Sumair Khan: And make sure you have the basic skills down. Basic skills of Perrier restorative [00:00:05] oral surgery and prosthodontics. Period. Definitely you need to understand how [00:00:10] to recognise it, manage it and how to stabilise it and maintain it. Yeah. Oral [00:00:15] surgery. You need to be able to raise flaps, draw bone, cut gum safely, raise [00:00:20] flaps safely, draw bone safely and close with sutures as well. Some of the times you see [00:00:25] people taking hours to put sutures and you think, this is this is not right. It’s not fair for a patient. It’s not right. [00:00:30]

[VOICE]: This [00:00:35] is Dental Leaders, the podcast where you get [00:00:40] to go one on one with emerging leaders in dentistry. Your [00:00:45] hosts Payman Langroudi and Prav [00:00:50] Solanki.

Payman Langroudi: It gives me great pleasure to welcome Sum Khan onto [00:00:55] the podcast. Summer has three practices of his own and [00:01:00] implantologists in partnership with Gillian Kish with the smile Group. [00:01:05] And I see some really at the events a lot where he’s teaching. [00:01:10] Implantology his son was responsible for the implant diploma that the [00:01:15] Smile Clinic group do. Massive pleasure to have you, buddy.

Sumair Khan: No, it’s absolute pleasure to be here. It’s been [00:01:20] a long time coming. Yeah. It has, it really has. Really? First, I want to just get into your [00:01:25] childhood.

Payman Langroudi: What kind of kid were you? What did your parents do? Why? Dentistry? [00:01:30] Where did you grow up? All of that sort of stuff.

Sumair Khan: That’s interesting. Um, my. My parents were both, uh, doctors. [00:01:35] My dad was an orthopaedic surgeon. My mom was a GP. My dad was told very [00:01:40] early on when I was. I was born in 1972. So I’m 52 now. [00:01:45] Um, and my dad, when I was about ten, was told that he was the wrong colour [00:01:50] to be a surgeon consultant in this country because he was training alongside lots of stress and not [00:01:55] being appointed so.

Payman Langroudi: Outright just.

Sumair Khan: Said that. Yeah, I think in those days you could say that’s a different [00:02:00] time. So he left the country and became a consultant, uh, back home in Pakistan, [00:02:05] became a professor, ran his own clinic, a very successful, uh, so I grew up here with my two brothers. [00:02:10] The three of us with my mum was my who’s busy GP she that 40 years. [00:02:15] And they still kept pushing us to be like doctors, dentists or like professionals of [00:02:20] some kind. I was off the rails a bit, a little bit when I, when I was [00:02:25] 18, I wanted to be a fireman. I thought, what is not to like? You get like awarded medals, [00:02:30] you get to work out all day. You get yourself on a calendar, you know, I mean, it’s, uh, women [00:02:35] swooning over you. This is brilliant. My parents were like, no, you’re out your mind. You are going to be a doctor. So [00:02:40] I applied for medicine and I had already had to retake. And my parents said, [00:02:45] apply for medicine. I applied and Kings said we could give it to you after another year. And they were like, no, [00:02:50] no, you’ll be two years behind. And embarked. Interestingly called me back after my interview with [00:02:55] medicine and said and said, look, we really like you. Can you come for dentistry? I was like, [00:03:00] uh, dentistry wants to be a dentist. I hate dentists type of thing. My only experience [00:03:05] of dentistry was going to a local dentist pretending to have an emergency so I could get [00:03:10] out of school, uh, with a friend of mine.

Sumair Khan: And so I rocked up at that local dentist [00:03:15] that night, and, uh, I knocked on her door, and she’s like, oh, what do you want? And [00:03:20] I said, look, I need a note from you saying that I’ve been here a few times. You think I’ve got a really good aptitude towards dentistry [00:03:25] and I’ll make a good dentist. And she said, oh, shut up. She went to shut the door and I put my foot in the door [00:03:30] and her husband came running down. And what the hell was going on? Here she goes, oh, this guy, he just turns up with [00:03:35] his mate to get like a letter for scored. So he’s off school with the dentist and [00:03:40] and it’s completely. I’m not writing him this letter. He has been here a few times, [00:03:45] but I’m not writing him his letter, and he’s her husband. Just. I’ll write it. So he wrote the letter. They [00:03:50] were both like, um, he was an accountant at upstairs. Well, he wrote a letter. She signed [00:03:55] it. And I took that letter to the interview and a couple of my brothers Airfix models to pretend I was good at in [00:04:00] my hands. So, yeah, I got into dentistry and, uh, it was great. I did it at Barts. I was very [00:04:05] happy. Barts was a lovely place. And Mile End is just a mad cultural [00:04:10] mix. Um, it’s shocking.

Payman Langroudi: When you see mile in the first walk.

Sumair Khan: Out. You see it first time, you’re like, what [00:04:15] is going on? Yeah, absolutely. But the amount of pathology and disease [00:04:20] that you see there, it gives you a great experience, a really good experience, especially the medical side, [00:04:25] uh, in the first few years as well. And I’ll get.

Payman Langroudi: Serious when you got there. I mean, it [00:04:30] sounds like you weren’t serious before.

Sumair Khan: No, no, I wasn’t the first two years. I still was hanging out with my friends outside of school [00:04:35] more, and it was a very, very. He’s a dear personal tutor. His [00:04:40] name was Gary Pollock. Really, really nice man. Sat me down at the end of my second year and said, look, he goes, [00:04:45] something’s got to change or you’re not going to, um, you’re not going to pass, uh, on time. And so [00:04:50] he told me what I was doing wrong. I’ve moved into college then because I was still driving in from home [00:04:55] in north London, and I changed. So my third year I changed, got serious, uh, and I actually [00:05:00] liked oral surgery quite a lot. So when I qualified, I did find ocean training. I [00:05:05] was very lucky to be on a brilliant scheme with some amazing people. Rajaratnam’s Lvrt advisor, [00:05:10] or at the time, the TPD and I had Chris Treadwell, who’s a dean at [00:05:15] Barts now, uh, I had a Daljit Gill. I had some very, very amazing people. [00:05:20] Um, they’re still friends of mine today. And let’s talk about 96 when I did, um, foundation training. [00:05:25] Uh, straight after that, um, I was actually kicked out my house, so I went [00:05:30] back to Ground Zero. I had, uh, I had, um, made, I think £27,000 [00:05:35] that year and spent 29 on a car, uh, and then [00:05:40] took, uh, a Hindu girl home to my Muslim parents, Pakistan, and said, this is where I’m marrying. And they were [00:05:45] like, you’re out of. Door. So I was driving around in my car with all my belongings, uh, and [00:05:50] £2,000 in debt. And, uh, I had to find a [00:05:55] place that would housed me as well as, uh, let me work. So I was desperate for a, uh, what they called [00:06:00] an sa ho job back then with DCT. Now it’s called. And I got one out in Ipswich, and I ended up [00:06:05] doing maxillofacial training as DCT for two and a half years in, uh, [00:06:10] Ipswich, Chase and Barnet over two and a half years until my parents came round and my wife [00:06:15] converted and we were married. And then.

Payman Langroudi: Did you meet her at.

Sumair Khan: The year above me [00:06:20] at uni? Yeah, yeah. A year above me in uni. So we, I knew I was going to marry her in my foundation training [00:06:25] year, but I didn’t realise my parents reaction. I mean, for that generation, that whole, [00:06:30] uh, India Hindu and Pakistan Muslim thing is a big no no. Still, both [00:06:35] my parents came over in the partition from India to Pakistan and have vivid memories of [00:06:40] that.

Payman Langroudi: So you were surprised, were you?

Sumair Khan: I just felt like I underestimated how [00:06:45] deep it ran. They ran that resentment still, because especially because my mum [00:06:50] was a GP and she was hanging out with most of her friends are like like Hindus, Sikhs and like Greeks, [00:06:55] Turkish. All her patients are Greek, Turkish in north London, like she gets on with everyone. But then [00:07:00] this hit her quite deep. Like a visceral level. Yeah, yeah, a level where she was like, [00:07:05] no, I don’t want this for my son type of thing. And I was like, wow.

Payman Langroudi: So what made them come around?

Sumair Khan: Well, [00:07:10] my aunt converted my wife. Uh, she taught her how to pray. She taught her how to read the Quran. And my [00:07:15] wife was already, um, she wasn’t from a very strict Hindu family. They were her [00:07:20] parents, her mum. Her dad was a GP in Stoke on Trent. And [00:07:25] they had integrated. They had or he had given them all English names and they were very, um, anglicised [00:07:30] in their manners. And they’d gone to a Catholic school and their Catholic school. Background and [00:07:35] religious upbringing. She understood religion as part of that. It was not difficult for her to make [00:07:40] the jump from that to Islam, actually, and she understood it quite well and she was quite happy to accept it. [00:07:45] It was a it was a blessing. Otherwise we’d still be in trouble.

Payman Langroudi: So [00:07:50] she’s a doctor.

Sumair Khan: She’s, uh. No, she’s a dentist.

Payman Langroudi: Yeah. [00:07:55]

Sumair Khan: She’s a year above me at uni.

Payman Langroudi: Oh, I see, I see. Yeah. So take me through some of those first jobs that you [00:08:00] did.

Sumair Khan: So the show jobs were tricky because I was away from home. I hadn’t lived away [00:08:05] from home for my first one. The second jobs, I understood a bit more the politics, because there’s [00:08:10] a lot of politics in hospital jobs, especially between consultants. You understand the competitiveness. [00:08:15] Not so much racism, but a bit of discrimination. I understood as [00:08:20] well that went on and it was a bit more acceptable back in 97, 98. And people want [00:08:25] us woke back then to some of the stuff that was going on. I would you just bite your tongue [00:08:30] and just take it. I think.

Payman Langroudi: Also the general abuse of juniors, yes, the bullying [00:08:35] culture, let alone the bullying culture is.

Sumair Khan: Still there. Yeah, but nowhere [00:08:40] near as bad as it was. Yeah. Uh, some of the things that your consultant could say to you and ask you to [00:08:45] do. Yeah, yeah, yeah. Wouldn’t get away with that now. But the consultants have changed. That’s a generational [00:08:50] change completely now since those days.

Payman Langroudi: I mean, I did similar thing. I did an oral surgery house job [00:08:55] around the same time, actually around 96, 97, in Cardiff. And I hated my life. [00:09:00] But at the same time, I’d recommend it to anyone. I would, I would, it’s [00:09:05] almost like going to the gym or something. It’s like a rite.

Sumair Khan: Rites of.

Payman Langroudi: Passages.

Sumair Khan: Yeah, you [00:09:10] have to have done it. You have to have that hardening or that quickening.

Payman Langroudi: Nothing fazes you after you’ve done a job like [00:09:15] that.

