After graduating in 1994, Sanjay Sethi quickly made a name as a leader in aesthetic dentistry. So, when brother Nik graduating almost two decades later in 2009, expectations were high.
In this week’s episode, Payman gets the brothers together for a frank conversation on their early years; how each followed their own unique career path; the highs and lows of working together, and much more.
“I think really we’ve been, on balance, really good because we have our own strengths. And yeah, there’ll always be some differences we’ll have along the way, and I’m not going to deny that. But on par, it’s sorted out on the day and we just move on. We have a laugh. We have a great time together!” – Sanjay Sethi
In This Episode
01.08 – Backstory
07.54 – On excellence
09.54 – Influence and associations
19.02 – Heroes
20.27 – Sharing work
23.55 – Square Mile
25.38 – Expectation, motivation and inspiration
35.51 – Buying in
38.55 – Friends vs colleagues
40.40 – Dark times and COVID
41.20 – Pricing
46.53 – Teaching and lightbulb moments
50.00 – Clinical mistakes
54.30 – New practise
57.44 – On family
58.46 – Digital dentistry
01.06.51 – Predictions
01.17.52 – AEsethiX
01.20.28 – Last days and legacies
About Nik and Sanjay Sethi
Brothers Nik and Sanjay Sethi are co-owners of Square Mile Dentistry in the City of London.
Sanjay graduated from Guy’s in 1994 and pursues a special interest in aesthetic and restorative dentistry.
Nik graduated in 2009 from King’s College London and is passionate about composite bonding and smile makeovers.
In addition to Square Mile Dentistry, Nik and Sanjay also co-own a practice in Essex and the AEsethiX dental training academy.
Sanjay Sethi: Knowledge is nothing without application. It doesn’t matter what you’ve learned. You can have all these facts in your head, but if you can’t apply it, whether it be in dentistry in life, life lessons, whatever, it meant nothing, did it? And you don’t want to be sitting there full of regrets. So you’ve got to apply and evolve all the time.
Speaker 2: 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 Langroud…: It’s my great pleasure to welcome Sanjay and Nik Sethi, onto the podcast. Some of the brothers in arms, brothers in the industries, there’s a few groups of those. Isn’t there? Good to have you guys.
Nik Sethi: And thanks [crosstalk 00:00:54].
Payman Langroud…: It’s weird Nik because I didn’t know you existed until you became a dentist. I have known Sanjay a long time-
Nik Sethi: He tries to keep me under, [inaudible] secret.
Sanjay Sethi: But at least, I’m not going to hold him back.
Payman Langroud…: What is the age difference between you guys?
Nik Sethi: Do you want to tell him?
Sanjay Sethi: 14 years. I was working out today actually, when I first went to uni back in ’89, he was only three years old.
Nik Sethi: And I remember actually I used to guilt trip him. Because Sanjay is like another father. Growing up, we were all super close to our dad as well. But he being 14 years older, he was like another dad. And it would be a Friday night when he’s 21, he’s getting ready to go clubbing. And Sanjay used to have this really real wild hair. And he must have spent more than an hour with the hairdryer, with the Brew cream, having it all up and ready to go. And then I didn’t want him to go out, so I went to play. And I’ll keep guilt tripping him. He’d leave. And then, because I’d be crying, literally about 10 minutes later, drive back and come in and cancel the night just to… I wouldn’t have done that for anyone when I was 21 going out clubbing.
Payman Langroud…: Was it just the two of you?
Sanjay Sethi: Just the two of us, yeah.
Payman Langroud…: Is your dad or your mom, or your parents involved in dentistry or how did it happen?
Sanjay Sethi: No. No, not at all. My dad’s sister in India, she is a dentist. But that had no influence on me. I think it was just one of those things. When you grew up is the standard Indian profession, isn’t it? You’ve go doctor, dentist, lawyer, accountant, and I wanted to do medicine really, but I just didn’t like the idea of people dying on me. So then I thought the next thing was dentistry and that was literally how I fell into it. So I went and watched people, like my dad had a few friends. I went and watched them and that was how I got into it, but I didn’t know much else.
Payman Langroud…: So a lot has happened. But Sanjay, I remember I came to a lecture once where you were lecturing. I don’t know where it was, man. It might’ve been one of the first FMC events or dentistry show, one of the first ones. And I remember it was the first time where I saw a composite that blew me away by a UK lecturer. I had been in America once, but it just blew me. I think it was a Durafill composite.
Sanjay Sethi: Payman, you’ve got a really good memory. Yeah.
Payman Langroud…: Like a highly polished, invisible, composite and up to that point. I’d never seen that before. And you were very active on the lecture circuit at that time. I mean, you were the composite guy.
Sanjay Sethi: Yeah. I got a name for doing composites in this country. I kind of just fell into it. I was very lucky with how I was brought up and how my career developed and I fell into the composite side of things. I was doing everything, but I was gradually expanding with all other sides. But you get known for doing one thing. I liked teaching composites. I still like teaching composite stuff. I think it’s a great topic. Well you’re passionate about composites, as you know.
Payman Langroud…: Yeah. I’ve gone that way now, but at the time you were the undisputed King. It was ages and ages ago man.
Sanjay Sethi: They gave me up too much now, I just-
Payman Langroud…: It was before Jason was around, it was just a long time ago.
Sanjay Sethi: I’ve got a lot more grey hairs than most, so yeah. It’s funny how your memories will make you seem even better.
Payman Langroud…: How did you fall into it? What was the story with that? Did you go abroad or something?
Sanjay Sethi: I was really lucky. My story started when I finished my VT and I met a guy who said, “Look, come and work with me. I’m in NHS and I’ll teach you how to make money.” So I thought, “It doesn’t sound quite what I want to do, but I want to learn dentistry. This guy seemed to be doing everything.” So I went to go and work with him and he said, “Look, come along. There’s a conference this weekend. We’re going to go clubbing here. We’re going to do this. We’ll go to this conference.” And I just by accident, I said, “Well, I’m going to go.” Because I just fancied going out that weekend. And I had nothing else to do. And we ended up in this place just North of Leicester called Belton Woods. And it was a BAAD Conference, British Academy of Aesthetic Dentistry. And I didn’t know anything about it. It was their secondary year. And I walked in and the first lecture just blew me away.
Sanjay Sethi: And I honestly felt like leaving dentistry because these guys were doing provisionals and I didn’t even know what a provisional was. And I thought, “I’m just qualified. I should know everything.” And I just wanted to do what they did. And I literally started from there. So met some of the guys and they were really good to take me under their wing. I was fortunate to have my dental dad, as I call him Tidu Mankoo. He allowed me to shadow him for a long time and then do his year programme. And he since then has always mentored me. So it’s been great to have him for his support. And then a number of other guys throughout the Academy have just taught me Lambert Fig, Shane Gordon, David Winkler, so many people. And then from there, you branch out. They always have that saying, if you surround yourself with excellence, you adopt that way of thinking and things happen to you. So I fell into that and I just happened to start watching people doing composites like I never thought could be done. And I thought, “Well, I want to do that as well.”
Payman Langroud…: Did you go on courses?
Sanjay Sethi: No, I did loads of… At one point, I think I did every course I could get my hand on. Literally, if I had the time, I’d literally be spending 10s of 10s of thousands-
Payman Langroud…: There weren’t that many courses back then I remember-
Sanjay Sethi: You had to go abroad. Everything was abroad. We’re spoiled now.
Payman Langroud…: Which year did you qualify Sanjay?
Sanjay Sethi: ’93. December ’93.
Payman Langroud…: Yeah, so I qualified ’95. And I remember thinking, “I want to be a cosmetic dentist and go on a course.” And there was only two. There was Howard [inaudible 00:06:40], I don’t know if you remember him. He had this sort of thing where he would test materials out or something. But it was called a cosmetic course. And then it was Larry in New York.
Sanjay Sethi: Yeah. That’s what I was saying. Everything was abroad really. I did most of my stuff abroad because at that time we weren’t as spoiled, those speakers didn’t come over here that often. And so you’d go to them or you’d go to these big conferences. But I think that was part of the journey. Wasn’t it? The fact that you were doing something different, but then trying to apply it back here was hard. You weren’t given that… I was in NHS practise back then, not now. I used to look really young. I barely could get into a bar without showing my ID, let alone trying to sell any high-end treatment to anyone. No one would believe me.
Sanjay Sethi: So I’d try and get jobs in private practises. And no one would employ me. I went to some really good places. And eventually there was this one guy who was holistic, Tom Nyerges, he was in Luton and he took me on to do one and a half days a week. And that’s when I started to get my hands in. And like I said, all the time, I was just getting all this knowledge and just soaking in, soaking in, and I just wanted to do it. So I’d practised in all my NHS practise patients. So my boss hated me because I had no money.
Payman Langroud…: But where do you think it comes from? Both of you have got this excellence idea. Like you want to be the best. And when I’ve even spoken to you on this course of yours, that you guys… We’ll get to it, but this is AEsethiX thing. And I was saying, “Well, how are you making the numbers work and all this?” And you were going “Well, the number’s not really what we’re interested in, we’re interested in the learning for ourselves.” Where do you think that comes from? Is it your dad? Where does it come from? Why do you want to be the best and not the biggest and the richest or whatever it is. Where did the quality thing come from? Both of you have it.
