Prepare to elevate your prowess in cosmetic dentistry, as we introduce our distinguished guest, Richard Coates, a renowned member of the British Academy of Cosmetic Dentistry (BACD). Dive into the intricate details of Richard's forthcoming workshop at the BACD annual gathering, as interviewed by Sam Jethwa. Drawing from his vast experience, Richard unveils the artistry behind perfecting a single composite veneer. He underscores the essence of understanding a tooth's form, hue, and contour, and imparts wisdom on replicating nature's beauty, emphasising texture and opacity for realism.
Journey with Richard, through his conversation with Sam, as he reflects on his rich history in dentistry, touching upon the monumental shifts he's witnessed over the years. He points to the pivotal role of clear patient communication and his unwavering commitment to meet their expectations by managing them realistically. Experience hands-on learning in Richard's session at the BACD event and ascend to new heights in your dental proficiency. Hurry, though, as availability is limited and slots are filling up swiftly.
Immerse yourself in Richard's dental universe, absorbing his tried-and-true methodologies. Seize this chance to be mentored by a master and amplify your expertise in cosmetic dentistry.
For the video versions of all BACD Podcasts head to https://youtube.com/playlist?list=PL_QEFI0rmiaNYJmACUGLq8Re3uZ0icAOU&si=qw2NCg1iBZ7iKBkU
Prepare to elevate your prowess in cosmetic dentistry, as we introduce our distinguished guest, Richard Coates, a renowned member of the British Academy of Cosmetic Dentistry (BACD). Dive into the intricate details of Richard's forthcoming workshop at the BACD annual gathering, as interviewed by Sam Jethwa. Drawing from his vast experience, Richard unveils the artistry behind perfecting a single composite veneer. He underscores the essence of understanding a tooth's form, hue, and contour, and imparts wisdom on replicating nature's beauty, emphasising texture and opacity for realism.
Journey with Richard, through his conversation with Sam, as he reflects on his rich history in dentistry, touching upon the monumental shifts he's witnessed over the years. He points to the pivotal role of clear patient communication and his unwavering commitment to meet their expectations by managing them realistically. Experience hands-on learning in Richard's session at the BACD event and ascend to new heights in your dental proficiency. Hurry, though, as availability is limited and slots are filling up swiftly.
Immerse yourself in Richard's dental universe, absorbing his tried-and-true methodologies. Seize this chance to be mentored by a master and amplify your expertise in cosmetic dentistry.
For the video versions of all BACD Podcasts head to https://youtube.com/playlist?list=PL_QEFI0rmiaNYJmACUGLq8Re3uZ0icAOU&si=qw2NCg1iBZ7iKBkU
Welcome to the official podcast of the British Academy of Cosmetic Dentistry. Whether you're a seasoned dental professional, an eager student or simply someone curious about the intricacies of cosmetic dentistry, you're in the right place. Here at the BACD, we bring together the brightest minds, groundbreaking research and innovative practices from across the UK and beyond. In each episode, we aim to delve deep, offering insights, sharing stories and demystifying the beautiful world of cosmetic dentistry. I'm Simon Chard, president of the BACD. I'm thrilled to have you join us on this enlightening journey. Let's dive right in.
Speaker 2:Hi Richard, thank you for joining me on this BACD podcast.
Speaker 3:Absolutely pleasure, sir.
Speaker 2:Good to see you Before I introduce you and say you know it would be a long list of introductions, but take the whole podcast. I know, but let's introduce yourself and we can then move on with what we've got to talk about today.
Speaker 3:Yeah, my name is Richard Coates. I'm a cosmetic dentist and general dentist working in Sunderland in the northeast of England. I've been involved with the BACD for a lot of years now and one of the accredited members of the British Academy and also working towards American Academy accreditation at the moment.
Speaker 2:We really can't. You've underplayed that, because BACD accreditation is not an easy feat and it's incredibly difficult to achieve. So we obviously congratulate you, and we do. We're very grateful for all of our accredited members Everybody listening. My name is Dr Sam Jethua. I'm a board member at the BACD and I'm currently the vice president at the Academy, and we're incredibly proud to have Richard not only as a friend and a colleague in cosmetic dentistry, but also somebody who's presenting at our annual conference. Now I have first hand sat in Richard's lectures and hands-ons and it is second to none, so I think you're in for a treat. So, richard, regarding your hands-on at conference, yes.