Sumair Khan: That’s exactly what I was going to say at the moment. I went back into general practice and we’re talking, uh, I [00:09:20] was working for one of these, um, original, uh, White cross was, oh, really? Corporate [00:09:25] in Barnet? Yeah, I got married. We’ve got a house, a flat, and, uh, I said, well, I’ll come [00:09:30] into general practice now. And the options were to go in, continue and do medicine to become [00:09:35] max fac or come in. Did you consider that I was I was still up for that even [00:09:40] when I was doing my in practice. But my wife was like marriages don’t [00:09:45] tend to do very well when, when people are uh, uh, do that. I mean, most Max surgeons [00:09:50] have been married at least twice. And so by the time they’ve done another five years at uni [00:09:55] with, uh, you know, it’s the socials and stuff, it’s difficult. And I understood that as well. Plus [00:10:00] the money, it doesn’t come so takes ages. It takes ages. Yeah. It takes ages to [00:10:05] specialise in things like that. And we were by ourselves. It was just me and my wife again. My mum was still a bit resentful [00:10:10] of the whole thing until we had our first child. And everything doesn’t matter anymore. But, [00:10:15] um.

Payman Langroudi: But so is that the reason? I mean, I.

Sumair Khan: Was very driven, I was very driven. [00:10:20] And I went into practice and I went to make money. And rather than Max fac, my wife’s idea was [00:10:25] that, why don’t you start doing implants? You’re good at oral surgery. You’re teaching oral surgery? I’d taken up a teaching role. [00:10:30] I always kept one hand one day in hospital. So even as a max fac, [00:10:35] I was doing locums, uh, as a staff grade. And I was teaching oral [00:10:40] surgery at Barts in London, where I taught mediation in Milan and people like that. I thought I [00:10:45] taught these guys oral surgery for seven years. I was at Barts. I kept one hand in hospital [00:10:50] always, and kept my oral surgery going. I was interested, so she said, look, if [00:10:55] you’re into oral surgery and you’re learning the sort of stuff now in practice, why don’t you do implants? [00:11:00] And so I got into implant dentistry in 2005. It was one of these [00:11:05] specialities where everyone thought they should be doing implants. So the period people thought they should be doing [00:11:10] implants Prosthetists think they should be doing it. The oral surgeons think they should have the right to do it, so it will never [00:11:15] be a speciality. So it lends itself very nicely to the generalist who can do oral surgery, [00:11:20] who understands peril and has done plenty of procedure as well. Yeah, you can just keep [00:11:25] upping your upskilling in those three disciplines and then add implant dentistry. And [00:11:30] I was at that stage in 2005. So that was nine [00:11:35] years after I, uh, had qualified, uh, when I started the MSC and placed [00:11:40] my first implants in 2005. So I’ve been doing it for 20 years, placing and restoring implants.

Payman Langroudi: So you did an MSC?

Sumair Khan: I [00:11:45] did an MSC at Warwick University was one of these private customers. I also realised you don’t have to go to [00:11:50] an ahsn, a proper teaching hospital to get upskilled and especially the [00:11:55] politics of being in a hospital job isn’t there, where you’re competing with others for like [00:12:00] cases or like trying to like round nose one consultant because he’ll give you this opportunity, [00:12:05] or this consultant doesn’t like you, so he won’t call you into theatres as much. None [00:12:10] of that mattered anymore. This was a very well known institution at university [00:12:15] that had was dabbling in, uh, healthcare and sciences. And they ran this MSC. [00:12:20] And it was absolutely brilliant. The patients were taken to, um, Harley [00:12:25] Street on a Saturday where they had their training centre, and we used to do the cases there under supervision. The [00:12:30] mentoring is how you learn it. And that’s what I understood, the importance of mentoring and [00:12:35] coaching and that’s, uh, that’s it. It’s I mean, since then I just it just [00:12:40] took off.

Payman Langroudi: So take me through that. My, my understanding of implantology is pretty basic. [00:12:45] But I get the feeling that back then, the surgery [00:12:50] was the main sort of thing that you play these days. Yeah, but you place the implants [00:12:55] where you thought there was most bone. No, that’s because.

Sumair Khan: I was an oral surgeon. So the oral surgeons. [00:13:00]

Payman Langroudi: The surgeons approved for it.

Sumair Khan: So the oral surgeons approach is to just raise a huge flap and look [00:13:05] at where the bone is, and put your implant in as much bone as possible and not worry about the angle. Yeah, [00:13:10] because that’s a technician problem or restorative dentist problem. Yeah. The prosthodontist will always [00:13:15] think of the occlusion first. Yeah. And the periodontist will always make sure that the bone, the gum, [00:13:20] the right type of gum is in the right place first before they put the implant.

Payman Langroudi: But are we not agreed on what’s the best [00:13:25] we are now?

Sumair Khan: And this is why you’ve got to have associations like the Adai. Yeah. Uh, and I’ve [00:13:30] got massive respect for Amit as well. Uh, a recent president and George now as well. I mean, [00:13:35] the guy does wonders to bring the whole profession together. So the speakers [00:13:40] internationally and nationally are generalists, periodontists, oral [00:13:45] surgeons, prosthodontists they all come together and they are all implant dentists. And it [00:13:50] is really, really good for the profession to have an interest like that rather than [00:13:55] just the restorative or just perio or just endo type of thing.

Payman Langroudi: And then even within [00:14:00] implants you get sort of subspecialists yeah, it’s crazy, it’s crazy. And where [00:14:05] and where are you on that level of, of I mean, do you what don’t you [00:14:10] do.

Sumair Khan: So I don’t I might am I, I don’t do um the zygomatic type implants. [00:14:15] I’m not doing pterygoid implants as much although I have done some recently under supervision with [00:14:20] uh reside uh, great mentor, great guy. Yeah. And Adeel Ali [00:14:25] is the other guy who’s doing them. There’s a couple of people who have made it a niche. Like there’s [00:14:30] a practice, in fact, Evo Dental that.

Payman Langroudi: Has all these.

Sumair Khan: That’s pretty much all they do. They put the [00:14:35] the all on four if you like. Yeah. Patients understand that. And there is a need for that. The [00:14:40] issue I have with that is a biological cost sometimes of taking healthy teeth out or potentially [00:14:45] saveable teeth out, uh, in order to sacrificing them or sacrificing [00:14:50] alveolar bone as well, in order to place the basal level implants and fit the [00:14:55] whole kitchen sink. And and it’s done. You’re done. Because everything in dentistry [00:15:00] fails. Yeah. It’s I teach all my trainees three certainties in life death, taxes, [00:15:05] and dentistry will fail. Uh, every technique you do, everything will fail at some point. So [00:15:10] where do you go once a zygomatic fail? I always think of that guy in, uh, Skyfall [00:15:15] when he says, look what you did to me, mummy. And he pulls his denture out and his face caves in. I think [00:15:20] that I don’t ever want a patient of mine to turn up saying to me, daddy and his face caves [00:15:25] in when he takes his denture out because his zygomatic implants fail. Zygoma has just melted away, [00:15:30] so I just that’s my limit.

Sumair Khan: So I, I do have people I refer to for [00:15:35] that. I was referring a lot of block grafting and sinus grafting until recently. Then a good friend [00:15:40] of mine, Victor Gurney, and me, we went on a course with us up in Manchester [00:15:45] and Prof. Right. Brilliant teachers, cadaver course and online stuff. It was [00:15:50] just at the end of Covid. In fact, we re-upped our skills or [00:15:55] reskilled ourselves in sinus and that since the last two [00:16:00] years have probably been my main area where I have been practising myself [00:16:05] and improving myself and getting more and more experience of block grafting, like [00:16:10] ridge splitting and sinus augmentation through lateral window in order [00:16:15] to gain enough alveolar bone to be able to house implants. And [00:16:20] majority of the time that I’m called in now to do surgery or people are referred to me, it’s for the difficult type of cases. [00:16:25] But, um, I mean, it’s it’s it’s not a niche as such, but that’s my [00:16:30] it’s the augmentation side that I’m trying to keep getting. Because what.

Payman Langroudi: You’re doing most.

Sumair Khan: Of right is what I’m doing most of is [00:16:35] augmentation cases. And I still have learning needs. Development needs. I mean, um, [00:16:40] the last three years I’ve been going a course in Dubai in [00:16:45] February, it runs alongside Adec, and we’ve been seeing people like Ramon Gomez made. I’ve [00:16:50] seen Ricardo Kearns and more recently Paolo Carvalho, and I’m taking the mentors [00:16:55] that teach with me on the SmartThings Academy. I’m taking them with me. I’m saying, look, this is the stuff we need to be able to [00:17:00] do. This is cutting edge. We have to keep inspiring to be better. I mean, what we do [00:17:05] is a very good level, and clearly we’re obviously more capable [00:17:10] and experienced than the trainees. But we need to be at a level where you can’t know it or [00:17:15] no one ever knows it all. Okay? I mean, I’m not even coming close. I don’t think even though I’ve been doing this [00:17:20] 20 years, I still feel like soft tissue grafting. Um, I mean, bone augmentation, [00:17:25] ridge augmentation, some of the stuff going on around the world, uh, internationally is absolutely stunning. [00:17:30] Uh, results people are getting. And they’re very, very talented surgeons, very talented surgeons. [00:17:35] We are limited here in the UK. I think we’re limited by the national health. We’re limited [00:17:40] in our access to that specialist type of training. Because, [00:17:45] because.

Payman Langroudi: Very few training places.

Sumair Khan: The National can’t afford to have all these specialists. If you look [00:17:50] at the number of specialists on the list and the type of demand there is out there for this type of [00:17:55] surgery, you’re never going to have to all just specialists providing this. You’re going to need [00:18:00] generalists who are upskilled to be able to do that.

Payman Langroudi: So look, when you did your [00:18:05] training, it made sense for you to do that. Msc the private one in Warwick. [00:18:10]

Sumair Khan: Yes.

Payman Langroudi: But if a if a young dentist today is trying to get into implantology, [00:18:15] what’s your advice?

Sumair Khan: I would say, think about why you want to get into surgery, [00:18:20] because it’s when you’re starting off. The first five years is not profitable at [00:18:25] all in anything. I think really, if you start learning because you learn through a lot of mistakes. And [00:18:30] mistakes in implant dentistry are expensive businesses. Yeah. So I, um, I mean, [00:18:35] like I said, 20 years down the line, I think now maybe 15% of my work is [00:18:40] dealing with mistakes. Other people’s mistakes. Yeah. Well, some of mine, very few of them [00:18:45] mine, thankfully, but mainly, yeah, I get other people’s mistakes. Foreign, um, dentistry. Referring [00:18:50] to me saying that this has fallen out or this broken stuff like that. And fixing implant dentistry mistakes [00:18:55] is expensive. It’s difficult. It’s expensive for me. So it’s expensive for the patient. Uh, [00:19:00] it’s very rewarding, especially if you if they’ve had it for more than, like, 5 [00:19:05] or 10 years. And then you can get them another 5 or 10 years out of, out of it that they’re [00:19:10] very, very happy. But it is difficult it fixing implant dentistry is [00:19:15] difficult. So if you want to get into it, firstly you can’t be doing it for profit. It’s [00:19:20] got to be because you want to be doing dentistry at a level where your perio is already [00:19:25] very good. Your profit flow is all understanding and skills are already very good and [00:19:30] you’re already all surgery skills are already very good, and you want to combine them to be able to provide [00:19:35] something that is additional to normal run of the mill dentistry, then [00:19:40] getting to implant dentistry and make sure you mean you’ve got the setup and the support around [00:19:45] you.

