Talking Ethics vs Profit With Tif Qureshi

Welcome to dentist, educator and former president of the British Academy of Cosmetic Dentistry, Tif Qureshi.

In this episode, Tif talks about his decision to follow a career in dentistry over medicine and the moment he realised that his practice could be a business as well as a treatment modality.

Tif’s impressive portfolio also includes directorship of the IAS training academy, through which he passes on his philosophy of simple, minimally invasive dentistry. 

He talks about the academy, why teaching is so attractive to dentists and much more.

Enjoy!

I can only imagine from my own experience that it seems to be far less to get into a dispute or argument with a patient if you trust them, they trust you and you’ve gone through things with them. Something has worked, something hasn’t worked, you fix it. – Tif Qureshi

 

About Tif Qureshi

Tif Qureshi qualified from King’s College, London, in 1992 and has spent time as president of the British Academy of Cosmetic Dentistry.

He is the clinical director and CEO of IAS Academy  – an international faculty providing mentored education for general dentists on a pathway from simple to comprehensive orthodontics.   

Tif has a special interest in simple orthodontics and minimally invasive dentistry. His goals are to empower dentists to provide alternative techniques and support them in offering a wider variety of treatments.

Tif pioneered the concept of progressive smile design through alignment, bleaching and bonding. He is also an experienced teacher in the Dahl concept, which promotes minimally invasive, patient-centred dentistry.

 

In this episode:

4:50 Dentistry or medicine?

20:43 Why Tif advocates the Inman Aligner

27:19 Can a general dentist be an orthodontist?

31:52 Dentistry as a business

33:52 Long-term vs short-term success

34:25 Why IAS Academy works

39:42 Assessment, diagnosis and third-party assessment plans

41:55 Artificial Intelligence in dentistry

46:42 Why dentists want to teach

49:57 The influence of BACD

54:58 Tif’s philosophy

57:49 Causes of relapse

01:09:10 Patient relationships 

 

Connect With Tif Qureshi:

Tif on LinkedIn

 

Connect with Prav and Payman:

Website

Prav on Instagram

Payman on Instagram

Transcript

 

Prav Solanki:
Hey guys. And welcome to the Dental Leaders podcast, and today, we interviewed probably one of the most famous dentists in the world, making a huge movement in tooth preservation dentistry, the king of align, bleach and bond, Tif Qureshi. I’ve had the pleasure of working with, alongside, and knowing personally him for well over a decade. There’s one thing that he’s very, very clear about, Tif. He is aggressively passionate about the actions he takes in terms of treating his patients and doing the very best for them, but more importantly, creating a movement that educates dentists in doing the same, right?

Prav Solanki:
I’ve had the pleasure of being in a lecture room or a presentation or a board meeting presenting to corporates, and Tif gets up, and he does his thing. Jaws drop. Light bulb moments are created, and it’s just spectacular to see. You’re going to learn a lot from this thing. And we go into his personal life and how he grew up. So, it’s all very, very interesting. Lots to learn. Pay, what’d you take away?

Payman L:
I mean Tif’s one of those guys, he makes me proud to be a product of UK dentistry. He’s a private practise guy, and yet, if you had to point to one person who’s changed the future of UK dentistry the most, I’d have to say it’s Tif Qureshi. I mean the whole market, the whole every single dentist, young dentist, out there now is looking at minimally invasive dentistry because of Tif Qureshi. It probably would’ve happened eventually, but you can see the UK now is right at the top of that because of Tif really.

Payman L:
There’s of course a bunch of others before and after Tif, but what really impresses me about Tif is just the common sense approach to just the way he looks at things. With everything’s he achieved, you’d imagine he could be arrogant with it, but not at all. Just very simple, common sense answers, and it’s just great to see the approach of looking at patients long term from a practise perspective, and to me, it shows that there’s so much knowledge out there in practise. It’s not all with researchers and university teachers. In fact, most of the knowledge out there is in practise.

Prav Solanki:
With GDPs.

Payman L:
With GDPs. And when you see one like Tif, who can actually, from his base in Kent, make such a big impact on the world of minimally invasive dentistry, I think it’s inspirational. And I love the fact that he’s a product of UK dentistry, and he’s on the world stage. Super nice guy with it. Enjoy, guys.

Prav Solanki:
Enjoy.

Tif Qureshi:
I took them once in Norway, but they were only 6 and 10 or something, and this old dentist leaned over to them both. We were sitting on a bus going somewhere, I think from the airport to the hotel, the Solstrand. It was a Swedish Academy, which I mentioned. And this chap leaned over to my son and said, “You should be happy, proud of your dad. He saved a lot of tooth.”

Speaker 4:
This is Dental Leaders, podcast where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.

Payman L:
It’s a real honour to have the great Tif Qureshi on the podcast. Thanks a lot for doing this, Tif.

Tif Qureshi:
Thank you.

Payman L:
We thought we were going to have some big hitters, but you’re the biggest one so far.

Tif Qureshi:
Oh, no.

Prav Solanki:
For sure. And I’ve probably known you for about 10 years, Tif.

Tif Qureshi:
Yeah, that’s right.

Prav Solanki:
And I’ve seen you create various movements in dentistry and pioneer techniques, and you’ve got this whole following behind you. And I think we’re going to go a little bit deeper on that and learn about how you came to discover these things and the story behind it. But before we do that, can we just go into your backstory, where you grew up, your childhood, parenting, and all that side of things? And just tell us a little bit more about that, Tif.

Tif Qureshi:
Yeah, I mean most of my life was spent growing up in Kent near a place called Rochester, where I went to school. My parents are both GPs, as many from my background are. And pretty much like many of us of that generation, we got told whether we were doing medicine or dentistry. Generally preferred to do medicine, and then if for any reason you weren’t quite there, you were doing dentistry. I had the grades to do medicine actually, but I chose dentistry fundamentally because of a cousin that I knew that was doing dentistry at the time who really, his name’s Mantu Qureshi, who people know, a lovely guy. And actually his influence on me really made me think, “This is something I want to do.” Looking at him, he felt a lot more free than my parents looked. And so, that’s one reason why I did it.

Prav Solanki:
And just in terms of your upbringing, was it quite a strict upbringing in a typical sort of Asian environment, similar to what I had really. When I was growing up, I wasn’t going out, mucking around with my mates and stuff like that. It was literally dad was working hard, and the whole focus was education, education, education, and folks know my dad’s message to me was, “I want you to be better than me.”

Tif Qureshi:
Yeah. Very much so. I mean my parents were… They may have been a little bit different to the norm at the time because I think they wanted me… I mean they sent me to, and my brother, to a quite a unique sort of public school down in Kent, which had an interesting reputation. I was literally one of one or two non-white faces in the year for many, many a year. But they just wanted me to go there to kind of integrate into this country I think. I could speak our language a little bit, but I have to say, now I can’t really speak much at all. I can understand a little bit, but they were more keen that I kind of integrated and worked well.

Tif Qureshi:
They came here, and my goal was to live here the rest of my life, not to then move away somewhere else. While I was still, you know, you’re still massively proud of your heritage and where you’re from and your cultural background, I think the goal, I always feel, if you’re going to move somewhere, you’ve got to be part of that country and contribute towards it. So, they had that attitude because where they grew up and where they came from, they had a, all those years ago, a love marriage, which was quite an odd thing as well. They met at university, and they kind of got together, and their parents were quite liberal. I mean my mother’s father was an ambassador for another country, so he’s kind of travelled around quite a lot. And so, one of my dad’s brothers was living here in the early ’60s and married an English woman back then. So again, you can kind of imagine what it’s been.

Tif Qureshi:
It’s been a bit like that, so they were quite happy for me to sort of integrate here. And they wanted me to sort of be here and be part of this country. So, it’s a bit of an odd thing to say, and I know there’s some people who actually look badly on that. And I’ve met people who don’t think that’s a good thing, but the reality is this is where I consider my home, and I wouldn’t want to live anywhere else.

Prav Solanki:
So, go back to I went to a school. Me and my brother were at a school where we were the only two brown faces in that school. Just talk to me about your experience at that school, and I don’t know. Was it similar to mine, or just talk to me about what that was like.

Tif Qureshi:
It was called, it was King’s School, Rochester. And I think, quite oddly for a while, yeah for a while, it was what you’d expect, and every day was an interesting day. And every day somebody came up to you and gave you a dead arm and called you this and called you that. But then, actually there were a lot of great people there as well. So, I got on pretty well with everybody. A strange place in that it was very eccentric.

Tif Qureshi:
But what’s interesting is I left there 30 years ago, and yet, for my year of people that I spent 12, 13 years with that at that time, I still know at that year, at least 75% of the people extremely well. And we had our 30 year school reunion, and literally more than half the people in the year turned up. So, we have a very kind of strange really tight sort of friendship, and not a lot of people I know have that. They don’t really know many of their people from school.