Speaker 2:What is it that you are planning to give to the delegates who are coming to spend some time with you there?
Speaker 3:Many of the hands-on courses around the world and I've been on many focus usually on a fractured single tooth. I'm going to teach people how to rebuild a tooth, but not just the fractured single tooth. I'm going to focus on one single composite veneer, which means I'm going to have to cut an awful lot of teeth myself because there's no preformed teeth in that kind of shape. But I want to create a situation where we can actually rebuild one single veneer tooth that's already got an incisal fracture on top of that as well. So there'll be a mixture of skills in mixing thicknesses of composite, multi-layering, composite stentene enamel. I'm going to bring into it highlights and also translucency. I'm going to emulate nature completely by recreating nature using composite. I've only got a three-hour window per set of delegates, but in that time I'm sure I can give enough hints and tips that they can all take them back to their practices and institute them to create some really marvellous effects.
Speaker 2:So, richard, you mentioned emulating nature there. What is it that? Because I've seen your work and it's exemplary and you really couldn't tell that there's restoration there. I know this is what the hands-on is going to be about. It's what they need to do in our practices, or what we can do in our practices to try and replicate that kind of work. But are there a couple of tips, like very short top three things or so, that you would always recommend in terms of before you go in and place this composite, what are the things that you always look for in order to emulate nature? Is it translucency, the texture? What are the game changers that, would you say?
Speaker 3:The game changers are. You've covered that pretty well Sam.
Speaker 3:The tooth has to have, rather than the single layer composite that you'd usually use and were taught to use at dental school. If you just start thinking and strip everything back and create the enamel shades where the enamel ought to be and in the same thicknesses the dentine certainly if you've got a fracture tooth where there's a transitional line between the fracture and the actual restoration, that has to be a dentine shade that's opaque enough. Most of the single composites aren't opaque enough. You have to have a specialist dentine to actually merge onto that fracture line and that gets rid of it visually. After that you're building the translucency.
Speaker 3:One of the main things is if you get the actual form of the tooth, that's, the shape of the tooth is what I call primary morphology, the folds within the tooth, which are the line angles and the mamalong grooves. Secondary morphology If you look at a tooth and you're copying the tooth next door, you want to copy the texture of the tooth as well. If you look at some of the greatest mimics in the world, or your cuttlefish, your octopus, if you actually look at some videos of them, they don't just emulate colour, they emulate the texture, particularly octopi or octipides, depending where you are on, green or Roman, you can actually emulate the actual texture as well as the colour. It disappears, it disappears. It disappears as well.
Speaker 2:So really it's an understanding not only of form and shape but also material colour, so hues and chroma, and the internal structure of the tooth itself. So there's a lot to go through and there's a lot that they're actually going to take away from that session, I think.
Speaker 3:There is. I could lecture on this for days. Obviously it's a hands-on session, so I'm not going to bore everybody with a finding of everything, but I want to make it a completely practical exercise. I'm going to sit at the front and I'm going to go through each stage step by step, so nobody is left behind and everybody has plenty of time to work. I'm going to create some stents, some incisal edge stents. I'm using more rather than silicon putty stents. I'm using a lot of very, very rigid stents these days that are fluid to start with, and then you get the creation of the polyethylmorphology.
Speaker 3:First, everybody's seen kind of guys saw this. They'll build things up from scratch, or I want to show how you can actually get that. It's not just a fracture tooth. We're doing. This is veneers. Equally, it's not an easy, quick fix. This is going to be how you can create world-class restorations and the patients will pay for a world-class restoration and the time it takes.
Speaker 3:I'm slow dentist, I'm not a fast dentist. I don't use the word speedy in anything that I do and there's certainly a place in our market for that kind of thing. But people who come to my courses nobody will be ridiculed. They're going to be an absolute safe space. There is no stupid question, because I've asked most of them in the past, so there isn't a stupid question that anybody can ask during the course. I can't be offended, so I'm just one of these guys that everything bounces off so anybody can ask me anything, and I'm really looking forward to getting everybody in the room so they can ask every question, from people who are inexperienced and want to learn the master craft to people who are already doing some masterful work and actually just want to get better.
