occlusion, no thought to the opposing arch, no thought to the periodontal state, the restorative state, and I mean, it’s worrying. It’s upsetting. It gives us all a bad name.
Prav: How do you deal with a patient like that? So someone who’s gone and had that treatment done somewhere else at probably a fraction of the investment that you do have[crosstalk 00:28:27]
Andrew Dawood: You see, remember, sorry. I said we’re a bargain. I mean, actually paying half as much for nine implants still costs more than four implants done properly.
Andrew Dawood: Buy once, buy right.
Payman: Yeah, absolutely.
Prav: The general point, you must be seeing a lot of failure cases coming to you. How do you deal with that without trashing the previous guy and all of the…
Andrew Dawood: We never do that.
Andrew Dawood: Sympathetically and empathetically and it can be very challenging. We also see patients who’ve gone abroad to have dentistry done.
Prav: Do you get a lot of that?
Andrew Dawood: We see quite a few of them and that’s upsetting because the patient comes back, not back, they come to us and they’re already upset. They’re already angry and there’s a tendency for them to sort of tar the dental profession all with the same…
Prav: Same brush.
Payman: Do you get a lot of people travelling here to come and see you?
Andrew Dawood: Oh, we do get quite a number. I can say that they travel from…
Payman: The Middle East and all that.
Andrew Dawood: Some from the Middle East, but also from Europe and even further places like Scotland.
Payman: So you’ve pioneered a bunch of things in practise. The imaging. You were the first CBCT, were you?
Andrew Dawood: We were. Yeah. We had the first CBCT unit in the UK.
Payman: You’ve [inaudible] and print bit and pieces, implants, titanium, things that we didn’t think were possible. This sort of being the pioneer, it comes with an element of kind of risk, going into the unknown, and you were saying when you moved from one practise to the other you jumped in. Didn’t really know what you were doing, but you just did it. That seems like a threat that you must be comfortable with. I’m not saying comfortable with risk, but comfortable with not knowing the future and trying to be the first.
Andrew Dawood: I don’t know if I’m comfortable with it or just stupid. We’ve been earlier doctors in so many things.
Andrew Dawood: And some of the things that we’ve been earlier doctors in have been really successful and some of the things that we’ve…
Payman: I was going to say, there must have been lots of false starts along the way.
Andrew Dawood: Oh God, yeah. Yeah.
Payman: I read somewhere you were printing in the 90s and you must have invested in things, thousands [crosstalk]
Andrew Dawood: Our first patient treated with 3D printing was in 1999.
Payman: That’s unbelievable.
Andrew Dawood: In fact.
Payman: So did you have lots of mis-starts and…
Andrew Dawood: There’s this thing, what is it called? The technology adaption life cycle, but there’s the chasm where people head out full of enthusiasm and suddenly you just fall into this chasm of, “Oh God, I wish I hadn’t been the first one to do that” and that’s happened so many times. I mean, in terms of 3D printing for example, we invested early on in costly industrial 3D printers. We’d have been much better off taking a small part of what we invested in the machines themselves and investing that into the 3D printing businesses, the companies that produce these machines.
Andrew Dawood: It’s very competitive. There are very small margins. The people who really make the money out of it are the people who produce the machines because they produce materials that are tied to those machines.
Payman: The ongoing…
Andrew Dawood: And so it’s a bit like buying a really expensive ink jet printer and having to buy cartridges all the time. Very frustrating, but you can’t look at one item on its own. You have to look at the bigger picture. So we’ve invested very much in technology and 3D technologies. Some of that’s been good, some of it hasn’t been so good, but it’s taken us into territory that’s been interesting, engaging, fulfilling. It’s led us to treat some amazing people, amazing patients, work with some amazing surgeons, dentists.
Payman: What is it about you that you were the young guy when all these older guys were putting in the implants and you seemed like you were comfortable with that, then you were the first CBCT, then the first this, the first. Why are you that person?