Nik Sethi: We’ve got amazing family of people around us, but I think that actually comes a lot from Sanjay. Naturally, I’ve got a good brain. I’m quite academic. I love reading. But Sanjay’s passion to just be the best he can be, but not just for the sake of being that, to deliver the best for his patients. And he’s one of these people that he may not, and he won’t mind me saying this, he may not get something as quick as maybe I do academically, but no one will work harder than him to then practise, practise, practise, practise. There’s no secret. Whenever people say, “How do you do this? How do you get your composite looking like that? How do you do that? As you know Payman, there’s no secret. You’ve got to follow protocols, meticulously. You’ve got to time things. If you’re told to X something for a certain number of seconds, you get a timer and time it.
Nik Sethi: And this is what Sanjay did. He took every little part of the protocol and just practised it religiously, again and again and again. And he would breathe down my neck when I first tried at Square Mile. And every day I’d have to show him before and after, and he’d have my nurse spying on me to tell him where I was going wrong. And that’s honestly the kick up the butt that I needed. But it’s how he lives. Literally every single day. Just learning, practise, practise, practise, practise.
Payman Langroud…: How much of an influence was Sanjay in becoming a dentist for you Nik? Did you Sanjay, did you actually plot and say, “I’m going to turn him into a dentist.” Or how did it happen?
Sanjay Sethi: I think when he was about 14, 15 years old, he won’t mind me saying it. Man, we didn’t even think this guy was going to get any GCCEs. We were worried, where’s he going to end up? We thought like, “We’re going to start having to look at something to set him up with.” Because we didn’t know what he… He was just wanting to play sports. And he’s always been full of life. And then we were just chatting and I said, “Look, I can’t help you with much in terms of business or whatever, but the only thing that I could give you direction in and give you the head start.”
Sanjay Sethi: Like me and you Payman, we went through the hard way of learning because that was all we had. We didn’t have any other routes really. And at that time, institutionalised academia was not necessarily the way to do the high end dentistry. Not that there’s anything wrong with it. I’ve really learned to appreciate that so much more as the years have gone on. But all I said was, “I think that’s the only thing I can help you with.” And he was literally like a son to me. And he just looked at me, goes, “Yeah, all right then.” And that was it. I don’t think he really knew what he was getting into. Because he goes, “Yeah, all right then.” But then suddenly something clicked in him and he just started getting amazing results and just excelling.
Payman Langroud…: Nik what about from your side. How did that feel? Was that how it went down?
Nik Sethi: He’s absolutely right. When I was, 11, 12, 13, all I wanted to do is play tennis four or five times a week. That was all I wanted to do. I had no interest. Then I had a hip injury and I had to have quite a major hip operation. I was homeschooled for a year, I missed the whole of year nine. And through support of the family, I had a great life. I just got to stay at home, playing PlayStation every day, which was brilliant. But I had an amazing tutor that was given to me by the local council to help me with schoolwork. And he just allowed me to see certain subjects like chemistry, biology, and make it relevant to the competition of having myself when I was playing sport. And suddenly I loved it.
Nik Sethi: So then I just got fully into education, from being literally in the bottom set of everything. Then I ended up being straight A’s GCSE and the same in A-levels. And I just got obsessed with it, but I can’t lie to you and say, “Dentistry was my path.” I was very torn between medicine, dentistry and economics. And I’ll be honest, Sanjay said, “Come and watch me for a day.” And when you’re watching someone spending an hour and a half on a composite and you don’t know anything about it. It’s really boring. I remember thinking, “There’s no way I’m doing this for the rest of my life, man. This is crazy. I should have gone to watch the NHS practise.” But I just thought, “Well, if I did dentistry, if I didn’t like it, it’s a great degree to have. I could then branch out and do something else.”
Nik Sethi: And as I then went through the degree, I started to have a much deeper appreciation with the biology, the chemistry, the actual understanding of the human body. And then once I’ve qualified, similar to Sanjay, I had Sanjay’s influence, which was monumental in my career and still is to this day. But the British Academy of Aesthetic Dentistry, again, Sanjay forced me to come. I didn’t want to go, I didn’t want to go to a conference. And the first lecture I saw, it couldn’t have mapped out my career better. The first two people I saw to back was Didier Dietschi talking about posterior rehabilitations in composite and Kenny Malament talking about posterior rehabilitations in e.max crowns.
Nik Sethi: And I was sitting there watching both of their arguments and thinking, these are both incredible Kenny Malamed talking about the cycles of lithium disilicate at the time, which was pretty nudity e.max at that time. And I thought this is amazing, but very destructive in some of the cases that it has been prescribed for. And then you’ve got Didier Dietschi who was taking a putty essentially in his hands and making a masterpiece. And I remember thinking to myself, “Okay, I appreciate these guys both, but I know where I want to lie on this spectrum.”
Nik Sethi: And it was very much towards the adhesive more minimalistic conservative way. And that, Sanjay’s influence and the people around BAAD just helped me feel protected in this environment of excellence. I was never allowed to learn bad habits. I was very lucky to have people around me. And that’s one of the things that a lot of young dentists miss, I think is that mentorship, that camaraderie that an Academy or having a-
Payman Langroud…: I think BAAD was very influential in my thinking as well. And it’s in a very similar way to what you’re saying, I went very early to a BAAD. And just all the way from the quality of the AV to the quality of the audience, to the quality of the speaker. And you know that feeling that I used to get all the time at dental events was, “Why can’t the coffee be a bit better, man? Why can’t the bloody screen be a bit better, man? And then when the lecturer’s speaking, why can’t they bring up slightly a better lecture?” Everything could have been a bit better. And then I remember going to BAAD and thinking, “Oh, it actually exists here where the quality is higher.” And then when BACD came along, and it was a bit… I don’t know you guys, what your feeling on why that came along and how it felt like BAAD was difficult to get into or something, was that sort of feeling, but it isn’t. But I think that was the feeling. You have to be recommended or something. Was that the thing?
Sanjay Sethi: No, there was a whole… I think that was the thing is, it was difficult to understand and maybe it wasn’t made clear at the time, clear enough. But it felt like people thought we were being maybe a bit too selective. But there was a thing you could come along, you could be invited as a guest. And then if you want to apply to join, you’d have to be sponsored by two people there-
Payman Langroud…: It was just old school golf club way of doing life things.
Sanjay Sethi: It was like that kind of thing. But I think it got a bit maybe misinterpreted and I think BACD did a wonderful job. I think what they did was, they took on everybody and they catered for everybody, which is the hardest thing to do. To make everyone happy in a room is probably the hardest thing to do. And there was some brilliant guys back in the day, what Chris Orr achieved and started from to make it the second or third biggest organisation in the country? It must be, after ADI and BDA must be. I think it’s phenomenal, the job that they’ve done and the guys that are on there, many of them have been my friends from the start and I’ve got many more friends from there. So actually, we’re two different entities. And I think BAAD knows where is that. We’re not looking to take thousands of people, but everyone’s welcome to come. If you want to come to us, some people, they don’t feel it’s for them? And it’s just one of those things. But I think it has its own special place.
Nik Sethi: Over the years, there’s less of that golf club mentality now. It’s got more open door. The energy there is fantastic as with the BACD, both fantastic organisations. And especially it’s been instrumental in my career. And I was a no one when I started, and I was welcomed with open arms. I know many people have benefited. Nowadays, you can’t afford to have that attitude where you’ve got to be selective. Everyone has a right to learn. Everyone has a right to have their journey to become the best. It’s not the Royal family for God’s sake. Everyone has a right to do the same. We’re all doing the same career. We have the same rights. So I think the BACD, BAAD, even the therapist academies, they’re all working towards the same mission of providing that safe network to expand. And like we discussed off air earlier, talking about your errors and failures, which it can be daunting to discuss with your fellow professionals talking about failures.
Payman Langroud…: Yeah. It’s a shame that these things become factional sometimes but from my perspective, Enlighten became very involved with BACD and not so involved with BAAD. Simply because of no follow-up, no one came and said, “Do you want to buy a stand at BAAD, ever. And you know how it is, if someone comes to you and says, “Do you want to buy a stand?” And then follows you up and so on, you end up just going that way. That’s why follow up works so well. But, what’s interesting for me is when we get calls to our office, people say. “I’m just thinking about a composite course. I’m thinking about coming on Depeche’s course, or I’m thinking about this other one.” And almost like, “Sell it to me tell me. Tell me why yours is better than the other one.”
Payman Langroud…: And the way I always say to them is, “Go on both, go on three or four.” The way you guys think about education, I’ve noticed, particularly Nik now, it’s almost like you’re constantly in education. And if I want to be the best composite guy, and let’s just say in my practise, it’s going to take more than coming to one course. I want to be the best composite guy in my postcode area. And then it depends on what you want, man. Some people want to be the best composite guy in the country or the world or whatever. You better go to a few courses, man. You better go to a few courses. Deciding whether to go to PACD or whether to go to BAAD, if you want to go anywhere, do both. It’s the way I would-
Sanjay Sethi: Have you ever watched that series, Heroes?
Payman Langroud…: No.
