This week we welcome one of the most prominent names in restorative dentistry and prosthetic dentistry, Dr Basil Mizrahi.
Basil talks about the differences between dentistry in the UK, US and native South Africa, and tells us how building extraordinary interpersonal relationships with patients has helped him maintain a reputation as one of the profession’s most thorough and exacting practitioners.
Basil also lets us in on his lecturing with the Eastman Institute and namedrops some the inspirational teachers and mentors who have helped shape his stellar career.
“You’re going to hate me halfway through treatment, you’re going to be cursing…You’re going to wish you’d never come here. I’m going to get you out at the end, and you’re going to love it.” – Basil Mizrahi
In This Episode
00.48 – A day in the life
02.27 – Early years and backstory
12.18 – On Gerry Chiche
13.22 – US Vs UK and SA
19.07 – Day-to-day
24.37 – Black box thinking
26.41 – Patient journey
45.39 – Early adoption Vs traditional WoW
50.45 – Perfectionism
58.57 – Training and mentors
01.14.45 – What most dentists don’t know
01.18.43 – Best bits
01.20.09 – Last day and legacy
About Basil Mizrahi
Dr Basil Mizrahi is a specialist in restorative dentistry and prosthodontics and widely recognised as one of the field’s most eminent practitioners.
Basil is an honorary clinical lecturer with the Eastman Dental Institute and one of only a few UK dentists to become a Diplomate of the American Board of Prosthodontics.
Basil: Because in the beginning, when you’re starting out, you have a big room of patients and you’re doing everything, just to get patients and to start earning money. Gradually, when I look back now or look at my practise now, you ask me, it’s I would say 99% referral, 99% for me, crown, and bridge, and implants, which is what I like. So you just end up honing your practise, being able to spend more time on less patients, doing the kind of work you want to do.
Intro Voice: 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: One of the nicest things about my job is that I sometimes get to meet some of the top people in our profession. And today we’ve got one of the top prosthodontists in the world, Dr. Basil Mizrahi on the show. Basil is in private practise in the West End in London. He has a teaching facility there also. They do many courses, which we’ll get to. And also teaches at the Eastman Hospital as well. Basil, the point of this podcast is to try and get to the person behind sort of the persona. So really first thing is, it’s a Friday, what’s your normal Friday like? What time do you wake up? What do you do?
Basil: Well firstly, thanks for inviting me onto the podcast. Thanks for the kind words, very kind indeed. Fridays generally, I tend to take off. If I’m not teaching, it tends to be my day off. So that’s the day I like to get up at about 7:30, do some gym. This morning, I’ve just been for a run, always like to do a little bit of exercise first and then relax. Inevitably I’ll do a little bit of work. I’ll meet some friends at the coffee shop across the road, we’ve got like a traditional hangout there we go. These days we can’t do it, so we end up grabbing a takeaway and going for a walk. But in the better times, I used to go across the road, just have a coffee, do a little bit of computer work. Can’t really remember, I guess in the last year now it’s been sort of just [crosstalk] put there going for walks. Yeah, so Fridays would be my day off. Although, I say that, but often, well I haven’t been doing teaching for a while. But that’s generally when I’ll do my courses.
Payman: Mm-hmm (affirmative), mm-hmm (affirmative) and take me back to, you grew up in South Africa. Take me back to what it was like growing up in South Africa, and your decision to move, what was it based on?
Basil: So I was fortunate to have a very nice upbringing. It’s myself and my sister, who’s also a dentist, and my father is an orthodontist, and my uncle is a periodontist. So I guess it’s in the genes. But yeah, I grew up in South Africa, we had a lovely upbringing, and a privileged upbringing. At the time, you do live in a little bit of a bubble, not an excuse, but you sort of don’t really know what’s going on around you. And you just enjoy the upbringing, so the climate was amazing. We lived in a lovely house, with a nice big garden. We’d wake up every morning not to weather like this where it’s dull and grey. If it was dull and grey in South Africa, that was a surprise. The sun was out every day, that was normal. But dull and grey, you got a surprise.
Basil: Here it’s the opposite. Dull and grey and if you see the sun is out. So it was a lovely place to grow up. I did all my schooling there. I was actually born in Manchester. So I’m actually, I was born here when my father came over in 1965 to specialise, to do orthodontics in Manchester, I was born. He did his, I think it was a year or two years in those days, and then I was born. And then he went back to South Africa. So I don’t remember anything, but I was actually born in Manchester. I went back and grew up in South Africa. Did my schooling, my dentistry there at University of Witwatersrand. We had a great education at dental school. I didn’t really excel at dental school. I would say I was probably in the middle half, definitely not the top half, definitely not the bottom half. So let’s call it the middle third.
Basil: And even at school, my results, I mean in those days was a different grading system, but it definitely wasn’t near the top of the class, I’d probably say again, middle third. So I never really excelled. I would say I excelled after the formal education part, which is often the case. I see it in many of my classmates now, who’ve done well all over the world. And I remember them from dental school. You would never have thought they were going to be sort of leaders in their fields. But it just shows, obviously the guys that did well at dental school and have been successful. But there were just as many who didn’t excel at dental school, but seemed to find their little niche afterwards. So I did my dentistry in South Africa, then I worked actually, almost like in an NHS kind of practise for a year.
Basil: And then I joined a prosthodontist in a nice private practise and he took me under his wing. That’s where I think I got switched on. And actually, in the Army, we had compulsory conscription, so I did 18 months in the Army. And I hate to say it, but that was probably my best learning experience because we had cart blanche to do whatever we wanted. So there were times, I’d read an article in a dental journal, I can still remember, about sort of periodontal surgery to raise a gummy smile. And I thought, “Oh, this looks good.” And then I’d be in the Army the next week and the next guy that came in, he had a little bit of a gummy smile, I had the article behind him, and I was sort of reading it as we were going along. So we got really amazing experience because money wasn’t an issue and you could take your time. And that’s probably where I got switched on and working in the practise with the prosthodontist.
Payman: What about the apartheid situation? As a kid, would you say that you just accepted it because that’s what it was, you didn’t understand anything else, or when did you wake up to that, or did you always understand what was going on?
Basil: No, if I’m honest, I don’t think I always understood as a youngster. I think I woke up to probably the latter years of school, when you get to 14, 15, and definitely university. Universities are hotbeds for politics. So that’s where you really sort of get switched on and you see the heated debate and you start realising. I mean, I can’t say I was a political activist, so I was probably pretty passive or sort of closed myself off to it. So I mean, I had friends who were really active, and took a much more active role in the sort of anti-apartheid. I probably wasn’t one of those. I’ve never really been an activist in any, whether it’s dentistry or anything. I’m more of a sort of just sit back on the sidelines kind of a guy.
Basil: But I’d say I got switched on, yeah, in latter years of school and university. And then as you get older, and especially when you come out of the system, when I left South Africa. When I left South Africa, I was probably 26. I was pretty mature and 27. But you leave it and then you start mixing with people who look at South Africa and say, “Well, Basil, how could you have been part of this? Didn’t you realise what was going on at the time?” And then you start sort of looking back and you look at the TV documentaries and you realise what you were involved in. But at the time, it’s not an excuse, but to be honest, I wasn’t really involved with it. And I actually say, I left I still think relatively young, but probably security, longterm security was an issue. But I can’t say I left for conscientious objection reasons, I had-
Payman: What was your primary motivator for leaving the country? I mean, you grew up in this beautiful place, you have these established family connections and so forth. Why not just stay in South Africa as a place to live?
Basil: I would say my primary reason was education. I worked for this prosthodontist, who was America trained. He’d trained at Boston University, which in the ’70s was sort of the golden temple for prosthodontics. And I just saw the way he practised and so it was for educational reasons. I just wanted to go to America and do prosthodontics. And that’s probably where I saw. So that was the primary issue, and probably to get out of South Africa, just because of the-
Payman: See the big wide world?
Basil: Yeah, see the big wide world and yeah. It was a way to get out, but I think the primary objective was education. But saying that, I knew I wasn’t going to come back to South Africa. So even going to The States. I didn’t know whether I’d stay in The States, or where I’d end up. But I knew I wasn’t going to come back to South Africa. So there was the sort of just wanting to get out of South Africa for the security and that.
Payman: And do you visit now?
Basil: Yeah, go back probably, my wife’s family is all still in South Africa. So not lately, but we probably go back every year, December. Yeah, so they live amazing lives. It’s a lovely country and I-
Payman: It’s an amazing place.
Basil: My kids are there. It’s a lovely place.
Payman: So then the decision to go to, you went LSU?
Basil: Yeah, New Orleans.
Payman: Yeah, so you targeted LSU because Gerard Chiche was there. Who told you to go there?
