At LCIAD, we are known by our colleagues for the quality, breadth and completeness of our consultation, reporting and consent process.

In late 2019, we teamed up with Dentinal Tubules, the UK’s premier online dental education portal to record our new patient journey in detail as a guide to the profession. The 8 part series * was launched in December 2021 and has already clocked up over 1,250 views.

We have honed our consultation method over many years to ensure that our patients received complete and documented reports on the conditions of their dental health. It is our duty to inform every patient of their current and potential future problems in the same way that we would wish to know. Timely prevention of potential future problems can save much time, money and discomfort later.

We spend a great deal of time and thought to complete this detailed process and we are delighted that Dentinal Tubules has chosen LCIAD to show our workflow and present our ethos to the profession.

Colleagues can also attend our expanded 2 day course on consultation, treatment planning, fee setting and the consent process at LCIAD Academy.

*(Dentinal Tubules subscription and login required)

Shiraz Khan’s philosophy on dentistry, getting into breaking and the power of exercise when working in the profession.

Taking up breaking may well be one step too far in any dentist’s move to boost lost activity levels in a profession known for its sedentary drawbacks. But for Shiraz Khan, his wellbeing ‘win’ is, in essence, all in the spin.

Shiraz is widely considered ‘one to watch’ among the younger cohort coming up through the ranks of dentistry. But his passion for the power of exercise is just as noteworthy.

As an accomplished competitive breaker, he takes seriously that simple principle that physical wellbeing is a vital component to achieving good mental health.

In a profession often beset by burnout and stress, Bboy Khanage (Shiraz’s breaking alter ego) is his route to redressing dentistry’s work-life imbalance when the burden of clinical work tips the scales in an unhealthy direction.

His breaking sets (you can find them on Youtube) are a sight to behold. They are all the more impressive considering the training and rehearsal they require. And which he fits into a hugely busy career.

Who is Shiraz Khan?

Shiraz graduated from Birmingham in 2013 but has already built a portfolio worthy of a practitioner beyond his years.

Within less than a decade, he has returned to studies for a masters in restorative dentistry. As well as founded Sculpt composite (an innovative online learning programme) and put his name on the map as a much-respected and accomplished aesthetic dentist.

A multi-award-winning clinician, he is director of the Young Dentist Academy. This is a body that offers high-level, top-quality masterclasses to those eager to excel.

Shiraz is a firm believer that exercise plays a key role in the successful pursuit of a fulfilling career. In fact, he goes as far as to suggest that he would be a poorer clinician without out it.

The ability to regularly exercise has, he says: ‘Categorically made me a better clinician’.

‘It is well documented that, if you are at a higher level of fitness, the ability to cope with the stress, strain, plot or mechanism is significantly improved.

‘It improves cardiovascular performance, which means your body is better equipped to pump blood round the body to the brain to come up with logical decisions.

‘Being able to regularly exercise, release endorphins, work the body and get the blood pumping massively increases your aptitude and your ability to cope with stress and difficult decisions. Especially when things are not going your way.’

Breaking in

Whilst admitting he is: ‘A little more creative than the routine gymgoers out there’ (he does this too by the way), he finds breaking: ‘Strangely enjoyable and addictive’.

He was always active and into his sport – cricket, football and basketball. But began breaking in 2007, which he says was ‘late to the game’.

At university he was searching for an outlet to stay active. He found training for other sports too rigorous to slot into his educational timetable. But was inspired to take up the hobby when he saw a street dancer performing in Birmingham town centre. The rest is history, he says.

A former medical science graduate, his father later suggested he stop that ‘rolling about stuff’ when he returned to study for his BDS after a year’s break.

But instead of the comment wrong-footing him, this was, he says, a moment of reckoning. He realised it was because he enjoyed breaking away from his studies that he was able to perform well educationally.

Synergy between dance and dentistry

Roll on a few years, is there synergy between the creativity in his dance and that of his dentistry?

‘With dentistry, although there is a heavy focus on its scientific aspects, there are elements of it where we can express our creativity.

‘But I am the kind of person who needs spontaneity in my life. The more we strive to improve and better ourselves, the more funnelled our lives become in terms of time commitments and in terms of being able to be spontaneous.’

So when life becomes prescriptive, that’s where an hour of breaking kicks in for Shiraz. And without the constraints of dogmatic thought required by his clinical craft.

He admits: ‘Of course, training is systematic. In terms of endurance training, strength training and rehearsals, so there is a science to it.

‘But I have become slightly less competitive in the last few months. This has given me a chance to be free and enjoy moving around. Which also gives so much solace to the mind.’

‘It’s all about the ebb and flow’

He suggests that when facing a seemingly unsolvable problem, that walking away and doing something ‘completely off-piste’ can empower us all to better deal with the challenges we face.

Breaking quite simply takes him out of a profession that is insular. With a constant cycle of patients, lectures, conferences and so on.

‘Just getting blood through the muscular channels and veins and feeling awful for it at the time, but fantastic for it weeks down the line,’ can make a huge difference he says.