Sanjay Sethi: There was a guy there who had no powers, but his one power, which he did develop was to absorb other people’s powers. His name was Peter Petrelli. So that’s exactly it. The more courses you go on, the more you absorb and your idea is to absorb all of their superpowers and make it your own. And that’s literally how you can become the best or the best at whatever you do or in your practise or whatever. So it’s going back to that way of thinking. I 100% agree with you. If you just do one course, you’d only have one way of thinking, one way of doing it. And when you’ve got another problem that doesn’t solve that issue, that course didn’t fill you, if didn’t fill your whole world up with how to resolve different problems.
Payman Langroud…: You guys now in the practise, I know Sanjay you’re involved quite a lot with implants as well, do you guys in a sort of organised way, decide, “All right, your implant… So, Nik’s not going to do the implant side and Nik’s going to do the minimally invasive side.” Is that how you actually think about it? Or do you think about it more like you’re going to have to learn it all of you, both of you are going to have to learn it.
Nik Sethi: That’s a really good question. So essentially for the first few years, Sanjay maybe do everything. I have to learn it the way Sanjay understood it. And I had to then obviously bring on what I knew from courses and learning. And I was doing the endos, the perios, I was doing composite, everything that Sanjay sew I did. And then before I started getting into surgery and implants, I suddenly thought to myself, “Well, I’d love to be a partner in Square Mile one day.” I love the practise dearly. It’s been such an instrumental part of my life. I love the team there. I love everything about the practise. And I thought, “Well, if I’m going to be a partner here, it doesn’t make sense to be exactly the same as Sanjay because Sanjay is Sanjay. He’s got his patient base for 20 years and why be exactly the same?” And so we then had a good discussion and I decided, “Well, I’m not going to go down the implants route.” Never say never.
Nik Sethi: But Sanjay, I’ve got a good knack with restorative dentistry. I’d like to think that I can produce nice results now, always learning. But for me to then get to that next level to where Sanjay surgically, that’s a whole another career. And what Sanjay has developed with his handling of soft tissues, it’s not just placing an implant in. His provisionals, he’s handling of soft tissue grafting, it’s such a niche, that I think he’s so good. Why do I want to go down that path? He’s the man. So the idea is now to pull. And recently we have been, Sanjay doesn’t do the endos. He doesn’t do as much of the composite stuff. And refocusing more on the surgery. I take on more of the adhesive ware cases. We’ve got wonderful clinicians in the practise. We’ve got Elaine Mo who comes on and does-
Payman Langroud…: I love, she’s seriously very good.
Nik Sethi: She’s the shining beacon for the next generation. She’s amazing. And her energy. And she does exactly what I do. She treats the practise like her own. She’s the first one in, she’ll stay well late. She’ll help the girls clean up. She-
Payman Langroud…: When we did that hands-on in Square Mile with Depeche, Elaine was on her hands and knees cleaning up, doing my job.
Nik Sethi: She is part of the family, she gets stuck here. So it’s exactly how I always was. So it’s been wonderful. So she does the ortho restorative and the composites, and we’ve got Amit Patel who-
Payman Langroud…: Yeah. Amit’s there.
Nik Sethi: TC’s son. So Amit comes on and does more of the prosthetic work with his university training. And he’s got some fabulous skills. So between us, we’re now differentiating and hopefully going to turn our practise into more of a referral base where we can teach dentists around us to improve their daily dentistry because we’d love to do that. And if there’s certain cases, they feel that they’re not comfortable with, they know that they’ve got us around the corner to be able to then help them and then send the patient back once our GT’s done.
Payman Langroud…: Sanjay, take me back to when you started Square Mile, because back then the idea of a practise in the city was quite innovative thinking in itself, wasn’t it?
Sanjay Sethi: Yeah. You know what it was for me was, I realised that no one’s really going to employ me in a private practise. Like I said, I just looked really young. And the only way that I was going to do it was to get a practise, but I didn’t have the balls back then to just go and buy it on my own. So I bought it with a friend of mine who is in the year below me. Selema Podany, unfortunately she’s now passed away. So it’s really sad. But we bought it together and we took a practise and just did the dentistry that we wanted to do.
Payman Langroud…: It was an existing practise?
Sanjay Sethi: Sorry. It was an existing practise, yes.
Payman Langroud…: Oh, it was. Okay.
Sanjay Sethi: It was a private practise. It had been there for about 12 years, but again, it was like one of those things, whoever had taken over it never developed it. And then I took over it with Selema and few years down the line, then I bought her out and then took it in the direction I wanted to go. I just wanted to keep going in this pathway no matter what. My thing was, it was just a journey. And it was like my excuse to practise the best industry. My philosophy has always been, money can’t buy you contentment, but ultimately we’re health professionals. And so as a health professional, we have a duty of care. I think dentistry can be seen as a business and healthcare, but it’s got to be healthcare first. And so taking all of that side of things, what you realise is when you want to try and do what these guys were doing on the stage, and I was learning from, it’s not easy, it’s really not easy. And that last little bit is painstaking to achieve. And the only way I could do it was if it was in my practise. Now if I was prepared to take a bit of a loss, not great business sense.
Payman Langroud…: We just had Tom Young’s on the podcast. I don’t know if you remember him either of you, but he was one of these young guns who was really into it. And then he’s quit dentistry. And he was saying the idea that the better job you do, the less money you make. Was really annoying to him. And it’s a difficult thing because, let’s say a lawyer the alignment of the patient goal with the dentist goal is the ideal situation. Isn’t it? That you can say, all right, this thing’s going to take me three hours or whatever it is. And I’m going to get paid for my three hours. But we know because we work in that, “20 years. Is this thing I’m going to doing now, when is it going to fail? And what can I do to minimise that and make it a 30 year.” But you can always do a bit more, can’t you? And he was saying that that used to just break him. The idea that that’s the situation
Sanjay Sethi: A 100% agree with them. But every time I go in with that thought, as soon as I’ve got someone in front of me with their mouth open, I just have to deliver. The way I see it is like, if you’re saying-
Nik Sethi: Careful how you say that, buddy.
Sanjay Sethi: I’m not going to rephrase it, but yeah, you get what I really mean. Yeah. But, you just have to deliver. I just always thought of it that if Usain Bolt is expected to run under 10 seconds every time, the 100 metres, that was his standard. And if he ran more than 10 seconds, that was a really poor race. So my idea of not trying to break the world record every time was to try and run that. And yeah, it came at a price, but you do get better. You do get quicker, but you might not be putting Ferrari’s in your front drive. And I totally get that way of working. It’s not for everyone. There’s no one course which fits everyone. And there’s no one way of being a business-minded that fits everyone as well. I’m not saying it’s the wisest thing, but for me, it was just right. I did it-
Payman Langroud…: I feel like we’re really lucky guys here. Because it’s a difficult job. By the way, I don’t practise anymore, so I know what I’m saying. But it’s a difficult job but there’s a bunch of us, or a bunch of you who adore their job, love their job. So what would you say for you, is the thing that you love most? Is it that? The fact that the trust issue… That’s the way it’s coming over Sanjay. This person’s come and he’s trusted you with his health and you take on that responsibility or is it the Meccano side? Some people are really that way involved. They want to put bits together. You implant guys that are a bit like that. Or is it this minimally invasive? For me, when I was a dentist, I used to enjoy just meeting people. That was my favourite thing about it, talking to people and all of that. Well, what is it for you?
Sanjay Sethi: Nik? Do you want to go?
Nik Sethi: I think I know what it is for you mate. Because it’s the love of what you do. Of course, you love meeting people, but Sanjay will go… We’ll have a business meeting, which the aim of it will be to discuss how we did last week and how the practise took last month. And within five minutes, we’re talking about a grafting case. And, “How I manage these like…” “Oh, you should have seen the suturing. It was just amazing. I was so happy how it came down.”
Sanjay Sethi: I sounded really sad though, don’t I?
Nik Sethi: [crosstalk 00:28:57], do it later. I’m like, “Yeah. That’s great. So shall we…” But that’s what he’s always the most to you, I say. Is just-
Sanjay Sethi: Yeah, I just found it addictive. I’ve always found it addictive that if you can achieve something, then you want to try and do better. My thing was when I first qualified and started getting to his courses, these guys at BAAD that were my mentors, my initial mentors. And since then I’ve had many, were all BDS. Hardly any of them had a postgraduate qualification yet they were blowing professors and teachers all over the world, out of the park with some of the dentistry that they were doing. And they were just BDS. So for me, what I learned was if my eyes and hands can do what my head is being told, then I’m on to something and if they can do it and they’re just BDS, well, then any one of us can do it. And that’s the way I’ve always taught it, that there’s nothing to stop anyone from being able to achieve it. But it’s, “Can you achieve it every day, day in, day out?”
Nik Sethi: For m it’s slightly different. I love the dentistry. I love the chemistry behind it. I love the science. I love the adhesions side of it. I love looking at the light curing. So the teaching for me, my future, as much as I love clinical practise, I do believe that my future lies in academia and teaching. And that’s why the education Academy stuff that we’re trying to do is very close to my heart because it’s just what I find lovely. Seeing the light in someone else’s eyes when they’ve understood something that was taught so complex, like occlusion or adhesion, it’s some myth in university. And even to this day, when I do a composite course, the first thing I always get asked is, “How do you get your composite so shiny?”
Nik Sethi: And I say, “Let’s forget all of that. What bond are you using?” Half the room won’t know. “What light cure unit are using? What’s the wavelength? What’s the power? How far away are you from the thing? Answer me these questions first, because these are the building blocks to everything else that you can achieve in the rest of your career.” And so shining the light where I have been so lucky to be taught by incredible people for me, that is so inspiring and I’m always learning from that. So that’s probably what I love the most about my career. Is being involved in that side of things.