Andrew Dawood: I think it goes back to when I wasn’t quite sure whether I wanted to be an electronic engineer or a potter actually or a dentist works pretty well. So it’s that sort of fascination with technology, I suppose, and also a bit of tendency to think laterally which I hope my kids have a bit of as well. I think they could be as annoying as I was at school. I’ve got a daughter who is in dental school.
Payman: Oh really?
Andrew Dawood: Actually so trying to look at technologies outside of dentistry, seeing how we can use them in dentistry or vice versa actually because dentistry, in many ways, is what drove the 3D printing market because with this new technology there are lots of things that people talked about doing, but in dentistry we were actually doing them.
Payman: Yeah. And so you have a 3D printing business that supplies outside of dentistry to architects and…
Andrew Dawood: Yes. So the business, I mean I’m not involved day to day in that side of it, but we work with architects, product designers, some quite well known individuals. People like Ron Arad. Some well known sculptors. We produce everything from architectural models to sculptures to patterns for sculptures to jewellery which is really the same as dentistry in so many ways.
Andrew Dawood: So anything that can be modelled on screen in a virtual environment and sent for printing or milling for that matter because we even make some large scale sculptures which are milled out of blocks of marble or polystyrene. Things like that.
Payman: I went to that exhibition. Have you heard of Moving to Mars? Did you hear about that one? What will it take to move to Mars and they took a bunch of these little plastic pipes along with them and then printed the houses and printed the tables and chairs.
Andrew Dawood: If you’re going to do that…
Payman: That’s going to be you.
Andrew Dawood: No, I’d get bored in a small space for a long time. If you’re going to move to Mars, you’re going to print it using Mars dirt. That would be the way to go. You’ve got lots of sunshine and make cement and use Mars dirt and print without it because a lot of people are printing houses in concrete and printing in concrete is a thing.
Prav: How do you split your time between the different businesses? Do you have certain days focusing on one business and another or do you have a team who’s leading the printing business and then report back to you?
Andrew Dawood: We have an excellent team of people and we work together. There’s synergies. Where there are synergies, we exploit the synergies, but our imaging businesses which is Cavendish Imaging is lead by Veronique Jackson who’s a medical physicist who’s totally brilliant and very self-sufficient, actually. So essentially I work as shall we say the clinical director and we meet regularly and chat about the way things are going and the imaging world is constantly changing, constantly evolving, and I’ve got a chat [inaudible] Matt Vinyl who runs Additive which is the 3D printing business.
Prav: Just give us an idea of the scale of these operations. So 50 people in the practise. How many people in the imaging?
Andrew Dawood: Probably about 15, 17?
Prav: Printing side?
Andrew Dawood: About 12, 15.
Prav: How do you lead all of that?
Payman: What kind of a leader are you?
Prav: What’s the secret to your leadership? Give us your top five tips for being an excellent leader.
Andrew Dawood: Well, I don’t feel like an excellent leader, I have to tell you. I wish I had more time for everybody if I could
Prav: You a workaholic?
Andrew Dawood: I don’t think of myself that way because I mean, part of it is I don’t think of what I do as being work particularly and probably I just really enjoy what I do. I really enjoy the people I work with. I enjoy the patients who I work with and the dentists and…
Payman: You’ve got incredibly high standards yourself. Then do you want that from your team as well and that you are quite a hard boss to work for or…
Andrew Dawood: I think if people want what I want which is the best for the patients, the best for the client, then things tend to run themselves pretty well and I think there’s a very strong work ethic in the environment we’re in. I mean, the people who don’t have a strong work ethic definitely stick out like a sore thumb and I think we’re quite democratic. I think the people around me kind of are as unhappy as I might be if someone’s not performing.
Prav: How involved are you in the recruitment of these team members? Are you just recruiting at the higher level and then having your sort of…
Andrew Dawood: So I have a wonderful practise manager who looks after most of the recruitment in the practise and then so higher level, yes. I’m more involved and of course, the people who run the other businesses are more involved. Susan absolutely is hugely involved in that side of things as well.
Prav: You ever had to fire someone?
Andrew Dawood: Yeah.
Payman: Who does that? Is that you or Susan?