Sumair Khan: There’s no way I could do what I do without the team around me. My nurses, my receptionists, [00:19:50] both at the Woodhouse Practice, the Smile Clinic in Essex and Cobbins Brook Dental [00:19:55] Smile Clinic, and the one in Oxford. The broadcast practice superb teams around me because [00:20:00] they manage the patients when I’m not there. I’m only there, like I said at the Oxford practice [00:20:05] twice a month, the Essex practice twice a month and the north London practice. I’m [00:20:10] there two days a week, so that’s where my main practice is. But, um, my practice is this year, thankfully [00:20:15] limited slowly now down to oral surgery and implant dentistry because the demand is [00:20:20] increasing because not everyone does it. And is an issue with having, I think, [00:20:25] visiting implant dentists. Yeah. In your practice, everyone has [00:20:30] implants on the front of their. Yeah, on their brochures and stuff like that. But a lot of practices have someone [00:20:35] who comes in and visits.

Payman Langroudi: Who’s hardly seen the patient. Never seen the patient. Yeah. There’s no relationship. [00:20:40]

Sumair Khan: There with the patient. It is difficult if they don’t have a relationship with the team, the [00:20:45] staff, the nursing, the reception staff, they don’t. Then that makes it much more difficult. [00:20:50] And then the kit and the equipment, like I said, it’s all very expensive to set up and then people don’t like travelling [00:20:55] around with it in their car, I mean, reside. Last month I think it was had his car broken [00:21:00] into, had £60,000 worth of kit nicked. They just took two suitcases. They didn’t know what was in [00:21:05] it. £60,000 worth of kit. Well it mad [00:21:10] so yeah. Visiting implant dentistry. I’ve done it for a while and I’d rather not do it anymore. I’d rather [00:21:15] it came to me.

Payman Langroudi: So back to the advice. Number one be serious because you need the. [00:21:20]

Sumair Khan: Serious.

Payman Langroudi: All in or not. Because a serious dentistry.

Sumair Khan: Serious dentists, expensive.

Payman Langroudi: Expensive [00:21:25] and difficult and dangerous. Right?

Sumair Khan: And make sure you have the basic skills down. [00:21:30]

Payman Langroudi: Basic skills of perio restorative, oral surgery.

Sumair Khan: Extrusion and prosthodontics. [00:21:35] Perio. Definitely you need to understand how to recognise it, manage it and what how [00:21:40] to stabilise it and maintain it. Yeah. Oral surgery you need to be able to raise flaps, draw bone, [00:21:45] cut gums safely, raise flaps safely, draw bone safely and close [00:21:50] with sutures as well. Some of the times you see people taking hours to put sutures and you think, this is [00:21:55] this is not right. It’s not fair for a patient. It’s not right. It’s got to be.

Payman Langroudi: But then the education side, [00:22:00] you’re saying have a mentor.

Sumair Khan: Definitely. There’s no doubt that that is I mean, if you look at [00:22:05] the training standards in implant dentistry that will produce originally in 2012, [00:22:10] this was the A.D again doing brilliant work with the then FDP, UK. Now [00:22:15] it’s KG dent. But they produce those guidelines and they do review them every. I think they’re [00:22:20] due for a review in either this year or next year, but they have added mentoring [00:22:25] to it. They’ve said you should be on a longitudinal course, meant they’ve added mentoring, you should be [00:22:30] mentored for your first cases of any type. And they’ve also said build a portfolio of cases [00:22:35] and all of that. We’ve included in our diploma the course that we’ve designed. [00:22:40] All the diploma courses should cover all of that and the mentor cases especially. And [00:22:45] without knowing it, that’s what the Warwick University did for me as well. But now those have been [00:22:50] standardised. So all if you’re looking for a course to learn about implants, make sure that they are covering [00:22:55] not just the theory, because you can get a certificate by attending a year’s worth of lectures and [00:23:00] not place it in the implants. And we have plenty of people come on our course who’ve got that certificate. You can [00:23:05] do a diploma and place only maybe 2 or 3 implants, and not gain [00:23:10] the confidence to go and set up and start doing it in your own practice. We have plenty of people who’ve done [00:23:15] short courses, um, who come on to our course. We have specialist trainees in [00:23:20] post-war period and in all surgery who have done the implants in [00:23:25] these big courses. No, no, in their hospitals. Yeah, yeah. But because it’s so [00:23:30] sheltered and because it’s all done for them, someone’s holding their hand. Someone else did this, someone else did that [00:23:35] part of it. It wasn’t comprehensive care by you. Total whole patient care for [00:23:40] that patient. They don’t. And the set up, they knew nothing about it.

Payman Langroudi: I think the variability between [00:23:45] specialist training. Yes. You know I had a I had a guy ask me should you do fixed [00:23:50] course at Harvard or should you do it at Michigan. Uh, okay. [00:23:55]

Sumair Khan: Because Michigan was rated number one. Yeah. Uh, for many, many years.

Payman Langroudi: Yeah. So classic Iranian [00:24:00] guy. I was at Harvard.

Sumair Khan: Yeah.

Payman Langroudi: The name, the name. Snobbery.

Sumair Khan: Badge snobbery. [00:24:05]

Payman Langroudi: Yeah. And then, but then he said, then he put, set out what they do. And [00:24:10] on the Michigan course they were doing three times the number of implant placements. Absolutely. And just, [00:24:15] just amongst two very famous American universities. You’ve got such variability. Absolutely, [00:24:20] absolutely.

Sumair Khan: And one of the best mentors we have a guy called Viraj Patel on our [00:24:25] course, went to the States and did the NYU course, two year course in implant [00:24:30] dentistry. And his skills are phenomenal. Absolutely brilliant dentists, absolutely brilliant, [00:24:35] uh, clinician and a very good teacher as well. And he’s learnt all of that from [00:24:40] his skills. She’s gained the skills and the confidence, but came back here and he then got [00:24:45] mentored by myself, by Gene Kish, being part of the Smile Dental Academy. We’ve trained him up to [00:24:50] be a mentor as well, because now you have to have a qualification in teaching and education as [00:24:55] well as proven skills. You need to have pace. I think latest mentoring guidelines [00:25:00] say 250 implants, or at least done nothing but implants for at least two years. And [00:25:05] you have to have experience of teaching and mentoring, as well as the [00:25:10] indemnity for teaching as well. You can’t just place 250 implants and start mentoring [00:25:15] people and doing sinus lifts, for example. You need to have done a certain [00:25:20] number of lateral windows, for example. Gain the confidence. Had experience of teaching them before. You can start saying [00:25:25] yes, okay, I’ll, I’ll mentor you to do a sinus lift.

Payman Langroudi: What about I’m going to ask you a really unfair [00:25:30] question now, but I kind of like the question. Yeah. Go. What was your aha [00:25:35] moment? Uh, in implantology like, if you had to boil it down to one. [00:25:40] Yeah, it was.

Sumair Khan: When I was on a course with a guy called Thomas [00:25:45] Linkevicius who has this thing called the zero bone loss concept. Uh, [00:25:50] he talks about basket of indicators like apples. And if you get all the apples in the basket, [00:25:55] you will get zero bone loss around your implants. And the aha moment was when he [00:26:00] was sinking his implants into the subcostally about a millimetre [00:26:05] and a half, because the soft tissue on top wasn’t thick enough. So when [00:26:10] you raise a flat. You just need to use a period probe against the bit that you haven’t pulled [00:26:15] up and see how many millimetres of thickness of.

Payman Langroudi: Bias I have.

Sumair Khan: Yeah, basically because [00:26:20] if you leave it at the crest and nurse tissue is only two [00:26:25] millimetres or less than three millimetres thick, then when a restoration is fitted and it [00:26:30] re-establishes a biological width which they now call scat super [00:26:35] crest attachment tissue as that re-establishes, it will remodel that bone. And that’s why people [00:26:40] used to accept bone loss down to the first thread. Oh, and I was like, oh wow. [00:26:45]

Payman Langroudi: That makes so much sense. You you place the implant deeper [00:26:50] than that so that the tissues aren’t thick enough. If the tissues aren’t thick enough, so.

Sumair Khan: Then it will create that [00:26:55] biological width. But you won’t get bone loss down to the first thread.

Payman Langroudi: Oh how interesting.

Sumair Khan: It’s just it just so [00:27:00] simple. And he explained it so beautifully. And he’d been doing the research in [00:27:05] Lithuania is brilliant guy Thomas Linkevicius zero bone concept. You’ve got to subscribe [00:27:10] to it or read it, whatever. It is absolutely fantastic about a different materials that that repel [00:27:15] tissues because it’s all about longevity. People don’t actually care how many millimetres [00:27:20] of titanium you manage to get into their bone. They want to lift their life up and they want to see [00:27:25] something that looks like a tooth. So it’s a pink and the white aesthetics. And [00:27:30] in my case, that’s why I went back, uh, to the Eastman in 2011 [00:27:35] or 12. And I started an, uh, MSC in restorative. [00:27:40]

Payman Langroudi: Uh, that.

Sumair Khan: To. Yeah, I had to do that because I was doing implants [00:27:45] as an oral surgeon. And, you know, the Dunning-Kruger effect, you get to the top of Mount Stupid really quickly, and [00:27:50] you see all these cases coming back. They look okay when you look at them straight on. But when you look in the [00:27:55] pallets, there’s like pins and screws going everywhere you go. Hmm. Maybe they should have been placed at a different angle. So [00:28:00] I went back and I did this and I can’t thank enough. The people at the Eastman there was Dev Patel [00:28:05] there. Paracha, Pranay Sharma, especially Rishi Patel, these guys [00:28:10] were absolutely fabulous. Teachers at the Eastman on the restorative diploma did that with Jenny Kish. [00:28:15] They in fact took it to the MSC and that’s how they, um, kicked off their, [00:28:20] um, teaching careers as well. And I dragged them kicking and screaming to that, actually, uh, [00:28:25] but I finished a diploma because I already had an MSC. I did not have the will to myself with [00:28:30] another MSC. So I finished the diploma stage and I got what I needed from that to get my implant [00:28:35] dentistry.

Payman Langroudi: I know there’s a difference between doing an MSC because you want the letters after your [00:28:40] name to get a job. Yes, yes, yes or doing the MSC because you literally want [00:28:45] that education. You need that education to absolutely push yourself forward. And I think a lot of times [00:28:50] people do courses for the first reason. Yeah, because they feel kudos.