Speaker 2:That was what I was going to ask you. Next actually is who would be best suited to come along to that? And it really is as wide as that, isn't it? Because I've seen you do that in the past and one of the things that's really quite amazing is you can be great at the work, but teaching it is different, and what you do is you manage to break it down so that anybody can really follow the steps. So, whether you have a workflow, you can introduce new bits into that or modify what you're doing, but also, if you are new to it, you can actually implement the workflow straight away on the Monday when we go back into practice. So I think it will apply to everybody.
Speaker 3:Yeah, everybody learns differently. I've learned from the masters in the world. I've spent a lot of time travelling around and if I can just go away with one or two significant tips from any of their hands on courses, I take those away with me and I institute them instantly into practice. I'm not going to go along to a big format, of course. I'd rather learn key tips of some of the real world masters, I hope. If anybody takes away one or two tips from my course, well, of course I'd be super proud that they're actually improving their dentistry. Absolutely yeah, it'll be a good day.
Speaker 2:Your seminar is focused not only on incredible clinical practice. I mean, you practice nearly every day of the week, I believe, and you still are teaching as well on top of that, plus what was your now the AACD accreditation which you've already been doing I mentioned.
Speaker 2:That's not an easy thing to do. To achieve so much with dentistry. There's got to be a drive. There's something that's kind of driving you to achieve all these ambitious things and actually get there to the end. What would you say? Yours is what's been your kind of background to lead you to where you are now.
Speaker 3:If I see it with the dentistry that I learned to dental school and stuck with it and I did for a while while I sort of perfected what I was gonna do then.
Speaker 3:Now I thought how am I gonna improve things? And I'm a traveler, I like traveling around. So it was a great excuse to go to Europe to start, where the UK first, and then I expanded to Europe. It gave me opportunity to travel. And then the more and more speakers I saw and I was coming back to work thinking, okay, I need to institute this now. And that sparked my interest.
Speaker 3:I never look at what I'm doing and think, well, we are there, now I look at something and say how can I actually improve what we are doing? And that drive creates motivation and I love my job. I love my job because I probably change it on a daily basis and I'm always looking for something new to learn and I hope the guys certainly people who turn up to the BA CD they've got to have a similar mindset where they can actually change up what they're actually doing. The digital formats are now coming through. I mean, dentistry is so exciting. I feel a little sad I've probably only got a decade left and it's like I wanna know what's gonna happen in 20, 30 years time. But certainly, if you stick with what's new and what's right at the cut edge, you'll keep your motivation. You want your patients feed off that. The patients feed off that and will pay for the better dentistry. I'm in one of the lowest socially demographic areas in the country.
Speaker 1:A lot of people who don't know where Sunderland is.
Speaker 3:They say it's okay for you to practice in the Sunderland man you wanna visit here sometime.
Speaker 3:It's like. But the people who want to the dentistry, people pay for what they want, not what they need. And if they can find a practitioner and hopefully I can give you some of this motivation I go to these courses to recharge my batteries, simple as that. I go to the conferences to recharge my batteries Because there's always days where you're looking at things and you know everybody's size and things, you know a patient's criticise and something I think is absolutely phenomenal. We all have patients like that and days like that. But if you can motivate yourself and keep going, it just it improves everything. It improves the atmosphere and the practice for the team, in particular, certainly yourself and the patients. And I hope I can actually instill, because I'm gonna talk a little bit about business and dentistry generally while I'm doing the clinical.
Speaker 3:Yeah, and just say how I actually can actually tell and inform the patients, as the difference between what I'm doing and what other dentists are doing.
Speaker 2:I think that's important because actually, when we all learn, we're always focusing on learning the clinical skills, aren't we?