And his advice to others in need of that all-essential resetting of the work-life balance? ‘We are all in search of the big “haymaker” type steps that are going to change our lives. But they don’t exist.

‘It’s all about ebb and flow. You have to accept at certain times that you will have much more clinical commitment or business commitment.

‘But, if you have a baseline core of things that you have to do in a week – squeezing in a gym session, for example – eventually you keep ebbing away to find that model.

‘It is the sum of incremental changes that creates a massive change.’

This article is published in Dentistry.co.uk. You can find the article here.
This article is written from an episode of Dentology podcast featuring Dr Shiraz Khan that is one in a series in which Frank Taylor & Associates’ Chris Strevens and Andy Acton discuss with their special guests ‘all things non-clinical in the dental world’.
You can view and listen to this and more episodes here.

Why is dentistry so expensive?

The very simple off-the-cuff answer is because the provision of private, quality, healthcare, be it dental or medical, is “expensive”. Everybody knows this. But what is expensive?

What is “Expensive”?

If I said that a chersonese costs £10,000 is this expensive? If a chersonese was a cup of coffee, then yes. Nobody (apart from possibly an exceptionally ardent coffee aficionado) would pay that for a cup of coffee. But if it is a land peninsula of several square miles that may allow multiple housing developments by the sea, perhaps it is a bargain.

One person’s expense is another person’s value.

Nevertheless, this is the question we get asked most.

• “How much will this cost?”

Worryingly this is asked far more often than other question. Even more than “Will this hurt?” (the answer is no). But nobody asks, “What do I get for that?” Nobody, in 30 years, has ever asked me this question. I find that fascinating. What exactly do patients think they are getting for the fees they pay that makes them feel that dentistry is “expensive”?

Is this question based on absolute costs or perceived value? Is a patient able to make a judgement on value unless they know what their fees include?

This article is to provide some information and food for thought as to why dental surgeons charge what they do. I speak from a position of owning a fully private referral practice in London’s West End, the roots of which were planted 23 years ago in central London. But the principles are the same for any practice anywhere. (Before you mention NHS practices, there is not a single NHS-owned dental practice in the UK. Every single one is a privately-owned business that receives most of its income from NHS government contracts. The laws of capitalism and market forces are still applicable to every “NHS” practice for their outgoings, only their scope of practice and income is regulated and capped by the government).

The reasons for the fees we charge may not be immediately evident to our patients. This blog article explains these reasons. Our hope is that when our patients see what these costs include, they will understand what cannot be left out if they are serious about their dental and general health. There will always be some dentists or huge multichair practices providing cheap dentistry around the world, for a while. But most will be unsustainable because either their low quality will lose them patients (or their careers) or their businesses will not be able to thrive long term.

What a patient pays for dental treatment covers the following:
• Business overheads,
• Level of experience, scope of work and quality of care,
• Service and peace of mind.

Let us look at each of these:

Business Overheads

Fixed overheads

It is a boring but inescapable fact that every business has overheads that must be met, from the local sandwich booth to Google HQ. Where a dental practice is situated will obviously affect this. A practice in a rural town or village will not have the same overheads as a central city practice so their fees can be lower.

Fixed or static overheads include rental or mortgage on a property, business rates, key staff salaries who not only work chairside but also in the background to prepare before you arrive and tidy up after you have gone, utility bills, loan repayments for setup and upgrade costs (presuming you would like a modern, safe and fully equipped state of the art environment for your care), technical and computer equipment and software subscriptions that must be kept up to date, insurance, uniforms, cleaning and laundry, compulsory professional subscriptions, accounting and bank charges, clinical waste collection, – everything that costs money to have a dental practice, or indeed any business, and keep it running day to day regardless of whether patients attend or not. Between 2010 and 2020 this made up around 60% of our practice costs as an average. We would obviously like to keep these overheads lower, but we rarely have a choice in making significant changes to them.

Variable overheads

Variable overheads are those associated with business activity, in our case, seeing patients for dental care.

These include consumable materials costs, laboratory fees, additional staff salaries as business activity grows and more patients are treated, up to a maximum capacity allowed by chair time in the practice.

Let us put one myth to bed. Dental fees have very little to do with the cost of materials. Dental materials including dental implants are around 9% of our costs on average over the last 10 years. So, the old excuse of “using better materials” to inflate costs carries little value. This is only a small part of your fees and the difference between the cheapest and best materials is a small fraction of costs.

Laboratories, however, vary greatly in quality and with good reason. An experienced laboratory and technician team has a unique skillset that is developed over may years. To be able to design and manufacture good laboratory work that looks natural and stands the test of time is a separate art and science about which a separate article can be written. We do not cut corners with laboratories. Cheaper laboratories cost far more in the long run than the savings they may initially provide.

These variable overheads make up around 20-25% of our overhead costs reflected in what we charge for phases of treatment.

What is left?

These overheads constitute 80-85% for running costs on average over the last 10 years. This has increased in real terms for us from about 66% ten years ago.