Andrew Dawood: Oh, I think when we really chicken, somebody else entirely will do it. I mean, that’s the pits, isn’t it?
Payman: It’s never easy.
Andrew Dawood: No, it’s never easy. It’s never easy.
Prav: Never easy.
Andrew Dawood: I mean, that’s not something that I enjoy or want to do.
Payman: So the toothpaste.
Andrew Dawood: So that’s really Susan’s baby. You’d have to get her along to talk about that.
Payman: I love that toothpaste. I really do. I love the four flavours of it.
Andrew Dawood: Well coming from you, that’s a compliment.
Payman: I love the four flavours of it and it’s a wonderful idea and the execution of it. I don’t know if you saw, Curaprox tried doing something like that. Was it Curaprox?
Prav: Yeah, yeah, yeah.
Payman: The gin and tonic. The execution on the branding was all right, not as good as yours, but the taste is still disgusting and it’s a challenge. I’ve played with taste in toothpaste quite a lot. Really, really brilliant execution.
Andrew Dawood: So Susan’s really managed that and I think we were a little early with the toothpaste and it’s something we want to revisit, but it’s very much something that I will leave you to discuss with Susan.
Payman: I like that.
Prav: Tell us about your family.
Andrew Dawood: Okay. Well, there’s obviously for this morning, the star is the budding dentist.
Andrew Dawood: Third year.
Payman: Did you encourage her to become a dentist?
Andrew Dawood: I didn’t encourage anything to do anything particularly. So my oldest son who’s currently doing a PhD in bone biology. I mean, that sounds like we’ve had a certain influence, doesn’t it?
Prav: It does.
Andrew Dawood: But when he said he wants to do medicine, I wasn’t mad keen on… I sort of said, “Well look, if you are going to do medicine, why don’t you do dentistry?” I got involved a little late on that one because I really think that it’d have been totally brilliant and then Hugo, our central child who’s actually a software engineer, I mean he was always going to do that. It was clear. I mean, he was always at his computer.
Prav: Programming geek?
Andrew Dawood: He’s a programmer but he’s just the most astute sort of business-minded and people centred person. So very into technology. Clever, clever guy. So he was never going to do dentistry and our daughter sort of piped up and said, “Well, I think I should do this.” It was fantastic. So thrilled.
Prav: Is that your youngest?
Andrew Dawood: She’s our youngest, yeah. So thrilled that she’s doing it and also for me, for Susan, I think it’s focused our attention more on the profession. I don’t think there’s a lot we can do, but thinking about her moving forwards into this profession we just want to make sure that it’s the right one for her. So it’s going to.
Prav: And when did the children come along amongst all this moving the practise and setting up businesses and…
Andrew Dawood: Well, we literally had our middle child in a drawer above the practise. So yeah, that was kind of take a little time off to have a baby and move straight into a building site, yeah.
Andrew Dawood: Which isn’t that what happens to everyone to an extent?
Payman: Sure. Do you still live in Central London? Or…
Andrew Dawood: We do. Yeah.
Payman: Yeah. [crosstalk]
Andrew Dawood: Thankfully no longer above the practise.
Payman: Did you ever have ambitions for opening more than the key centre? I mean, did you ever think of doing lots of them?
Andrew Dawood: I don’t think lots, but I can see a reasonable argument for being a little more distributed than we are.
Payman: So you think that might happen?
Andrew Dawood: Ooh. Watch this face.
Payman: Well because we have these younger kids on the show sometimes and super ambitious and people are ambitious when they’re young, but I’m thinking of Robby. He wants to put one in every city in the world. He meant it. He really, really, really meant it.
Andrew Dawood: I think the challenge is…
Payman: The excellence in that one centre as the key thing.
Andrew Dawood: Yeah, I mean the challenge is as soon as you do that, you need people who are like minded, who want the same for their patients, and to find people who are going to work for you somewhere else, it’s tough. It’s challenging and so you see a lot of multi-centre practises and you see them open, then you see them close. Are the corporates that we see out there a bit of a dumbing down of dentistry where what we can offer is a bit more limited? I don’t know. The dental industry is becoming a bit more of an industry.