Basil: To be honest, not really. I didn’t know anything about Gerard Chiche and I often say to young guys asking me, they say, “Well, Basil, where should we go in America? What’s the best dental school?” Because New Orleans was in the middle of nowhere. I mean, it’s a fun place and I’d recommend visiting for a weekend, and I spent three years there. And to be honest, it was the place I got in. There was a South African guy in charge, and in this world it’s often not what you know, it’s who you know. So he was a sort of connection, I went for an interview, and I got in. I would say the same to anybody looking to specialise. It’s not so much the place you go. So just go where you can get in, go where you kind of… That was the other thing, it wasn’t a private school.
Basil: I could have gone to Penn, or UCLA, but there you’re paying like, I don’t know what it is now, it was like $40,000 a year. So New Orleans was what they call state school, so the cost was low. It’s a cheap place to live, so I just went where I could get in. And then when I was there, I heard about this Gerard Chiche guy. I mean, I was a dentist from South Africa. So I didn’t know about him and then I realised how fortunate I was to be with him. But even today, I would say go where you can get in and we’re going to get out what you put in. So whether it’s Guy’s, Eastman, Kings, Manchester, or whatever, decide where you want to go and you’ll get out, it’s like a driving licence. You get that piece of paper and then afterwards you do what, that’s just stuff. So I didn’t go there because it was the top place. It happened-
Payman: Interesting. And the experience, that three year experience, did it involve some research, as well as just traditional teaching?
Basil: You had to do a little bit of research. My research, I did a master’s in education, instead of an actual dental research project. I’ve done my master’s in dentistry in South Africa, did some bonding study when I was in South Africa as part of a sort of a master’s in perio. So I’d done my dental research. So in America they gave us the opportunity to do a sort of, a master’s, but in education. So we tagged onto sort of the New Orleans non dental school and I did a master’s in education, which actually turned out to help. Does it help me? I don’t know, it’s a nice degree to have. Practically, I learned about America history. But it’s one of those things, we had to do it pretty much, didn’t have the choice. I did it and it’s stood me in good stead.
Payman: What was the great man like? What is he like? I’ve never met him.
Basil: Gerry Chiche, amazing guy. So humble, amazing clinician, good educator, and you can relate to him on a one-to-one basis. He’s friendly. Yeah, I would say he’s definitely one of sort of main influencing factors in my life. He’s a lovely human being, he doesn’t have a huge ego. Yeah, so yeah-
Payman: Excellent because I remember when I disqualified, I was a little bit sort of, I don’t know, disillusioned with VT practise and my boss, Nick Mahindra. He said to me, “Look, go to the BVA library and pick up some books on something you enjoy.” And I said, “Oh, I want to be a cosmetic dentist.” And I happened to pick up his book, and it changed the way I looked at everything. So he’s been a massive influence on my career, but I’ve never met him. The red one, what’s it called? Aesthetics of the Anterior Fixed-
Basil: Fixed Prosthodontics.
Payman: There you go. There you go.
Basil: Yeah, it’s a great book.
Payman: So now you’ve been exposed to the system in South Africa, the US, and now the UK, and you lecture all over the world I’m sure. How would you say we rank here, from the quality of dentists that the country produces, number one, and then the quality of dentist that the dentists become within the system? Because definitely before, I think we didn’t rank anywhere near the top. But for me, I see sort of green shoots of excellence coming through. But I see people who’ve qualified at WITS for instance. I mean, maybe they’re just the ones who come here. But all of them are just superb. So how would you rank us? Where are we?
Basil: Difficult to rank. I can see the results, I haven’t been involved in UK education system. I know we had a great education at WITS, it was very practical in those days, I’m talking what’s it? 25 years ago. I don’t know what it’s like these days. All I know is the South African guys have done very well all over the world. We had an amazing… I think because also, we had so many patients. We had a huge pool of patients to get practical experience on. I mean, we used to come and do extractions and surgery. I remember, we’d arrive Monday morning and there was a queue of about 20, 30 patients we each had to get through in three hours, extracting teeth. And then when you wanted to do perio surgery, you had old cohorts.
Basil: And dentistry, I’ve always said, is a practical profession, so you have to get your hands wet. So from a practical point of view, we had a very strong course because of the patients. Dentistry as a whole, would I say it’s better in the UK, or the USA, or South Africa? I’m fortunate that I think I’ve got both sides of the pond as they say. So America I would say is pretty aggressive. I mean, I came back from my pros programme and you’re looking to cut, you didn’t blink twice. Okay, you’ve been in a prosthodontics programme, so they push you to be a little bit proactive. They call it MRB, maximum resident benefit because if you were prepping teeth for something that you knew may not, they’d say, “Well, don’t worry, Basil, it’s MRB, maximum.”
Basil: So you will get guys coming in, full mouth rehabs. So I would say you come back from The States pretty aggressive, that most things become crowns. When I came over to the UK, then you pick up the European and the UK perspective, which is probably a lot more conservative, more biomechanical approach, more almost thinking. And that took me back a little bit. I think I’ve got a nice balance in the middle. I would say for aesthetics, The States, obviously they got their specific kind of aesthetics.
Basil: But they’re very aesthetically conscious, for better or worse. So they’ll do a lot more veneers and crowns there than we would here. For probably thinking man’s reconstructions, probably the European approach, adhesive bridges they use here. So it’s a lot more I think thought based here. I say here, I’m talking about Europe as well. UK, I find a little bit, I’m not sure why, maybe the NHS system. But there’s a lot of, look, there’s amazing dentistry, but you just see a lot… And I think it’s the system, that NHS just produces a lot of not great dentistry. I mean, I teach dentists all the time and the frustration is, how do we get to do good dentistry on the NHS. And it’s a hard balance to do.
Payman: Yeah. It’s funny because there’s a big portion of the workforce, who’s made it their job to understand the NHS regulations rather than anything else. And you have to because you’re in it. You have to understand what you can and can’t do. But it’s sad. But on the other side of it, I do see, I mean, you’re perfectly positioned to see this. I do see some hope in terms of, we do get some people coming out of here, who are actually nearing the top of the pile. We never had that before. I remember, the top teachers were always Italians, or it was one of those things. Now, I’m sure as a whole, Italy’s got its own problems as well. But I don’t know, the system here is, I’d agree with you. I’d say it probably is the NHS that’s caused that problem. So all right, going forward, how much of your time is spent actually practising being a dentist, and how much of your time is teaching?
Basil: Probably on a percentage basis, 75% practise and about 30% teaching. And I like that balance at the moment. I think probably as I get older the balance will gradually do less practise, more teaching. But at the moment, still my primary focus is the practise. And I think the two feed each other pretty well, which is good.
Payman: Sure, sure. And in the practise, how much of the work if by referral, and how much of it is by word of mouth referral
Basil: Referral, I’m not sure I think, I’m fortunate and pretty unique. I think it’s probably about 98, all referral pretty much, 99% referral, which is quite unique, I think for prosthodontic practise. Yeah, and even in The States. So I count myself very fortunate. Look, I’ve worked hard to do it. But it is pretty much I’d say 99% referral. I get the odd patient who gets referred by a friend. But most of it is by other dentists or other specialists, which is a nice way to practise.
Payman: Definitely, definitely. And then how far ahead are you booked for instance? What are day-to-day situations in a practise like yours? Do you get booked up way ahead, or no?
Basil: No. I don’t look to book up, as long as my week is pretty busy. And even if it’s not, I’ve never chased appointments or been worried about a book that’s quite empty because there’s always other stuff going on, whether it’s the teaching. So if you ask me, if you look at my book, you will get an appointment next week with me, as a new patient. I always try and get new patients in within a week or two. My appointments, a lot of them are very long, three, four hours, sometimes all day. Those take a little bit longer, but you wouldn’t have to wait. It’s not as I would say you got to wait three months to see me. I can start another big case in two, three weeks’ time. So I’m not chock-a-block. Sometimes you go through phases, but I feel a little bit uncomfortable, I always want a little bit of manoeuvring time. So about on average, two, three weeks.
Payman: And what’s the set up in the practise? You’ve got yourself, and associates?
Basil: Associates, so at the moment, I have two small practises, just got two surgeries. I’m there, I have an associate, Jurgita Sybaite, who’s lovely and an excellent dentist. I’m sure you’ve heard of her. She’s going to be one of the stars of the future that you talked about. She’s rising fast. So I love working with her. I have an orthodontist, Nazan Adali, who comes in once a week. And I have two hygienists, who do about two and a half days a week.
Payman: And so you take care of perio yourself?