Speaker 2:But, nobody really tells you or teaches you how to communicate that to the patient. So to tell you what, you've just gone on and spent your weekend and travelled and spent the money and away from the family or what not learning, but that patient doesn't quite value that automatically because they don't know all of that. So how do we communicate that you know? How is your composite that you've learned out on Richard's course at the BACD gonna be worth a lot more of the patient's time, your time and in terms of value as well. So we gotta be very interesting to hear how you practice in your clinic in Sunderland but are working at the top end of the private dentistry market. Yes, that's actually really fascinating. So I think it is. One of the things that I know the BACD does want to focus on is how to implement these things, because it's key. Have you always been in that area or have you worked elsewhere as well? Or is that your home ground and you kind of stuck around?
Speaker 3:I've worked Gateshead, newcastle. I've worked down in Darling. I have been moved around. I think one of the practices I was working on is the only one to ever be closed because of a compulsive repurchase order. So sometimes I've had to be forced to move, but I've worked in Sunderland, certainly for the last 20 years.
Speaker 3:But I did move around a bit initially trying to find a home, because sometimes, particularly with the better quality dentistry, sometimes you're working with practitioners who don't want simply don't want to get into that market and often it's best to find practitioners who are willing to actually see your vision and follow that and walk alongside with you and support you, because it's very difficult to work with somebody who just wants to do the very basic dentistry and do the really high end things. I'm not going to criticise that. I was a pure NHS dentist for 10 years. I was a mixed dental practitioner for another 10 years and for 10 years after that I'd be purely private. So I've been in every camp. I'm not going to sit there and say everything's okay for me.
Speaker 2:It started it was difficult, but I've been there, you've been there.
Speaker 3:You've been there. You've been there, yes.
Speaker 2:So, being in one place for 20 years, have you? You've obviously seen your cases come back and that makes us better, doesn't it? To see our own failures as successes, absolutely. What are the few things which you say that you've changed or learned along the way, that now you feel your dentistry is much more predictable?
Speaker 2:Because I remember, as a simple example, when I was in the NHS for the first few years after graduating, I went on a course I learned how to do composite inlays and onlays for posterior teeth and I was like this is amazing, you know, just doing loads of them, and it didn't take long for me to stick around in the practice to see most of them come back, failed because I didn't have the occlusion and bonding understanding that I may now do. So choosing the cases wasn't right, but had I moved on so quickly, perhaps only a year later or six months later or something like that, I would never have seen those failures, had never really got better. But you've been there, you've stuck around and you've learned new things implemented. What are the things that you think you've seen change or that you feel now is much more predictable for you?
Speaker 3:The materials have gotten much better, but the materials are still only 5% of what we do. I think our skills have improved. It's a bit of a cliche, but you do learn more from your failures than your successes and that communication with the patient is key. Old dentistry will fail and I'm quite proud to tell the patient that these patients have managed to destroy perfectly good nature and our jobs. To restore that and if you just instill a realistic expectation to the patient of what they tell the patient.
Speaker 3:Look, I've seen my cases last five years, 10 years, 15 years, 20 years. My companies, my big companies, are cases. I'm not give longer than a 10 year guarantee on that because I haven't seen the full success. I've been doing a certain level for a certain amount of years. I'll give them 20 years on, postulate 10 to 20, realistically.
Speaker 3:Equally, I'll have patients sometimes come along to me with unrealistic expectations. Now I'm sure they'll be happier to see another dentist and I'm sure another dentist may fulfill their expectations. But if I can actually work that out, I'm pretty good in and out whether I'm going to be able to fulfill somebody's expectations or not. Then my life's an easier life and I'm sure the patient can go somewhere else. But I do that and I'll be going over this on the course with the power of the mock-up Mock-up everything from a single tooth to a full smile.
Speaker 3:And if you think that simple mock-up at a first consultation is pretty good and the patient picks holes in it, then maybe they're better off with somebody else, or maybe they're just after something completely different. And if I can't work out what the patient's expectations are, then but I'll talk more about this because I'm a real dentist I'm not going to give stars and flashing lights and send up rockets and see all the dazzling material that quite often I've seen fail in the past. Maybe get a realistic expectation of what to expect from the restoration and what to teach them how to do and the longevity of it. I'm quite proud to say, well, you don't do this with porcelain, but I'm quite proud to say that composites sometimes needs some maintenance.