Andrew Dawood: I’m not sure that that’s really the way I want to go. We’re proudly independent. I mean, it’s interesting, isn’t it? When I graduated, an independent practise was one that wasn’t happy to call themselves a private practise because they didn’t want to frighten away the patients.
Payman: Yeah, yeah.
Andrew Dawood: But they were also trying to move off away from the NHS, but now an independent practise to me is us.
Andrew Dawood: We’re not a corporate, no desire to be a corporate, and yet we can be out there and offer our patients exactly what they need. There are no commercial pressures towards uniformity.
Prav: Standards and all of that.
Payman: I mean, you must have put in thousands of implants by now. Have you got a number?
Andrew Dawood: I actually laugh when people give numbers. I mean, if you’re still counting then there’s [crosstalk]
Payman: But my point is, my question really, is with surgery you can never be blase about it. You have to still always be on it, but there must be an element of it where it’s second nature to you and that sort of tension between it being an easy thing but it’s a surgery at the end of the day and I guess the things that you’re doing, the risks are higher.
Andrew Dawood: Well, some of them, but I love surgery whether it’s a single tooth or… The drive for me is always to keep it as minimally invasive as possible, the interventions as small as possible. In this day and age of sort of Instagram dentistry, I do laugh sometimes. I open Instagram and I see these incredibly complex scenarios that there’s the before, but there’s never an after. Bone everywhere, bone materials, screws, and membranes and incredibly complicated things and you think, “Well, was that really necessary?” And we’ve tried all sorts of things in the past, but at the end of the day keeping it simple is the way forwards. Keeping teeth. That’s keeping it simple. That’s the way forwards.
Payman: I notice in your ad it says something about, “You may have been told you need a bone graft, but actually we can do many things without them.” Is that what you’re alluding to?
Andrew Dawood: We might have said something like this in the past or even currently.
Andrew Dawood: I mean, very much a bit of clever thinking, clever 3D thinking, can very often allow you to skip those sort of extra treatment which actually quite significantly affect predictability and definitely affect the timing of procedures. So if you could avoid grafting, that’s one less procedure. Very often a quicker, more predictable result.
Payman: Do you ever get bored of it?
Andrew Dawood: Do I ever get bored of it. God.
Payman: Because what if I gave you a billion dollars? Would you still put implants in? I mean, you answered the question.
Prav: He’s thinking about it. He’s answered the question.
Andrew Dawood: There are maybe some of the simpler things that I do I would do less of, but then on the other hand I do enjoy the simpler things that I do. I probably would. I mean, I love the max fax stuff, I do, but I couldn’t be at the top of my game with that if I wasn’t doing some of the other stuff around it. It’s very hard to say… Everything you do feeds into what you do to make you the person that you are. So if I wasn’t doing the simple things, then I probably couldn’t do the more complex things and yet, doing the more complex things that I do helps to make the simple things simpler. So it would be very hard to take your…
Payman: I hear you, but I think what I’m saying is you know when you ask someone, “If you weren’t an implantologist, what would you be?” You would be a technologist of some sort.
Andrew Dawood: No, I’d probably be a potter actually.
Payman: Potter. There you go.
Andrew Dawood: I mean, when my parents said, “What do you want to do” and I said, “Potter.”
Andrew Dawood: Yeah. It didn’t go down well. It really didn’t, but that generally was…
Payman: What do your parents do?
Andrew Dawood: It really was a conversation.
Andrew Dawood: What my parents do. Well, my dad was an author, a translator, and a publisher. Advertising, marketing. Not at all anything that I ever got into, but we were probably the first dental practise in the world to have a 3D printer, but he was the first person doing what he did to have a typesetter, but a computerised typesetter. So I used to operate that as a 14 year old. I’m remembering this now. So this thing was the size of a room and in my summer holidays as a 14 year old I would be operating this thing that essentially moved a matrix of tiny negatives around to set print for lithographic reproduction onto photographic paper. So I’d be in the dark room changing this thing. So he spent as much as a house on this computerised printer.