Sumair Khan: And interestingly, [00:28:55] you’re right, because the other kind of people we get on the course that surprised me is people who’ve been [00:29:00] doing implants longer than me. Oh, uh, and they turn up because they want to be they want a qualification [00:29:05] because they were just placing them without any formal training in implant dentistry. They were just, [00:29:10] uh, had been mentored and cracked on with it. And some of them just want to be updated [00:29:15] to make sure what they’re doing is evidence based. And some of them just want to be, uh, want to see what [00:29:20] the latest techniques and materials and everything can do for them and improve their practice. [00:29:25] So you’re right, some people will come and do our diploma because they want the qualification for lots of different reasons. And [00:29:30] there are a few people, the younger ones, who feel like they want to go on and do an MSC [00:29:35] so they can take our diploma. They can take the credits for our our diplomas at postgraduate level, seven [00:29:40] diplomas. They can take that onto a university. The cap points [00:29:45] cumulative accredited. I can’t remember what it is. Credits of something it’s [00:29:50] recognised. Yeah it’s recognised training points um for education. But they can take [00:29:55] our diploma and they can take the cap points and they can go to university, apply it and they can start the embassy. They have [00:30:00] to surrender the diploma. They do an MSC. And we had an agreement with, uh, Chris Treadway at [00:30:05] Peninsula when he was at Peninsula. And hopefully we’ll get that accreditation again so that we can do it at Barts as [00:30:10] well. Uh, so they should be able to go and apply to universities with [00:30:15] our diploma, hand in the diploma and their credits and get on to an MSC and [00:30:20] just finish with one year MSE. It’s usually cheaper as well.

Payman Langroudi: So it’s so interesting, [00:30:25] isn’t it, that this notion of, you know, when I say, gee, what’s an aha moment, I ask, I’ve asked several [00:30:30] implantologists, for instance, that question. Yeah. Nilesh who you talked. Yeah. Said something [00:30:35] about suturing. Yes. He said, he said for him it all comes down to suturing. [00:30:40]

Sumair Khan: Yeah. The closure. He’s he’s right. Some a lot of that. Um, uh, he’s [00:30:45] absolutely right getting the passive closure. Yeah. And you see that sometimes [00:30:50] when you’re teaching suturing and you see especially the periosteal release. So when [00:30:55] you need to advance the flap and you first see someone holding the [00:31:00] C, I see it with my foundation dentist as well, because you teach them that on beachheads as well. Flap design. [00:31:05] And when they first pierce the periosteum it’s only about a millimetre or a half a [00:31:10] millimetre in. To do it first. And they play and they see the flap just opening [00:31:15] up and that you see their eyes just winding up like, wow, okay, this thing is going to go right [00:31:20] over the socket. Now I’ll be able to extend that and that just understanding [00:31:25] that the periosteum is what’s restricting the flap from extending over and just releasing [00:31:30] it the way it can be released. That also, I mean, was it was an aha moment for [00:31:35] me. Yeah. Uh, when I was in Chicago. Uh, but it was always I found it [00:31:40] difficult to explain it, much easier to show it on a pig’s jaw. So I’ve always [00:31:45] said when we do our foundation, when we do our foundation training, I’ve got as many as skills like [00:31:50] days as possible. Even with the diploma, none of our days have no hands on element to them [00:31:55] because people learn differently. Some people like to research and read things, but [00:32:00] a lot of dentists like to touch things and see things and feel things happening before they [00:32:05] will try it on a patient, which is right. I think it should.

Payman Langroudi: I asked Andrew Darwood, who [00:32:10] must have placed thousands and thousands of implants, and he said something about 3D thinking. [00:32:15] Yes, and and look, it’s all of these things. It’s all of these things. But you’d [00:32:20] be amazed.

Sumair Khan: About the availability of Cbct has revolutionised [00:32:25] implant dentistry. Definitely. And I do some GDC work, fitness practice [00:32:30] work for you as an expert witness and, uh, um, clinical advisor for implant [00:32:35] cases. Interestingly, the GDC in its like kind of revolution [00:32:40] in about three years ago, um, the guy’s name, but he’s a brilliant guy. [00:32:45] The GDC, he recruited about 20 or 30 of us who are [00:32:50] established implant dentists to be expert witnesses. So he put us through the expert witness training [00:32:55] and showed us how to write a report and stuff like that. And he’s now we get the stuff from [00:33:00] general practitioners that’s gone wrong, because traditionally they [00:33:05] would all be seen by a specialist, or those cases would be the expert witnesses would be specialists. [00:33:10] But the GDC charter or the rules, if you like, say that you will be assessed [00:33:15] or your case will be assessed by a peer.

Payman Langroudi: Oh yeah.

Sumair Khan: Someone. So you shouldn’t really have a specialist prosthodontist [00:33:20] looking at a case done by a generalist. So they recruited about 20 or 30 of [00:33:25] us and put us through this training pathway for expert witnesses. And I’ve seen a few cases, and you’ll be amazed [00:33:30] at the amount of people who will plan implants and place implants using RPGs [00:33:35] and using Pas. And I was trained in 2005, and I wouldn’t [00:33:40] want to place an implant without. Uh cbct. But you still get people teaching that. [00:33:45] You still get people on their courses teaching that it’s okay, uh, to take a PA roughly [00:33:50] measure clinically what a bone is going to be like, and then just place, place, implant immediately, [00:33:55] if you like. I just, I just medico legally. I don’t know where you stand with that level [00:34:00] of planning. I mean, it’s okay if you were trained that way and you were experienced in [00:34:05] that way. But for new graduates, a lot of the surgery will be cbct [00:34:10] and guided.

Payman Langroudi: We look at a lot of things in 2D when it’s an x ray like we were talking about, and [00:34:15] it’s different.

Sumair Khan: I mean, you can look at an OPG and we’ll see something very different than what [00:34:20] a new graduate would.

Payman Langroudi: Yeah, yeah.

Sumair Khan: Because we’ve been looking at RPGs for many, many years. Yeah. We have [00:34:25] then treated those patients who are the 3D model of that OPG. And we understand that, oh God, [00:34:30] that was this. This was that type of thing. Yeah. When you see it. But then nowadays [00:34:35] you they can’t make mistakes and medical legal climate in this that we are in now [00:34:40] in the last five years with dental law partnership and what is uh, I mean which [00:34:45] is why the insurance based stuff is like coming up so, so much because the indemnities [00:34:50] can turn around and say that wasn’t safe. We’re not they have discretionary cover. They don’t have to cover [00:34:55] you. So a lot of people are now just gone with the insurance based stuff. Do you think.

Payman Langroudi: That climate of [00:35:00] the medico legal that we’ve got here is holding us back? Yes. In [00:35:05] terms of progress, there’s no doubt trying things.

Sumair Khan: There’s no doubt. But I mean, I take two [00:35:10] cohorts a year to Cairo to place implants that are planned by a professor over [00:35:15] there and his department. Yeah. The future university in Egypt. Yeah. Uh, and these guys can go there and they can place [00:35:20] implants. They’ll get it wrong. They’ll take it out and put it in again. And the patients are grateful because they’re getting the implants [00:35:25] are free. The implants are restored by their final year, their students and their post grads. But these [00:35:30] guys can go there without that element of fear. They’ve signed up to be trainees of the of the university [00:35:35] temporarily. They pay for that, and then they pay for the implants and they they crack on [00:35:40] and they place 1015 implants.

Payman Langroudi: And like in your practice, let’s say, I don’t [00:35:45] know, 2010 or something where you had a few years of experience. Yeah, yeah. What [00:35:50] you actually take on when the medico legal environment [00:35:55] is like this compared to what it was back then? Yeah. Have you found that [00:36:00] there are times where you think, you know, if I would have done that, but the risk. [00:36:05]

Sumair Khan: Yes, the.

Payman Langroudi: Risk is too high. But legally, there’s no doubt.

Sumair Khan: That the people.

Payman Langroudi: That we go.

Sumair Khan: And learn [00:36:10] from. Nationally. Yeah. The people that come here and teach and go abroad, like the [00:36:15] Ramon Gomez made as a Palm Pilot, Cavaliers, Ricardo Gomez, they have worked. [00:36:20] They have made mistakes. They have learned from their mistakes and they have got better. Whereas [00:36:25] here we are all fearful of making mistakes and it is a throwing [00:36:30] each other under the bus type of culture that has done it. The ambulance chasers, [00:36:35] dental law, partnership, all these things have done it. And I understand that they’re trying to make things safer for [00:36:40] people. They’re trying to get people their money back because they’ve been harmed type of thing, but it’s just [00:36:45] gone too far. Yeah, the.

Payman Langroudi: Pendulum swung too far. It has.

Sumair Khan: Got.

Payman Langroudi: It’s just Ricardo Kearns [00:36:50] wouldn’t have come out with all of the innovations that he came out with. Wait, if he was working here? Wait. [00:36:55]

Sumair Khan: We are stifled. We are stifled by by the NHS. Because the undergraduates. [00:37:00]

Payman Langroudi: Because there are rules and regulations.

Sumair Khan: The undergraduates have zero exposure to tooth whitening, implants, [00:37:05] facials, anything that the patient that that brings the peoples practices. Yeah, they [00:37:10] have very limited because they are trained as undergrads to do foundation training. And foundation [00:37:15] training is 99% NHS dentistry. So all the upskilling and the [00:37:20] stuff that will enable them to grow a practice, it happens after the foundation training so they [00:37:25] are stifled till then and they are still in this environment trying to upskill while not [00:37:30] being allowed to make any mistakes or being severely punished for any any mistakes they make. [00:37:35] Do you want to talk about mistakes?

Payman Langroudi: I yeah, yeah we come, we come. Nicely [00:37:40] on to my favourite part of the podcast. So clinical mistakes.

Sumair Khan: I [00:37:45] made it easy. I had a very very difficult patient. She had [00:37:50] a, an old lady. She’s in her 60s, late 60s coming up to 17. She had [00:37:55] a, she had her upper teeth, but she had a severe class two malocclusion. [00:38:00] So her lower jaw was set quite far back from, from when she [00:38:05] was a child. She never had corrected or anything, and her lower teeth had virtually, in order to be able to touch [00:38:10] her upper front teeth, they had just extruded virtually. They were pointing out those [00:38:15] tips of the roots were just hanging in the bone. Uh, and I said to her, look, you’re [00:38:20] going to lose these teeth. I’m going to place him. We’re going to have a denture here. You’re going to find [00:38:25] it difficult. But I need to take these teeth out and put a denture in to see what the bite is I [00:38:30] can achieve and where I can put implants type of thing for you. This is like five years into it. This is actually [00:38:35] before my MSC at the Eastman. But but I took those teeth out and [00:38:40] I gave her a denture, and it was going to be at least three months before I could [00:38:45] put the implants in for those three months, she came in every week to have that denture adjusted. [00:38:50] She hated it. And you can imagine it’s a massive class to the [00:38:55] teeth are like edge like that. So she just has to touch and the denture like tips. Um, I was like, this, [00:39:00] this is awful. The day finally came, I walked in and, uh, Saturday morning, [00:39:05] was it.

Payman Langroudi: Edentulous on the.

Sumair Khan: Blower? Yeah, I made her edentulous, so she just had the lower front, like three.

Payman Langroudi: So [00:39:10] it was like a freehand. Yeah. Yeah, yeah, yeah.

