ALPHA OMEGA COFFEE BREAK WITH DR JONATHAN LACK

13/11/2020

WHY DID YOU CHOOSE DENTISTRY?

Oh my, this feels like my first interview when I applied to dental school! Well, I really didn’t want to be stuck behind a desk doing paperwork. I loved science and working with my hands but decided that medicine was not for me. I went into dental school intending to do orthodontics, but by the time I finished, it was out of the question! I loved periodontics as it seemed to be the foundation of all the restorative work that we build upon. I also loved implant surgery, which was in its infancy then. So, perio was the obvious choice for me.

WHAT EXCITES YOU MOST ABOUT THE BUSINESS/PRACTICE OF DENTISTRY?

Probably innovations in periodontics and surgery that can improve and simplify the kind of care we can offer patients. Although there are no major changes on the immediate horizon for the way we treat periodontal disease, there have been numerous subtle changes over the last 26 years that I have been a specialist.

Obviously, regenerative grafting techniques and materials, both in bone and soft tissue, have evolved, as have locally applied antimicrobials and the use of photodynamic therapy. A large part of my practice is implant surgery with bone and sinus grafts. On this front, innovations in access, along with implants’ size and strength and drills have allowed for less invasive, faster treatments to take place. All of this has major advantages for patients and I find that really fun and exciting.

TELL ME ABOUT YOUR CULTURE FIX…. HOW DO YOU UNWIND? BOOKS: WHAT ARE YOU READING NOW; FAVOURITE TV OR NETFLIX PROGRAMME?

A mixture of spending time with my family, exercise and watching Netflix. I love hiking around Snowdon and the Peak District if I can get away and on the west coast of Canada. I’m hoping to pick that up again in the future!

I binge on Netflix boxsets and even listen to them when my patients are watching the iPad that’s hovers above them when I am treating them. The Danish language in Borgen can be a challenge without access to the subtitles though!

Graduation is the beginning of your ‘real world’ dental education; so get as much exposure to as many disciplines as you can, as soon as you graduate.

WHAT ADVICE WOULD YOU OFFER AN UPCOMING DENTAL STUDENT?  AND WHY JOIN AO?

Get as much exposure to as many disciplines as you can, as soon as you graduate. Take extended courses, not just hour-long lectures, find experienced mentors to spend time observing in practice. It’s worth 10 times the amount of income you may lose by being out of your own clinic for a day. This way you can find areas that really interest you and that you may even consider specialising in. Essentially, when you graduate as a dentist you only know the bare minimum! Graduation is the beginning of your ‘real world’ dental education. Joining AO offers a fantastic networking opportunity for young dentists to meet more established dentists, not only for potential career opportunities but for learning and discussing different approaches to cases.

HOW DO YOU SEE DENTISTRY IN 5 OR 10 YEARS?

In my opinion, there will be a larger proportion of corporately-owned dental practices, both in the NHS and privately. In addition, the proportion of private dentistry will grow as the government puts the squeeze on NHS funding. Because of that, there will be more development of pure private dental insurance, which is currently unsatisfactory. Hopefully, the insurance companies will wake up to this soon; there is a huge untapped market out there.

Ultimately, this will allow greater access to dental care and improved oral health as a result. But as a profession we need to be cautious that the development of this private insurance does not impact on the patient’s right to choose their practitioner, nor on the practitioner’s treatment decisions. I have seen this happen in the USA and Canada. I also see a continued shift in the development of digitised dentistry such as 3D impressions being overlaid onto CT scans, allowing for highly accurate computer- generated surgical guides to be used on a regular basis.

GREATEST CHALLENGE TO DATE

Moving to the UK after training and working in Canada and the USA and trying grow a pure periodontics and implant surgery practice from a squat! I had very few contacts in the UK, but AO helped me to meet colleagues here who were incredibly helpful. I rented rooms for 10 years until I moved into my current location. I built up the referral base by lecturing extensively and publishing articles, plus of course getting involved with AO more than 30 years ago.

Besides that, dealing with the COVID-19 pandemic and its impact on the profession has been incredibly challenging. I find it remarkable how our profession came together to educate and influence our regulators when they were frustratingly slow off the mark. In particular, AO’s bravery in writing the open letter to the profession, offering an evidence-based approach (where there was evidence) on how we could return to care for our patients, was both challenging and rewarding. With the help of fellow AO members (Richard Horwitz, Andrew Eder, Rob Pittack, and Eddie Scher), we helped draw attention to our profession’s needs and the needs of our patients who were effectively abandoned.

This letter led to an invitation to join the Royal College of Surgeons, Faculty of General Dental Practitioners (FGDP)/ CGDent task group, drafting guidelines for our profession to return to work. This was a great honour. The task was huge, the pace was frantic and the responsibility was immense, but it had to be done. Under the tireless guidance of FGDP dean Ian Mills and chair of the group, Onkar Dhanoya, this group produced the first guidance document, which became the basis upon which the OCDO and PHE subsequently created their guidance. Although there were variations with these other documents, the basic premise that dentists could return to work safely for both patients and dental personnel was the same. This crisis has created more dialogue behind the scenes between all of the governing bodies of dentistry – PHE, NHS England and the CQC – than ever existed before. I hope this kind of joint discussion and problem solving amongst these governing groups will be a silver lining outcome in all of the turmoil we have had to endure.

WORST/MOST EMBARRASSING THING THAT EVER HAPPENED TO YOU?

I have an iPad over the dental chair to distract the patients during treatment and they occasionally have chosen something rather saucy or steamy to watch!

WHO WAS YOUR MENTOR?

One of my professors in specialty school (Louisiana State University) in New Orleans was a gifted surgeon and an incredible human being. His name was Denis Leblanc. Sadly, he died a few years after I finished my training there, after contracting an infection when helping out strangers after a huge flood there.

Surround yourself with the friendliest and most experienced and upbeat team that you can find!

FUNNIEST THING THAT HAPPENED TO YOU IN A DENTAL SURGERY?

I used to treat a married couple and their mistresses! Very careful scheduling is essential!

MAIN PIECE OF ADVICE FOR SOMEONE SETTING UP THEIR OWN SURGERY

Have a good relationship with your bank manager, solicitor, and HR adviser! But, more importantly, hire smart… surround yourself with the friendliest and most experienced and upbeat team that you can find!

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