This is before tax. If we remove tax, this means that around 10% is left. This pays for the final aspect, which we think you might feel is quite important:

Level of experience, scope of work and quality of care, service and peace of mind

So about 10% of your fees goes towards the commodity that is the most hugely undervalued: The dental surgeon’s time and knowledge and skill. Time is the only irreplaceable resource and usually the least valued. Patients tend to think of only paying dentists for the dentistry they physically do at the chairside, as if we sold dental items like a trader. They ask, “How much is a crown?” or “How much is an implant”. But this not how we work in reality. We don’t sell items. This is the remnant of a national tickbox healthcare system where items are arbitrarily costed against a budget for bureaucratic or insurance purposes and listed like a commodity but have little relationship to actual costs. Our time is the most costly asset, not items of treatment.

Patients, overall, do not pay for our time away from the chair planning their care. Every hour of dentistry requires an hour of administrative time. This is expected for free. How much would a patient expect to pay a barrister for the same amount of time we spend planning? To get an idea of this, please see our video from our website on what happens after your consultation. Yet dentists are not remunerated for this most priceless of commodities. Would you pay a builder before paying an architect first? Yet that is how most patients see the dental surgeon. The builder and not the architect. The architect side is expected for free. Often this means the building side costs more, both financially and biologically, due to errors. This is why we charge additional fees for full dental reports for patients with more complex issues that require much thought, planning and collaboration with multiple parties involved with your treatment.

What is the value to you of the following?

• knowledge accumulated over 5 years at dental school and years of clinical practice including specialist training,
• extensive experience,
• diagnostic skills,
• dedication,
• service,
• manual skill,
• stamina,
• patience and ability to listen and empathise,
• responsibility for our decisions and advice,
• organisation,
• accountability,
• diligence,
• sound advice,
• looking after your general health and safety,
• time for clear thought,
• time for reflection and self-evaluation,
• continuing personal training and development via a multitude of resources including travelling to conferences and seeing and discussing advances in our profession with our colleagues,
• compliance with a multitude of ever increasing and costlier regulations,
• time spent thinking and planning on your behalf to organise your care in a way that benefits you for the rest of your life, usually at weekends and evenings when we should be with family,
• everything else that goes into your long-term genuine care.

What is the value that gives you, our patients, the feeling that enough time is allocated to really listen to you, address your concerns and give you real peace of mind for the long term that your dental care is in the hands of professionals with your best interest at heart and who proudly put their name to your dental care and results achieved?

As we plan and carry out your work, we make literally hundreds of observations and decisions based on our knowledge that most patients do not appreciate. How does one put a price on this level of personal dedication, one of the most labour- and skillset-intensive professions in the world and certainly one of those with the highest problems with mental health and suicide rates, to call it expensive?

What happens when you ask for a fee reduction or discount?

THIS is what is most often cut out when patients complain that fees are too “expensive”. The automatic tendency of a professional to give a discount not to “lose” a patient comes from their own slice of the pie. Their own time and remuneration. Nobody else invoicing a dental surgery will reduce their fees for the patient to be able to pay less or the dental surgeon to earn more. The reward for being someone that carries the full ethical, moral and legal responsibility of your welfare and maintaining a compliant practice that caters to your dental problems is around 10% of your fees and this is normally what is discounted when a patient complains that their treatment is too “expensive”.

When you pay £1,000 to a dental practice, your dental surgeon would normally receive around £100 net. Outside city centres where running costs are lower, this may be £200 or even occasionally as much as £300. But statistics from practice accountants and practice sales teams up and down the country suggest that there are very few that achieve this figure, or better, consistently.

Most dentists have seen a real terms cut in their income of around 30% over the last 10 years whilst overheads and time spend in administration have doubled.

Dental surgeons are not expensive. They are often the least costly aspect of your dental care but carry the greatest burden of responsibility. One error can spell the end of their careers due to the current litigious nature of healthcare in this country which is the most litigious in the world, even more than the US.

Dental care is costly. Running a modern, compliant business that enables us to provide the immense skillset that we train for and love to do, with adequate allocated time to do a correct job in an environment that makes you feel cared for, is expensive, not just for you, but also for us. This is the same as any quality business that has trading facilities and face to face contact with their clients.

But for those that can benefit from what modern dental care can provide, only a tiny percentage claim that we are “expensive” at the end of treatment. They then understand the value and realise that as with all things in life, quality has a hidden cost and cutting corners by trying to do things cheaply often has a much higher cost. One of our patients once said “There is nothing more expensive than cheap dentistry” after having had work done cheaply but poorly abroad that required extensive revision. Not just financially, but biologically and time-wise.

Prevention is always better than cure. Paying a hygienist to look after your teeth every 3-6 months is infinitely better value than neglecting everything until thousands of pounds of dental work is required. Yet over 50% of the population still do not see a hygienist.

Dentistry is not expensive. Dental neglect is expensive.

Quality dental care may just be the best value for money you ever receive.