Sumair Khan: So she was already on a losing battle. She was going to lose her teeth. Yeah. [00:39:15] So they finally came like three months down, almost down the line. I [00:39:20] went into the surgery on that Saturday morning. I said I can’t wait to for this lady’s implants because three months later [00:39:25] I can give her a dentures fitted or a fixed bridge. I think she wanted a fixed bridge. She [00:39:30] was set on that idea. She didn’t want a denture. And I said, that’s fine. So she comes in her first thing my nurses [00:39:35] say to me at the top of the stairs. I was like, oh, it’s like, oh my God, we haven’t got any bone. I was like, what? You [00:39:40] mean you haven’t got a bone? She goes, I’m going to buy some wire guide. I go, well, actually it doesn’t matter. She’s got I’ve [00:39:45] measured the implants so that they will fit exactly in. I don’t need and I can harvest [00:39:50] bone from her if I need to augment as well. It’s not going to be an issue. So we’ve draped the surgery [00:39:55] patients in antibiotics. Everything draped up of of numbed [00:40:00] her completely up. Opened the flap from lower right five to lower left five. Okay. And [00:40:05] peeled it back and made sure I’ve seen the mental frame and I’m nowhere near it. I’m going in between it with four implants. [00:40:10] I made the first hole and I said, right, can I have the first implant? And [00:40:15] that’s when my nurses realise they didn’t order the implants. And [00:40:20] I, they just at that.

Payman Langroudi: Moment they couldn’t find him.

Sumair Khan: They said, um, we don’t have the [00:40:25] implant. So what do you mean don’t have the implants? And they looked around and one of them started crying. The other one started, went into [00:40:30] a cupboard and started throwing out all these implants, uh, for other cases, saying, oh, we’ve got a four [00:40:35] by five, we’ve got four by ten, we’ve got a five by ten, we’ve got four by five. I said, put those back. [00:40:40] Otherwise we’re going to have exactly the same situation for next week for those cases. [00:40:45] And I just in silence. So this lady ladies are flat back [00:40:50] up and just kept thinking in my head, how am I going to word this to her? She knew something was wrong straight away [00:40:55] because the nurse was crying like crying hysterically.

Payman Langroudi: That would do it.

Sumair Khan: And I just sat [00:41:00] her up and I said, clearly this hasn’t gone the way it needed to. I’m going [00:41:05] to find out exactly why we don’t have your implants. I’m going to [00:41:10] find out what we’re. Long, and we will take measures to make sure it doesn’t happen to anyone else for you. I’m afraid you will have [00:41:15] to come back on Tuesday now, because Monday I will need to order the implants [00:41:20] and get them. And on Tuesday afternoon I’ll clear my diary. I’ll get you in. I’ll reopen [00:41:25] this place. The implants. She goes. I would like an explanation. I said, you’re absolutely entitled [00:41:30] to that as well. She went home. I turned to my nurses. I go [00:41:35] if she makes a complaint, that could end my career. And I just walked out of there. No nurse, both [00:41:40] crying by then type of thing. And on Tuesday she came back. She was fine [00:41:45] because it wasn’t that much pain, thankfully, and I just opened a flap again. Placed her for implants. [00:41:50] She’s been good for 15 years, Bob. She’s she’s had the implant bridge of lights, six [00:41:55] months a year, all paid. It’s a.

Payman Langroudi: Good story.

Sumair Khan: It’s a scary one.

Payman Langroudi: Because.

Sumair Khan: Story, it [00:42:00] tells you the importance of the team around you. Yeah. I mean, the [00:42:05] fact that they were crying meant that they knew instantly something had gone wrong. But they will never make [00:42:10] a mistake like that again.

Payman Langroudi: And, you know, a lot of dentistry mistakes [00:42:15] and errors. And these are non actual clinical.

Sumair Khan: Absolutely absolutely absolutely absolutely [00:42:20] absolutely.

Payman Langroudi: And it goes to show right that the training of your team and all of that [00:42:25] very very important.

Sumair Khan: That’s a good.

Payman Langroudi: Areas to end your career.

Sumair Khan: Yes you could. She made a complaint. That’s [00:42:30] harm that’s negligent.

Payman Langroudi: And ordering error. Yeah. Could have ended your career. Yeah. Yeah. Which [00:42:35] you know it’s sobering.

Sumair Khan: It’s crazy to think that.

Payman Langroudi: Now what did you look into or what was the error with. [00:42:40]

Sumair Khan: They both left it to each other. So I had two nurses both implant nurses. [00:42:45] Both were responsible, but they both left it to each other to make sure that along [00:42:50] with the side the lab work, the implant, the four implants were there. One of them thought the other one had done [00:42:55] it. One of them thought the other one had done it.

Payman Langroudi: But it never happened before, right?

Sumair Khan: It hadn’t. But this was, [00:43:00] say, 2010. Like I said, it’s nearly 15 years ago. So [00:43:05] it was only like five years after I had started. And this was one of my bigger cases, [00:43:10] like I said. And we had lots of cases lined up as well.

Payman Langroudi: And it’s also, you know, that perfect [00:43:15] storm of the denture didn’t go very well. Yeah, exactly. And in a way, [00:43:20] you were lucky. Yeah. Yeah.

Sumair Khan: In fact, she’s come back because she had a fall and I’ve done upper bridge for her implant bridge for. [00:43:25]

Payman Langroudi: Her as well. Okay.

Sumair Khan: So she’s come back and every time she comes in she goes, I remember what you did with that lower. And [00:43:30] my friend said, I’m mad for coming back to see you, but she comes back every year. Delight.

Payman Langroudi: Did you say something like, I’m not going [00:43:35] to charge you something like that?

Sumair Khan: No, no, I said to her, I can’t charge you any less because I’m charging [00:43:40] you the minimum already. And she said, that’s fine, but she was. I wrote her a very long letter [00:43:45] explaining how I was very sorry, and it was completely a failure of the team. I [00:43:50] hold ultimate responsibility. You mean at any point, if anything goes wrong, I’ll [00:43:55] fix it free of charge as a result of that. But luckily that’s 15 years down the line. It’s [00:44:00] a good one.

Payman Langroudi: That’s a good about what? About in your expert witness role, can [00:44:05] you can you stuff that’s gone wrong that you’ve seen? I think [00:44:10] the one of the worst case I’ll learn from you know.

Sumair Khan: So one of the worst cases. So I don’t accept [00:44:15] all cases. Uh, some of them, I’ll read the brief and said, like, this is not for [00:44:20] me or I don’t I can’t see anything wrong here. So one of the least pleasant aspects of fitness [00:44:25] practice work is when the cases you feel are not really a case. So we had [00:44:30] a guy who was sent to fitness practice because a patient had complained that he had called the practice. [00:44:35] So this guy was like me and you sitting at a computer at work. His receptionist knocked on the door, comes in and said, look, we’ve [00:44:40] got a patient on the phone who’s in pain and can you see him today? And he goes, well, what’s the problem? And [00:44:45] the guy, then she went away. She came back and said, actually, he’s had the implant in Turkey or Romania [00:44:50] or something like that two weeks ago. And now he’s got a facial swelling and he’s in pain. And this guy said, no, I’m having [00:44:55] nothing to do with it. And that patient went straight to GDC, and GDC opened the fitness [00:45:00] practice case because they felt that he had at least the [00:45:05] duty to get the patient in to see what the problem was. Make [00:45:10] sure it wasn’t a severe problem. At least give some antibiotics or refer him on to someone who could [00:45:15] help him. But he hadn’t done, even though he hadn’t shown that level of care either. But he didn’t know this patient from Adam. [00:45:20] He anyone random just calling any random practice like that. And I felt like that [00:45:25] was a bit harsh for him to have a fitness to practice against him. Because of that, that patient, [00:45:30] the receptionist, could maybe have said, look, you’re going to need to go somewhere else.

Sumair Khan: We can’t see you today. You’re going to [00:45:35] need to go to A&E if it’s severe. So those things they could have done. But the worst [00:45:40] fitness practice, um, case that was sent to me was a blue on blue. [00:45:45] Um, so this is the visiting dentist issue I told you about. So a visiting [00:45:50] dentist had come in. Very good dentist, someone I know and very well [00:45:55] now, but he was a visiting scientist. He was quite well known and renowned [00:46:00] at the time. I didn’t know him that well, so I was happy, uh, to take on the case. [00:46:05] I know, like, there was no conflict of interest. And so I [00:46:10] was surprised to see his name. Go on. I know this guy. He does. He does a lot of implants. He’s quite well known. Not seen him [00:46:15] teaching stuff like that. And he had been invited in to do a case for a lady [00:46:20] by another, a lady dentist, and that lady dentist had then [00:46:25] seen the patient post-op to take the stitches out, things like that. And the patient was complaining. They were complaining [00:46:30] that bits of the implant were visible, which can be if you’re doing tissue level. Some of the stitches [00:46:35] had opened up, which can happen to any of us post-op. It was a big case. She’d had [00:46:40] teeth taken out at the same time, which is always painful post-op. And she came back [00:46:45] maybe 4 or 5 times within two weeks to say she’s in pain. She [00:46:50] was hurting. It wasn’t nice. She’s not happy. So that dentist, the one [00:46:55] who invited the implant dentist in, told the patient to refer him to fitness to practice well, [00:47:00] and that’s.

Payman Langroudi: Throwing them under the bus. Question.

Sumair Khan: Absolutely not. Managing [00:47:05] post-op pain, not being able to manage patients expectations. So [00:47:10] there was full on the dentist part as well. Slightly. But it was like I said, [00:47:15] blue on blue. It would not have happened if they had just got together and seen the patient together and explained [00:47:20] things to the patient together. It’s majority of the issue is communication stuff. Yeah, yeah. [00:47:25] When it’s when it’s, uh, implant stuff, then the implants just fall out. So when it’s clinical stuff. So they haven’t [00:47:30] managed the perio to the implants just all fall out. There’s a guy who paid, like, 20 grand for his [00:47:35] upper and lower teeth. And after two years, he was wearing dentures and then being sent [00:47:40] for cbct been planned on an OPG and everything failed. And even on the wiki [00:47:45] you can see perio and some of the other teeth. So you think that’s that’s that’s substandard.

Payman Langroudi: Yeah. So [00:47:50] was that dentist the female dentist, was she the principal? Yes. Because, [00:47:55] you know, sometimes the nuance is so important. Yeah. And [00:48:00] sometimes, I mean, there’s nothing like your situation, but sometimes we get dentists tell patients [00:48:05] to contact us when there’s a problem with the bleaching. Yeah. And. Oh, right. [00:48:10] Okay. Well it happens. So when I.

Sumair Khan: Say when I say the team around you. Yeah. I’m not just my [00:48:15] nurse, I’m a receptionist. I work with amazing implant companies as well.

Payman Langroudi: But [00:48:20] my point is my point is so some sometimes you call up that dentist and say, hey, what’s going [00:48:25] on? Yeah.