Basil: No, I mean I’ve done a master’s in perio, I’m not a periodontist. But I like the elective perio and the surgery, but not disease. Disease I send to the periodontist. And if I’ve got a tricky crown lengthening, or some kind of connected tissue graft, I’ll use a periodontist as well. I do some myself, but not all. Perio disease, I don’t get involved. So it’s more the elective perio.
Payman: And endo?
Basil: No endo. Endo I refer out. Also, no endo.
Payman: And what about the, I know you do a lot of implants, but do you do the hardcore grafting part yourself?
Basil: No, I’ll do a sinus lift, but no. If there’s big, major like I don’t do the teeth in a day kind of thing. I don’t advanced lateral window sinus lifts. I keep it within what I know and what I’ve sort of honed my skills at. Every now and again I may dabble, but I know my limitations. I think that’s important, to know your limitations and use the people out there who are better than you for those specific things.
Payman: But kind of in a way, you’re kind of the end of the line, as far as the prosthetics referral goes, right? I mean-
Payman: Do you feel the weight of that sometimes, or is that not the case? I mean, you’ve got nowhere to send someone, right?
Basil: Yeah. It’s funny, I use that expression. I just say to the patients when they come in, “Well be glad you got here because somehow you got here because I pretty much am the last stop saloon.” So I’ve created that niche for me. So it comes with a weight of responsibility. But it’s just different stresses than other dentists. We all got our own kind of stress, so I enjoy that.
Basil: I like to think, and I’ll often say it, if I can’t do this, I don’t think, unless it’s something specific like a sinus graft, but if it’s broken down dentation, then I sort of like to think if I can’t do it here, I often say to the patients, “I think this is the best place you’ll get it done, I don’t think you’ll get it better. You’ll get it a lot cheaper anywhere else, but not necessarily better. So yeah, I build my practise on being the last stop saloon and maybe that’s why the referrals, I don’t need that many referrals. I mean, I’m always grateful for them, so keep sending them. But a complex case can keep me busy for a long time.
Payman: How often do you hit a situation where you just don’t know what to do next? I mean…
Basil: I suppose my limit, if they’ve got teeth I’m pretty comfortable, most of their teeth and some spaces. Dentures, I’m not a huge expert in removal, so that would be sort of a-
Payman: But I mean within your own scope, how often hit a situation? I mean look, you must be being referred quite some complex situations. Am I seeing it in the wrong way. I mean, explain it to me.
Basil: Yeah, I mean, unless there’s sort of major surgery or after a trauma or something, then I’m not the right person, maxillofacial. But don’t forget working in the private environments, not the hospital realm, so I am seeing relatively, I’m not seeing anything that’s crazy out there, or trauma. They would end up probably in a hospital, in a multidisciplinary environment, that kind of thing. So I mean I’m not saying I can handle it all, I work with a lot of specialists, so they’ll often look at a case and go this is beyond me doing it myself and I will get in a orthodontist, a periodontist, oral surgeon. But I think as the conductor…
Payman: You got it down.
Basil: Yeah. Yeah and I have to think-
Payman: Maybe this is a good time to segue into our portion of the show where we ask about errors. So we ask everyone this and it’s kind of like a black box thinking idea. Have you read that book, Black Box Thinking?
Payman: It’s about plane crashes. When a plane crashes they don’t say, “Whose fault was it?” They say, “All right, how do we make sure this never happens again?” And they bring out all the facts and try and figure out what it was. And then he actually segues into medical. And he says, “In medical, it’s the exact opposite, where they hide the facts, and everyone’s worried about the blame part of it. And the system’s looking for blame.” So just to counteract that culture, we’re asking everyone and it would be nice to hear Basil Mizrahi’s made a few mistakes.
Basil: Well, there’s always mistakes and there’s always room for improvement, some gross ones. A while back I was pretty much cementing, this is after two years of a case, we’re getting right to the end, my technician’s flown over, we’ve got a full arch going in with individual crowns, probably doing two at a time the cement mix. And I cement the damn, and I mix the two premolars up, so upper right, and upper left somehow. You’d think, well how did it even seep? I don’t know if I was rushing or panicking, there was a lot going on, seated.
Basil: By the time I clicked, or I saw it hadn’t gone down properly, we were working with Fuji PLUS or something, so it was pretty quick. I was pulling it, pulled off and the tooth fractured with the tooth. So then we had to do endo, post and core, new crown. So, that one will stick in my mind. And then recently, implants and then extraction, upper six, close to the sinus, you know what I’m going to say. Dropped it in the sinus. Thank God, oral surgeon colleague, thank Jonathan Collier. And I referred, and he managed to get it out, no problem and put another implant in.
Payman: That works. That works for me. Tell me about the patient journey, Basil. I’m a patient, I get referred by, I guess, what’s the model? A call’s delegate is a referee, the guy who refers. I get referred by this guy, and what’s the first thing that happens? I want to hear about the patient journey. Your examination, how long does it take?
Basil: Yeah, so the examination, you come in, the first appointment’s normally an hour. And a lot of that is talking and getting to know the patient. So I’ll sit down with a notepad for about 10 minutes, just talking to the patient. And then often what I’ll do, and this was told to me by Michael Weiss, another mentor of mine. I’ll take out my Dictaphone once I’ve listened to the patient and I’ll actually record in front of the patient for my secretary, the patient’s complaints, their history. So the patient’s nodding like you’re doing, no, and saying to me yes. And stopping and saying no, it wasn’t. I actually had that for three years. So the patient’s listening to what I’ve heard.
Basil: And then I look, I do an examination. First visit I don’t too much. I get an idea of what’s going on in the mouth. I always take photographs, I think a picture’s worth a thousand words. So I’ll take some photographs and my nurse will get them up on the screen at the appointment. I may take a couple of x-rays just for myself, [inaudible] of that. I generally don’t take models, but the photographs for me. And then I’ll sit with a patient, looking at the photographs. They’ll stand up with me and come over to the screen and we’ll talk. And I’ll show them on the photograph, my thoughts, my initial thoughts. If it’s a relatively complex case, I need to get across to them, that it is quite complex.
Basil: I have to change their perception that it’s what they’re used to, when they go to the dentist, they have a few appointments and their problem’s solved. And often they’ll come to me like that, even though they’re referred, they don’t understand, or they haven’t seen the way I work and sort of want to look at the whole mouth if there’s an underlying cause. So I may need to get across, well, we do have to open up your bite, I can’t just fix that one tooth because you see how you’re smashing. So there’s a lot of trying to get into their mind and just change the way that they’re seeing it one little problem, if there is a bigger, underlying cause.
Basil: And that I do with photographs, maybe some models, and trying to relate to them. Most patients I can get through to, other patients, you sort of realise they’re just not the right fit or they’re not taking it on board. And that may be a patient that’s not suitable for me because I also try and get to the patient across that they’re asking me for the treatment. They need to be wanting it from me. It’s the opposite of me trying to sell it to them. And I stress that back to, I said, “You’re going to hate me halfway through treatment, you’re going to be cursing. But you’re going to start a treatment.
Basil: You’re going to wish you’d never come here. I’m going to get you out at the end, and you’re going to love it. But I just know from experience, you really have to be up for this. It’s a huge commitment to time, to effort, to money.” So I almost try and talk them out of it and if they’re understanding and they see the problems. And I say, “But if you don’t do it, these are some issues.” And I say, “Have a second opinion. You’re going to get a lot easier, you’re going to get it a lot cheaper anywhere else than here, okay. I don’t think you’ll get it better.” So I want them to almost be begging, not begging, but wanting the opposite of selling it to them.
Payman: To understand the value of it. I mean, it must be a big problem for you, Basil, yeah, in that dentists think you’re some top of the pile king of prosthodontics, but you have to, every time you see a new patient, have to convey that over. I mean, from a patient perspective, of course the dentist would have said something to the patient before they refer them. But from the patient perspective, I’ve come to the see the dentist. They don’t know they’re coming to see Basil Mizrahi, right?
Basil: Yeah, I know and sometimes also, when I teach I say to dentists, you don’t always have to come across with everything on day to the patient. Sometimes I’ll see a problem, but the patient is not buying into me on the first day, they don’t know me from Adam. I’m telling you treatment could take a year and costs tens of thousands of pounds, they’re going to run out the room. So sometimes I’ll ease, in major treatment, yes, we can deal with that problem. Let’s put a temporary on there because I always say, it’s one thing talking the talk, so I can talk the hind leg off a patient, and talk, and tell them how good I am, and show them, look at this picture.
Basil: But at times, you got to walk the walk, and that’s when the patient buys into, when I make a first temporary, when I do that temporary on the back tooth. Something relatively simple, then they start seeing, okay, he’s not just telling us [inaudible] easy, this was nice. It was painless, he’s made a lovely temporary. And then they become almost more putty in your hands. And then they’re sometimes more open, that’s why I put a big emphasis, you know me, on temporaries because then they become more open. And before you close off treatment and finish the one tooth, it’s in a nice, stable temporary. Now maybe we can start talking about we may have to open your bite.