Payman Langroud…: Who are the people who really inspired you? Sanjay mentioned to do, and I’m sure there’s others. But who are the people for you Nik?
Sanjay Sethi: Man, there’s so many, UK based, I would say you’ve got fantastic people. You’ve got Gavin [inaudible] doing amazing composite. And actually, I have to say, even though he’s my age, or maybe a year younger, even watching Depeche really, really inspired my love for anterior composites. And that’s what I’m known for doing. And I was really proud of watching Depeche, considering all the lovely things he said about Sanjay in the past and learning from Sanjay, it was really nice to watch Depeche absolutely nail what he does. It was fabulous. And then on the more prosthetic side of things, I suppose I went to watch Mauro Frediani last year in Italy, 12 days, and bear in mind I’m 10 years in. And it made me rip up my rule book for treatment planning totally. Just to see things in a whole different light about how to treatment plan a patient properly from start to finish, how to charge properly for it and believe in that. And also how to meticulously make sure you’re doing what you’re talking every single step of the way-
Payman Langroud…: It’s a 12 day course, is it?
Nik Sethi: The 12 day’s masterclass. So you go there for three months and you do-
Sanjay Sethi: That was three months?
Nik Sethi: Yeah. Three, four days at a time, he was fabulous. But in the UK, again, the A courses have been on Basil Mizrahi for me. He again reminded me a lot of Sanjay. Yes, he’s doing great for himself. And he deserves to, but he really punishes himself on the standards he expects. The temporaries, the finals, and you can tell even when he shows a case, he never shows a case and says, “Isn’t that amazing?” You can tell what he’s looking at. And he’s thinking, “I just wish…” And it’s that. That for me inspires me.
Sanjay Sethi: You never want to see someone break down a case more than Basil Mizrahi, I’ll be really surprised because that guy is phenomenal the way he breaks it down. Even the number of stages he takes to do just one or two things, let alone a rehab.
Payman Langroud…: Yeah. And we’re having him on actually. I’m looking forward to having him on.
Sanjay Sethi: He’s awesome.
Nik Sethi: But it’s not just dentist for me Payman, I have a massive amount when it comes to communication with people and not just patients, but also other dentistry teaching from the trade. So one person for me that deserves a big singling is David Ultram. He was obviously a managing director of Optident. Now a big part of Henry Schein. David Ultram, funny enough, I met him at that first BAAD conference I went to in 2011 and we just started talking at the bar and I had no idea who he was. We just really got on. And a couple of days later, he got my details from Sanjay and we met up for a couple of drinks. And we came up with an idea of this thing called The Diary Of An Aspiring Dentist, whereas where I’d get to write a blog or articles for FMC on my experience where I’ve failed, things I’ve learned, because I was never afraid to talk about things I’ve failed.
Nik Sethi: And Sanjay always taught me that, we all mess up. I was going to say the F word there. We all mess up and you learn from it. So we did a series of articles on my experiences. And David gave me my first chance to give a composite lecture, which was horrible. Back in 2013, I tried to teach about 10 days worth in one day. And I look back at the lecture slides and they were awful, but you learn. But also how to talk to people, how to manage difficult conversations. I watched him when I’d help out on the stand for Optident, I’d watch him talk to dentists. How much is this? Without understanding what a product is. It’s like someone coming to you saying, “How much do you charge for your licence. Without understanding the story or the benefits or what it can do for your practise growth. You get these questions all the time. Learning-
Payman Langroud…: David’s influence on the profession. A lot of people don’t know him because in the trade, we all know him very well. But David’s influence on the profession’s being huge.
Nik Sethi: He’s amazing and he’s taught me a lot about people skills. So I owe him just as much as I owe Sanjay, Bazil and all the other people I mentioned as much credit and people don’t often get to trade enough credit. These are the people that teach us about materials that we use on a day-to-day basis.
Payman Langroud…: Yeah. That’s true. There’s a lot of information even from a salesman, who the receptionist is taught to keep away. Let’s talk pre-COVID when they used to actually visit. The nightmare the salesman has to just get his foot in the door is such a funny thing. Because the amount of information that’s in the salesman’s head about materials, about what’s coming next, about what other people are doing. It’s like free education you can get from a salesman. A lot of dentists spend their whole time keeping salesmen away because they think they’re being sold to. The best salesman, as you said, partners, aren’t they? The way you’ve just mentioned someone in the trade who has a massive influence on you. I like that. So now that you’ve bought in to the practise, how did that change your relationship with the team and with Sanjay? Is it basically that you’re now financially involved and everything stayed the same? Or did you actually make a change? To Sanjay, did you step back on some things and Nik took over or how’s that working out?
Nik Sethi: The buy in hasn’t completed yet for Square Mile as of now. It’s going to be soon. We completed on the [inaudible] one this week, the buy in is almost there. Essentially I, for the last-
Sanjay Sethi: I have stepped back in terms of running things because it’s not my bag. And he’s just literally for the last two years has put so much effort into the practise. So in [crosstalk 00:37:27].
Nik Sethi: I’ve treated it like I’ve been partner for the last few years, I’ve always treated like family. And I can say a lot of the team has been there for many years and they’ve known me since the kids. And it’s been easy in terms of getting them on board because it’s all running in Sanjay’s vision, but just bringing it forward to what I feel the practise could be to be able to be financially more successful, but also be doing more of the cases that we are known for doing and feel that we have the skills to do. And I think the team have bought into that new vision of pushing the practise forward of how special, the work we feel. And I do feel that some of the dentistry that we provide is life-changing. I know it sounds silly to say that, but I do feel that is, I’m very proud of that.
Nik Sethi: The work we put in, the blood, sweat and tears that goes into it, not just the dentist, but the nurses. I mean, Sanjay’s nurse Shaz. She’s like a second mum to me. She’s been there for 18 years. When she nurses with me, I’ll be doing preps on teeth, and I’m really tired and I’m not sure I want to prep the last two. And Shaz would kick me and look at me and say, “Go on. Carry on. We are two hours after the end of the day, she could easily be rolling her eyes. And yet she’s pushing me say, “No, come on. Your brother would finish it. You’re going to finish it.” It’s incredible the people we have around us.
Payman Langroud…: What about the thing, the tension between being the boss and being a friend and all of that?
Sanjay Sethi: I think really we’ve been, on balance, really good because we have our own strengths and yeah, there’ll always be some differences we’ll have along the way, and I’m not going to deny that. But on par, it’s sorted out on the day and we just move on. We have a laugh, we have a great time together. We enjoy each other’s company. He’s a crazy dude. This is my brother is just one Nutter. If you’re with him and it gets to midnight, trust me, his evening is just beginning. I remember once we went out and at the end of the night, I’m thinking, “Listen, it’s two o’clock. I’ve got to get back because I’ve got so much to do tomorrow.”
Sanjay Sethi: And it was like an old boys reunion with like say, Rob Beretti, some of the guys that you all know, we were all together. And he goes, “All right, no worries.” He goes, “Can you order an Uber?” And I’d never even used an Uber App. “I’m used to all this stuff.” He goes, “Don’t worry, I’ll order you something.” So he orders me an Uber. I get into this car. I didn’t know what the hell I’m doing. I’m just sitting there. And next thing I know, we’ve gone around the corner, we’ve picked someone else up. I’m thinking, “What’s going on?” He must’ve gone around East London to all these different estates. I thought I was going to get raped in the back of this car. Some of the people [inaudible 00:40:17]. I got home at six. And I’m phoning him, he left at five and he got home before me.
Nik Sethi: I got him an UberPool. I wanted to save about 10 quid.
Sanjay Sethi: [crosstalk] I don’t let him get me a cab anymore. Forget it.
Payman Langroud…: That’s funny man.
Sanjay Sethi: Yeah. We’ve had some good sometimes.
Payman Langroud…: You’ve had some good times, what about dark times Sanjay? In this evolution, there must’ve been some.
Sanjay Sethi: Oh, with me and Nik?
Payman Langroud…: No. In the practise-
Sanjay Sethi: Yeah. I’ve been really lucky in life that I’ve had fantastic parents. I’ve married my soulmate and she’s been a rock to me. I’ve got wonderful kids, wonderful family, wonderful friends. And so for me, when I look at dark times… I look at all the things that are around me, how dark is it really? And okay, we suffer for three months. We don’t get this. We don’t get that, but I’ve been blessed. So I can’t really complain. And if-
Payman Langroud…: What about COVID? And the fact that you’re in the city, has that been like a challenge?
Sanjay Sethi: It is ghost town around here. Fortunately we’re busy, people are coming in to see us. But it’s ghost town. If you walk around there, it’s airy. It’s picking up now that restaurants and bars are coming.
Payman Langroud…: But patients are still coming?
Sanjay Sethi: Patients are still coming. Yeah. Touch wood. Let’s hope so. [inaudible] right now,
Nik Sethi: It was a difficult year and difficulty for all of the profession, but especially in the run-up to COVID because we didn’t know about a fallow scheme in the beginning. The hardest thing about this all is trying to navigate the questions from the team, because it’s their livelihood. Luckily we’re in a profession where I’d like to think all of us have a little bit of a nest egg, that we have some savings that we can afford a couple of months if shit hits the fan. But a lot of our team aren’t maybe as fortunate. So having to navigate that situation where we were trying to talk about shorter working hours, it was tense times. And luckily with the fallow scheme, a lot of that was helped out.