Sumair Khan: So it’s not the dentist. I don’t think it’s ever the [00:48:30] Austin Straumann noble. Whatever system you’re using, I don’t think it’s their fault. [00:48:35] But you want their backing.

Payman Langroudi: Yes. Yes, of course, of course you want to know. My point [00:48:40] is when when I call up that dentist and say, what are you doing? Why are you telling the dentist patient, [00:48:45] contact me. Yeah. The patient shouldn’t be contacted. We do handle it. We try and make [00:48:50] sure the dentist does.

Sumair Khan: Your dentist?

Payman Langroudi: Yeah, because of that. But sometimes. Yeah. You [00:48:55] find that dentist. Yeah. Has got another problem. Yeah. With the practice [00:49:00] associate or something. And is under massive stress. [00:49:05] Yes. And you know we all know it’s a stressful job. Life is stressful now. Now the principal’s doing something [00:49:10] to that dentist or is pissed off. Anyway.

Sumair Khan: Very interesting. I was just at a talk, [00:49:15] so I went to an alumni event after 28 years back at the Barts, and there was a [00:49:20] speaker there called Gan who was talking about Black Box. He runs a company called Black [00:49:25] Box that talks about human factors, teaching human factors, and they talk about your capacity bucket [00:49:30] and, and in the morning, like waking up and there’s a bit of traffic or you’re late, someone [00:49:35] cuts you up. You’re already like on edge. On edge. You get into work and then your favourite nurse [00:49:40] isn’t there. Yeah, you’ve got a locum nurse you’ve never worked before, takes you slightly up to the edge. And [00:49:45] then while you’re doing a difficult procedure, the last patient turns back up and sits down because [00:49:50] he’s still bleeding and you’re like, the capacity bucket overflows. Yeah. And you start to lose [00:49:55] it. Then you don’t. You can’t manage other bits. So then if this patient comes [00:50:00] in he’s not happy with whitening. Then you say just call Payman.

Payman Langroudi: Yeah, yeah, yeah yeah I think that’s what happened to it. I [00:50:05] think that’s what happened. That’s exactly what happened. Very well put.

Sumair Khan: Capacity. But people need to be operating [00:50:10] at. Well, if you’ve got your peak operating like like a bell [00:50:15] curve and the top is B, you need to be operating at a most of the day. [00:50:20] And people always overestimate how much time they can work at maximum [00:50:25] capacity in the day. And you should be working at a not at the top of the bell curve because you need [00:50:30] the capacity to go up there if things start going pear shaped.

Payman Langroudi: And I think for me, [00:50:35] if you’re doing intense dentistry like you’re doing, I’d say four days, [00:50:40] not.

Sumair Khan: Yeah. Or even just do a little bit of day.

Payman Langroudi: Yeah.

Sumair Khan: Just just do one [00:50:45] intense case in a day or do two days of dentistry.

Payman Langroudi: It’s hard when [00:50:50] it’s when it’s when it’s intense dentistry. Like, I’ll.

Sumair Khan: I’ve never done it. I’ve always [00:50:55] had one day teaching. Yeah. Uh, which is like my weekend, which is my day off, if you like. Uh, [00:51:00] and I can, I.

Payman Langroudi: Can just, I can just imagine this principal’s listening to this going, shut the hell up. Yeah, because [00:51:05] everyone’s really annoyed with all these young dentists saying, I want to work two days a week, but.

Sumair Khan: They’ve got it right. I think [00:51:10] they can see our generation. Yeah. And they think, I don’t want to be stressed out like that. And yeah, I [00:51:15] still want to have hair when I’m 50. I still want to be healthy. Want to be able to like, yeah, [00:51:20] go like scuba diving or whatnot. And when I’m in my 50s, I just feel like they want [00:51:25] that work life balance and they’re right to ask for it at the start as well. And I think start [00:51:30] as you mean to go on. Yeah.

Payman Langroudi: Tell me about when you first met Jen and Kish.

Sumair Khan: So [00:51:35] Jim was my foundation dentist back in 2000, I think 13, 12, [00:51:40] something like that.

Payman Langroudi: Oh, he was your.

Sumair Khan: He was my vet and my practice.

Payman Langroudi: Okay.

Sumair Khan: And I mean, there was [00:51:45] he was quite he was a King’s guy. So he was quite full of himself. We had to take all the mirrors out [00:51:50] of practice because he couldn’t walk past them without fixing his hair. And then. But [00:51:55] he was a lovely guy. He really, really humble. And what Jen and Kish were actually [00:52:00] part of, because I was part of what everyone thought was an elite, uh, team [00:52:05] of trainers. We used to deal with the March Ummidia scheme, so the people who didn’t pass [00:52:10] their finals on time joined our scheme. So all the other trainers looked at us like, oh, they deal with the difficult [00:52:15] trainees, what they don’t realise. And what I realised when I became a training program there and ran [00:52:20] my own schemes, is that the March scheme trainees have actually [00:52:25] already are easier to teach and and progress faster [00:52:30] because they’ve already had a massive knock back lesson in resilience. Yeah, yeah. [00:52:35] So they know things don’t go well all the time. Whereas you get September trainees [00:52:40] where everything has been rosy all their lives. I mean, the first time an amalgam comes [00:52:45] out with a matrix band, they don’t know what to do.

Sumair Khan: They’re like panicking, run around the circle thinking, what’s happened here? [00:52:50] Uh, whereas these guys know things don’t go right all the time. So they were [00:52:55] very actually easy to treat in terms of their egos and their attitude. [00:53:00] They’d already taken a knock. Okay, so I felt like these guys [00:53:05] both, but they also were very driven the way, like I say, I was driven [00:53:10] because I was kicked out of my house when I finished Foundation. These guys were driven because they felt like they were playing [00:53:15] catch up. Yeah, I’ve also Shahab was one of them as well. You know Shahab very well as well. Jafari. [00:53:20] Yeah, he was one of them and Nahum was one of them as well. Nihar Patel isn’t is a now [00:53:25] teaches a PhD at King’s and ended up. Yeah. So these guys already were very, [00:53:30] very driven from the fact that I feel like they were playing catch up anyways, six months behind and they had to like prove [00:53:35] themselves. So that’s how I met them. And they have not stopped. They [00:53:40] are still just driven, very, very driven guys. Really humble, [00:53:45] really charismatic.

Payman Langroudi: Yeah.

Sumair Khan: It’s difficult to describe [00:53:50] because charisma, everyone thinks is I mean, this guy is good looking. He’s tall, [00:53:55] his ears, he’s fine. He’s got he’s got this, he does this, he does that. He’s charismatic. But [00:54:00] charisma is not about how people think about you when you walk in a room. [00:54:05] Charisma is about how people feel about themselves because [00:54:10] you’ve walked in the room. So when you walk in a room, if you’ve got that servant [00:54:15] leadership style where you’re empathetic, you’re present, you’re there [00:54:20] for these people for their benefit. That immediately gives you amazing [00:54:25] charisma and presence.

Payman Langroudi: Yeah, very good point. Very good. Because I think Majid and Kish, [00:54:30] you when you look if let’s say you don’t know them. Yeah. I mean yeah, I mean you see [00:54:35] the photos. Yeah. Well I.

Sumair Khan: Mean that’s a branding thing with appointing.

Payman Langroudi: Each other.

Sumair Khan: No socks, [00:54:40] the spiky hair and spiky hair.

Payman Langroudi: Yeah. And let’s say you don’t know them. You’ve never met them. Yeah. You’d get annoyed. You’d get [00:54:45] a bit wound up. You’ll have one. One particular angle on what’s going on. Yeah, yeah, [00:54:50] yeah. But then when you do meet them, you’re quite right. I mean, for me, the most interesting [00:54:55] thing is how serious they are. Yeah. Of course, very serious people.

Sumair Khan: Credibly driven, incredibly.

Payman Langroudi: Driven, driven, [00:55:00] kind and still.

Sumair Khan: Empathetic and humble with it.

Payman Langroudi: Great nation. Fantastic. [00:55:05] It’s a great. And they deserve the sort of the the movement they built. Yeah, [00:55:10] absolutely.

Sumair Khan: I’ve always been there for them. They’ve always like helped included [00:55:15] me when they’re doing something, uh, big or like I said, with the diploma and stuff like that where they [00:55:20] see my skill set would benefit them as well. They say, are you available? I’m always available for those guys, [00:55:25] always have an advice. And even socially, if you’re out and about, they’d always invite me. I’m a bit old now, but I still [00:55:30] rock up. Keeps you young, though, right? It does. It does serve as a foundation training job. Like every year [00:55:35] I get a new bunch of 25 to 28 year olds, 12 of them, to bring them into the general practice [00:55:40] every year. And I guess.

Payman Langroudi: Your spiky hair came from. Yeah, it.

Sumair Khan: Came from them. Yeah, yeah. Gene has cut my [00:55:45] hair once, I will admit.

Payman Langroudi: Tell me this about younger dentists. I mean, you train [00:55:50] so many of them. Do you can you spot early [00:55:55] on? Like how quickly can you spot people with with talent or with potential or [00:56:00] or am I framing it incorrectly? Do we all have talent and potential? But I think.

Sumair Khan: Everyone has [00:56:05] talent and potential. I think not everyone’s talent and potential [00:56:10] is clinical. I think some of them are more academic, some [00:56:15] of them are more social. They’ve got social skills, communication skills. Uh, some of them are, [00:56:20] like I said, more academic. They’re more into the theory and uh, and uh, and research type stuff. [00:56:25] I think it takes at least 3 to 5 years for them to work out [00:56:30] what they enjoy the most. But I said to you earlier when we were talking, I can’t imagine [00:56:35] anything worse for a dentist or a professional to wake up and go to their job [00:56:40] and hate what they do every day, especially five days a week. That would be horrible. [00:56:45] So the whole point of foundation training is to give them a taste of as much as possible [00:56:50] the NHS, a private get them involved in conferences. It’s a shame that our [00:56:55] deanery, the Thames Valley and Wessex uh area is the only one that goes to the BDA. Um, [00:57:00] this year anyway, a lot of the other deaneries see it as a conflict, [00:57:05] not conflict, uh, or like a commercial type two commercial for the NHS, whereas [00:57:10] it is the only union that dentists have. And it was actually very educational this year. It [00:57:15] was brilliant. You guys were there. We had Prof. Bartlett there and we had some fantastic speakers [00:57:20] there. Uh, from Shannon was there from uh, from guys as well. And the [00:57:25] guys. So it was brilliant. It was very, very educational as well as inspiration. And yes, they’re going to be [00:57:30] exposed to the commercial stuff, but what isn’t commercial in dentistry.

Payman Langroudi: The [00:57:35] majority are going to be business owners. Yeah, not just that.

Sumair Khan: I mean, they can’t even when they’re teaching them in the schools that [00:57:40] you can’t teach them composite and cover the computers with like a white tape to say generic [00:57:45] composite. Yeah. It ever says 3 a.m. or it says GCC or it says something doesn’t, you can’t. It’s [00:57:50] not possible to hide. If you’re going to cut teeth, you’re going to have to buy a burr from somewhere. You’re going to have to cut it [00:57:55] with like a stone and a chisel. It’s it. Everything [00:58:00] is commercial in dentistry, and you have to they have to be introduced to that in a controlled [00:58:05] way as well. Yeah. It’s, uh, it’s interesting how conflicts of interests are [00:58:10] always highlighted in favour of some people and. Yeah. And [00:58:15] rather than.