Basil: Obviously you want to know that if the patient does say no you can still finish the one tooth. But so it’s either some patients are willing to jump in on day one and they know what to expect, or other patients need to be sort of drawn along, got more comfortable. And I’ll say to the patient, “I’m not ready to do all this yet, I need to get to know you. I need to get to know your mouth. So let’s not worry about all this big stuff. It’s not urgent at the moment. Yes, you’re wearing your teeth down, but I don’t know you well enough to know what I want to do. Do I want to go in full mouth rear, or can I manage this with a bite split?” So that’s-
Payman: So, that first appointment’s one hour. How much do you charge for that one?
Basil: I think at the moment it’s 280.
Payman: Oh, okay. And then so what happens next? Patient goes off, do you send them a report from this?
Basil: No. No, no, no. I never-
Payman: That’s just the initial?
Basil: Yeah, that’s the initial. They get to know me, they get an idea of what treatment may involve. It’s either going to be a simple crown, or it’s going to be big complex treatment. If it’s treatments then I want them to come back for detailed investigations. So that’s another hour, and that’s when I’ll take my study models, that’s when I’ll do full mouth x-rays, that’s when I may send them for a CT scan. I may take a bite registration. There’s a cost for that, they need to understand that. But again, that first, initial consultation, they have to know what they’re sort of in for before they start saying-
Payman: Yeah. Yeah.
Basil: I don’t want them to come for investigations and then I’ll tell them, “Okay, now it’s going to be 30 grand.” So they’re pretty much on board if they’re coming for an investigation. If a patient’s hemming and hawing, I may do the investigations for no cost. For me, for my benefit because I can’t explain in detail, and I don’t know what they need until I’ve had my mounted models. So a patient-
Payman: Do you charge a lot more for that second visit because you got to spend the time?
Basil: Yeah, that’s a more expensive visit for most patients. But again, I sometimes will judge the patient, if that’s going to [crosstalk].
Basil: Yeah, if that’s going to scare them off, I may not charge that much, and I may build it into the fee because I know if they give me, if I have time, another hour with the patient, I’ll be able to explain, and then they will have the treatment. And that’s when I make up the fee.
Payman: Yeah, I get that. So let’s say you’ve done that second visit and they’ve paid whatever the fee is for the investigations and all that, when do you actually start working on that case? Not during that appointment, right? Is that outside of the-
Basil: Still even one more discussion appointment, after the investigations, I say I need three or four weeks to do my homework because I don’t know, the investigations, I’m not telling them what I need. I don’t even know what they need. So then I say, “Then you have to come back three or four weeks later for a follow-up appointment. So that’s just a relaxed one. Me and you are going to sit down.”
Payman: You’re going to present?
Basil: Yeah, and we’re going to sit with a coffee and just chat through your models, and that’s when I present my thoughts and I hear back from them, their thoughts. And after that, I say at that I’ll present everything, costs, potential costs. They’ll feedback to me and we’ll have a little bit of discussion. And here, all this time I’ve always built my practise on communicating with the patient, building that rapport because I think that’s what’s missing. And I’m fortunate, well I built it that way, but I want the patient to get to know me and me to know them. And very personal interaction because I think with modern medicine, you go see a doctor, it’s 15 minutes in, 15 minutes out. So I don’t write them a report after their investigations.
Basil: I get them back for a discussion. So that’s now three visits where I’ve just been talking, maybe taking some models, no work’s been done yet. But now, I’ve already got to know them pretty well when they come in for the first visit it’s, “Hi, Basil, how you doing? How is this?” And after that, then they get their written report. And that report is pretty concise because I’ve already talked to them. I don’t have to put six pages together with five different treatment options. I’ve spoken to them, they’ve said they don’t want a partial denture, they’ve said they don’t a Maryland bridge, they’ve said they prefer the implants. So my letter is two pages, boom, implant. They know the fee, it’s in there. But there’s no surprises in the letter. So that’s sort of the patient’s-
Payman: Okay, now I’ve had almost three hours with you as a patient and the letter’s arrived. And you’ve already kind of said, “Look, this is going to cost you 100 grand, or 50 grand, whatever it was.” And now I’m seeing, I’ve got a thing in my hand, 50 grand to get this done. Is there a follow-up now? What’s happens next? You make another appointment?
Basil: No. No, not another appointment. Most times we know by that sort of discussion appointment, the patient said, “Yeah, okay, I’ll probably do, just put it down in writing for me and then I’ll have a look because I’ll put the appointments and I’ll call your secretary and make an appointment.” So by that stage we know we’re going to have pretty high acceptance rates. I wouldn’t have done investigations and spent all the time. But there are patients, you’re right, who get the letter and they just don’t get back to me. I’ll get my secretary or I may call them as well, or drop them a quick email, “Dr. Mizrahi Centre, we’re just wondering have you had any more thoughts. Do you want to come back in and have another discussion?” Sometimes I’ll try and get them back in and see another discussion, is there something you’re unsure of?
Basil: But most times, by the time they get to that letter, because that letter will be tailored for them, if they’re not a 50 grand patient, I would have picked that up at the discussion. And they’ve said, “Listen, Basil, I want to do this. But I can’t do it this year, I can’t do it next year. I can’t do it at the moment. What else can we do?” So I would have swung around and said, “If you can, okay, well let’s just do that lower left tooth for now. It’s not ideal, but that’s all we can work with.” And the letter will just be focusing on the lower left because I’ve picked up that they don’t have, they just can’t do a full mouth. Even if they need it, I will tailor it for them. So they get that letter that’s tailored to, we’ve already discussed what they can go ahead with.
Payman: Okay, so let’s say they decide to go ahead and let’s say it’s, I don’t know, two years of work that they’re going to need. Now, outside of the clinical, do you guys do anything above and beyond to sort of… From my perspective you’re doing things above and beyond in the mouth every time they see you. But do you translate that to the patient journey somehow? Do you call them after every appointment? Do you send them presents? What do you do?
Basil: No, but I build, personally, a very personal relationship, every patient, every single patient has my mobile, my personal mobile. The same mobile you have, every patient of mine has it. So I’m texting patients often, they’re texting me. I mean, they don’t abuse it, so otherwise I mean, I’ve been practising now 23 years. But that’s what I was saying, I build a very personal kind of practise. And I get that across to the patient. You will have me at your side, you will feel like you’re the only patient in the practise. So if a patient’s worried, if there’s a big procedure, I will call them.
Basil: But often a patient, I’ll text a patient, “How’s your mouth feeling?” They’ll text me back. We’re on WhatsApp and they all have my phone number, personal. So often they’ll call me to make the appointment. “Basil, I can’t do this appointment.” So I get very involved with my diary, with the patients. And I micromanage which may or… But that’s why my small practise with three or four patients a day works for me, with three days a week, I can micromanage that. That’s my personality. So asking what do you get? They get me, they get 100% of me outside the clinic.
Payman: Yeah. Yeah.
Basil: Okay, they phone me, they want to go in on a Saturday, because they’ve got a tooth, I’ll drive them to Harley Street from Mill Hill and see them, okay?
Payman: Yeah. And what about on price. I mean, your prices are, you just said higher than everyone else’s prices, do you get people saying, “Oh, I can get this cheaper somewhere…” I mean, do you get that discussion?
Basil: Yeah, and I’ll tell the patients, you need to realise you’re at the highest level of cost here. Sometimes even with referrals, they come in and they just don’t realise. So I will say that.
Payman: So what can it run to? What’s your biggest case?
Basil: That being 180, 200K. I mean, that’s few and far between. That’s one case I’m thinking of, but that probably went for about two or three years.
Payman: What about if I ended up needing one crown from you? From the first three visits, how much does that end up costing, 1,000 pounds maybe? I don’t know, you tell me. How much does it cost, the first three visits, before I’ve started?
Basil: Oh, if you need a single crown, you won’t have such a comprehensive first three visits. So I don’t have a recipe. So if you came in and there were single central, a lot depends on the patients. I always say when I’m teaching again, I don’t have a fee per item. So I can’t tell you what a single crown is, because it’s going to depend on how demanding you are from me. What you’re going to put me through, okay? So if I can pick up from you, and that’s why it’s important to discuss, that’s a single central. I will go back and do my treatment planning, and it depends which lab I’m going to use. And I may say to the patient, it depends which lab. And I will gauge from the patient.