Speaker 1:It's all about realistic expectations.
Speaker 3:The patient is very happy, but not disappointed. If anything needs, polish them two or three years time.
Speaker 2:This is your experience talking. You're totally confident with your clinical work. Of course, that goes into having been sticking around long enough to see the failure so you can be really sure when you tell the patient this is going to work or this isn't going to work, and then that controls the outcomes, doesn't it?
Speaker 3:in terms of expectations, I'll see some of the work that I did five or ten years ago and I'll look at it and think why did I do that? There are so many better ways of doing this, but it was what was available at the time. What we are all doing now, in 50 years time, it'll see be seen as our kick and old-fashioned.
Speaker 2:That's why we work with what we've got now. That's why we keep attending, so we keep having the conferences, so we keep learning new things, even if it's just taking it a little bit further. When you actually add those increments up in five-year period, you look back and think God, what was I doing then? And you thought that was great at that time.
Speaker 3:Yeah, I don't criticise any dentists for staying within a certain realm of where they're going, but they tend to be. When I talk to them, they tend to be the more unhappy dentists. Whereas you go to somewhere like the British Academy conferences, you're surrounded by a light-minded people. Some people are just trying it out to see what they think. Some are actually riveted and they recharge their batteries every year, certainly by going to the British Academy, and I would encourage anybody to come along, try different courses, try mine, try a lot of the other courses. Some of the other courses will be for faster dentistry. You have to decide in yourself as a profession what kind of dentists you want to be Slow, fast, volume, quality.
Speaker 3:I would never criticise anybody who picks one particular genre of dentistry that they want to go into, but certainly the genre that I'm doing. I've got a full diploma in implantology. There's multiple facets to what I do. Can you be a specialist in everything? I tend to leave a lot of the major orthodontics alone. I do some simple alignment using invisiline, but other than that, I tend to let people way more qualified than me to do some of the orthodontic bits before I'll come in with my skills.
Speaker 2:So would you say, that even though I know from my experience I did a lot of implant training etc I can replace any implants now but I can treat the implant in any implant case. When a patient sees us, they have the right advice at the consultation stage. So, richard, obviously we've discussed your background and how you've ended up doing the kind of dentistry you're doing and what you want to impart on to your delegates at the VACD, at the conference Outside of dentistry. If you have any time left at all, what are your passions? What do you like doing?
Speaker 3:I cycle everywhere. I really fund the food, so I have to cycle everywhere if you're in the Army. So, for instance, I'm into work today with my bike. I'll go out on 60, 70 mile rides the weekends. I occasionally go scuba diving as well in the North Sea, here and during the winter. I'm a snowboarder. I've never learned how to ski, so I'm the oldest snowboarder on the hill. So I mean, it's yeah, north Sea diving is challenging. It's, you know, it's quite you know. My wetsuits, like you know, year thick.
Speaker 3:So you're wearing a hundred pounds worth of gear with your weights and that kind of thing. So it's very technical. Diving it means if you ever go abroad and dive, it's really easy. Cycling and cycling. But yeah, cycling tends to be most. Our roadways cycle during the weekends and I'm kind of on a between me and work and home. I'm on sort of road for half of it and cycle track, old railway lines for the other half. So I use a cycle cross bike to come in and work. So it's yeah, it keeps you fairly trim, allows you to be where you want, so it's pretty cool.
Speaker 2:So what I'm getting is that you're quite a disciplined, quite an ambitious but disciplined and you kind of you need a lot of drive, not only to do dentistry you're doing but also to even maintain the hobbies that you maintain. So it's kind of personality type that's coming through. So, with that in mind, if you weren't a dentist, if you hadn't chosen dentistry, what would you have loved to have done, or what would you now say, possibly, that you do instead?
Speaker 3:Well, people might say it's lunacy. Bro, I want to be a dentist from the age of 12. But before then. Before then, I want to be an RF pilot. Wow, so yeah. But then, back in the old days, you'll be able to work on my age here. When I was 12, it was the Falklands War. And I remember seeing a plane being shot out of the sky on the.