Payman Langroudi: Others. And you were saying your, your son has decided he wants to be a dentist. [00:58:20] Yeah. One of your. Yeah. Yeah, yeah. And we were talking about did you encourage that. [00:58:25] Would you encourage that. And the general doom and gloom [00:58:30] that there is sometimes and I’ve asked the question in this room from [00:58:35] lots of people, would you encourage your kids to do dentistry?

Sumair Khan: I think if they show an aptitude [00:58:40] for it so they’re actually interested in it. They are impressed by what we do. [00:58:45] They would like to be able to do that. They can see the rewards in it for the patient and [00:58:50] for you, and they are interested in exploring that. Definitely. [00:58:55] I would encourage them to go and visit. So I’ll my my son is doing work [00:59:00] experience now. He’s actually training to be a dental nurse while he’s doing his intercalated BSc. Now he’s [00:59:05] doing his dental nurse qualification so he can come and nurse with us, takes the photos of our cases and I show him what [00:59:10] I was discussing with him. So he’s getting interested and he does want to do it. The old one [00:59:15] was not interested at all. He was like he had taken photos of us doing like, uh, full [00:59:20] arch case. And he was like, man, you know, he’s like, it’s just one aspect [00:59:25] of surgery or medicine that you’re doing. There’s so much more. He was his eyes [00:59:30] were much wider field. He was. So he’s like I said, just done a master’s [00:59:35] underlain, uh, in physics at UCL and has applied to do medicine. [00:59:40] So, um, I don’t know where that’s going to go, but we’ll see. But I wouldn’t force [00:59:45] it on anyone. There are a lot of doctors and dentists.

Payman Langroudi: The enthusiasm that you’ve got, I mean, it’s clear when you talk about [00:59:50] dentistry, your your eyes light up. Yeah, yeah. What’s the difference between you [00:59:55] at 52, you said.

Sumair Khan: Yeah, yeah, yeah.

Payman Langroudi: Still trying to learn all the time. Still excited. [01:00:00] And many of us at 52 maybe stopped [01:00:05] learning at 32. Yeah. And just do the same thing every day. Yeah. And [01:00:10] you know why I think you’re right I think why why do some people really love [01:00:15] it and some people don’t?

Sumair Khan: I think you have personality types and you have [01:00:20] the culture that you’re around as well. So when you’re around young people who are learning still and [01:00:25] you can teach them and you want to learn something else to teach them as well, I think that is is a driver [01:00:30] for you to keep learning. I think definitely being able to offer your patients something [01:00:35] else and get the reward of giving them something else [01:00:40] apart from amalgam fillings, for example, like you want to be able to give them something really good that they will [01:00:45] appreciate. It’s got to be a win win win. It’s a win for you, a win for the patient, a win for whatever system you’re using [01:00:50] as well. It’s. A collaborative thing, but definitely it is an [01:00:55] attitude. It’s to do with your attitude and your zest for life. [01:01:00] And when you have to love what you’re doing, okay, I get up, I can.

Payman Langroudi: With you [01:01:05] just listening to you. Yeah, it seems to me like improvement is is a key [01:01:10] thing. Oh no. No. And you can see, I mean, even even in the five, eight years that I was [01:01:15] a dentist. Yeah, I got to a point where I wasn’t improving in particular in some areas. Yeah, [01:01:20] yeah. And then if you’re not improving those areas, you’re just doing the same thing every day. Yeah. Yeah. It [01:01:25] can get it can get terrible I agree, I agree. It took me.

Sumair Khan: A long time to start dropping bits that [01:01:30] wasn’t good at as well.

Payman Langroudi: Right, right. Um, but especially because, you know okay, you’re across three practices. You’ve got [01:01:35] the thing, you’ve got a lot of sort of different levels of things that it.

Sumair Khan: Means I’ve got people who are good [01:01:40] at the bits I’m not good at.

Payman Langroudi: Yeah, but but from the, from the, you know, when you assess your life. Yeah. A [01:01:45] lot of dentists are in one room. Yeah. One nurse who they don’t necessarily like. [01:01:50] Yeah. For the sake of the argument. Tolerate. Yeah. Yeah. They tolerate, let’s say the two of them, they like each other. Yeah. So [01:01:55] already you’ve got a situation where you’re in a room with someone you’re not particularly want to be in that room with. Yeah. Yeah. Let’s [01:02:00] say the dentist wants to do four handed and the nurse does for the sake of the argument. Or let’s say I [01:02:05] had a nurse who wanted the local radio station on the radio, or a.

Sumair Khan: Temperature cooler.

Payman Langroudi: Than [01:02:10] the temperature. Yeah, yeah. And loops would team. So you’ve got these weird, like, uh, yeah. [01:02:15] Tension already there. Yeah, yeah. Now the patient comes in and, uh, let’s say [01:02:20] you’re in a situation where there’s a third party who’s constantly telling you what you have to do [01:02:25] and can’t do. Yeah. Or let’s say you’re in a private situation where you’re not improving. You’re doing the same thing every [01:02:30] day. It keeps, you know, this question of why do dentists kill themselves? Yeah, I [01:02:35] think.

Sumair Khan: Upskilling isn’t just about. There’s a big part of it is being able to charge [01:02:40] more. Okay. So doing the higher level stuff so you can charge more definitely [01:02:45] because you want your.

Payman Langroudi: That conversation needs to be heard.

Sumair Khan: Your time needs to be more [01:02:50] money for your time as it what you’re making per hour as a foundation dentist should [01:02:55] be very different to what you’re making per hour five years later, and then five years after that, you should [01:03:00] be making more because as you get older, you can’t actually work that much. [01:03:05] You can’t put those hours in or as quickly or as quickly you can’t. I couldn’t see 30 patients [01:03:10] a day. Now, if I tried to, I think I would suffer. I mean, the moment you start upskilling, [01:03:15] you can start slowing down and charging your money’s worth as well. And and when you start [01:03:20] enjoying what you do as well, you don’t feel bad charging for the money because a lot of dentists don’t like [01:03:25] doing is talking money. A lot of dentists don’t like talking money with their patients, and they find it difficult to [01:03:30] charge. The younger generation are better at that than we are, by the way, but they still [01:03:35] will feel like unless they’re giving extra, they’re able to upskill and give more. They [01:03:40] don’t feel justified in charging more as well. So I think a lot of it drive comes from that being [01:03:45] able to justify what you’re charging and get what you’re worth money wise, because the [01:03:50] NHS, unfortunately, has not just stifled our development in terms of upskilling, [01:03:55] but it has demoralised us as a profession.

Sumair Khan: If you look at what we [01:04:00] get paid for, a silver fillings or amalgam, or even for a [01:04:05] composite or even for an endo compared to what you [01:04:10] can charge privately in Australia, America, anywhere in Europe, even in India and Pakistan, they [01:04:15] charge more for an endo. And it’s crazy. It’s absolutely crazy. [01:04:20] I mean, it’s been underfunded. A years and years of underfunding has [01:04:25] just demoralised the profession, which is where all the doom and gloom comes from. But the fact that [01:04:30] the upskilling is there so you can upsell and it’s all acceptable [01:04:35] now, it’s not seen as like you’re not seen as like an evil car salesman type of thing anymore. [01:04:40] You’re upskilling appropriate and charging appropriately for your time, and it’s not seen as a bad thing. I [01:04:45] think that has changed the generational. There has been a change that people understand.

Payman Langroudi: How do you [01:04:50] deal with the youngsters who are so scared of being sued all the time? Because I hear that a lot. Yeah, I. [01:04:55]

Sumair Khan: Do as well. And it can they can get frozen. So we actually have to stop [01:05:00] them going to the Edu and NPS coming in to talk to the FDS now.

Payman Langroudi: Because [01:05:05] it was scaring.

Sumair Khan: Them. They scared them. So they’re already scared. And then they would just do nothing. They’ll work like therapists. [01:05:10] Yeah. Like just simple fittings and scaled and polished because. Didn’t want to do anything complex. [01:05:15] Yeah. So what we’ve done is for foundation training, for example, there is a minimum standard [01:05:20] of complex minimum number of complex items they have to do before they do [01:05:25] it. So they have to do at least 12 windows, of which six have to be older windows. They have to do at least 12 [01:05:30] cast restorations of a certain foundation. Now we have this we’ve [01:05:35] had it, uh, satisfactory completion and foundation training. It was, um, myself and Liz Jones wrote those [01:05:40] requirements as a pilot first, about 2000, I think 15, [01:05:45] something like that. 14 is when it came in and it’s been mandatory now. So they have minimum [01:05:50] standards, and those are the standards that all the ORS or the POVs need [01:05:55] to meet to get onto the NHS performance list. Now it’s the same I see.

Payman Langroudi: Well, [01:06:00] we come near to the end of our time. Um, it’s been a massive, massive pleasure [01:06:05] to have the dawn of the small clinic here. I’ve been wanting to [01:06:10] have you for the privilege. I was going to ask you the same questions as we ask everyone, [01:06:15] please. Fantasy dinner party. Oh, yes. Three [01:06:20] guests, dead or alive.

Sumair Khan: Brian, would you had I had Mohammed Ali, the boxer. Uh huh. [01:06:25] Uh, just I mean, achieving what he did, having everything stripped off him when [01:06:30] he didn’t want to go to Vietnam and then coming back and then.

Payman Langroudi: And just all around.

Sumair Khan: Just [01:06:35] all around. Cool guy. Absolute legend. I had asked him winger then as [01:06:40] well, what are you, an awesome I am an awesome fan and what he did for that club is just phenomenal. [01:06:45] I mean, it’s still the Invincibles, it’s still not been done. And like I was a season [01:06:50] ticket holder that season, just absolutely brilliant, absolutely phenomenal. And in fact, I qualified [01:06:55] as 90 sixes when he joined. So because I had my career as of in the start [01:07:00] was.

Payman Langroudi: It was it was a beautiful time when the Blair government came in as well. And there was a lot [01:07:05] of absolutely positivity around it.

Sumair Khan: And then, uh, for my third person, I was I [01:07:10] was struggling, but I thought I might have Jeremy Corbyn in who? Jeremy Corbyn. Oh, Jeremy.

Payman Langroudi: Corbyn. [01:07:15]

Sumair Khan: Yeah. Just because he.

Payman Langroudi: Always is interesting. Yeah.