Tif Qureshi:
So, there’s definitely something unique about our school, our year, I don’t know. I think we all went through a very interesting time in the ’80s. Interestingly, one thing that everyone was talking about recently when we had our reunion is what changed in the ’80s? And what’s quite topical is Live Aid changed people’s attitude. It was quite odd. I mean I remember, and one of my other friends who’s a sweet chap there, he’s one of my best friends, who’s now a doctor, both of us have often said, “After Live Aid, all of a sudden, it seemed like the racism stopped,” which is quite a strange thing, isn’t it? And talking to some of the guys I know now, they say, “Yeah, it was one of those things that made people kind of realise why we’re behaving in this way and what our life is actually about. I’m not saying Live Aid was a massive enormous international success. You can sort of see all the problems that still go on, but it was a massive exercise for conscience I think.

Prav Solanki:
You noticed a difference.

Tif Qureshi:
I noticed it literally. I literally walked into school on the Monday morning, and school was a different place. And that’s because all of the people at the time that we all kind of worshipped , be it David Bowie or it could be U2 or Queen and all those people suddenly made a statement that actually… I think it moved people on. I think Live Aid is not remembered for that, but it actually is one of the most important moments in the history of this country. I think a lot of people don’t appreciate that. A lot of people who also think this country is racist, and no country is perfect, should have tried living here before then because it was quite different at that point. It wasn’t perfect at all, and as I say, I think after then, things changed quite a lot. And why it’s topical because of course, that Queen movie came out recently.

Prav Solanki:
Of course, yeah.

Tif Qureshi:
And not just enjoying that film, but one of the bits that I found extremely kind of emotional was watching that whole section because it kind of took me back 30 years. And suddenly, you thought, “Wow, now I remember what was so great about that day that really I don’t think anything has come near since.”

Payman L:
It was a big day.

Tif Qureshi:
It was a big day.

Payman L:
Do you remember?

Prav Solanki:
Yeah.

Payman L:
How old were you?

Prav Solanki:
Child.

Tif Qureshi:
Child.

Prav Solanki:
You’re younger than us.

Tif Qureshi:
Yeah, yeah, yeah. I think I was-

Prav Solanki:
I ran the world, that one.

Tif Qureshi:
Yeah, we’re going to have to ask, Pay, how old are you?

Prav Solanki:
I think I’m a couple years younger than you. I’m ’72, I was born.

Tif Qureshi:
Yeah, I was-

Prav Solanki:
But it was who? Your mother?

Payman L:
At dental school, yeah.

Tif Qureshi:
Ah, yes. Yeah, yeah. I just met her the other day.

Payman L:
When did you qualify?

Tif Qureshi:
Well, I qualified in ’92. So, I-

Payman L:
With Anoop.

Tif Qureshi:
Yeah, so, I’m ’69. So, how old would I have been? 16. So, at 16, that was a time when I was discovering music and all that sort of stuff and realising what I wanted to listen to and what I wanted to hear.

Payman L:
And in dental school, were you one of the top kids in the class or not?

Tif Qureshi:
Absolutely not. I just kind of melted into the background, bit like Anup really. I was certainly not one of the standout people. I didn’t fail anything. I didn’t have to retake anything, so I kind of got through it. To be truthful, I can’t tell you I enjoyed dental school. I made a lot of friends there, had some good times, but I didn’t enjoy a lot of the components of learning dentistry. I loved the first year. That was brilliant, being on the Strand with all the medical students and everything.

Prav Solanki:
That was where you felt like a student.

Tif Qureshi:
Yeah, you felt like a student. But second year, for us, it was the second year, it was just like work, work, work.

Prav Solanki:
It’s a tough course.

Payman L:
It’s a tough, tough course for sure.

Tif Qureshi:
Yeah, yeah. There’s some great people, though, who taught me at King’s. And some of those have shaped my career, no doubt.

Prav Solanki:
Who are those people?

Tif Qureshi:
Well, yeah, people like Martin Kelleher, Brian Miller, Brett Robinson, Steve Dubb. Those guys, work I do now, when I’m working, I’ve still got them in my mind. So, that’s quite a powerful statement.

Payman L:
Yeah.

Tif Qureshi:
I’m still thinking about what they said and what they instilled in me. Equally, there’s probably some people I shouldn’t mention, who I probably didn’t learn anything from. So, it was kind of quite polarised there, but certainly I think that was also quite a special place actually, not that we see that many people from my year at reunions anymore. Certainly, I still know quite a lot of people from that year of course.

Prav Solanki:
Yeah, I mean, when you look around at all the people in dentistry now who are, whether you consider them to be the superstars of dentistry, who are teaching or inspiring other people or pioneering, there are a lot of people from your year who are part of the who’s who of dentistry today, right?

Tif Qureshi:
Yeah. I mean a who’s who is always a bit of a weird one, isn’t it? Because you can be who’s who by just having a huge amount of Instagram followers, which actually is a skill in itself, and not to disrespect anyone that does. You can have a bad reputation, you can have a good reputation, be an academic. But certainly, there was definitely a few people in my year who are high profile, use that term. And I think there was definitely an element of being in King’s in that year and just getting a slightly different sort of feeling perhaps that went on in other years. I don’t know. But yeah, there’s a few of us. There’s Anoop, James Goolnik and Nav Kharia. There’s actually a few guys years above and below who are quite well known, Asif Chatoo, Paul Baker. So, all these kind of guys are quite well known. And they’re all King’s. So, King’s is clearly the best university, obviously. I don’t want to finish off now.

Prav Solanki:
Was it known as a notoriously tough course at King’s? Clinically, were you expected to do more than other schools? Do you know anything about that?

Tif Qureshi:
Not that I remember. Back then, I think we didn’t really appreciate it. Now, I think we all look back from whatever university you’re at, and you sort of hear these common comments that a lot of the younger dentists aren’t doing anywhere near as much as we were doing back then, which does seem a shame. We’d done several hundred extractions and all these root canals and all these crowns and everything by the time we’d left, and you hear these anecdotal stories. I don’t know how true they are, but you hear these anecdotal stories of people could leave university without doing more than two or three root canals or a couple of crowns. And it seems strange.

Payman L:
I’ve got a question for you. I did VT in Kent, and in my VT year, there was three King’s people, three Guy’s people, three London people, and me. And interestingly, I found that my teaching, I was from Cardiff, my teaching was stronger than them on some aspects. But the area that was weaker from my course was ortho as it happens. We learned ortho class 1, 2, 3 was, and that was basically it. We didn’t do… Was there ortho in your undergrad? Is that where this comes from?

Tif Qureshi:
No, not at all.

Payman L:
Not at all.

Tif Qureshi:
But there was some. And yeah, to be fair, we made-

Payman L:
Did you do rotation?

Tif Qureshi:
Yeah, we did. We used removal appliance. We’d do anything other than removal appliances, and we made ortho appliances as well on a kind of ortho clinic type of technicians clinic as well. So, yeah, we did, I wouldn’t say we did a huge amount of it. I don’t think we were encouraged to do a huge amount of it, but it wasn’t excluded at all. I have to say I think the whole idea… I made a joke about King’s being the best. I think the whole idea about any university being the best is just bizarre because the reality is you learn everything as soon as you leave dentistry. It’s actually when you start treating patients you start to learn dentistry.

Tif Qureshi:
So, yes, a university can certainly guide you at the early stages, but fundamentally, it’s then what you do after in your post-graduate years. What course you take is one thing. But then as I commonly say is treating your own patients and staying in one place teaches you more than anything can teach you. So, that may be why a lot of the super high flyers at King’s are the people who kind of won all the awards and everything, you don’t really see much of them now. And people like myself perhaps, and neither of us were particularly fantastic at university, but we’re on the international circuit lecturing. So, I don’t think there’s any correlation between your university and how you then come out. It’s then what you do with yourself after, I think.

Payman L:
And so, did you have VT in your day?

Tif Qureshi:
Yeah, we did. I think I was one of the first years that did it. I think we didn’t have to do it. But I think we had the first options.

Payman L:
Yeah, I think we were the first year who absolutely had to do it.

Tif Qureshi:
Had to do it, yeah. I was very lucky. I mean younger people listening now probably would be quite sickened by the fact that I just picked the place nearest to where my parents lived, called them up, and got the job immediately.

Payman L:
Yeah, it was a different world.

Tif Qureshi:
Yeah, it was a different world.

Payman L:
But one of the biggest influences of my career was my first boss, my VT boss.

Tif Qureshi:
Yeah, my VT boss was a great guy actually. That was the only other practise I’ve ever worked in, so I did VT there.

Payman L:
Is that right?

Tif Qureshi:
Yeah, I did VT there for one year, but then I needed to move closer to London for kind of personal reasons. And so, then I picked a job in a practise that I’m now as a one year-

Prav Solanki:
Christ. You’ve been there more or less since you qualified.

Tif Qureshi:
Yeah, yeah. So, did my one year VT, and then I’ve been at that same practise ever since.

Payman L:
And it is gold, that thing that you sort of popularised the idea of you learn by looking at your own patients. It’s absolutely right. I mean I only practised for five, six years overall. But even within that five, six years, I saw some things that I should… Veneers, I’m sure we’ll be getting onto veneers, the staining of veneers at five, six years old. Five or six years, not much, and learning that oh, maybe that wasn’t the right thing to do. And the lessons you must have learned in 25, 26 years.

Tif Qureshi:
Definitely.