Payman: I think the beginnings of it, right?
Andrew Dawood: I seem to remember that it had 64 kilobytes of memory which is as much as your washing machine now. It’d probably be less than your washing machine.
Prav: Less. Less.
Andrew Dawood: Maybe your cappuccino machine. So no, there was that and like him, he never knew how to work it and there are a lot of machines that we have that I have no idea how to run either and my mother is, was a simultaneous translator and…
Payman: Which language were they translating into?
Andrew Dawood: Arabic, actually.
Payman: Oh really?
Andrew Dawood: Yeah, yeah.
Payman: What’s your background?
Andrew Dawood: My parents came to the UK in the 40s.
Andrew Dawood: From [inaudible] in Lebanon.
Payman: Oh, okay.
Andrew Dawood: Yeah. What else did you ask me? Sorry.
Payman: Well, I was getting down this route of if you weren’t a dentist, what would you be?
Andrew Dawood: A potter.
Payman: But where I’m going with it is that you’ve achieved pretty much everything in dentistry. I mean, you could…
Andrew Dawood: Oh, I don’t know.
Payman: Well, you know what I mean, but you could stop being a dentist and being something else if you wanted to. So where I’m going with it is do you feel like retiring? Do you think you’ll retire early? Are you one of these types that says you’ll never retire, you want to work forever type of people?
Andrew Dawood: Well, my dad was still working when he was 85.
Payman: Is that right?
Andrew Dawood: So I couldn’t really consider that. I’m not sure how good of a dentist I’ll be at 85, but maybe I’ll have stopped putting in implants by then, but I enjoy what I do.
Prav: Was it your dad’s own business?
Andrew Dawood: Yeah.
Prav: That you were working in, yeah.
Andrew Dawood: Yeah.
Andrew Dawood: Only on summer holidays, mind.
Prav: So what’s the next big move for you? I remember before, we were just chatting outside and you were talking about MRIs and where that’s going.
Andrew Dawood: Well, I mean that’s a feature of what we do. So we got involved with CBCT back in 2005 which is volumetric imaging. People compare it with CT, but there isn’t really a comparison because CT is sliced acquisition whereas in CBCT we’re requiring a volume at the same time. Same time. That’s very important. It’s the same time and MRI is moving in that direction as well. So instead of requiring MRI data a slice at a time, you’re acquiring it volumetricly. A whole chunk of data. What that means is that if you give contrast agents, for example, you can actually start to see vascular systems in one chunk.
Andrew Dawood: So we have some incredible imaging. This is rather sort of new really working with guys at UCLH. Incredible imaging of tumours, vasuclatures, nerves. We’re running through [inaudible] glands for example and so we’re getting into some very interesting surgical planning 3D printing of that kind. So we’re looking at how MRI can be fused with CBCT or just used on its own. Lots of projects in mind there, but really that’s just a little…
Prav: Side project.
Andrew Dawood: Side project. Something that is a hot topic for me because I’ve thought about MRI a lot, but brilliant radiologist called Simon Morley showed me some of his work which was so inspirational. I want to try and help with that. Promote that.
Prav: What’s the next big thing for you?
Andrew Dawood: The next big thing is probably catching up on sort of a trail of growth and expansion that we’ve had over the last few years and actually just making what we’ve achieved so far solid and stable.
Payman: Consolidate it.
Andrew Dawood: Consolidating and I mean, rather than looking forwards and doing more, I just want to make sure that what we’ve done so far is better.
Prav: Sure. Sure.
Payman: Andrew, we’ve been asking all of our guests about clinical mistakes that they’ve made in the help that it’s not the normal medical situation where everyone hides their mistake or blames the thing. It would just feel so good if you said you’d made some clinical mistakes that were…
Andrew Dawood: Well, I mean we learn from our mistakes, right?