Nik Sethi: Obviously, all practises didn’t get as much help as would have been nice from the government. But equally, as Sanjay said, it was a rare opportunity for us to look at the business about where we want to come back. And I was sure that I didn’t want to come back and I don’t want to compete with local practises. I don’t want to compete on them for times we take for treatment, for prices we take on treatment. I want to be like what Sanjay said, take the time we want to take, do the treatments you want to do, charge appropriately for that, and you look back and you see, “What patients do we want to treat in the practise? Do we want to see everyone and anyone or do we want to see the patients that value us? And obviously we value them.” So it was a nice time for us to reset and look at what type of practise do we want to be coming back after COVID.
Payman Langroud…: What would you pitch it, as far as the pricing, are we right at the top?
Nik Sethi: No, I don’t think so. We charge on an hourly rate, but I would like to be where, not necessarily top in Harley Street prices, but we’re certainly not cheap. The people could definitely go and get… And I always say to patients, “Don’t feel pressured by this plan. Go and get a second opinion.” Just like what you said Payman about going on different composite courses. I’ve always believed in planting the seed. I feel that we do one of the most comprehensive checkups around with-
Payman Langroud…: I had Coray on and he said he charges 400 pounds for the checkup and it’s a loss leader. He loses money on it.
Nik Sethi: I think we’re 120 and –
Payman Langroud…: It sounds beautiful. It sounds amazing. He really meant it. He really meant it. He was like, the amount of hours he puts in after that examination, that 400 pounds, he’s losing money. And so it’s really interesting because I don’t know, in an NHS situation, whatever, how much is that check up there? I don’t know. I have no idea. And you know, there were different outlooks on these. And then I remember as a dentist, the treatment plan numbers. I remember the first time I heard 20,000 pounds treatment plan. I couldn’t believe it was real.
Payman Langroud…: And then, first time I heard a 60,000 pound treatment plan, couldn’t believe that was real. And it just goes up and up. And it’s a funny thing because if I turned around and said, God forbid, that a family member’s ill, and it’s going to cost 80,000 pounds to get the best doctor to fix this person. A lot of people who even didn’t have the means would find the 80,000 pounds if they thought that that was the real situation. And so it’s funny because people who’ve got a bit of money, then we’ll certainly do it. Understanding that people value what you just said, about people valuing you.
Nik Sethi: Well, our ethos is a little bit different and this is where our associate, [inaudible 00:45:42]. But we have, I would like to thank especially Sanjay the skills to and that the cases to back up big plans, 30, 40, 50,000 pounds that Sanjay skills are incredible. And I’d like to think I’ve got a bit of experience myself, but we’ve always had this ethos that we will talk to a patient, look at what they can afford. And we don’t have to do all of that at once, you don’t have to just jump into a mega plan. We can get a plan that can get them stable for a few years, not kick the can down the road, but if we can improve them and get them stable, then if we plant that seed, when times are right, we can then go back to do a quadrant and then another quadrant. So we’ve never been the practise to turn over 50 grand cases. We’re the practise that will spend 15 years doing that case. I think that’s fair to say, isn’t it Sanjay?
Sanjay Sethi: Yeah. I’ve been there nearly 21 years, this January and that’s right. So you’re staging it, you get there, but it doesn’t sound… Again, I just did it my way. Is it ideal? No. But it’s got everyone buy in, you stabilise control, make sure and they know it’s part of the bigger picture.
Payman Langroud…: Sanjay, tell me about, you’ve been there for 21 years. Tell me about the thing Tiff talks about, about being in the same place for a long time being the best teacher of them all.
Sanjay Sethi: Yeah. I think it’s joy, but it’s also very painful sometimes to see some of your work.
Payman Langroud…: So tell me about that. Let’s talk about, we were asking everyone this question.
Sanjay Sethi: It’s really interesting because what I learned over the years, and that’s why I got involved with the teaching more and more, was the fact that it’s all great when you see these cases that have been done and you’ve got a week postdoc or six month post-op, but really if you’ve invested so much in your dentistry, even if you’ve just done one restoration, don’t you want it to look like that five, 10 years down the line? Ideally we know things are going to tie up, but we want to see can it last that long. And it’s those little nuances, those little things that you learn that can actually make things last, but it’s not every time. And I’d be lying to say that we don’t get failures or based on how you manage you failure.
Payman Langroud…: Can you give me a couple of examples of light bulb moments of something that you thought you did right 15 years ago, and seeing it now you realise that now you would do it differently because of seeing that ageing. Couple of examples.
Sanjay Sethi: My first one would definitely be at the beginning, probably a lot of the guys wouldn’t know this, there was this thing called Open Sandwich Technique with glass ionomers [crosstalk 00:48:21]. And there was some great guys that were advocates of glass ionomer like Jeff Light from Australia back then, but we were all taught, “Glass ionomer, glass ionomer.”
Payman Langroud…: This is a wonder because it realised fluoride, remember?
Sanjay Sethi: Yeah just fluoride everywhere. Well I’ve taken glass ionomer out restorations and there’s been carries underneath. So it’s not completely true. And I’m sure anyone that’s been around long enough would have seen that themselves. But I’ll tell you what, when that starts to go and ware, and you get the hygiene is scraping away at it because it feels rough after about five to seven years, it literally looks like another cavity underneath. See you’re back to where you started almost. Maybe you’ve got something sealed. But that was probably one of my light bulb moments when I thought, “Listen, if you’re going to do it, seal it all in.” I think the other thing was knowing the limits of what you could achieve with the material and then being the superhero idiot that I can be sometimes push those limits all the time.
Sanjay Sethi: And surprisingly, some of it just works like what Nik was saying, you take a case on, and back then we were doing direct… Well I was doing this before he was qualified, direct composite, full on lays and full teeth, almost like crowns in direct composite back in early 2000s and then using materials that getting better and better and better. And then eight to 10 years down the line, they’re still there. They don’t look as well polished, but they’re not really stained. And you’re thinking, “Did I do the wrong thing?” And then you’re seeing other people talk about it now. And maybe we were onto something back then, but I don’t think if I go back, would I want to do it all that way again? No, because I get a lot of backache because of it. It’s hard work.
Payman Langroud…: What about you, Nik? What’s the biggest clinical mistake you’ve ever made?
Nik Sethi: Wow. Many, first of all. And that’s why I always say when I’m teaching, and one of my mentor, Shane Gordon always said to me, “The minute you’re sweating, when you’re treating someone is when you’re out of control.” And believe me, I’ve spent a lot of time sweating in the last 10 years. It’s not necessarily a clinical, I’ve got lots of clinical examples, but one of the most recent ones was actually only about three, four months ago. It was a communication issue, which I took very personally because I’d pride myself from being quite good with my patients communication. And it was one of the times where I took my eye off the ball a bit and paid the price or lost the case.
Nik Sethi: And it was a patient referred to me where I’ve seen the rest of their family. I’ve treated his wife, I’ve treated the son and they all love the work I did. I’ve transformed their smiles, really got them happy with the dentist again when they’ve had terrible experiences. And so I saw this patient who didn’t have much of an aesthetic issue, but post-steria, he was in real trouble. His bite was collapsing, ware, clenching, fracturing everywhere. So his plan was actually a lot more complex and a lot more costly than the rest of his family’s.
Nik Sethi: And normally for every patient with a significant plan over a couple of thousand pounds, I will put together a PDF. I like to do a presentation. I do a zoom call. I put together the photos. I annotate them. I spend a lot of time in my free time doing this because I believe that no patient should start treatment with us until they fully understand what they need done. And with this chap, I was kind of going on holiday that week. And I said, “Okay, I’ll put the plans.” [inaudible] normal plan eight crowns, back, go do this to do that, however, many thousand pounds it was, and I just sent it.
Nik Sethi: And I had a chat with him and it was a really awkward chat because he said, “Oh, how did you just pluck this figure out of thin air? And what this you’re charging me, wants the provisional then charge me again for finals, is it because you like getting paid twice?” And at the time I was angry. I kept it together on the phone, but I was only thinking, “Do you know how much hard work this is going to take?”
Nik Sethi: And it’s only after I calmed down I realised I handled that totally wrong, totally wrong because I broke protocol. I pride myself on planting the seed and having as many interactions with that patient as possible, they call it touch points. Touch points, touch points, touch points, zoom calls, reviews, whatever it needs to be done. Let’s talk plan and see, if they go somewhere else and get it done. That’s fine. But at least they know what they need. And with this chap, I broke protocol. And actually it really ruined my weekend knowing that I didn’t communicate with this person as well as I could have done.
Nik Sethi: And it made me really reaffirm. And to all young dentist up there, I think a lot of the reason why there’s a lot of litigation of profession is communication. Clinical skills are one thing, but having that patient on the side from the beginning, if they know what to expect, they know why, they know the limitations. And they’re much more understanding when things do go a little bit pear-shaped. So that was bad. It really beat me up and I wish I handled that better.