Basil: If I come back and say, “If you really want to hit, it may cost 7,000 pounds.” And that may be two tries, it may be a lab in Italy flying over. But I know I can go right back down to 1,500 pounds or 1,000 pounds, whatever. I always have an associate I work with, so that gives me another tier system, which works well. So Jurgita is an excellent dentist. And very often I will say like that kind of scenario, it’s a single crown, I often say to the patient, “Listen…” And I’m fortunate to have Jurgita working with me because I’ll say to the patient, honestly, there’s really not much more I can do than my associate can do, and her fees are literally half my fees because I see all the new patients myself.
Basil: But I’m very honest for myself, because I prefer getting my hands wet on the big meaty cases. And for my conscience, I can’t sit there doing a single crown, my fee per hour would make a single crown, I don’t know, five grand. I can’t justify that. I can justify easily paying 150 grand for a full mouth rehab because I know how hard I sweat and what the patient gets out of me. And that nobody else would probably do it at that level. But when it comes to a single crown or three in a bridge, or nice composites, I’ll often, I will refer the patient to my associate, because I say, “I can’t do anything more than my associate, who’s excellent. She will do the same job as me, but half the price.” And the patients appreciate that. And that’s how we work it within the practise.
Payman: And what about longterm follow-up? I mean, you’ve done so many big cases. Do you end up following them up over the years or do they go back to their own dentist?
Basil: No, I need to follow them up. And I make it clear to the dentists. I do say, “I would want full responsibility for this patient, seeing my hygienist and me following it up.” Because I take responsibility, and the patient also understands that when they come in on day one, often I’ll say to them if it’s going to be a complex case, I’d say, “You do realise, I would need to take control of your treatment? I can’t work with your dentist on this.” Because they’ll up and say, and it may sound quite harsh, but they’ll often say, “Well, can’t my dentist do this part, and you do that part, and then you’ll do this?” And then I’d rather say, “No, rather stick with your dentist.”
Basil: But just too many cooks, you need one person you can come back to for responsibility. And so I will say, and often to the dentist, I’ll call the dentist and just be honest and say, “I know you’ve sent me for this and you… But this is going to affect this. So either I need to do all that, or better you handle it, or refer it elsewhere.” But if I’m going to take responsibility, and yes, it is longterm. So I say to the patient, this is a longterm relationship. So besides trusting me with your work, we have to build up a report. And that’s why again, I do those discussions, three, four visits before I start because I say, there has to be a mutual respect, there has to be a mutual trust because we’re going to spend so much time together.
Basil: You have to get on with me as a person, nevermind how good I am because that will get us through one or two appointments. And I have to be able to accept you as a patient and see that you’re not going to drive me crazy. And so I express that to the patient because it’s a longterm and I said, “Going forward, I’m hopefully going to be around for the next 15, 20 years, practising . I’m the one that you’re going to be looking after. If something goes wrong, you’re going to come back to me, not your old dentist, not the periodontist, not the orthodontist. I’m responsible. So I’m your port of call.” So they have that reassurance, that I’m there for them.
Payman: Basil, what drives you in the clinical practise part of it? I mean, you’ve got this reputation for being very accurate, sort of perfectionist. Is it playing against yourself? Or-
Payman: Is it?
Basil: It’s probably a little bit of OCD, just getting into the zone, and just wanting to know that I can go to sleep at night knowing I couldn’t get it better. And you’re never going to get to that level, I mean, it’s an elusive target because there’s always somebody who can do it better. But I always draw, I don’t know, you’ve probably seen my lectures, but that picture of the staircase and that’s my logo at the practise. That life is a staircase, also the clinical cases are staircases. So I’m always just wanting to get that next level, which you never get to. That staircase never ends. I don’t know if it’s a good way to live or a bad way, just I’ve had sort of [crosstalk].
Payman: It suits you, right?
Basil: Yeah, it suits me.
Payman: And so as far as being who you are, what’s the tension between brand new stuff that comes out and it sounds like a good idea and people like me, companies are pushing it as a new idea? You’ve seen a lot come and go I’m sure, so you’ve got experience in understanding that. But what’s the tension between wanting to be an early adopter and understanding all the latest stuff, and also not wanting to be an early adopter, and only doing things that are well used and understood? I mean, what do you think about scanners and the whole digital workflow and all that, for instance?
Basil: Yeah, okay, so it’s a good question because you’re constantly being taught, and the longer you’re in practise, the more you realise you’re starting to become a little bit of a dinosaur now. And I never thought I’d hear myself saying that because I remember being a little junior in the room, looking at this guy talking. And so I know I’m probably at the latter end of the career, but it’s a combination, I think experience is huge, you can’t discount experience. So there’s the balance. Yes, you do want to embrace the newer technology and I did buy a scanner last year, we do have a scanner.
Payman: Which one did you get?
Basil: [crosstalk] scanner. To be honest, I use it, I haven’t scanned preps yet. I use it for making retainers because it’s nice and-
Basil: … and expensive. No, but you get to use it a lot and I see what people get out of it. But it’s a crest, where you sort of probably feel you’ve got what’s working for me. Have I missed the wave? Is it too late for me to get into DSD? I see some things that I know my works for me, I haven’t got into the DSD because I think I can do… It has to be quite something to show me how much better it can be. I know people come and say, “Why don’t you mill your temporaries? Why don’t you plan your case using DSBs?” And then I look at my temporaries and say, “Because milling is not as accurate as my temporaries because DSB doesn’t…” So it’s a combination of me probably not embracing it because I haven’t got fully into it. So I’m sure the guys that do DSD will look at me and say, “Well, Basil, you’re not doing it properly.”
Basil: So to get good at something, you really, you have to embrace it. And before you critique it, try it. But there’s a limit to what you can try. Can’t try everything. So yes, you do end up scanning, I’m dabbling in scanning, doesn’t mean that scanning’s bad. No, just means I haven’t spent the hours that the other guys have spent scanning and milling at a margin. Will I get there? Maybe, or maybe I’ll just stick with my analogue impressions because that’s what I have spent hours. You have to also, well for me, focus on what I’m good at. So I do that, I’m glad, that’s why I get on so well with Jurgita, because I’d see her as the young, enthusiastic blood, and showing me all the DSD, she’s amazing at this kind of stuff. So there is constantly that battle.
Payman: I mean, in the last, call it 15 years, how’s your practise changed? I mean, not your practise, your clinical. What do you do differently now than you did 15 years ago? Because of changes and…
Basil: Clinical technique I would probably say it hasn’t changed, still using the same hand pieces, the same acrylics, the same articulators, the same bite registrations. What has changed-
Payman: Adhesive dentistry’s got more reliable, right?
Basil: Yeah, okay. Sorry, yeah. That’s a good… Yes, we’re doing more adhesive dentistry. I suppose implants, I’m doing more adhesive dentistry, doing more implants. Yeah, what else? Yeah-
Payman: On that question of new technology and new technology doesn’t necessarily have to be a computer, I mean, it could be a new porcelain that someone comes out with. I mean, I’m sure you remember, Emax wasn’t always Emax, we didn’t know that Emax was going to be a reliable thing until it became a reliable thing. I mean, how do you asses something? Do you call up your buddies around the world and say, “Hey, Pascal, what do you reckon about this?”? It’s difficult, isn’t it? It’s a difficult situation to be in because you’re-
Basil: Yeah. And again, that’s why in practise, I don’t want to be the first to try something and I don’t want to be the last to adopt it. So I think the world’s a smaller place now, thanks to social media and internet, you can read articles. And we get an idea that things are working. Some things you do push the boat a little bit, but yes, I’ve adopted. I haven’t been the biggest adopter of adhesive dentistry. I’m gradually coming along now. I still think sometimes the pendulum swung too much. I try and keep a balance between mechanical. I do that lecture on mechanical versus adhesive.
Payman: Yeah, I’ve seen that, very good.
Basil: But we all have our biases. So yeah, the materials are evolving. It’s beautiful now we can use things like Emax. We don’t have to prep, cut teeth down to do crowns. So yeah, adhesive dentistry is a big advantage I’d say. Probably the biggest-
Payman: Now, you’re a perfectionist, right? So some people they’re such perfectionists that for instance, I was on your Instagram yesterday. I never thought I’d be saying this. I was on your Instagram yesterday. There are some people who are perfectionists to the point that they can’t even post because they’re worried about what people think about them. That sort of thing. Now, in your case, it might be in the mouth. You don’t stop, right? There’s a point where you have to say all right, you were leading to it before, where we’re going to take impressions now, yeah. But we’re not going to make any more changes. As a perfectionist, there must be a downside to being a perfectionist is what I’m saying. Where does it hurt?