Andrew Dawood: I mean, we learn every day. I mean, there’s mistakes that we make where we can beat ourselves up and then there are mistakes that we make that everyone makes and I mean, what’s all so challenging in dentistry in general and in the implant world in particular is that what we do has a patient at the other end of it and we have the challenges of our regulators. We have the challenges of a population who are evermore increasingly litigious and so it’s a difficult environment, but nonetheless we learn from our mistakes and we improve ourselves by reflecting back on what we’ve done and that goes for everyone from the receptionist all the way through to all the team who are terribly important to us.
Andrew Dawood: I mean, one of my big pleasures is seeing development within our team who are so important to us. So yeah, we want an open culture to reflect and share problems amongst clinicians. We’re really lucky to be able to sit together or stand up together in a corridor, whatever, and discuss the problems that we have.
Payman: So what are the clinical mistakes that you’ve learned so much from?
Andrew Dawood: Oh gosh. Where do you go with that? I think the kind of implant dentistry I practise today is very different to the kind of implant dentistry I practised 15 years ago, for example.
Payman: In what way?
Andrew Dawood: I think we had higher powered rose tinted spectacles back then and maybe, maybe we were a little more likely to look at the implant as a huge panacea to any problem that came along and possibly back then we might have put in more implants than we do now. The converse of that is that maybe more teeth came out than that need to now. I think we were always operating in an entirely ethical…
Payman: Yeah, of course.
Andrew Dawood: Way. I feel confident and secure in that knowledge, but I think ideas have changed generally.
Prav: Did you ever have one of those moments in practise where you thought, “Oh my God. I can’t believe I’ve just done that. I’m going to need to tell the patient that I’ve screwed up” or whatever. Made a mistake and put it right. Any situations like that before?
Andrew Dawood: Well, probably one of the most upsetting occurrences for me, so you’re pushing me to give me my particular disaster.
Payman: You don’t have to.
Prav: You don’t have to.
Payman: No, no, no.
Andrew Dawood: So I would say one of the most frustrating and upsetting things that happened to me was a pure sort of pressure consent administrative issue where…
Payman: Perfect storm.
Andrew Dawood: You had a perfect storm of a very, very busy, challenging day with actually emergency, I don’t mean serious emergencies, but people who were seriously impinging on your day and compromising…
Payman: Your work flow.
Andrew Dawood: Your work flow and I had seen a patient, had a really detailed consultation, had written a really detailed letter, had gone through scans, had talked to the patient. I knew exactly what I was doing. He should have had the letter that said exactly what he was going to have done and we got on so well that because he was uncomfortable, he came in within about three days of that consultation and actually I was also working with a new member of staff who… our work flow wasn’t what it should have been on that day at that moment for that particular patient who had a huge cyst on a first molar and absolutely failing second and third molars.
Andrew Dawood: I’d written my letter that these three teeth were going to come out and I said to him, “Okay, here we are. We’re going to take out these teeth”, numbed him up, and took out the teeth and he said, “Hang on, there are three teeth. You’ve taken out three teeth.” “Yes. That was in my letter.” “Well, I didn’t get your letter.”
Payman: So you learnt from that.
Andrew Dawood: So this new patient who I didn’t know very well turned out to be a thoroughly difficult individual.
Prav: Piece of work.
Andrew Dawood: And anyway, a couple of implants and a sinus lift later, managed to pacify him, but these things sort of…
Prav: You’re not going to have a 30 year career without things going wrong.
Andrew Dawood: No, an event like that, it absolutely changed the way we work.
Prav: Of course.
Andrew Dawood: Because I mean, it’s silly, it’s subtle, but it’s not subtle. Did you get my letter?
Prav: Reshaped you, yeah.
Andrew Dawood: It reshapes you. So I mean that’s probably the worst clinical error and clinically it wasn’t an error.
Prav: It was an administrative error.
Andrew Dawood: We did exactly what needed to be done, but what needed to be done didn’t coincide with what he thought we were doing. So if you want my worst error, that’s probably it.
Payman: What were your darkest times in professional life? I mean, did you have any issues like, I don’t know, building issues or people leaving you at the wrong time or loss of confidence? You don’t look like someone to lose confidence.
Prav: Work life balance.
Payman: Work life balance sort of.
Andrew Dawood: Well, I mean I think we’ve been pretty lucky.