Payman L:
I mean there’s a very interesting point. And the other really interesting thing, I mean you’re a teacher, so you’re going to have 100 different things that you’ve learnt and you teach, but we were discussing this before. The amount of knowledge that there is out there from people who aren’t necessarily famous or teachers or on the international lecture circuit who’ve had that experience of treating the same patients.

Tif Qureshi:
Yeah, that’s absolutely right. I do make these statements, and I post them. And you have a bit of a following on whether it’s LinkedIn or Facebook, whatever. And if I make the statements, people will read them. But what’s interesting is that I get a lot of nice comments from other dentists, all been there, 25, 30 years, “Couldn’t agree any more. This needs saying, etc, etc.” Because I don’t think it is said enough. And I think one thing it’s concerning me over the last few years seems to be the kind of devaluation of what being a GDP is.

Tif Qureshi:
I actually think the GDP is the most important person in dentistry full stop, in the sense that we need specialists, and specialists do an incredibly important job obviously. But what a GDP can do is just incomparable because a specialist very rarely ever get to see their treatment again. Certainly don’t see it regularly. GDPs will carry out treatment, and then be able to monitor it and intercept and prevent and do whatever they need to do, and that’s far more valuable than perhaps anything else we ever imagine. Plus, you have the ability to build a relationship with a patient, which is over many years. And that’s again something I’m finding is quite devalued nowadays. People seem to be more bothered about getting new patients in through the door than necessarily treating the people that are sitting there already.

Payman L:
Yeah, I remember it was World Aesthetic Congress.

Prav Solanki:
Whack, whack.

Tif Qureshi:
Real good memory.

Payman L:
Yeah, if Ken’s listening, good on you, mate. But the World Aesthetic Congress of it was maybe 2003, 2004, you were very a very junior member of the BACD.

Tif Qureshi:
Yeah, yeah.

Payman L:
Nowhere near president of the BACD, and you came over to me, and you showed me this model. And on the lower, there was some sort of Inman device on it. And you said to me, “Hey, you know all these veneers we’re doing, the upper, of course we’re going to veneer those, but the lowers, the veneers on lowers are quite hard, aren’t they? I mean we shouldn’t really be doing that. So, what I’m thinking is, maybe you can just straighten the lowers with the…” So, when did that start? I mean when did you bump into, is it Mr. Inman?

Tif Qureshi:
Yeah, yeah.

Payman L:
How did that happen?

Tif Qureshi:
I would say probably even a couple of years before that, I was fiddling around with the little mini ortho appliances with Z springs on them.

Payman L:
How? Why?

Tif Qureshi:
Fundamentally why, because I felt wrong about doing what I was doing. Fundamentally.

Prav Solanki:
Can you remember that moment where you thought, “Shit, I shouldn’t be doing this?” Was there a defining moment?

Tif Qureshi:
Yeah, actually, on one of the veneer courses I went on. The first veneer course I sat and watched, I just thought, “Mm. I’m not totally comfortable with this.” Let’s not mention the name of that course, but certainly, I sat there and I thought, “Okay, there’s a lot of great stuff going on here. This is life changing. I’m learning how to do impressions, and I’m learning how to do preparations. I’m learning how to handle patients in a very professional way I’ve never learned before.” But the flip side of that, I was looking and thinking, “I wouldn’t have that done.”

Tif Qureshi:
So, it made me feel uncomfortable, and it didn’t mean that I didn’t do any of it. What I would commonly do is refer the patients to the orthodontist. And very typically, at that time, where when only really comprehensive ortho was offered, the patients would just say, “Forget that. I’m coming back and having this done.” So, you did it. And upper teeth, because you could kind of build them out a little bit, you could try and not to prep them heavily, you still occasionally had to do that, were easier to treat. But a lot of it, as you say, Pay, were almost a nightmare to do. And if you often didn’t treat the upper teeth and didn’t treat the lowers, you just treated the uppers, you actually created this kind of two tone syndrome, which looked bloody awful. Let’s face it.

Prav Solanki:
And bleaching back then wasn’t up to much.

Tif Qureshi:
Bleaching wasn’t good, and people take it for granted. And what’d tend to happen was you’d sort of watch these extreme makeover programmes on telly, and even my own patients would look at them and think, yeah, while you smile, it looks okay. But for the rest of the 99% of the day, let’s face it, England, that’s the way it’s going to be, when you’re not smiling, you’re actually going to be just seeing the lower teeth, which look worse and actually create this horrible contrast. And that made me feel quite uncomfortable. So, I started looking at other ways of just trying, and I was using a lot of composites as well. I have to say, a lot of composite to try and mask it as well. But then I started thinking about minor ortho, and Inman Aligner came along because it was in… The irony of the Inman Aligner was it was in the AACD journal, the American Academy of Cosmetic Dentistry journal, which I subscribe to-

Prav Solanki:
Is that where you came across it?

Tif Qureshi:
That’s where I came across it. And I open it up. I think I’d stumbled on it before once in something else, but I sort of read it there again. And I thought, “This is fascinating.” These teeth, one and a half, two millimetres of crowding being moved in what seemed like a short period of time. Of course, they’re just moving that small amount, but I thought, “Okay, if I only focused on the front teeth, so no moving everything. So, I wonder if my patients who are currently booked in for veneers over the next few weeks who went to the orthodontist and said no, I wonder if they’d have this done.” So, I actually got one of them back or two of them back, and literally, this is no joke, probably over the next several months, I’d had 10 to 15 patients scheduled for veneers. Every single one said I’ll have that done instead because they could see it was only going to be there for a few weeks. And they could see that it meant that we wouldn’t have to then prepare their teeth or prepare their teeth less. They wouldn’t need an endo etc.

Tif Qureshi:
So, that then made me realise there is a place for this. That was just the start because of course, then the whole concept of progressive smile design and bleaching and bonding, that came in later. But just as a beginning, it was that kind of moment where I read that. Now a couple of years on, and this is the sad part, Don Inman once said to me, I mean it may be an anecdotal comment, but he did say to me what was interesting about that article, he said, “I put it out, and I was so excited when it went out to 10,000 people.” But he said, “You were the only person in the whole world, as far as I know, that’s contacted me referencing that article.” And I don’t know why. It was probably because everyone else was too busy with the veneers at the time. I was in a practise where people didn’t have that much money, so it kind of always was making me think slightly alternative ways of doing things. Obviously, I’ve never been in central London, so that may have been a reason for it.

Payman L:
And then, how did it move on from okay, you started treating those lowers, then started treating the uppers?

Tif Qureshi:
Started treating the uppers. And actually, then what happened was, I started sending some cases that Don said to me I couldn’t do. And these were just like one and a half, two millimetre, three millimetre cases. And he kept saying you can’t do it, you can’t do it. But what I started to do was develop a kind of protocol of space evaluation and space planning, and where I was doing the IPR. And I kind of explained to him this is what I’m doing. Now, he’s a technician, so he kind of listened to me. And I also created this sort of attachment sequence protocol as well.

Prav Solanki:
Were you talking to some orthodontist at the-

Tif Qureshi:
Not really. I have to say not at that point. A little bit later I did.

Prav Solanki:
And it was probably the biggest advantage was that you weren’t talking to ortho, you know what I mean?

Tif Qureshi:
But I wanted to. I did want to early on, and I did. And actually, funnily enough once of the first people I consulted with this was Asif Chadi.

Prav Solanki:
Oh, right.

Tif Qureshi:
And the great thing about Asif was he looked at what I was doing totally, and I’m like maybe some others at the time, was totally open-minded to it in saying, “Look, I can see what you’re doing. You’re just moving the front teeth, and if those patients have come to see me already and have refused, this has surely got to be the best thing to do.” So, he was really quite instrumental in at least making me feel, “Okay, this is the right thing to do if we do it correctly.”

Tif Qureshi:
Another person a year or two later who I started to sort of bounce back some ideas from as well, and I was very lucky, and this is an amazing person to have mentoring me briefly, was someone called Bjorn Zachrisson, who’s one of the greatest orthodontists ever to have lived. Still around today.

Prav Solanki:
How did you come across him?

Tif Qureshi:
Again, this is thankfully through the BACD, and that’s one of the big things about BACD. You get to meet people like that, and he focus spoke many years ago. And then I stayed in touch with him after. And they came on the stage, spoke, and then afterwards I sort of talked to him about what I was doing. And again, he said it makes perfect sense. I was trying to learn a bit more about IPR and the limitations, and he’s obviously written tonnes on it.

Payman L:
Where do you have confidence to go up to the world’s top orthodontist as a GDP and say, “I’m doing this. What do you think?”

Tif Qureshi:
I mean that’s again, that’s where you got to thank people like BACD. You get the opportunity to, and that’s a lot of what of… You’ll always be grateful for that in reality. But the fact is I was thinking that way, and I was thinking that way in an environment where others weren’t. And so, yeah, to be fair, I’m not saying that it would’ve been exactly the same, but I was heading that way anyway. So, I would’ve spoken to one person or another. I just wanted to validate it and make sure that this was something that was I was doing as well as I could.

Payman L:
Have you ever thought, or maybe I’ve even heard you, write or read about you saying this. But today, it would be impossible because you’d be so scared of legal ramifications of being the only one doing something.