Payman Langroud…: Sanjay, with your reputation, you must get that type of patient that turns up and says, “I know you’re the best.” And it’s always, I hear this a lot from people who’ve got big reputations, is that the patient turns up and starts picking them up. And it’s kind of like alarm bells, have you had many of those?
Sanjay Sethi: Because we’re not trained as psychologists. We’re not trained to spot it. We just want to do the work. We see the case and we literally want to get in there and do what we know we can do. And I think one thing that I’m still not the best at, excuse my French but it’s spotting a nut job. And I’m not the best at it because I just want to do the work and I know what I can achieve. I know what’s possible. And I set realistic aims for it, but sometimes it’s just never enough on a different level. I don’t-
Payman Langroud…: Sometimes the problem is psychological rather than physical if you just thought about it.
Sanjay Sethi: I really don’t spot it. Like he said, I bury myself into clinical and yet I love to communicate with patients. I love to get involved, but that kind of psychology, I just don’t spot it. I just literally just want to get in and do the work. I think I can help, that’s the way I look at it. And then like all of us as professionals, we can all help.
Payman Langroud…: Where’s this new practise you’ve bought?
Nik Sethi: We just bought a practise in Essex in Langdon Hills, which is a native Basildon. We bought that with a good friend of mine, Dev Patel, part of Dental Beauty Group. So looking forward to-
Payman Langroud…: Existing practise?
Nik Sethi: Existing practise, yes. Which is going to be a mixed practise. And our plan is to really bring that kind of Square Mile standard to Essex. I’ve always been asked by my mates, local, “When are you going to get a place in Essex?” And finally I thought, “Okay, this was the opportunity.” And I’ve known for a while now that for any associates out there that think owning a practise is easy, it’s not. Because since I’ve been part of helping out with the operations at Square Mile, and now at Basildon, it is a lot of work. And again, it’s like learning a totally new skill for me there, so I’m very excited about what we can bring to Essex, bringing that patient care. Even for NHS patients, we’ve made a protocol that our new patients are going to get a 45 minute examination, which is unheard of. So that we can explain to them what’s going on in their mouth, educate them, help them rather than patch them up, help them towards kind of a better future. And also-
Payman Langroud…: I didn’t know what you were going to do next year, but if I had to make a bet, I would have thought… Because you guys are real like homey. You were saying you both live one street away from where you grew up in Brentwood or where… Is it Brentwood? Near Brentwood.
Sanjay Sethi: It’s near enough.
Nik Sethi: Yeah. I live one mile from him and we live one mile together from my mum and dad.
Payman Langroud…: So I thought what you would do is go for one of these experiential squat jobs like get a warehouse and turn it into this unbelievable thing.
Nik Sethi: That would be the dream.
Payman Langroud…: Is that in the pipeline? [crosstalk 00:56:18]. A high risk idea.
Sanjay Sethi: We don’t have to blame you Payman.
Nik Sethi: The light bulbs are going. No. But the reason why I teamed up with Dental Beauty is because it allows me to be clinical director, bring in the clinical standards, teach the team, teach the dentists, and learn from them as well.
Payman Langroud…: No, no. Let’s look about my idea again. Let’s talk about-
Nik Sethi: Yeah. I will do it. One day I won’t do that.
Payman Langroud…: You know what I’m saying you’d do? Because Essex, there’s a kind of a can do. It’s what I love most about Essex. It’s like the America of Britain. There’s kind of a can do, is going to happen. Let’s just do it.
Sanjay Sethi: It is [crosstalk] and people want to have good stuff and they’re not [crosstalk 00:57:07].
Payman Langroud…: You want to try new stuff.
Sanjay Sethi: Yeah, they like it.
Payman Langroud…: Everyone’s a bloody property developer builder type. Like if you wanted to make something extraordinary inside this book, I don’t know if you’ve seen Robbie’s place in Liverpool. Like he’s done that. It’s a box. On the outside it’s just a box and then you go inside and it’s like, “Whoa.” [crosstalk 00:57:28]. You should do it man.
Nik Sethi: Great. Next time we meet mate, you’re going to be like-
Sanjay Sethi: Stop giving him ideas. He’s going [inaudible] with ideas. I haven’t got enough time in the day to keep up with him. Please don’t give him anything else right now.
Nik Sethi: I’m so terrible. I like it. One day let’s see what happens.
Payman Langroud…: Tell me about your situation as far as family, kids and all that. Sanjay, you’ve got a couple of kids, have you?
Sanjay Sethi: Yeah. I have. My son has just, unfortunately he didn’t get to celebrate his 18th birthday. That happened last month because it was in lockdown. So I felt really sorry for him, but he’s a really good lad. He’s the Apple of our eye. And then I got my daughter and again-
Payman Langroud…: Are they going to be dentists?
Sanjay Sethi: No. They just look at me and say, “Dad, you work too hard. We don’t want to do that.” He wants to go into economics and finance. I don’t think he knows what’s going to hit him. But that’s [crosstalk 00:58:15]. He’s good at all of that sort of stuff.
Payman Langroud…: And your daughter?
Sanjay Sethi: She’s 12. We still see her as baby. She’s creative. She likes drama and she’s sort of just finding her way. So yeah, she’s still daddy’s girl, which is great.
Payman Langroud…: And what do you do? Do you work five days or less than that?
Sanjay Sethi: I’m four days now. And actually that was Nik. So that’s actually… Nik had a great influence in trying to make my life a bit easier. And then when he sees that I have a gap in something, then he’ll give me something else to do. He’s quite quick to find me something to do, to be honest. But it’s all good. I like the-
Payman Langroud…: Have you gotten on with the whole digital, I’m not talking Instagram, I’m talking digital dentistry scanners? Because I saw that stuff you sent me was with… Was that [inaudible 00:58:58]?
Sanjay Sethi: That probably was done an extra cat by the lab. I’m still learning it. I think I’m still finding my feet with it. I’m getting better and better at doing the actual scanning and procedure. It does take a bit of time to understand it, the limits of where you can push digital dentistry. I’m still not so comfortable. The problem is when you’ve got this old school technique that just works really nicely, it just becomes difficult to switch. And when you do push it and it doesn’t work rather than [crosstalk 00:59:30], “Let’s do it this way.” I just go back and then I have to literally get-
Payman Langroud…: I was exactly the same thing with Nik CEREC, it was in the powder days where it wasn’t very good. But I remember thinking, I’ve got something that I know how to do. It’s fully predictable, an inlay prep or whatever inlay. And then I’m doing it with steric and it’s introduced all this unpredictability into it. And like you said, unless you… There’s a kind of, Andrew Dogwood was calling it the technology chasm. You get into something new and then you think, “Oh, what the hell did I do?” And like you said, you’ve got to go through that. And like you said, it takes energy.
Sanjay Sethi: I’m getting there. I’m always a bit tentative, but I’m doing it more and more. I found that some techniques, interestingly enough, like implant impressions, the technicians with who I work with, I work with some fantastic technicians. They prefer-
Payman Langroud…: Who are they?
Sanjay Sethi: Sorry, who are they? One is called… Well, I’ve got a number of them. Daniele Rondoni I’ve got Eva Force at fusion. There’s Eddie Marker. There’s a number of technicians that I worked with over the years. And I’m sorry if I’ve forgotten anyone else at the moment, but they actually still prefer with certain things like soft tissue work to have it on a stone model rather than doing it from digital and they can manipulate things a bit better. So maybe that’s their understanding. Maybe that’s the way that I’m expecting things of them. I don’t know. So haven’t quite found my feet, but actually to me it’s quite impressive going back to CEREC. I’ve seen patients with CEREC restorations over 20 years old in their mouth. They don’t look pretty. I’ll be honest, but they’re working.
Payman Langroud…: 20 years ago, [inaudible] as well. Nik.
Sanjay Sethi: Yeah. [inaudible] Payman.
Payman Langroud…: I wish. Nik what about you as far as digital? Are you digitally native or you just take too easily.
Nik Sethi: No, I don’t think I am. I’m really enjoying the scanning side of things. I never loved taking impressions, I guess because I knew scanners were already available when I was in-
Payman Langroud…: [crosstalk 01:01:37], guys?
Nik Sethi: Yeah. We’ve got the TRIOS 4 four. And at the new practise we’re going to have the CEREC [inaudible 01:01:45]. So we’re going to have [inaudible] and CEREC going as well. I really love the fact that I have to take impressions. I just think that’s such a patient centred-
Payman Langroud…: It goes way beyond that, doesn’t it? It’s not just about the gap, it’s everything else.
Nik Sethi: Well, actually the communication with the lab is fabulous. I really do enjoy the fact that I can get that digital design. I agree with Sanjay, at some phase that when things are working so well with someone like Eva Force from fusion who is phenomenal. When her wax ups were coming back, stunning, handmade racks ups, you can’t get that on a computer. And if you do get it on the computer, you certainly won’t get it when they print it. So it’s not that same level to that end degree, but it has made communications so much quicker. And even from clinically, the fact that you can just scan and check your clearance. Because one of the things I always make a mistake when you ask me about clinical mistakes, I always used to under-prep the occlusal surface for [inaudible] in the-
Payman Langroud…: That’d be so minimal, right?
Nik Sethi: Yeah, exactly. So I’d always end up having these ultra thin on lays sent back or having reduction [inaudible] that I don’t have to manually correct. Or getting the patient back for an adjustment. So being able to just check your clearance and go again, for me has been a real triumph for me. But I wouldn’t say I’m the quickest at getting adapt to all the new smart design stuff that’s coming out around 10 years in. I’m not old. I am a little bit old school.