Payman: Where I’m going with this, you don’t achieve excellence like that without some sacrifice.
Prav: Most have ended up in the hole at some point.
Payman: Because you’ve achieved so much, you know what I mean?
Andrew Dawood: Yeah.
Payman: He runs a business, I run a business. To make something, you want to be best in the world at something, you do end up sacrificing along the way. I mean, my particular problem is I sit in a room on my phone with my kids, but I’m on the phone, yeah? And so I go away for conferences all the time. It affects them. It does affect them.
Andrew Dawood: Yeah. I suppose that’s true, but I think we live close enough to work. Susan has worked throughout her life and seldom took a lot of…
Prav: Is she a specialist too?
Andrew Dawood: She was a specialist prosthodontist and she seldom took time off. One was going to the hospital to have the baby come out, but I think our kids have benefited from that. I think they’ve seen how we work and [crosstalk]
Payman: Work ethic.
Andrew Dawood: Great work ethic and you can keep yourself very busy doing nothing and I think we keep ourselves busy doing quite a lot and I’m not complaining.
Payman: What do you like outside of work? What are your hobbies?
Andrew Dawood: Pottery.
Andrew Dawood: In case you haven’t gathered.
Andrew Dawood: Pottery, I love.
Payman: You cycled here, right?
Andrew Dawood: I wish I could say that was a hobby. I mean, it’s transportation. I did go to London, to Brighton last year which was good fun. Pushed along by one of my sons. I loved it.
Prav: Are you a gym person? Health and fitness?
Andrew Dawood: Well, I hate to disappoint you, but when I get on the running machine it’s with my dictation machine in my head.
Prav: Two birds with one stone.
Andrew Dawood: Yeah, exactly. That’s exactly it. So I do that. Yeah. I go to the gym and work out. Try and keep reasonably fit and healthy, but I like my food.
Prav: Don’t we all?
Andrew Dawood: Yeah. Like my food a lot.
Payman: So if you were going to leave the legacy, what would you say? I mean, if you were going to leave some advice for your kids or for your… Listen, do your bit.
Andrew Dawood: This is seriously deep. I wasn’t ready for this at all.
Payman: You should have listened to an episode before you…
Prav: Let me paraphrase.
Payman: Yeah. He likes to close on this.
Prav: It’s your last day on the planet.
Andrew Dawood: Oh.
Prav: And your children are with you and you’ve got three pieces of advice you can leave them with. What would they be?
Andrew Dawood: Oh sugar. Maxine, you should have told me that it was going to be like this.
Andrew Dawood: Well, I’d say do your best for everyone and always do your very best and be kind and good God. Look out for each other.
Prav: As in the siblings, look out for each other.
Andrew Dawood: Each other.
Prav: Stick together. Always support each other.
Andrew Dawood: Absolutely.
Payman: That’s good enough for me. Be kind.
Andrew Dawood: You said that better than me. You’ve obviously done that before.
Payman: He just likes to make our guests uncomfortable.
Prav: Not at all. Not at all, but certainly for me irrespective of what my kids end up doing, the big dream I have for my kids is that they’re always together, they’re always best friends, and…
Andrew Dawood: Absolutely.
Prav: If shit hits the fan, they’re there for each other.
Andrew Dawood: Absolutely. So that’s very much… each other and your fellow man, really. God, that’s getting deep.
Andrew Dawood: A long way from implants [crosstalk]
Payman: I enjoyed that, Andrew. Thank you so much…
Prav: Thank you so much.
Payman: For coming on the show.
Prav: So thanks a lot.
Payman: Thank you for that. [inaudible] I think.
Announcer: This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.
Prav: Thanks for listening, guys. If you got this far you must have listened to the whole thing and just a huge thank you, both from me and Pay for actually sticking through and listening to what we had to say and what our guest has had to say because I’m assuming you got some value out of it.
Payman: If you did get some value out of it, think about subscribing and if you would share this with a friend who you think might get some value out of it too. Thank you so, so, so much for listening. Thanks.
Prav: And don’t forget our six star rating.