Tif Qureshi:
I think you’re totally right, Pay. And I think that’s actually quite a sad statement really. We’ve all being lucky to a certain degree for the times we’ve lived in. But nowadays, yeah, you’d probably would fear it. However, I’m getting to the point where I’m just turning that argument around, where I used to hear, and I still hear people say, “If a general dentist does ortho, it’s dangerous.” Well, actually I flip the argument around now and say that, “A general dentist who doesn’t do ortho is dangerous, okay?”

Tif Qureshi:
And I can justify that based on the fact that a lot of dentists don’t understand the concept of constricting envelopes. And why do envelopes constrict? Because teeth move. And how do you fix it? Not restoratively. Yeah, you can do some restorative, but you need ortho. And there are probably, I’d estimate, millions of patients around the world who have a repeatedly chipping front tooth. It keeps chipping. The dentist’s solutions is another composite, another composite, or a splint, and a lot of those patients end up with crowns. Actually, the dentist understood that they needed a little bit of ortho to get the right, overjet the right overbite, bit of bonding to improve the overbite. You’d probably find that actually a lot less people would have anterior veneers or crowns. I’ve seen that. It’s absolutely clear, and I think it’s a really strong part of the message now.

Tif Qureshi:
So, I think general dentists have got to… Here’s something I would say controversial, if you’re a general dentist, and you’re my general dentist, and you couldn’t do any ortho, I wouldn’t even sit in your chair. That’s just what I would say. I wouldn’t even sit in your chair. If you needed to do my endo, I’d be all right with that, but if there was some anterior, and your solution for my front tooth that kept chipping was a crown, no way am I sitting in your chair. So, I know it’s a powerful comment, but-

Payman L:
The thing is, saying it now with your record, then you can basically say what you like, and everyone will pay attention.

Tif Qureshi:
Back then of course.

Payman L:
Saying stuff like that as a GDP from Kent, I find it super interesting.

Tif Qureshi:
Well, I was saying stuff. And actually, we stuck our neck out, and we were showing what we were doing. And I’d say there were, you’d stick your head up, and again, you’d get people in wanna shoot you down. And I got a couple of invites to places where I was terrified, an audience of orthodontists and all sorts of stuff. But the reality was when they sat and watched what we were doing, many of them have come up to me after and said, “Actually, you’re doing just the front teeth. You’re looking at what’s actually going on.”

Tif Qureshi:
So, the key part here, and this is where people like Ross Hobson have actually made a huge difference is actually to validate the fact that what we’re trying to do is make sure the patients understand the difference between comprehensive treatment versus the compromise. That’s the key. As long as you can diagnose the case completely, and you’ve got to diagnose it, not somebody else. This is really important. And you can explain to the patient why doing just the front teeth is okay versus actually what the patient may really need, which is have the full mouth done. It really shouldn’t be a problem at all. And once we brought that message in, I think it’s made it clear that there’s nothing wrong with doing this. And that actually, you’ve got to start thinking about doing it if you’re not doing it already.

Prav Solanki:
So, we go from you found this appliance, you made it work, you started shifting teeth, doing less veneers. And fast forward, you assembled an academy.

Payman L:
Straight talk seminars, I seem to remember.

Tif Qureshi:
It was. And that’s a good time to bring in James Russell and Tim Bradstock-Smith because they were two of the first people who were part of the… They were actually at the first study club in inverted brackets, where it was just them and me. We had our own little study club, and one week we would talk about a different subject. And I think by the time we got to the fifth subject, which was just Inman Aligner, so I’d done composite, and Tim did occlusion, and James did temporary veneers. So, we were just lecturing to each other. A bit sad really when you think about it.

Tif Qureshi:
But when Inman Aligner came along, they were like, I don’t want to swear, but their jaws were on the floor, like, “What the hell is that? Wow.” And all of a sudden, they wanted to start to learn how to use it. And I kind of coached them on it a little bit. They didn’t need a lot. And then, before we knew it, we were just running a course as a bit of a experiment for a few of the people and a few of the BACD guys wanted to know, and then it just suddenly went from there. But it was very rough and very innocent. And we were trying to do the right thing, but equally, the way things have changed now, we really developed it to do everything in the right pathway.

Tif Qureshi:
The good thing about it you can’t really do that much with it. That was probably the best thing about it. It wasn’t a treatment that could treat a lot of teeth. So, you could see well, if the back teeth need treatment, it’s not treatment for it. Simple as that.

Payman L:
Do you remember the point where you thought rather than this being a treatment modality, this could be a business?

Tif Qureshi:
I think there was never a contrived pathway for that. And that’s probably a weakness in itself in that we could’ve been much further ahead than we are. But the truth is I think a good few years ago, maybe five or six years ago, I think once we started running courses… In fact, it’s longer than that. We’ve been running courses in Denmark for nearly eight or nine years now. But once we started going abroad, and of course, a lot of that was just you get an invite, and it’s a bit of fun and that sort of stuff. But once we started going abroad and you started to get a lot of feedback from dentists who were just saying, “This has completely changed the way I’m doing dentistry,” I think we realised that we kind of almost had a responsibility to do something and set something up more official. So, we set it up, set the forum up, the support forum, all that sort of stuff. And yeah, it just grew from there.

Tif Qureshi:
Now it’s a business. Yeah, I mean it is a business, and we have to make sure it runs and operates correctly. But there still is very much led by dentists, so we’ve got our ethical hats on the whole time. Sometimes, we probably do things which are hardcore Hard business would say, “Don’t do this, do this instead.” But we can’t. We just have to do things that might hold us back in the long run. But ultimately, I’ve got to stand up and look in the mirror, and I know the other guys need to as well. So, that’s kind of why we’ve taken it the way we have.

Prav Solanki:
So, ethics above profits.

Tif Qureshi:
I think that’s always been a good message, not just in what we’re doing, I think in dentistry generally, a lot of people believe that and want to believe it and want to say it louder. It’s the old cliché, if you do the right thing, the money will follow. And it does.

Prav Solanki:
Of course.

Tif Qureshi:
It does. I think we’ve got to be thinking about patients over a much longer period of time rather than a short ticket, a quick ticket to success. It’s a relationship. You look after them, and you do the right thing for them all the way through. That’s kind of our goal.

Prav Solanki:
So, now you’ve assembled a team as part of IAS Academy with different people, with different skillsets, doing different things. What is the overall validation of that message because, let’s be honest, there’s loads of other ortho companies, teaching institutes out there. What differentiates the academy? I look at it, and I’ve got friends who’ve just qualified. And they say to me, “Prav, what course should I do?” And the first thing I’ll tell them is, “You need to take ortho.” And I’d suggest they’d come onto the IAS Academy pathway. But why the IAS pathway instead of any other pathway?

Tif Qureshi:
Well, there’s lots of different things that I think we’re a little bit different in many ways. Firstly is the type of mentoring we do. So, what we want to do is just make sure that no one gets on board without having all the right images, the right records, and then they’re guided all the way through. So, that’s really important from one aspect.

Tif Qureshi:
Another thing that I think is different is that I don’t actually think of us as an ortho company. So, that’s different. So, there are people out there that teach ortho. That’s fine. We teach ortho, but it’s actually part of a whole restorative process of thinking. But also, it’s a lifetime view. So, there are a lot of people out there that teach ortho, and we teach ortho. We want to teach you how to move teeth correctly and sensibly. But we also want to teach you how to restore cosmetics and function, but the real kind of for me, the kicker, is we want to teach you how to communicate with the patient and maintain things and retain things for life. And I don’t think anyone is really doing that.

Tif Qureshi:
The whole concept of retention for life and what that means, I’m not just talking about having a retainer stuck on the teeth for life. It’s actually to observe the patient and see how their occlusion changes and the movement changes and the function, the guidance changes. Those things are actually immensely more valuable than one single kind of… To me, the kind of work I do is never just ortho. It’s always ortho restorative functional occlusion. That’s what it is. I think the only people that are just pure ortho really applies to is probably children in many ways. Once you get to an adult and your teeth have been around for a while, you need to make sure that you’re going to end up in a better situation, certainly not a worse situation after having some orthodontics done. And usually there can be some restorative element of that.

Tif Qureshi:
So, those are the things that are a bit different. I think we try and move on what we do. A lot of it is based on because the fact we’re all practising , and we look at stuff, and we change stuff. We’re never going to just sit there and do the same thing. But to me, I think where dentistry is going to move in the future is ortho restorative, and I think that is almost a new subject in itself. And it’s so powerful because it can really change the way people think about what they’re doing every day. And very importantly, the communications in your daily examinations are very different once you have that sort of thinking as well. I hope that answered your question.

Prav Solanki:
Yeah, it did kind of. So, what about if I’m a Invisalign Diamond practitioner, and I’m married to Invisalign? Can I still come on one of your courses? Is there a conflict there at all?

Tif Qureshi:
No, not at all. I mean what we’re trying to do is be system agnostic, and that’s the whole idea. I know I can help anyone doing anything, get a better result. That’s kind of the way because actually when you start applying those correct ortho principles and ortho restorative principles, and very importantly, you start thinking about a load of different things up front, you can put into any case. And it doesn’t matter what you… One thing I would say is I think too many dentists are sucked into brands, and they say, “Oh, well, the power of this system, the power of that system.” It’s just not true. It’s about what you’re doing as a dentist. I actually don’t want a patient to ever come into me and say to me, “I want you to give me that.” I want them to come in and say, “I want to see you.”