Speaker 1:TV.
Speaker 3:And I thought, ah, I like a certain number of risks, but yeah. I mean most of the hobbies I do just indicate you know they are very focused lunacy type drives and kind of. I think everybody in dentistry has to have that kind of we're all custom to the same cloth, it's. Yeah, you tend to find a lot of dentists do cycle and that kind of thing, so sorry about that.
Speaker 2:So, Richard, just to conclude I mean we're very excited to have you Could you just summarize for us the title of your session, maybe who's supporting you in the session as well, and where it's going to be, and just a summary of kind of the topic that?
Speaker 3:you'll be covering Well, it's down in London the engineers and institutes it's going to be. It's a fantastic location. I had the opportunity to have a quick glance in while I was in London recently. I told me I'd be in the morning and afternoon session, so yeah, it's going to be a really cool session. I'm looking forward to it. And what else was it you wanted to know?
Speaker 2:Is anyone? Are you working with anyone on the hands-on? Is it just yourself? Are you working with any trade partners?
Speaker 3:I work with DMG, then I've used a lot of a lot of composite residents in the past and a lot of composite systems are fantastic. I'll tell you why I like their systems on the day Particularly. For me it's more the handling than anything else.
Speaker 3:A lot of composites come with some great attributes now, but the actual handling and a certain amount of opacity that allows me to work with a certain composite, that I can work with all sorts of different composites. You know they're not going to have the. My trade partner, dmg, might not want me to say this, but I will discuss with them materials. I think there's an awful lot of instruments that are required for the kind of dentistry I do. It sometimes is about the tools when you're working. You know there's various forms of.
Speaker 3:I see people with loops all the time and personally I mean I get the opportunity when I travel to talk to the likes of Manier and some of the really big guys and when we've sat down before and said what kind of magnification do you mean? I think for cosmetic dentistry it's the times four and the both and that's certainly the consensus. But I'll go through sort of the tools et cetera, if anybody on the course wants to know which instruments I use and which birds I use. They're fairly standard set of birds you can get from any company.
Speaker 3:It's how you use them. You know, and for me a lot of it's kind of put down. Quite often the finish of a composite is very important and I have a very certain protocol as to how I get that shine and that long lasting shine for your two composites and I'll go through that in detail. And there are lots of different pieces of kit from dots of different manufacturers that are brought together into a certain protocol. It's not all. Dmg simply provide me with some of the tools for the actual scent and certain composite.
Speaker 3:Yeah, I'm really looking forward to actually telling everybody why I use what I use and what each piece of equipment that I use represents and how it helps, because a lot of people don't realise some of these birds, some of these polishes, have to be run at different speeds as well.
Speaker 2:And if you're just using an?
Speaker 3:air order. That can't be done, but again I'll go over that. Sometimes it's worth the initial investment, which isn't huge.
Speaker 2:So it sounds like anyone attending is going to get no clinical skills. A little bit about the business side implementation in terms of communicating to patients, as well as actually what they need in order to get it done as well. So it's an all rounded session. So thank you so much, Richard, for joining us.
Speaker 3:Absolutely pleasure to talk to you today. Jeff Sands, it's been a pleasure.
Speaker 2:Really appreciate your time and we appreciate you giving up your weekend of being at VACD conference. It's always a pleasure to see you there on a social side as well as as a speaker and as a delegate. Of course, we're able to see him Nice to catch up.
Speaker 3:I'll come for you, Castle You've got to have a beer, absolutely.
Speaker 2:So if anyone hasn't yet chosen their hands on sessions and are listening to this or watching this and do want to go ahead and book onto Richard's session, then you can do by the BACD website. If you haven't bought your conference tickets, just don't leave them too late, because there will be a cutoff and we will close the bookings when they get sold out. They're sold out. We can't really easily squeeze people in. There are limits, and having seen Richard's teaching firsthand and his dentistry which we will throw onto the screen in various points in this podcast too, so you can kind of have a bit of a relevance as to what we're talking about then you will be no doubt eager to come along and learn more. Thank you once again, richard, and look forward to seeing all those listening and watching at the conference later in the day.