Basil: It hurts, it probably takes some of the enjoyment away, or some of the happiness. I’m quite an intense, I think it spills over into your personality. So I think in the mouth almost, you can handle it because myself that’s why I like doing it, because there’s nobody stopping me, I’m not interacting, I’m interacting with a tooth. I can just bury myself, I don’t have to react to people. So I think for me, sometimes stifles your, just your enjoyment of things or people because you’re trying to keep ducks in a row, if that’s making sense, so.
Payman: Yeah, it does. So for instance, do you have unreasonable demands of your people?
Basil: Yeah, I think if there is a weak area I’d like to work on, it would be a personal area, just my interrelationship. I know I’m not the easiest guy to work with. I think outside the dental environment, I’m pretty relaxed, I’m probably very shy, and unassuming, and probably like I said, the passive one, who you won’t notice at the dinner table. But then something changes when I get into the practise, that’s my little kingdom and I’m the king.
Basil: And I always say to the nurse, when I hire a new nurse, it’s again, I try and talk them out of working for me because I say to them, “I’m going to drive you crazy. It’s hard.” And so that’s where I don’t think I’m the easiest to work with. I’d like to be a little bit better interaction with staff. But saying that, my staff went a little bit over rough patch recently, but my staff generally stay with me many, many-
Payman: I see a problem with perfectionists sometimes where they… Look, in the profession, we see perfectionism as a plus point, right? In a way. So when I see some dentists, they’ll fit a case let’s say, and they’ll be talking out loud in their head to the patient. And they’ll say something that in our world, would make sense. Like you say, “It’s all good, but if only that little thing was a bit better, then that would make it much better for me.” And in our world, I’d see, “Oh my God, Basil’s just put that case up and he’s still saying it could be improved. He’s amazing,” right? But from the patient’s perspective, if you speak in that way, the patient’s thinking, “Oh, there’s something wrong with it now.” And I see young dentists make that mistake quite a lot. When we speak between ourselves, that kind of way of talking makes a lot of sense. But with patients, I’m not sure it makes a lot of sense. Have you been guilty of that one?
Basil: Yeah, I don’t know if I talk out loud. But what I do say is we are our own worst enemies because I’ll take a patient that comes in, that’s not so fussy. By the time I finished making a temporary saying this, they suddenly get switched on and then the site comes back to bite you because they become so demanding, we switch them on. So I see that and I think going back to your point, I think perfectionism’s acceptable in the kind of work I do. I think it creates a better product, but it’s not a good trait to say is it good or bad. So yes, that may be good, but it’s not bad, I think not a great trait to have in life, out of the dental surgery because it stifles you. So could be good and bad like anything. I’m glad I’m like that in the mouth, but I’m not glad I’m like that in life.
Payman: I get it, I get it. You must sometimes get referred a patient because the dentist relationship has broken down with that patient. So a patient who’s a difficult patient as opposed to a difficult mouth and the way the dentist gets out of it is by referring to you. That sort of psychological issues, you must get that.
Basil: Yeah, you do have a breakdown and sometimes it’s almost easier to be a fresh person. It’s easier to take on the case because you’ve got their previous experience to sort of relate to. And it’s always easy to say or show why you’re different. Yeah and again, you’d have to make sure that you can see what you can do differently, because again, the patients will see through you. So again, it’s one thing convincing or talking the talk, and saying, “Well, I’ll do it differently, and don’t worry, that’s not going to happen with me. I’ll treat you kind,” or whatever. But you need to really believe that you can do something different. So if it hasn’t been the optimal dentistry, you need to say, “Actually, I could do that.”
Basil: But if a patient comes in, and it’s happened to me, where I really can’t see that I can do something significant. They may have had a full mouth rehab and yes, the teeth are all white. But it’s not too bad and they’re going off that, “This dentist ruined my mouth.” And that kind of patient I will steer clear of. And I’ll say to them, “Honestly, I really don’t think I can do significantly better. Yes, I can cut all these crowns off.” The risk to benefit ratio, I can’t justify that. So no, I will just say, “I don’t think I can do this. You may want to go somewhere else.” So I need to really see that I can do, or change something, or relate to them better than the previous dentist.
Payman: I guess you got pretty good at spotting that kind of patient. It’s the ones that get through that’s the problem, isn’t it?
Basil: Yeah and again, that’s why I always say to the younger dentists, to spend that initial time. Time is our biggest enemy in dentistry and when you say how malpractice has evolved. I know earlier you asked what’s changed and you were focusing on clinical things, adhesive. But for me, I think in your practise, what changed is again that staircase. If you make your pool of patients just split yourself smaller and smaller, which is nice because in the beginning when you’re starting out, you have a big pool of patients and you’re doing everything, just to get patients and start earning money.
Basil: Gradually, when I look back now, or look at my practise now, you asked me if it’s, I would say 99% referral, 99% for me, crown, and bridge, and implants, which is what I like. So you just end up honing your practise, being able to spend more time on less patients, doing the kind of work you want to do. And then gradually evolving that way. So the spotting, going back to what I was saying, you just need to spend time with the patient. For me, that’s been my biggest practise builder, just that personal time, getting to know the patient. And then you spot the patients that are going to give you trouble.
Basil: And hopefully, obviously every now and again one creeps through. And also, when things go wrong, getting back to what you talked about earlier, because I make mistakes and my mistakes are big P mistakes. But the patient needs to see you as a human being and when you have that rapport, that’s better than any consent form because then they say, “Okay, he’s human. He’s made the mistake. He put the crown on the wrong tooth. Idiot. But he didn’t do it on purpose, whatever. He’s broken my…”
Basil: I dropped a implant in the sinus, the patient wasn’t at my neck, trying to sue me. I apologised, I explained what happened. And that comes from spending time. So when these mistakes happen on a patient, they’ve got to know me. They’ve seen how I break my back, working on them. And the level I’m going to. And they see that you’re a human, whereas if you haven’t got that time, they see you as a robot, in, out, in, out. “Oops, the color’s not right, I’m going to sue him or he better do it again for no fee.” So I don’t have that kind of aggression coming at my neck because of the time. And I’m not a big consent or a huge letter writer. I mean, we do it. But my letters are pretty short, consent is pretty concise.
Payman: So you’ve been teaching for a long time now, both in your Mizrahi Dental Teaching bit, and at the Eastman. How much do you do at the Eastman?
Basil: Eastman, now, probably about six, 10 days a year. Again, in the beginning [crosstalk], yeah, it’s not much any more. I used to do a lot more. But again, when I came back from The States, I did a lot of teaching because I didn’t have patients. So life, your balance is constantly swinging. So as I was doing a lot of teaching and lecturing to get my out there, when the practise starts building up, you cut down on the teaching. So now my practise is at a peak.
Basil: I’ve moved the teaching from a university environment to more my own teaching centre environment. I still go to Eastman, I enjoy the Eastman. And then gradually, that balance will swing, I’m sure in the next five, 10 years I’ll probably start doing more. As I get older I’ll do more teaching back again. So, that’s what’s nice about dentistry. There’s so many directions you can get into when you look out there because people are going all different ways. You’ve started your own company, people who have multiple practises. And that’s the beauty of dentistry, there’s a niche for everybody.
Basil: [crosstalk] enjoy it.
Payman: Sorry to interrupt you. In the teaching, there’s a view out there, I don’t know if you resonate with this or not. But there’s a view out there that coming on your course isn’t something you should do straight away because it’s like a higher level course. Is that true, or is that wrong? I mean, how many years do I have to practise before I come on your year course, or would you say the sooner the better?
Basil: I would actually say the sooner the better and people ask me this all the time because you want to get into good habits. And that overall perspective of you want a combination of inspiration. Yes, you’re not going to take everything I do. But you also want good basics and you want someone who’s been around, showing you and guiding you, how you can get into that at your level. So I always say to all the delegates that come on, you want to see where you can aspire to be. You don’t want to be a Basil Mizrahi, you don’t want to be another Basil Mizrahi. But you want to see what can be done because I just know when I first started out, I used to see these lectures and things, I would get inspiration.
Basil: So you want to get put on the right track and when you look at all these guys that are coming up now and doing, like you said, all the leaders coming through our profession. I’m sure if you ask them, they were exposed to good people early on. And that gets you on the right track. Yes, different people will take different things from my courses, depending what level you’re on. But even the person first year out of dentistry, yes, their preps may not be as good as the guy sitting next to them, who’s been doing it for five years and been on three courses. But they will still be shown, I will be over their shoulder, because the courses are kept very small and very personal, same as my practise, same philosophy, very small and personal.