Tif Qureshi:
I appreciate that younger dentists kind of, or maybe some dentists, need a brand to work with. And I think established brands are always good things, but I think the more we allow brands to take over the value of dentistry, the more danger we’ve got of actually losing control. And so, that’s where all of a sudden, do it yourself style treatments come in because then, it’s the system that becomes more important than the actual dentists. That’s what I would worry about. And I certainly don’t want to mention any company names here because we know how litigious this whole area is, but I think it’s really important that as dentists, where we can, we make a stand to control our profession. And the minute companies start coming in and automating stuff so that patients can just literally get their own aligners to their door, or you know what I mean? I think we’re in danger.

Prav Solanki:
Which is huge, right?

Tif Qureshi:
Which is huge. If it could be done and delivered perfectly safely, which I just cannot imagine it can, great. But it’s not going to happen.

Prav Solanki:
In this case, we’re talking about orthodontics from a vending machine.

Tif Qureshi:
Potentially, or a scanning centre, or something. But see, the problem with all of this is even if there’s a dentist involved, doing the base creation or whatever, what I can see from virtually any orthodontic plan that’s put in front of me that a lot of guys talk about, I can say, “Well, you know what? If you’d done a couple of little bits and pieces up front, which I won’t go into, a couple bits and pieces up front, you could get a much better result.” And actually, the problem is people take the scan. They take the scan, and they think that’s it. Someone else is going to now sort me out. And actually, a lot of cases you could stop yourself getting in black triangles by just doing a couple little minor things first. And my eyes can see that, but the computer’s eyes can’t. And certainly, someone in a high street scanning your teeth won’t be able to. So, by allowing brands to take over, we devalue dentistry. It’s so important.

Prav Solanki:
So, am I correct in understanding you could teach dentists how to do Invisalign better? It’s not the system that matters, but it’s the approach.

Tif Qureshi:
I don’t know want to talk about one particular brand like that, but-

Prav Solanki:
I’m using that as an example.

Tif Qureshi:
I know anyone who’s got a kind of ortho restorative style case, I know that if I look at the case up front, there’s lots of little things that we can see and we can teach that actually would make the dentist think, “Yeah, you know what? I realise that tooth’s the right functional tooth. This tooth I’m going to start to change the shape of.” If you’re taking a scan and you haven’t looked at those things, you’ve already missed an opportunity. Do you see what I mean?

Prav Solanki:
Yeah.

Tif Qureshi:
The standard orthodontic assessment and diagnosis is extremely important that everyone should be able to do. And I think a lot of people, again, they get sucked in because a third party is designing the plan for them. They think somehow they’re safe. They’re not. You have to come up with that plan. It’s your plan. You’re responsible. So, you need to do the assessment, diagnosis, the plan. So therefore, you’ve got to spend that time, you can still take a scan, but what you put into that treatment plan beforehand could literally save your career later on. Plus on top of that, you get a better result. It’s simple as that.

Payman L:
But it must keep you guys up at night, that their AI or something will get to the point where-

Tif Qureshi:
Yeah, I’ve got no doubt that algorithms, things will go… The reality is I think there’s nothing that can ever replace a human brain, and maybe we’ll get-

Payman L:
But maybe there is.

Tif Qureshi:
Maybe there will be one day. I don’t know. But think of like-

Payman L:
My brother’s a radiologist. In their world, it’s one of the use cases for the IBM Watson thing was radiology. And they’re all very, very worried that they won’t be needed to-

Tif Qureshi:
But I mean, would you step on a plane? I mean planes can fly themselves completely automatic now. Would you step on a plane knowing there’s no pilot? It’s kind of that’s the way-

Payman L:
I would step in a car knowing there’s no driver.

Tif Qureshi:
I’m worried about that. I’m worried about that.

Payman L:
But the point I’m trying to make is I completely get it. We have it in whitening. I completely get it. But if the AI can be shown to be safer than an orthodontist in its treatment planning, of course you can’t do IPR and stuff. There are limitations.

Tif Qureshi:
Yeah, it may be robotically done.

Payman L:
It’s going to be the same thing as Uber, right?

Tif Qureshi:
Potentially.

Payman L:
At some point they’ll say, “The self driving car is safer than a human being.”

Tif Qureshi:
But the power is in the knowledge. It may not necessarily be in the gathering records and the execution of a procedure. It’s actually in the knowledge, and you still need to have somebody who could actually overview it and look is this going well? We may end up doing dentistry hands off completely, but I still, until the day I die, I’d still want a dentist looking at what I’m doing and not a robot. I mean in 100 years or 50 years, it might be completely different. I don’t know. But where we are today, I think you can show, but I would imagine that patients who certainly don’t have the correct orthodontic planning and assessment and diagnosis, I would imagine certainly those cases are far less likely to actually be satisfactory.

Payman L:
So, you coined the term ABB. Aligning existed, bleaching existed, bonding existed, but you kind of brought them together and sort of popularised that idea.

Tif Qureshi:
Yeah, yeah.

Payman L:
And certainly I would say you’re responsible for the fact that the UK went from being pretty much a second division player as far as minimally invasive dentistry was going, and to make us we’re really up there now. And you were definitely the key person behind that.

Tif Qureshi:
I wouldn’t say key. I was born of the people. I mean there’s a lot of guys out there who moves things on me, Jason Smithson and Dipesh now is just doing amazing things. I mean there’s lots of people. We could actually look at what’s coming out of the UK and be really proud, right?

Payman L:
Yeah.

Tif Qureshi:
When I go and travel abroad, people are talking about UK speakers now. There’s usually two or three on most international lectures, whereas in the days, it would always be full of Americans or Italians.

Payman L:
Yeah. It does feel good, doesn’t it?

Tif Qureshi:
Yeah.

Payman L:
But you were the first.

Tif Qureshi:
One of the first, yeah. One of the first, yeah.

Payman L:
Do you think about that?

Tif Qureshi:
It’s a nice thing. It’s a nice thing. I don’t think you can ever get… You sit there focusing on it too much. It’s there. It’s something you can be proud of I suppose.

Payman L:
Listen, I’ve come across young dentists who don’t realise.

Tif Qureshi:
Well, young dentists all listen to Instagram, don’t they? That’s probably a bit of a generalisation. But I think it’s easy to get an idea from Instagram of what everything is going on. Yeah, you can’t expect to be known for stuff. Look, put it this way. One of the greatest dentists ever to have lived died about five or six years. That was Ferker. His work still goes on now unappreciated, and it probably will carry on going unappreciated. So, people should be looking at that, I think, rather than swiping up. And they’ll probably learn a lot more about sort of the battle of trying to change thinking.

Prav Solanki:
But I think you’re using social to change thinking, right? I see posts that you do, Tif, and you post a 15 year follow up case on there, and that’s a game changer, right? Because there aren’t many people out there who have been in the same practise for 15 years.

Payman L:
You’re not saying you’d rather Instagram… Dentistry doesn’t resonate with Instagram.

Tif Qureshi:
No, no, no. I think Instagram is powerful and useful. It’s powerful and useful, but I think what we’ve got to do is we’ve got to be very careful about what we put out there. So, we’ve got to be very careful about what we put out there because it’s very easy to start to create this idea that you’ve got to be a certain way. You’ve got to have this many followers. You’ve got to post this regularly. And one thing I do find, I’ve made posts actually recently saying, “Don’t get sucked into the whole Instagram thing.” And I posted that on Instagram, but I’ve had a lot of private messages from young saying, “It’s so good that you said that about not having to get new patients all the time.” Because actually, I think there’s a lot of pressure to get new patients and distinguish yourself and get a brand and all this kind of stuff.

Prav Solanki:
This fear of missing out, right?

Tif Qureshi:
Yeah. People do seem like they’re in a big rush, and you don’t need to be in a big rush. You’ve got your whole career ahead of you. Just take your time. Just take your time.

Prav Solanki:
What advice would you give someone? You’ve come from a general dentist in Kent to being probably one of the most sought after international speakers. If somebody else wanted to follow in that sort of footstep or wanted to get involved in teaching, speaking, and that side of things, what advice would you give a young dentist?

Tif Qureshi:
I think I’d just say take your time. Don’t rush. I mean it goes back to what I said earlier. See the same patients. There’s people out there posting composite video cases who actually haven’t even seen their work a year later or two years later. Okay. And they may post it, may be proud of it. There’s people teaching it who actually haven’t seen their work three or four years later.

Prav Solanki:
You must get people approaching you saying, “I want to teach.” Why? That’s what I always ask someone who comes to me, saying, “I want to teach.”

Prav Solanki:
“You want to teach. Have you got something to say?”

Tif Qureshi:
I think you’re right.

Prav Solanki:
But wanting to teach for wanting to teach on its own, it’s a bit mad.

Tif Qureshi:
You’re right. But again, that’s what you said a bit earlier. I think people are actually a little scared of dentistry, and they’re kind of trying to find another thing to do, and teaching does look like… It looks glamorous. It looks like you might travel here or there or have another alternative income. But the reality is-

Prav Solanki:
There’s no money in it.