Sanjay Sethi: I like waving a wand and then looking at the patient go, “Wow.” And then thinking… This is so great. You’re just literally showing them it. And they’re just literally like putty in your hands when they’ve seen it. When all the other stuff that I did for the years meant nothing to them just by seeing their teeth in a digital format.
Payman Langroud…: I think a mistake some dentist make though on the communication side, you know this thing you were saying about Basil and it’s never right. And all of this, I’ve seen this happen before. Some young dentists and particularly some very good dentists. When they’re looking at the work on the patient, they start talking in that way and for the patient, the patient doesn’t see that as a top dentist being hyper-critical. The patient sees that as, “What did you say is wrong with it?” Between us, we understand. If I’m this hyper-critical [inaudible 01:04:11], “It could be just a little bit better.” We get it right. But when you’re a patient, you put yourself on the patient’s position, but then she’s just looked at it and instead of going, “Wow, it’s amazing. I’m really happy with that.” He’ll go. “Yeah. I’m happy with it. I’ll be even happier if X, Y, or Z.” And the patients then thinking, “Well.”
Sanjay Sethi: Where we qualified back then, if you told patients they needed six crowns, they go, “Yeah. All right, let’s do it.” Now you have to justify everything. Show them, take pictures and everything. It’s all different. Now. Because they don’t trust dentists and doctors like they used to.
Payman Langroud…: Quite rightly. Yeah. The world’s better in that respect. You know one thing that is interesting for me, when we talk about bedside manner, chairside manner, and soft skills and hard skills. And we got to a situation my wife needed an operation and we were trying to choose the right surgeon for the job and crazily bedside manner. The manner of the surgeon was probably the most important thing in deciding which surgeon to go with. And it’s counter-intuitive, because you’re thinking from our perspective, you want the hands and the eyes and the brain. And yet the guy who was most understanding was the one we went with.
Sanjay Sethi: He might have not been the best, or she might not be the best-
Payman Langroud…: Yeah, he might not have been the best. The prickly one might have been the-
Nik Sethi: You reminded me of a great story. Someone we know I won’t mention the name or where they were, someone we know years ago told us of a story where they were doing an endo and the file fractured down a root canal. And they sat the patient up and they said, “You know these files we used, they’re handmade in Switzerland with the highest technology of steel. And they’re designed to be hard as they’re so strong. Your teeth have such an incredible shape on them. Amazingly, that file fractured. And you know what the patient turned around and said?
Payman Langroud…: Separate it.
Nik Sethi: She said, “I’m so sorry that I did that. Do you want me to pay for the file?” Can you imagine now someone like me I’d get slapped around the face. It’s ridiculous.
Payman Langroud…: I have to pay for the endodontist to get the fractured file out. I’ll remember that.
Nik Sethi: We’re not mentioning where they worked, remember.
Payman Langroud…: So we’ll need to get from both of you, a couple of predictions. Predictions, as far as clinically, what’s going to be hot? Where do you see clinical dentistry going? Whichever way you want to say that? Are we talking short-term or go bizarre and tell me what things will be like in 50 years time, if you want. Whatever you like. And number two, as far as the dental world in the UK, what are your predictions going forward? Like let’s not leave that 50 years. Let’s call that, next year.
Nik Sethi: I’ve got a good and bad prediction. A good prediction, I think that we’re not allowed with the whole COVID thing with the whole aerosol risks, I think the quality of adhesive dentistry is going to go through the roof because more dentists than ever now finally have a good excuse to use rubber dam. So I think we’re going to see less composites failing. And when I’ve been teaching recently, a lot more dentists that weren’t using rubber dam recently were over that Hill, as you know Payman, it’s just practise, practise, practise. It’s not rocket science.
Nik Sethi: So forgetting all the digital stuff and all the things that are going to be incredible, I think going back to building blocks, which is what you probably gathered me and Sanjay are all about. I think basics are going to improve. I think finally, we’re going to lose this amalgam mentality of GV black cavity preparations. I think finally people are going to embrace these open infinity margin preparations rounded, composite doesn’t want a margin. I think isolation is going to be a big deal. And when the bonding Asia is getting so versatile with these universal bonding agents, I think we’re going to see these adhesive restorations finally achieving in everyone’s hands what amalgam did over the next few years, which will be amazing. They may not last as long, but they’re certainly much less harmful to the teeth in the longterm. That’s my hope anyway.
Sanjay Sethi: Yeah, I just think that dentistry is becoming faster and faster, more and more efficient. And sometimes maybe we’re forgetting basic principles, especially with things like implant dentistry. Some teeth are being taken out where they could have been saved. And it’s a bit sad to see it because, if you’ve got someone that’s in their 40s and could live into their 90s to a 100s, they could’ve kept teeth for another 15, 20 years, maybe even 30 years. I’ve seen really great perio and teeth lasting. And I just think biology takes time. If you can save teeth first, you can stabilise, then you’ve got a chance to reassess. But people want to go in fast, fast, fast, and see results.
Sanjay Sethi: And I think on the one hand, that’s great business, it’s great money, but it’s almost like the old school ethos. I think that’s where dentistry is changing. It’s become more from my point of view, maybe from what I’m seeing it’s more business orientated and maybe the healthcare side of things, the love, that little part that was actually very important to some of the old school generation is changing or has changed because business, marketing, speed, efficiency, profit timelines, everything has just become more important.
Payman Langroud…: So that’s a bleak future analysis.
Sanjay Sethi: Not really because if you find the right people and there are a lot of good people out there as well. It’s like any profession, there are good accountants, there’s bad accountants. It’s like in any profession, there are a lot of good people out there that have good ethoses and work hard. So I think that’s not bleak. I still think it’s just a case of finding someone that is prepared to take the time. And are you prepared to spend that.
Payman Langroud…: I fully agree with both of you about the basics. Just in a little bit of dentistry that I know something about bleaching all about the basics. Get a good impression, you’d be amazed the number of poor impressions that come in for enlightened. A large number of poor impressions come in. Just that, start with that.
Sanjay Sethi: I was thinking, another 30 seconds of putting the impression-
Payman Langroud…: It makes a massive difference to the results. And then you go to the next bit, understanding the basics is really a key, key, key thing. You’re absolutely, absolutely right both of you. What about for the profession as far as NHS private, what’s going to happen next? What are going to be trends? What’s caught your eye? I’ll tell you what’s caught my eye and it goes opposite to what you guys are saying. This story with digital and the idea that we can take the dentist variable out of the equation and have a system that anyone can use. Like what’s happened with Invisalign and we all know that you still need to know what you’re doing when you’re using Invisalign. But that idea that the system can take over. What’s the name of the… Sorry man. It’s late on a Sunday.
Sanjay Sethi: [crosstalk] diagnosis and all of this sort of thing, everything in digital in that way?
Payman Langroud…: Yeah. For instance, the avant-garde with Robbie. Robbie’s whole idea is that the dentist skills should be minimum and the system should be able to make it so that the dentist skill is minimum in it. And he’s right, if you’re looking for that, it’s the notion that a big Mac is a big Mac in Moscow as it is in Tehran, as long as the formula is the same.
Nik Sethi: It’s really funny you say that. And I can’t tell you where I was or the company that it was for because I have signed an NDA. But I saw this most incredible robotic arm, which is totally pressure sensitive when you’re moving it. And you can push it fast, you can push it slow, and it’s totally adapted to what you’re doing. And it’s like a dead straight surveyor. You imagine prepping with something that is dead, accurate, everything around. And I think just like we have done with the hair transplant industry, these machines that just come in, we all know where this is going.
Payman Langroud…: Touch your hair then Nik.
Nik Sethi: Yeah. Well, you never know. I am feeling a little bit, but I have to say, we know where this is going. What I saw in that robotic arm was incredible. And you think for dentists-
Payman Langroud…: Why should a dentist hold a drill, man? But that’s really one.
Nik Sethi: In one way, I love this whole thing of the geeky science and how things work. But in the other way, I don’t necessarily think… There’s a lot of people out there that think you have to be able to layer in 50 layers. You have to know how to put these translucent bits in with your hand. You have to be able to manipulate composite in a way, and you’re thinking, “Well, if I have something that could do that bit for me but I was still prescribing it and diagnosing it properly and getting a result, I couldn’t achieve freehand. Am I doing anything wrong for the patient? I think we’ve got to drop our egos and accept that things are going to very much change.
Payman Langroud…: Have you seen that DSD thing where they make a prep [inaudible 01:14:00]?
Nik Sethi: Yeah. And the veneers are pre-made. We saw that in Poland. Sanjay and I lectured at the-
Sanjay Sethi: Well, I think what’s possible is incredible. And once it becomes mainstream, you’re absolutely right Payman. If it takes that level of skill as expected out of the dentist away, but then they’re able to achieve the same, actually they’ve done the profession a favour, haven’t they?
Payman Langroud…: But see along the way, there will be pitfalls just like the sandwich technique, the glass ionomer, just like composite, when it first came out, Sanjay, you remember. Posterior composites were a disaster.
Sanjay Sethi: You didn’t use them.