Basil: And they will be guided at their level. So if their margins are all over the place, I’m not going to get onto their level and say, “Well, you need this microscopic margin, come under the microscope.” I will take them with their no loops approach, whereas the next guy, who’s on five and a half times loops and been doing crown preps. I’ll take him to the microscope and say, “Right, you want to do the next level, come sit under the microscope now and get your margins.” So everybody, we can take people from different levels and that’s a beauty of a personal feature. And then you get… Sorry. The sooner you get onto that right road and realise the correct approach, then it sets you on the right pathway, going into the future.
Payman: Yeah, so the reason I’m asking, I was in VT. I went into a Mike Weiss lecture. And I think what you just said actually is true. I didn’t really understand what the hell was going on, dude, to tell you the truth because he was trying in crowns. And the idea, no one had ever said that to me. But you’re right that I was definitely inspired. I was definitely inspired that someone was doing something like that. But if someone’s been, I don’t know, five years qualified, or 10 years qualified and they’ve done a bunch of work compared to someone who’s just qualified. You’re saying within the same course, you can talk to both those characters?
Basil: Yeah, because it’s relatively small, so people will bring their study models in, or some guy who’s been doing it for 10 years or so, Basil, how do I take a bite registration when the patient’s got no teeth or all preps, whereas the other delegate next to them has only been their single tooth dentistry and wants to know how you do a squash bite [inaudible] or something. So there is-
Payman: By the way, on our composite course, we feel the same. We feel it’s as good for a newbie as it is for someone who’s been there, doing it for a long time because we start from the beginning. And it’s one of those things, I think that. But there is that feeling out there though, Basil, yeah. I guess it’s one of the problems of being top dog, that, that’s what happens.
Basil: Yeah and again, you can’t be everything to everyone, even in practise. You have to be prepared to lose patients. And I know I’m not, my course is not conducive to everyone. So I speak to every delegate on the phone that applies to my course, they get called, same as my every patient, they have my mobile. And I’ll bounce off of there. So not just the application process on the web. I’ll bounce off of them on the phone, “What are you looking for?” “I’m looking just this.” “Okay, maybe do that course and maybe mine in a few years’ time.” So I’m not trying to be everything to everyone. I learned that in practise, you can’t.
Basil: So same way, I will develop that niche and it’s really developing like you say. The opinion is out there, that yes, Basil’s course is… And I wouldn’t want that to change because I wouldn’t say it’s an advanced course. But yes, you may get more out of it if you’ve been doing things for longer because then you can pick my brain at a higher level. You can take advantage of me, more than someone else doing another course, who hasn’t had as much experience in complex dentistry. You can’t pick their brain as much, so-
Payman: How much do you teach abroad, Basil? You must be invited to a lot of conferences and things.
Basil: Well now, definitely not any more.
Payman: Not now, yeah.
Basil: Yeah. But it’s more around the UK. A lot doing that, the lecture segment, there’s so many people out there that are better than you, or better than me. And that’s what I always say to young, just expose yourself, especially with social media, and YouTube, and everything we’ve got now. Go to conferences, because it’s very easy to get stuck, and I see that all the time, going on local courses, or thinking these are the good guys. The good guys are out there in the big world. I mean, you can go to the furthest part of South America and there’s some amazing lectures. So I don’t run around the world, lecturing.
Basil: I don’t see myself as top. I know when I go to these conferences there’s guys a lot, my niche I think I’m top. But there’s amazing guys out there. And I say, just expose yourself to these people. Go to these international conferences because again, I think the level of conference here in the UK is not great. I’m not talking about the dentistry, there I’m guarded. But conferences, if you go to a conference in Europe, in Italy, you get 1,500 people in an auditorium. You got a conference in England, you get 300 people.
Basil: So somewhere the enthusiasm, that’s what always strikes me. That doesn’t seem to be, there’s a much smaller pool of enthusiastic dentists here than there is in like sized countries, in Europe. I just keep remembering Italy. I went to a prosthodontic conference. I walked into this huge auditorium, 2,000 just in Italy. [crosstalk] I’ll go to a prosthodontic, prostho conference here, we get 200 people. We get boring lectures. So thank God we got people travelling around now. But I would say, can’t now, but when we can travel again, expose yourself. There’s some really top guys. What you see here, locally is not always… I mean, we got some good guys here, but there’s a lot-
Payman: Tell me then, Basil, a couple of questions. What are some lectures and some mentors that stick out in your head from back in the day when you were getting electrified by this? And also now, who do you see out there as great?
Basil: The first one that really stuck out back in South Africa, we had, I don’t know if you remember Garber and Goldstein?
Basil: Garber and Goldstein, Ronald Goldstein, David Garber, they came over to South Africa. That was the first time I think I was probably second year bent, maybe I just finished then. But I saw these guys lecturing, and making these temporaries, and doing veneers. And that sort of turned a light. Then there was a guy, Harold Charbel, you won’t have heard of him. But he’s retired now, he’s probably about 80. He came to South Africa as well, and he gave a course there. And I just saw the way he did morphology, and the way he worked with his hands, and the way he created temporaries, and knew his [inaudible] and he was just such a passionate guy.
Basil: And he practised only on one or two patients a day. And I said, “That’s the way I want to practise.” The guy, the prosthodontist I worked with in South Africa, Gerald Kaplan, he was an amazing mentor to me. I worked in his practise as an associate. He gave me a lot of time. Lecturers on the lecture circuit, Gerry Chiche, so many good guys, we all know the name Gerry Chiche. He’s good, I think he’s retired from lecturing now.
Basil: I’m going to keep saying because I’m sure I’ll leave someone out. There’s Markus Blatz, there’s [inaudible], Gambarini. And for me, I like to see guys doing what I do, because that’s what I want to learn and for now I’m still a bit in the traditional crossover phase. There’s not that many guys lecturing about that any more. The aesthetics is amazing stuff, and implants is amazing stuff. And there’s so many. There’s names that you’d never recognise, but you look at their work, like you go to these conferences, and you’re going to be blown away. So all out there.
Payman: I think a lot of the, I’ve seen it in your teaching as well, talking about failures and problems in cases. It’s where we’re kind of going. I think before it was all a lot more about showing off, and before and afters. But now we’re going, I think people, the audience wants to see failures more. And you really do learn from those. I remember long time ago, I read one of yours, I think, it was a crack, was propagated in a veneer in cementation, yeah? And I’d done that myself. It was one of those that, I could see it, but the patient couldn’t. And I wasn’t sure what to do next. And then I read yours many years after that and I think you said, “It’s all right.” Something like that. But you know what I mean? That little, it’s a nuance, it’s a small nuance in the work, but it’s something that went wrong. And stuff does go wrong. That’s something, as dentists we need to understand. And be open about, I think.
Basil: Yeah, and I think that comes also with age and experience. You’re not that scared any more. Like when you’re starting out a practise or trying to get your name out there, you’re not going to show failures, you would be scared to. Now, I have no qualms. I do my treatment planning webinars and I always say this is a decision I made at the time and I try and stress it. But then since there’s many decisions and they’re always going to be different, that you can make. Dentistry is not recipe. So we make a decision at that time, on that patient, in that environment, at that moment and you live with it.
Basil: When you come back, there may be another patient, same situation, different time and you’ll make a different decision. I just say be comfortable with the decisions you’re making at that time. But you will always look back and say, maybe now I would make another decision. But I think that’s where it’s good to lectures, to try understand the thought process that got you to making that decision, even though it’s going to be different to your colleague sitting next to you, to another lecturer, who says something different. You want to understand the thought process and decisions are always going to be different, in your own mind and colleagues.
Payman: On the teaching, is there a continuum about this all? I mean, if I do the year course, then I want to do more. So is there more I can do?
Basil: I haven’t affiliated to a university and given formal diplomas and certificates. I know that there’s a lot of that out there. Again, just it’s very time consuming. I want to focus on the practicalities. I don’t want to have to be looking at dentist research and giving them exams, so that they can get the certificate. So I make it very clear, you’re coming on my course, just to learn to be a better dentist, not to get a diploma or certificate. There’s other courses, if you want the master’s then you need to do. So my continuum is the course and then I have the study clubs three times a year, where I take these complex cases and just go through them. We spend a day and bounce questions that always, just from a case presentation you get so much out of it. Then they can start asking you cases.
Basil: I offer my services to people on the course, they can come and have one-to-one treatment plannings. Again, it’s not so formal as many more courses out there, more formal. But I just stick to my little niche and because at the moment, it’s a small ship, I can turn that ship very easily. So if I decide I’ve got a great case and I want to do it live, I’ll say to the patient, “Do you want to come in? Let me do this with 10 dentists standing around, you don’t have to pay.” And I’ll invite 10 dentists to come in. So that just may be one course. It’s not as structured as other courses, but that’s got pros and cons. Gives me the freedom to just turn my shop quickly. People are asking me a lot maybe this year on temporaries, so in three months time, I may put on the website, okay, we’ve got a course coming on temporaries. So that kind of-
Payman: I noticed during the lockdown, you were doing some webinars as well, on a Sunday or Sunday night, Sunday night webinars. How did that work out for you? Was that something you enjoyed doing?