Tif Qureshi:
There is no, yeah. But the reality is you’d be better off spending six days a week just working your surgery. That’s the truth of it. I mean people build companies up and all sorts of stuff, and they’re very lucky. And I’ve been lucky.

Payman L:
If you’re the best, of course there’s money. If you’re the best pin maker in Europe, you’re richer than all of us, right? If you’re the best, of course. But there is this thing of I want to teach, and it’s interesting. I always ask those people to look at their motivations. On the other hand, there are people who really should be teaching, like you. And it’s a funny time we’re in from that perspective as well. But what do you think about this sort of… Do you not agree that there’s a bit of millennial bashing in terms of, look, I think they’re better than us?

Tif Qureshi:
Oh, do you know, this is a joke. There was actually a good post on it the other day, and I think actually the standard of work that you see from young dentists now is clearly higher.

Prav Solanki:
Much, much higher.

Tif Qureshi:
Oh, yeah, yeah. I think the fact is the courses are accessible.

Prav Solanki:
Yeah, there were no courses in our day.

Tif Qureshi:
No, there weren’t. The techniques, the materials are just on a different plane.

Prav Solanki:
And social too.

Tif Qureshi:
Social helps, absolutely.

Prav Solanki:
You get inspired early.

Tif Qureshi:
And a lot of people are buying cameras standardly. They’re picking up cameras and looking at… Picking up a camera and looking at your own work is not just about taking a nice photograph. I’ll tell you what, a little tip is take a close photograph of something that looks rubbish. You’ll learn more from that than you will from ones that look good. So, I try and take dry photographs of every single case I do. And yeah, sometimes they look rubbish, and I actually put those up in my lectures, okay? Because I say to people, “You need to look at it like that. You need to look at it, and that way you kind of learn.”

Tif Qureshi:
So, I think, going back to your point, I think they are. And I think there has been a bit of millennial bashing probably because you do see, as you get older, sometimes it is harder for dentists to swallow when they’ve been around for 25, 30 years. And suddenly, you see someone with two years experience posting stuff up that looks better than you. However, I still do think what’s extremely important is to look at what it looks like in a few years to come. Before and afters are all very interesting, but they’re not really that interesting until you can see it again. And even a year can actually give you so much information, and it might not look perfect.

Tif Qureshi:
But in a way, if it doesn’t look perfect, learn from it because it’s actually a valuable… I’ve always found there’s a bit of a thing in dentistry where you sort of stick something in a tooth and turn your head away immediately. That’s what it kind of used to be like when we were back in the old days. Now I’d say, “Look at it, analyse it, swallow the fact that it could look pretty bad. And actually, now you had to do it again better.”

Prav Solanki:
You touched upon the BACD earlier. You’re a ex-BACD president. Can you just talk to me about what influence that’s had on your career? And prior to being president, what it was like being president, and what influence you had then, and then since as well, the direction they’ve gone in?

Tif Qureshi:
I mean I’ve got a lot of friends in the BACD. I’ve had a lot of friends, and I’ve still got a lot of friends. And I will have friends to make there, and it was probably a really key part of my career. There’s no doubt about that. You get to meet. You get to stand up on a stage and lecture. You get to go to places that perhaps you never would’ve done before. I think for my own personal view, I probably realised at one point that what I was doing wasn’t necessarily the same thing that what they were aiming for. Now, it may well be that they absolutely are now.

Tif Qureshi:
But I think for a period of time, I just became a bit less interesting cosmetic dentistry, okay? Because I’m even saying it now, and I’m sort of saying it when I’m lecturing that when I look back on my own cases, and this has come from my own embarrassment of what I’ve done in certain cases where, I used to act like a typical cosmetic dentist, in that you would market to people. You’d bring them in. You’d smile design them up. You’d wax them up and take pictures, and we were doing a version of DSD 20 years ago quite frankly. It’s a bit different but-

Prav Solanki:
It’s DSD

Tif Qureshi:
Well, it was digital. Believe it or not, it was digital. 1999 piece of software called DICOM imaging.

Prav Solanki:
I remember that. You’re right, you’re right.

Tif Qureshi:
And actually, do you know what? It isn’t that different. The DSD now is something on a much higher level. But we were doing that sort of stuff, and I would see the patients, do the treatment, finish the case, good-bye to the patient. They’d go back to their dentist. And we all did that, and lots of people still do that today. I’ve actually now realised that’s completely irresponsible because I don’t see patients that come back 10 years on. And actually, I would look at the patients, and I once or twice came close to welling up with tears in my eyes, thinking, “What the hell have I done?” Okay, the patient’s not sitting there in pain and complaining, but I’m looking and seeing teeth that I veneered, and have now moved back to the position that they actually were originally. And so, what I kind of realised is lots of things can change. Lots of things can change, the occlusion, the function. Tooth position can change, and if you just palm a patient back off to a general practitioner who you don’t know very well, you have no idea how that patient is going to actually be managed.

Tif Qureshi:
There’s a few other things that really made me think very hard about the whole concept of cosmetic dentistry is that there’s this thing called the replacement event. I sort of use this term quite a bit. And the replacement event is something that when you go and watch a lecture on cosmetic… I’m not talking about the BACD here. Just generally, when you go and watch a lecture about cosmetic dentistry, very rarely does anyone ever stand up and talk about the replacement event, as in the three little fundamental factors that I’ll give you. There’s others.

Tif Qureshi:
Number one, will the patient be able to afford it again? So, we would take the money off the patient, and he could be their 30s, even 20s. I mean thankfully, I didn’t do many like that, 20s. But you don’t know, 15, 20 years on, the patient now needs something done, and they can’t afford it. And there’s no contingency for that. The minute you start doing that sort of work, you’re kind of responsible for it.

Tif Qureshi:
The second thing that I’ve found is that patients have got to the point where actually they could afford to do something again. But you know what? They can’t be bothered, and they literally cannot… For whatever psychological reason, they cannot be bothered to go through that process or even part of that process again.

Tif Qureshi:
The third thing, and this is the real killer, and anyone that does this sort of work, and it doesn’t get talked about a lot, is veneers don’t all fall off, I mean doing a one go. What usually happens is 10, 15 years on, one fails, okay? Upper central, upper left lateral. No one tells you how hard it is to match a brand new veneer to a set of eight or nine that have been sitting there for 10, 15 years.

Payman L:
That’s a good point.

Tif Qureshi:
Absolutely a nightmare. And you’ll end up doing three, losing half the hair on your head, and feeling ultra stressed about it as well.

Prav Solanki:
Is that something that you would personally struggle with, somebody with your skill as well?

Payman L:
Anyone would.

Tif Qureshi:
Anyone, yeah. I’ve got a great technician. I’ve been working with Luke Barnett and Tanya Knight for years. They’re excellent, but I know when that happens, my heart sinks because it is just… You know, eight years on, when an aligned, bleached, bond tooth chips, and the edge chips, there’s no stress at all. Just shrug my shoulders. Just trim that off, rebuild it. It’s a totally different kettle of fish. That’s the thing that people need to hear when they’re thinking about cosmetic dentistry. Now, I’m not saying of course that the BACD’s all about doing veneers. It clearly isn’t. It moved on a lot, but my goals are now not cosmetic. Actually, I’m looking at functional treatment on patients long term.

Prav Solanki:
Do you think their definition of a cosmetic dentist is different, the results that you’re giving your patients? Because in my mind, as a non-dentist, I look at cosmetic dentistry as just improving somebody’s smile so that they’re happy with it. That’s what I would consider in my own head. And I’ve just heard you talk about, it was almost like, you talk about a cosmetic dentist being different to what you’re describing. Is there a definition of a cosmetic dentist that’s popularised maybe amongst the BACD or the dental crowd that’s very different in line with what your philosophy of-

Tif Qureshi:
That’s a really good question. I don’t think you could certainly say that everybody in the BACD is a certain way because you’ve got a whole mixture of general dentists. And you’ve got some people that just do cosmetic dentistry, and some people do a lot more and a lot less. I think what I’ve realised is I don’t want to be this sort of pseudo-specialist that just tries to pull people in and treat them and do big cases on them. I’ll do big cases on patients, but generally, I’ll want to have known those patients for a period of time and do it for the right reasons at the right time.

Tif Qureshi:
Now, I’m not saying that the BACD doesn’t believe in that message. They may well do, and I know a lot of the guys. And I think they are totally open-minded in everything they do. I think John Kois, from what I understood, stood up on the stage and said pretty much the same thing the other day. And he gave an amazing lecture. And it’s not about the BACD. It’s about cosmetic dentistry in general that I think that it’s made me reevaluate my goals slightly. I won’t take a case on unless the patient understands they’re going to come back and see me. Simple as that, but it changes the dynamic because that might not fit into everyone’s cosmetic dentistry’s business model, where you see you’re doing big cases, and then you palm them off back. I’m not saying that that is going to end in disaster, but for my personal feeling, if I do something like that on a patient, I want to make sure they’re okay. I want to see them again. It’s as simple as that.

Prav Solanki:
Sure.

Tif Qureshi:
But you can apply that thinking, I mean this is where it gets controversial, you can apply that thinking across the board in specialism.