Payman Langroud…: Not when they first came up. But when people first started doing posterior composites, it was disastrous what was beaming. So there will be errors along the way. There will be pitfalls like Smile First, it’s amazing the way that the market’s taken that up.
Nik Sethi: What’s funny is that I-
Sanjay Sethi: It’s the same reason. It’s the same reason that the system can take over where the artistry of the dentist isn’t as important anymore.
Nik Sethi: We both know [inaudible] really well. Actually, I feel sorry for some of the backlash that he was getting on Facebook totally unfair by some prominent minds that I won’t mention.
Payman Langroud…: Did he get backlashed?
Nik Sethi: Yeah. Because they were like, “This is taking the R out of it. You’re layering composite over the two, you’re doing this.” You’re thinking, “Well, people are doing freehand five to five, horrendous, direct composite veneers out there at the moment. But if you can systemize, as they’re getting a beautiful result in a predesigned manner, that’s easy to replicate and less likely to fail then it’s going to help raise the general level of dentistry. There’s always going to be the depression. There’s always going to be the me, the science, think of in the past, we’re always going to want to do things to that next level. But if we, as a collective and systems like Smile First can raise the level of UK dentistry as a general like Bioclear for example, and other companies, I think actually it’s a good thing.
Payman Langroud…: If they can, right? If they can. That’s a key point. You’ve got the long-term implication. This is what I’m trying to say, we don’t know, do we? And by the way, we didn’t know with Enlightened, right we said, we’re going to make bleaching better. That by itself was a big thing to say, but we were going to make it better. We didn’t know long term there was going to be problems or not. We didn’t know for sure. You’re trying your best to do everything right. But it’s funny the tension between progress and doing things exactly the same as they’ve always been done. And I was talking to Tiff about this as well, would he have even bothered doing all the work he did in the current GDC environment? The risks.
Nik Sethi: I was talking to two young dentists I’ve just taken on for basil them. And they’ve missed out a lot because of COVID in a time where it’s so important to have the experience, you just learn your hand skills. And a lot of that’s been robbed from them and it’s scary, they’re scared shitless of what they’ve got to now jump into because now it’s the real world. They haven’t got demonstrators checking what they’re doing. They haven’t got a mentor over their shoulder for every single case. And litigation’s at an all time high. So for the younger generation is very, very scared. And I really do feel for these FD dentists that I’ve been training a lot recently. And this, again, comes right back to where we started this whole thing today about surrounding yourself with an Academy, whatever it may be, Bart, BACD, therapist academies, something that makes you feel safe and a camaraderie to be able to discuss your failures and learn quick. Because if you don’t learn quick and you’re already lacking experience, it’s trouble.
Payman Langroud…: I know you guys are so humble, you’re not even pushing your own boat up, but tell us a bit about this Aesthetic. Do you call it Aesthetics?
Nik Sethi: Aesthetics. That’s all training we do under-
Sanjay Sethi: [crosstalk] say it properly Nik, Aesthetics.
Nik Sethi: Aesthetics. But Sanjay and I, we’ve been doing this for a little while. And as you know, you generously supported us with [inaudible] last year, it was fabulous. We ran 10 days. We became really close with another fabulous clinician, Riaz Yar, who is just one of the most prominent minds in UK dentistry. Just takes understanding to another level. He’s finally made me understand occlusion, and if I can understand occlusion, then we all can. So we’ve teamed up with Riaz to start a company called Elevate Dental and essentially that’s Aesthetics and Riaz together. And we’re going to be doing online education, which we’ve already had recorded. We’re going to update short courses on minimal prep onlay preparations, which I’ve been doing a lot of. And Riaz’s talking about simple occlusal assessment with onlay preparations. Sajay is going to be doing a two day course with Riaz on vertical preparations and occlusion.
Nik Sethi: And then we’re also releasing next year, a two year diploma, which is going to be down South with Dental Beauty Dentists, and then up North, we’re going to be running it in collaboration with a Smile Academy. So there’s some really exciting things going on behind the scenes, that I can’t wait. There’s a lot of hard work, but I’m putting into it with many others. But again, it comes back to what we said that we love being able to inspire the younger generation to be as lucky as I have been to have people like Sanjay around me. And if I can be part of their journey to improve, then I will be over the moon and surrounding ourselves with wonderful people like Sanjay, Riaz, Depeche, Elaine, Amit, yourself. I do think we’ve got some fantastic people in this profession. So I do think despite challenges ahead with good minds together and good opportunities, I think there’s going to be some exciting times for young dentists going forward.
Payman Langroud…: Prav is not here, but I don’t know if you listened to this show Sanjay. Prav, he likes to end it with a particular question and it’s funny we got some feedback on it. Someone said, “I don’t like this question because it mentions death.” But the question is, if you’re on your death bed and you’ve got your family around you, what are three pieces of advice that you’ll leave?
Sanjay Sethi: Nik, you go first. On the death bed? I don’t remember that being a question.
Nik Sethi: On my death bed, that’s really tough. I would say, don’t be afraid of being wrong. I feel like I wasted a few years just following the status quo, doing whatever Sanjay said, whatever [inaudible 01:20:52], and I maybe stifled myself with starting the education company today a bit later than I would have wanted to. Don’t be afraid of being wrong and making new challenges. And if you fail, get up and go again. Knowing your limits clinically. In life, just knowing your limits and being prepared to take on challenges when you’re genuinely ready to. Don’t just do it because you think you can, because you can fail very quickly and very hard.
Payman Langroud…: Those two are in opposition with each other there, isn’t it? Don’t be afraid of being wrong. [crosstalk] I like it.
Nik Sethi: I felt I was ready to start an education company a few years ago, but I stopped because I was worried I was too young and people wouldn’t take it right. Like, “Oh, who are you Nik? You’re only 30 years old.” So I don’t mean it in terms of don’t do stuff. I mean, take on a new challenge when you know you’re ready, but know your limits of what you can do. Like the few speeches you hear from, one out of Denzel Washington have dreams, but make sure you have goals because dreams without goals are just dreams. And I love that saying.
Payman Langroud…: And what’s the third one?
Nik Sethi: Have a laugh all day. Sanjay and I have always done that. We have a few drinks. We have a good time and we know when it’s Friday night, we put everything else aside, just switch off, enjoy with your loved ones. I’ve got a beautiful wife who I cherish more than anything. Beautiful family, love my niece and nephew, just have a blast while you’re doing to, COVID for, everyone’s been a stressful year. But for me, honestly, financially aside, which is a bit crap, I probably had the best year of my life. I learned to cook. We made a stupid song, Raving in Lockdown, which was-
Sanjay Sethi: That was good [crosstalk 01:22:40].
Nik Sethi: We had such a laugh drinking in each other’s gardens and zoom calls. And just spending time at home, spending more time interacting with the parents and stuff. Just put your phones away every once in a while, get digitally disconnected and go back to the roots, get bored. I remember being young and wondering, we had four channels on TV and Sunday used to last forever. I remember sitting there thinking, “Well, when is this day going to end?” Now, I don’t know where the year goes, let alone the day. Unplug make yourself bored every once in a while and enjoy that feeling.
Sanjay Sethi: That was good.
Payman Langroud…: Sanjay?
Sanjay Sethi: All right. So I’d say it’s got to be a little bit dentistry related, but it’s still alive. I’m no Dalai Lama, but I’m just saying in terms of dentistry and profession, I think patience and perseverance. If I could say to anyone who’s young and in dentistry, even at-
Payman Langroud…: In any endeavour.
Sanjay Sethi: Patience and perseverance, take your time and enjoy the ride. I think that’s really important. That’d be my first one. Second one would be hindsight is a really powerful thing and it’s easy when someone says, “What would you go back and change if you were on your death bed?” Well, nothing really. Because that was all part of your learning experience, which puts me down to this one saying that I gave my kids and my son wrote it on his wall. Knowledge is nothing without application. It doesn’t matter what you’ve learned. You can have all these facts in your head, but if you can’t apply it, whether it be in dentistry in life, life lessons, whatever it meant, nothing did it? And you don’t want to be sitting there full of regrets. So you’ve got to apply it and evolve all the time. And third one, I agree with Nik. And again, I say this to the kids all the time, life is all about moments and making them so go out there and go and have them enjoy it.
Payman Langroud…: I like that buddy. And how would you like to be remembered?
Sanjay Sethi: Just a great guy and great friend. I think that was what I’d love to be remembered for. I think that would be the way you want to be in someone’s heart, not just for doing a great composite. What’s that?
Payman Langroud…: Nik?
Sanjay Sethi: Make a difference.
Nik Sethi: I think just a similar of having energy. Have energy, just do things. Whatever your dream may be, I always did things in my life with a lot of energy. So I’d like to just be remembered the guy that had a lot of energy really.
Sanjay Sethi: He’s definitely got that, trust me.
Nik Sethi: The Duracell Bunny.
Payman Langroud…: It’s been lovely having you guys on. Thank you so much, guys.
Nik Sethi: Thanks so much.
Sanjay Sethi: Thanks so much.
Payman Langroud…: Take care.
Nik Sethi: Cheers. Bye-bye.
Payman Langroud…: Bye-bye.
Speaker 2: 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.
Nik Sethi: Thanks for listening guys. If you’ve 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 guests has had to say, because I’m assuming you’ve got some value out of it.
Payman Langroud…: 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.
Speaker 2: And don’t forget our six star rating.