Basil: Yeah, I enjoyed doing that. And I think again there, the little sort of focus I’ve gone through is because over the 20 years, I’ve got so many cases, so well documented. I just choose a case pretty casually. I’ve put it together and then I present that case on the Sunday and I take questions as the questions come through. And I just breakdown that case. We all see befores and afters, especially with Instagram. We all know you scroll down and you see before, look at this amazing veneer case. But nobody gets to see, I always say the endpoint, we all know where the endpoint is. You can see a patient and say, “Okay, you’re got to end up with six front crowns.”
Basil: The hard part is the journey. How do you get them to that endpoint without making them have too many emergencies, without disrupting your diary? And how many appointments do you need? How do you plan the fee? So those are the Sunday night webinars, and I still do them every six or eight weeks. I put out on social media and I’ll just take a case and show you behind the scenes because again, I think that’s where you learn a lot. Why did I make a decision? Why did you use fibre post there? Why didn’t you use a gold post? Well, I used gold post because of X. You could use a fibre post, but then this is the reasons you would use. So it’s a lot of thought. I like teaching that way. The thought processing, rather than saying, “Well this patient had 10 veneers, this is how I did it,” because that’s out there.
Payman: Basil, what would you say a few things that most dentists don’t know, or get wrong, that you wish that they got right and they thought more about? Was it that, what you just said, that zoomed out thought process thing? I mean, let me give you an example. So on our composite course, I wish more dentists paid more attention to primary anatomy, yeah. I mean, we try and put that into their heads when they get there, but they’ll come in talking about layering, and colour, and secondary anatomy.
Payman: But they haven’t focused enough on primary anatomy, simple thing or finishing and polishing for instance, yeah. Everyone’s got their head into colour for some reason, yeah and shape hasn’t. And bleaching, I wish people gave a damn about their impression as much as they keep pretending to know what they’re talking about when it comes to percentages of gels, yeah. Everyone goes into that. It’s always the first question, oh, percentage, gels are gels, that bit. But I wish more people took better impressions. What about in your world?
Basil: So I wish people paid more attention to the temporaries because-
Payman: Yeah, of course. Of course, yeah.
Basil: Because I think again, that allows you to go from single tooth dentistry to multiple tooth dentistry. So I think the temporaries are definitely the key to success when you want to start doing more complex cases. And I don’t think dentists realise that when they come out of dental school. And then they try, the limited knowledge of how to make temporaries, stable temporaries. And when you try and do a more complex case and it goes pear shaped.
Payman: Or even what temporaries are for, right?
Payman: I mean, your temporary’s a kind of functional thing, isn’t it? It’s not just there to protect the tooth.
Basil: Yeah, it’s not the stop gap. You can’t get to that endpoint unless you go with the temporary, it’s because again, it’s the journey that’s more important than the end result because the end result we can all do. But that end result will be compromised if you’ve had to cut corners going through the journey. And the thing that stops you cutting corners, going through the journey, are the temporaries. And the temporaries allow me to take the time. You see me putting those pictures up on Instagram. I didn’t do that prep in one visit, okay. I may have done that prep over three visits, driving myself crazy. But what allowed me take three visits to do the prep? The fact that I had a temporary and said to the patient, “Okay, come back in four weeks’ time, okay.”
Basil: I’m exaggerating [inaudible], but that’s kind of the only way for me, I can get that level is taking as much time as I need and that’s what the temporary gives. And then also, the hand skills. For me, I think dentistry, sometimes people are losing their hand skills, focusing on the aesthetics. And adhesive is good, but there still is a place for mechanical, and that’s where hand skills, teaching the hand skills are important. And also again, social media, I think a lot of people just focus on the front teeth. I mean, we see Instagram pictures just the cosmetic results. I would love to see, and you never see the gum margins, or we never see a close up picture or impression, what do the gums… That kind of thing. So I think it’s quite daunting, yeah.
Payman: Sorry. The thing with Instagram, a lot of it is aimed directly at patients. And patients don’t want to see the gum.
Basil: Yeah, you’re right, yeah.
Payman: But it’s dangerous, it’s dangerous in so much as if you’re only talking to patients, the way that you can present the thing is different, isn’t it? I mean, you don’t have to be so meticulous as far as what-
Basil: Yeah, and I guess that’s where sometimes the difference is. So my market would be pitching it at dentists, whereas average dentist’s market would be pitching at patients. So there is a slight different perspective.
Payman: So, we’ve got to end of our time. I’m sure you’re busy. But my cohost, Prav, who couldn’t be with us today always ends these conversations with the same question. Oh sorry, I did have one other thing there. What do you enjoy the most? I mean, what’s the bit of it? Is it the treatment parts, like the sort of zoomed into the tooth? Is it the planning part? Is it the social part of actually talking to the patient and getting into their head? Is it the teaching? Is it the light bulb moment, when the student suddenly gets what you’re saying? What’s the thing that you love the most out of all of the things that you do?
Basil: I like the end of a big case and we cement everything, that’s always, after a year and a half of working, when everything goes in and we get to the end. I like zoning out and making a nice temporary. Spending half an hour myself, chairside, just working with my hands, making the temporaries, I enjoy that. That’s probably why sometimes I go overboard because I just like, I don’t know, get into my own world, so I-
Payman: You’re meditating at that point.
Basil: Yeah. I’m meditating. I like the teaching and it probably fuels the ego a little bit. I like the adoration you get from the students when you’re showing them things and they look up and say, “Wow, that’s amazing.” That does make you feel good. So there definitely is that aspect.
Payman: Very honest there.
Basil: Yeah, I mean you like it. A lot of what we do is self fulfilling.
Payman: Yeah. So my final question, Prav’s final question. You’re sitting on your deathbed, you’ve got the five or 10 closest people in your life with you. And you’ve got to leave them with three pieces of advice. What would those three pieces of advice be?
Basil: I think you want to be able to sleep at night with your decisions that you’ve made in practise and in life. And I haven’t lived by that, far from that. I don’t think it’s something hard to aspire to. But if you want to try go to sleep every night just being comfortable with the thoughts and actions you’ve done that day, that’s something to aspire to. I think we may never get there, but that’s something I’d like to say to my to kids, just try to, yeah, try aspire to do that, just get into bed at night saying, whatever you’re doing, for me, that’s key. But also in life, whether I relate it to my kids, my staff. Doesn’t happen that often, but it’s something that’s worth trying to aspire to.
Payman: That’s one.
Basil: That two, or three, or is that only one?
Payman: That’s one.
Basil: I mean, enjoy your life as you… It sounds cliché. I mean, I haven’t thought about it much because I still think I’m quite far off from there. Try create the environment that you enjoy working in. You can tailor your own environment. And I think that comes again, with experience. And you start to see that actually, I can start doing this. Make the environment so it brings the best out of you rather than-
Payman: Make a change. If you’re not happy, make a change.
Basil: Yeah, exactly. Rather than trying to fit in all the time. And that’s yeah, that’s pretty much-
Payman: The third one.
Payman: What would you do, Basil, if you’ve got half a day to yourself? What’s Basil time? If you could do anything, you’ve got no responsibilities to anyone, half a day to yourself, how would you chill?
Basil: A bit of tennis. I like tennis, I’d go for a walk. Meet a friend, just go for a walk. Having a coffee and maybe just scroll through a little bit of social media, that kind of stuff. Yeah, just chill out. I’m not a huge TV fan. I watch a bit of TV. At the moment all I can relate to is, within the last year-
Payman: Yeah, the last year has just been-
Basil: It’s really different. Well, I haven’t actually got into, I need to do podcasts more. Everyone raves about podcasts, maybe after this.
Payman: It’s like radio on demand.
Basil: Yeah, I need to get into podcasts-
Payman: The nice thing about radio is you can do something else while you’re listening to it.
Basil: Yeah. Yeah. Yeah, I must start doing, everyone tells me about podcasts, all different topics. I’m going to put that on my list of things to investigate, look into.
Payman: Perfect. Well it’s been a real honour, real privilege to have you on, Basil. I know you’re a super busy guy. And I wasn’t even expecting you to say yes to this. So I’m really glad, thank you so so much and we’ll catch up soon. Thank you so much.
Basil: Yeah, thank you so much. Thanks for inviting me on and well, look after yourself. Thanks, man.
Payman: You’ve been wonderful. Thank you.
Basil: Thanks, cheers.
Outro Voice: 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’ve had to say and what our guest has had to say because I’m assuming you got some value out of it.
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