Prav Solanki:
Any industry.

Tif Qureshi:
Any specialism, any dentistry. If you do something, you’re doing ortho, well, you damn right should see the patient again, you know what I mean? And that goes across the board, general dentists, specialists, and all the rest of it. You cannot pretend everything is okay. Things change, and everything changes.

Prav Solanki:
Why are most of the cases that you face here relapse? Because there’s no long term follow up, right?

Tif Qureshi:
There hasn’t been. And I think it’s a very difficult one when it comes to actually being what a specialist is because you haven’t got any there. It’s impractical to keep seeing those people, but I do think that there hasn’t been, certainly in this country, I don’t think we’ve had enough coordinated retention strategy in this country. So, what’s happened is we have a lot of people doing very high quality orthodontics perhaps, but then, general dentists who are then looking after those cases aren’t really fully aware of what happens when a retainer’s failing, what to look for, changes in the anterior function and guidance and all of those things. So, I think there’s a long way to go still on getting the whole ortho and maintenance retention kind of protocols right. I do think the BOS are doing a good job in trying to raise everyone’s attention to understanding what retention is. But the reality is that the evidence has been there for years, and it just does feel like it’s been brought up recently, when really, it should have been there 10, 15, years ago.

Payman L:
So, is that a UK problem?

Tif Qureshi:
Oh, it’s global.

Payman L:
So, how come orthodontics hasn’t worked this out?

Tif Qureshi:
I think this is probably always one of the issues with the concept of specialism. It’s got nothing to do with the patients. This is actually because of how dentists want to change their careers. So, we sort of change our careers to suit us, and specialism is great. It’s a wonderful thing to be able to do. But again, one of the biggest sort of problems with specialism is you don’t really get to follow up. I’m sure some do. Actually, perio specialists certainly often do.

Tif Qureshi:
But unless you’re in that environment where you are going to be closely communicating with the dentist who are looking after the case, who knows, in 20, 30 years time, it probably should be standard that every patient… Right now, patient has ortho. They finish the ortho, and the general dentist should be then sending a full series of clinical photographs back to the orthodontist every year to review. How hard’s that? You see what I mean? And that should be built in to the programme. Actually, it should be built into the NHS programme, and there should be some funds that pay for that. But will that happen?

Payman L:
No.

Tif Qureshi:
I don’t know.

Payman L:
What is your week look like? How much work do you do?

Tif Qureshi:
For quite a long time, it was three, three and a half days of clinical practise. More recently, I’ve gone to two quite long days. Partly because I kind of find myself teaching virtually every week or doing something virtually every week, and that sometimes is going to involve travelling. So, if I have to travel on Thursday, I don’t really want to be working Wednesday or Thursday and then travelling in the evening. Otherwise, I just don’t see my family. So, the swings and roundabouts of it are yeah, I might do a bit of travelling every now and then. But then, if I’m not actually doing a lot of teaching, I’d be finished on Tuesday night and back at work on Monday. Having said that, there will be a lot of work from home and a lot of meetings and phone calls with all the people in my business. So, it’s busy.

Payman L:
How many events do you go to a year? It’s a gigantic number, no?

Tif Qureshi:
I think we probably do at least 50 in the UK, don’t we?

Payman L:
5-0?

Tif Qureshi:
Yeah. And probably-

Payman L:
Jesus.

Tif Qureshi:
Probably double or triple it if we look at all the different places we’re in, yeah. So, there’s a lot going on. And the thing is, we’ve got a big group of people. Now, we’ve talked a little bit about the team that we’ve assembled. But I think it’s important to mention them because all of these people are people who have… They’re friends. They’re not my friends previously, but they’ve become friends because they were people who believed in what we did, and then went on to teach. Many of them never taught before at all. Now we’re actually international lecturers. Nobody’s come into this in a kind of contrived, planned way. It was all people that believed in the concept.

Prav Solanki:
Tif, I’ve known you for years, and all the time I’ve known you, you’re incredibly passionate. You’re hard working, and you put a lot of physical time into what you do. How does that impact your work life, family balance, and what impact does it have on your relationships with your kids and wife?

Tif Qureshi:
I think I’ve got a very understandable wife. I mean she’s lovely.

Prav Solanki:
Understanding.

Tif Qureshi:
Understanding, yeah, sorry. Understandable, yeah. Understanding, yeah. I mean she’s lovely. She understands what I do, and she understands the pressures you get if you get put under. She also understands what it’s about. I’m not out there just having a laugh.

Prav Solanki:
She’s a dentist.

Tif Qureshi:
She’s actually a dental technician. She was trained at King’s. We actually met at King’s. We weren’t together then. We kind of met a few years after.

Prav Solanki:
You met at uni?

Tif Qureshi:
Yeah, we met at uni, but as I said, we weren’t together at the time. But she was at Kings. She’s a northerner. She’s from Preston or St. Anne’s actually. I like to say it’s Blackpool, but it’s near there or thereabouts.

Prav Solanki:
Manchester mate.

Tif Qureshi:
Somewhere out there, yeah, basically somewhere out there. But no, I like the place anyway. But no, she’s very understanding. I think, looking back, there’s things that I regret where there were times where I was flying off to the States and doing this and that, and part of it was just kind of not being able to say no and not being able to balance out what was worth doing and not doing. And I look back at those moments and times that I think I really missed out on certain things. I mean I can’t believe I missed her 40th birthday to do a lecture in the States. And actually, it kills me thinking about it, particularly because of what a waste of time it was. It went well, but for one reason or another, things didn’t quite work out the way I wanted them to work there because of some of the people we were working with. And we never had problems filling courses there, but there was some issues over there at that point. And you know, I just sort of look back and think, “That wasn’t wise.”

Tif Qureshi:
And now, I think because I’ve sacrificed the practise, if anything, so, the practise ticks over. I do what I need to do, but I could be doing a lot better with me there full time. We’ve got a great team there. But I’d rather sacrifice that than my family. So at the end of the day, I get to spend a lot of time with them. I’ll be at home five days on the trot sometimes, and then the odd week, I’ll be away for two or three days. Very rare now that I’m flying every single weekend for three or four days. I probably fly maybe once a month and maybe have something in the UK one weekend as well.

Payman L:
So, every other weekend, you’re away?

Tif Qureshi:
Every other weekend, I would probably say I’m doing something, but that could be in England.

Payman L:
But away?

Tif Qureshi:
But away, yeah.

Payman L:
I think Jason has a similar situation.

Tif Qureshi:
Yeah, yeah. I see his feet up on the platform. I don’t think my schedule is as intense as Jason’s looks right now.

Payman L:
But a big shout out to the partners. We do once a month, and that seems like hard work. Away, you know.

Tif Qureshi:
That’s why you have to sacrifice week time. You’ve got to. I could be in the practise making a bit more money, but I’m not going to because I want to be at home. I want to be able to pick my kids up from school. Literally, it’s actually quite nice to be able to do that. And you get to a point in the week where they get sick of your face, and that’s definitely when you know it’s probably good that you’re away the following week. So, it is swings and roundabouts. Last summer, I only did two days a week even though I had no lecturing. Imagine how wonderful that was, and I was literally off five days a week. So, I’m not going to feel too sorry for myself.

Payman L:
But no, the sacrifice is real though. You must’ve missed… Even I missed, I don’t work, I’m not a dentist at all, but even I miss some key events, whatever it is, carol service or whatever you want to call it. There are some things you’ve missed out by-

Tif Qureshi:
Definitely. And occasionally it gets thrown back at you by your kids and by your family. And it gets quite hard to try and-

Payman L:
There’s no defence.

Tif Qureshi:
There’s no defence. It’s so difficult to balance it out.

Prav Solanki:
What’s the most painful thing that you’ve missed, kids-wise?

Tif Qureshi:
Oh.

Payman L:
You bastard. What a question.

Tif Qureshi:
I have to say I don’t think I’ve ever missed their birthdays, although actually I missed my daughter’s last birthday, but that was only because she was away in Malta, so that was her own fault, on a basketball trip. But that was quite painful actually. But no, I think there’s been times where I just wish I’d been at home where things were going on. It might have been a friend’s birthday or-

Prav Solanki:
Just an event.

Tif Qureshi:
Yeah. You think, “Why am I here doing this?” And I think that’s why I’m much more picky about what I’m doing now and just not necessarily saying yes to everything. It’s like you were saying, people want to learn and teach. If you’ve got that attitude and all you’re thinking about I’ve got to learn and teach, you’d say yes to everything. And you just shouldn’t. You’ve got to peg it out.

Prav Solanki:
I’ve met your son, Aidan. And he’s quite interesting because he’s doing a little bit of work for the academy now. And it’s only recently I think he’s just started to understand why Dad’s putting all this sacrifice in.

Payman L:
What’s he doing?

Prav Solanki:
He’s doing a bit of social media work for us and helping us out.

Payman L:
How old is he?

Tif Qureshi:
He’s 17. He just posts stuff that we’ve checked. It actually makes it a lot easier because he’s next to me, and he can show me and say, “Before you, just to make sure it looks correct.”

Prav Solanki:
But more recently, he’s seen you lecture on a big stage as well, the whole family and stuff. And they know now. I mean he’s spent some time with us, came to Manchester, and even he said to me, “When I saw Dad up on that big stage, it made everything real and really made me understand.”