Sumair Khan: He always seems [01:07:20] to be standing up for the right thing. And he was also [01:07:25] ousted after being, like, labelled an anti-Semite in the media and everyone just [01:07:30] abandoned him. But he’s still there standing for the same things. And I was ousted as well when [01:07:35] I was at the, um, in the London, uh. As well. There was a lot of, uh, toxicity, [01:07:40] uh, going on when, uh, London in cases combined and I was labelled [01:07:45] as a bully and a sexist. So I made a little joke, and it [01:07:50] was just horrific. Um, what you go through when, when people are trying to oust you. [01:07:55] But I was very lucky the BDA supported me. They investigated [01:08:00] his role, and I was given an option to move, and I was able to reinvent myself back [01:08:05] as a TPD in Oxford and I’ve loved it. The culture there is so much different. And it [01:08:10] comes back to that thing about having the right culture and team around you, and that’s very, [01:08:15] very important going forward for anyone in any career to really make [01:08:20] sure you’re never going to get to a point where you love what you do and you do what you love. Unless you’ve got [01:08:25] the culture and the support and the team around you. If a team around you is toxic and just [01:08:30] self-serving Leaders rather than servant leaders, then you’re going to be in trouble. [01:08:35] You need to get out.

Payman Langroudi: And it must be a very difficult time.

Sumair Khan: It was it was very difficult.

Payman Langroudi: Would you [01:08:40] class that as the most stressful period in your work?

Sumair Khan: In my work career, yes. Apart from that time that [01:08:45] I opened that lady’s flap flap and I didn’t have the implants.

Payman Langroudi: Um, [01:08:50] the next question is a deathbed [01:08:55] question. Yeah. On your deathbed, surrounded by your loved ones? Yeah. [01:09:00] In many years time. What are three pieces of advice you would leave them?

Sumair Khan: So [01:09:05] first and most important is what my dad said to me many [01:09:10] years ago. And that is just get good at what you do. Don’t chase [01:09:15] money. Don’t get good at something because it will make you money. Get good at what you do and the money will [01:09:20] come. The second thing would be to get into a position [01:09:25] where you’re blessed enough to do what you love, and love what you do. Exactly what Steve [01:09:30] Jobs said is, the only way you can do good work is to love what you do. And the third thing is to [01:09:35] be don’t be afraid to make mistakes, because when you make [01:09:40] mistakes, you learn from them. And. Learning from [01:09:45] mistakes is how you get better. The difference between a novice and an expert. I tell this to [01:09:50] my implant trainees as well, is that the expert has tried and failed more times than you’ve [01:09:55] even tried. Okay, and I’ve had to deal with that failure. And that’s why I’m an expert, because [01:10:00] I’ve managed it. So don’t be afraid to fail. That’s how you grow.

Payman Langroudi: Continuous growth. [01:10:05] Word. That word. Experience. It’s all about mistakes. Absolutely. [01:10:10] That is what experience is.

Sumair Khan: Experience equals mistakes. Mistakes equals experience. That [01:10:15] Dunning-Kruger thing. I’m now climbing the second curve that comes up where you are [01:10:20] more cautious about what you take on, but you are much more come from a position of experience, of lots [01:10:25] of failures.

Payman Langroudi: How would you like to be remembered?

Sumair Khan: As a servant leader, [01:10:30] as a leader who inspired and helped [01:10:35] other leaders to grow to where they are now, like Jean, like ish, like Nihar Patel. You know, just [01:10:40] someone who they look back and when they think about or who helped them in their career, they go, [01:10:45] oh, it was him or someone. When they’re teaching a certain technique, the way you raise a flag like, oh, Doctor [01:10:50] Khan used to teach this, or Doctor Khan taught me this back in the day. I hear it sometimes and I hear my [01:10:55] my previous PhDs who are now trainers themselves when they’re talking to their trainees, [01:11:00] and they say that thing like the three certainties in life death, taxes. And I know [01:11:05] they got it from me. So I love I love just hearing that. I like inspiring future [01:11:10] teachers and future leaders as well, even if they’re just learning from my mistakes. Because I’ve got [01:11:15] like I said, I’ve I’ve been loud, I’ve been brash, I’m a type A or [01:11:20] Red personality and not everyone can work with that. So at times I’ve made mistakes. I swear [01:11:25] quite a lot when sometimes when I’m teaching, I’m quite aggressive. Like when I was at Barts [01:11:30] and the London, it was called Khan’s Kitchen. I had the, the what’s his name? [01:11:35] Gordon Ramsay style of teaching. So it was, it was just what those trainees [01:11:40] needed at the time. But now it’s very different.

Payman Langroudi: So after that incident, did you now did you have [01:11:45] to start worrying about your style of teaching or.

Sumair Khan: No, [01:11:50] I what I did is I developed, I had some coaching. The good thing about what hap [01:11:55] came out of it is they, they paid for these top um coaches to come in that deal with NHS [01:12:00] consultants. So they paid for me to have some coaching sessions. And I’m really, really [01:12:05] good coaches. And they taught me about emotional intelligence, personality types and [01:12:10] and that’s where I learned all this stuff about empathy, servant leadership and things like that. [01:12:15] And then I did a coaching and mentoring, um, degree in uh, coaching, mentoring and leadership [01:12:20] qualification as well with the Chartered Management Institute. But it is [01:12:25] absolutely amazing how many people get into those high positions and [01:12:30] have no idea how to actually be a leader and how to inspire the people around them [01:12:35] that all about themselves. It’s they’re still like just like an [01:12:40] inward facing rather than outward facing. And you can see the cultures in like [01:12:45] in some top NHS places as well, where it’s very toxic. [01:12:50] And it’s because the leaders don’t understand servant leadership.

Payman Langroudi: Institutions lend themselves [01:12:55] to these sort of problems.

Sumair Khan: Politics wherever there’s money.

Payman Langroudi: And yeah, but even [01:13:00] in a dental practice, you’re leading a dental practice. Yes. Of course. Yeah. I mean, even even leading [01:13:05] a small company like this one. Yeah. There are things that I’m good at. There are things that my partner [01:13:10] is good at. You build on each other’s. Yeah, but but but you know, this course that you’re talking about. Yeah. [01:13:15] I reckon I’d really benefit from that. Definitely. You know. Absolutely. There are times where I put my foot right [01:13:20] in it in communication. Absolutely, absolutely.

Sumair Khan: That’s there. I mean, if I could say a fourth [01:13:25] thing, my deathbed, I’ll say learn how to communicate with everyone. Yeah. Because [01:13:30] there are lots of different people. They all communicate differently. People have different backgrounds, upbringings, [01:13:35] just learn how to not just communicate, but properly on a level, touch [01:13:40] everyone’s lives positively. Because that’s what people will remember. You is what change [01:13:45] you made in their lives, how you touch their lives. If you made it better, if you made it worse, and [01:13:50] going around making people’s lives worse, that’s just toxic behaviour. You don’t [01:13:55] want to be remembered like that, that’s all.

Payman Langroudi: Will you look back on your career? If you had to think of maybe [01:14:00] one incident one day that you felt like was best. What [01:14:05] comes to mind?

Sumair Khan: Well, my first son was born. Definitely. Your first son was. Yeah. [01:14:10] Yeah, absolutely. Absolutely. Because I knew it would change the dynamics for me at work, for me in my [01:14:15] life, for me, in my my responsibility wise in terms of growing up, but [01:14:20] also for my parents. Like I said, they were already.

Payman Langroudi: I found I found that very difficult, but it was.

Sumair Khan: Difficult.

Payman Langroudi: But [01:14:25] but I mean, on that day, I found that day difficult, I didn’t already. Yeah, yeah, I said that. [01:14:30] I said that on episode one and my, my son listened to it three years later, I [01:14:35] had to apologise to him. But no, I mean, you worked life in your work life. What was the. [01:14:40]

Sumair Khan: The best day in my work life?

Payman Langroudi: What comes to mind? Oh, God.

Sumair Khan: Ah, [01:14:45] there were so many great days in terms of clinical practice. Like I said, [01:14:50] fixing things that have gone really wrong for people. So one of the best days, very [01:14:55] like a lady who had come in, she has got this hydrocephalus. This on my Instagram, this, [01:15:00] this. She’s got hydrocephalus. She’s got very smaller jaw and she’s got tube coming out [01:15:05] that drains this, um, excessive CSF. And she had been fitted with some implants. [01:15:10] Her lodge was very crowded, very retro, um, retro kind. And her upper denture [01:15:15] that she came in with, it would walk in the door before she did. It was that far [01:15:20] forward, her lips thing come over it fully. It was really bad. And she had had it fitted 18 [01:15:25] months ago. So 18 months she’d been a pariah in her room, scared to go out and practice. [01:15:30] And her mum and dad, her mum had come in with her. They couldn’t afford [01:15:35] the new implants or anything like that. So I had worked with the implants that she had had, and it was a specialist practice [01:15:40] in Essex that had done this for her, and she’d been back at least six times to try and have the [01:15:45] denture adjusted and stuff.

Sumair Khan: It wasn’t right. So I managed to give her a fixed [01:15:50] upper bridge with the teeth in the right place for her to be able to close the lips over it and smile. And [01:15:55] just the look on that lady’s face and the tears in her mom’s eyes up for me. Like this. [01:16:00] This is what? This is why I should be an implant dentist. This is why [01:16:05] I’m glad I got to a point where I could do that for that person, not refer her to someone who [01:16:10] could fix it for her. I could be the person that fix that for her. And it’s [01:16:15] immensely rewarding to see patients win like that. And it’s not about like, [01:16:20] disrespecting the what the work that had been done before. It clearly wasn’t what that patient [01:16:25] needed or wanted or could live with. And I could give her something that she could live with, and it just changed [01:16:30] her whole face. But her mum took from the way she was crying is like as well. I was like, wow, okay, [01:16:35] this is special. This is special.

Payman Langroudi: Sometimes, you know, we’re guilty of not remembering [01:16:40] because we’re so in it. We’re guilty of not remembering. The teeth are stuck to people. Yeah, that’s right. Changing [01:16:45] lives. Especially in implant dentistry. Maybe you’re giving someone a chance to kiss [01:16:50] for the first time.

Sumair Khan: Just go out and eat and eat.

Payman Langroudi: Exactly. You know, the lives [01:16:55] question of it is what? I constantly have this conversation with my marketing people to say that, you know, [01:17:00] you can talk about teeth, you can talk about the colour of teeth, but they’re stuck to people. Absolutely. Tell those. Absolutely. [01:17:05] That’s the most.

Sumair Khan: Important part, isn’t.

Payman Langroudi: It? It’s been a massive pleasure, mate.

Sumair Khan: Thank you so much, Dawn.

Payman Langroudi: It’s [01:17:10] been an absolute pleasure to have you. Thank you so.

Sumair Khan: Much for coming. Look after yourself. Thank you. Have a good day. [01:17:15] Thank you.

[VOICE]: This is Dental Leaders, [01:17:20] the podcast where you get to go one on one with emerging leaders in dentistry. [01:17:25] Your hosts. Payman [01:17:30] Langroudi and Prav Solanki.

Prav Solanki: Thanks for listening, guys. [01:17:35] If you got this far, you must have listened to the whole thing. And just a huge thank you both from me [01:17:40] and pay for actually sticking through and listening to what we had to say and what our guest has had to [01:17:45] say, because I’m assuming you got some value out of it.

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