Payman L:
Yeah, so last time we were in Birmingham, I brought Depish’s whole family in at the end. And just to see that this is why you’ve lost your son.

Tif Qureshi:
It’s a wonderful thing to be able to do, and that’s probably one of the… I mean when they came to New Zealand with me, and we did this big event, the New Zealand Institute of-

Payman L:
They all went there?

Tif Qureshi:
Well, we are very lucky. I had an invite in Singapore and New Zealand all over two weeks, which just happened to be the Easter break. So, basically they were coming whether I liked it or not, they were looking at the flights, and they were coming. So, we went to New Zealand, spent a bit of time there. I did this big lecture of about two or three hundred people, and it went really well. I mean I love all the people there. I think I got on with them very well. But the kids came and watched the last bit and came up on the stage with me, and that was a moment that I’ll kind of always look back and think that was great. And whatever happens to me one day, they probably will see a picture of that and think that was a nice time.

Payman L:
They’ll be very proud.

Tif Qureshi:
Yeah, I think so. I think so. I think they’ll understand what it’s all about basically. A few years ago, I remember we were going in Norway. I took them once in Norway. But they were only 6 and 10 or something. And this old dentist leaned over to them both, we were sitting on a bus going somewhere, I think from the airport to the hotel, the Solstrand. It was the Swedish academy, which I mentioned, and this chap leaned over to my son and said, “You should be happy, proud of your dad. He saved a lot of tooth.” But my son just rolled my eyes, didn’t even have a clue what he was talking about. And I almost wept at that point. But anyway, it was a nice-

Prav Solanki:
What would you have done differently, if you could go back?

Tif Qureshi:
I think even though I look back at some of those cases that I wish I hadn’t treated, obviously there were a few. The weird thing about those is they’ve taught me so much, and I’m hoping to teach other people so much. So actually, it’s a good thing. Probably from a business point of view, there’s probably certain things we wouldn’t have done, maybe one or two people we wouldn’t have worked with, and places I wouldn’t have travelled to that I just didn’t need to go to. I don’t want to name names and stuff, but certainly there are things I wouldn’t have done in that respect. When you’re a dentist, you’re not a hardened businessperson. It just doesn’t work.

Prav Solanki:
Have any of your cases came back to haunt you? The ones that you feel now you wouldn’t have given them that treatment today, right?

Tif Qureshi:
Oh, yeah. Yeah. Not to the point where patients have come back in screaming and crying, but I think the haunting I find the fact that when I see a case that I veneered 20 years ago for crowding, and the patient just never came back, and then came back 18, 20 years later. And then the teeth are as crowded as they were when I veneered them. That’s quite haunting, and it’s a really powerful lesson. The photographs are hugely valuable in that it’s an education that’s cost somebody. And I’ve made that mistake. I’m lucky enough to have the relationship with the patient. The patient’s certainly not complained, but I’ve explained what’s happened. And these people have been okay, but I think now, knowing what you know, that’s not a great thing to-

Prav Solanki:
In today’s world of litigation, you do something wrong, a patient sues you. But you talk about having this long term relationship with your patient. What impact does that have on a patient even if you do screw up, right?

Tif Qureshi:
I think that is such an important question, and I think it’s a question we need to be talking about a lot more. We need data. I haven’t got it, but I’d love to see data that highlighted what the demographic of patients were who made complaints, how long they’d known the dentist for.

Payman L:
I think there is a lot research for that.

Tif Qureshi:
Is there?

Payman L:
Yeah, yeah, yeah.

Tif Qureshi:
I’d love to see it. I can only imagine from my own experience that you seem to be far less likely to get into some kind of dispute or argument with a patient if you’ve known them, if you trust that they trust you, and you’ve gone through things with them. Something’s worked, something hasn’t worked. You fix it, you know what I mean? I think compared to this rush to treat new people. I thought we were talking about it a little while ago. That’s what worries me a little bit about the whole kind of Instagram thing. It reminds me a bit of Groupon. Remember those days a few years ago. Am I allowed to say that? It reminds me of some of the online purchasing, where people were self-diagnosing and having stuff done. I think that just seems to be fraught with risks. You need to get the patients in and get to know them before you start something. If they push you that fast, I probably would walk away.

Payman L:
I mean it’s very interesting. I used to work in Kent in a-

Tif Qureshi:
Where were you by the way?

Payman L:
In Ashford and in Folkestone.

Tif Qureshi:
Oh, right.

Payman L:
My VT job was Ashford. I did most of my veneers in Folkestone.

Tif Qureshi:
Right, right.

Payman L:
But the type of people and the type of practise that you had, actually you’ve got a much less stressed situation. It’s all well and good to say some young associate, “Don’t go looking for new patients.” But there’s some young associate in the city right now, and the only option he’s got is to find new patients. But what I’m saying is it doesn’t make your point any less relevant. Your point’s right. When people trust you and you know them, you can give them appropriate treatment, and if things go wrong, they’re going to be much more forgiving. It’s absolutely right. But the reality for people is very different sometimes.

Tif Qureshi:
I get that. And you’ve got to build a list. You have to build a list. But I think the key thing is you’ve got to look at what you’re doing for these people, and don’t let get yourself pushed into doing too much too quickly. I actually like to put barriers up in front of people. I like to push them off to the hygienist. They often need that anyway because you want to make sure they’re completely… The perio is looking really good. The hygienist is an excellent way to start. You push them into them a couple of times, and then I’ll actually have a conversation with the hygienist, like, “How did you find the patient?” And if it’s negative, we’re going to hold off a bit more. Do you kind of get my point? There’s little things that you can do just to make sure things are a bit… It’s a safer approach.

Tif Qureshi:
Doesn’t mean you don’t ever see new patients, of course. But I think we need to focus more on who’s there already as well, and look after those patients. And actually, look at what happens to them because people don’t look at actually what’s going on long term. We tend to look too statically at dentistry, rather than long term. It’s a snapshot.

Prav Solanki:
Got two questions for you, which relate to legacy and advice. So, it’s your last day on this planet. And there’s just one piece of advice that you can leave the world with.

Tif Qureshi:
One dental advice?

Prav Solanki:
No, any, any.

Payman L:
Just have both.

Prav Solanki:
But one of each, right? So, there’s one piece of advice, dental and non-dental life that you can leave the world with. What would that be?

Tif Qureshi:
Okay. Before we started, I said no religion. No talk about religion.

Prav Solanki:
Yeah, of course, of course.

Tif Qureshi:
But I’m going to bring it in now.

Prav Solanki:
Okay.

Tif Qureshi:
Which you guys are probably happy with. But I’m not going to make any comment on anything other than that. But one thing I do always believe and I think is extremely important that I think every religion has it totally right is that you just do unto others as you’d do unto yourself. And it’s not a difficult… It’s the Golden Rule. It applies in so many areas of life. And if you just put yourself in the position of your patient, the person you’re talking to at the supermarket, the person you’re maybe having a go down the phone, who’s in the bank, I think it helps you hold yourself back slightly and just think about how someone else is feeling. So, that’s probably one thing I would do.

Tif Qureshi:
Do you know that applies in dentistry as well? It’s exactly the same thing. I think it’s interesting. Like I said, I think if every single dentist on the planet subscribed to that, it would be a quite different profession to a certain degree. England, I honestly think is one of the most ethically orientated countries in the world. I travel quite a lot. I don’t want to point fingers at anywhere else, but there certainly are some places I’ve been to where you could tell the difference between what a healthcare professional is and what a businessperson is. And I think fortunately in England, and certainly a lot of Europe, we start off as healthcare professionals. Yes, we have to bring the business in, but that’s not what’s leading us there.

Payman L:
You mean America?

Tif Qureshi:
I’m not, no. It sometimes is like that, and I think they are more interested in businesses, no doubt. But equally, I know they’re interested in this-

Payman L:
But the public expects it there too.

Tif Qureshi:
I think they do. But when we started going there, I have to say I thought we would never have anyone come to our courses. They were always full, always. So actually, I think there’s a really strong demand for this kind of process. In the institution and the traditional look at cosmetic dentistry or whatever may not make you think that, but actually I think people do want this kind of thing done. So, I think it’s an approach basically.

Prav Solanki:
And my final question, Tif, that day’s past, and your legacy, Tif Qureshi was… Finish the sentence.

Tif Qureshi:
“An all right bloke” would do me, quite frankly. But a normal bloke who you could have a chat with and isn’t going to judge you and all the rest of it. That’s kind of the way I like… Yeah, all the dentistry stuff is nice, and if you get known for doing this sort of thing, but I just want people to feel that I was approachable and easy to speak with and I listened. That’s kind of… And I’ve listened to myself and the thing in my head, telling me that things I did were wrong, and we changed them. So, that’s kind of the way I’d like to think about it.

Payman L:
That’s really lovely to hear that from someone who’s had as much impact as you have. Thanks a lot for that. Cheers.

Tif Qureshi:
That’s all right.

Prav Solanki:
Thank you, Tif. And very good, thank you.

Speaker 4:
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.

Comments have been closed.
Website by The Fresh UK | © Dental Leader Podcast 2019