Andrew Chandrapal: on reflection

Just before he reached the end of his tenure as president of the British Academy of Cosmetic Dentistry, Andrew Chandrapal spoke to Sophie Hatton about the Academy’s achievements over the past year, and discussed the future of aesthetic dentistry in the UK

Tell us a little bit about your background. How did you get into dentistry?

I was born and bred in Essex, and my parents were both physiotherapists. They really struggled when they arrived in the UK as they had to provide for themselves (and eventually myself) as well as their family back in India. Growing up in Essex at that time was full of ups and downs – I have to admit, it has made a big impact in defining my temperament and how I manage situations to this day! My family life was very close and we remained a very contented unit where material things never mattered.

I attended a comprehensive school in Loughton, where I had the opportunity to play various musical instruments and soon found I had a talent and a passion for music. This led me to tour Italy and Germany, as well as perform in bands and orchestras around the country.

To be honest, dentistry did not feature in my life until just days before my UCAS form needed to be submitted. Selfishly, I knew I could not give my life to medicine alone (which as the wish of my parents), yet I communicated well and felt that something therapeutic would fit my personality. It really was a matter of heart versus head, and in this situation I weighed it up and the head won.

Why did you decide to focus on cosmetic dentistry?

To be brutally honest, I am not sure I ever did. My main focus was and remains to be general dentistry; I have never wanted to be coined a cosmetic dentist. I feel the term is overused and over simplified at times.

I simply made a decision to focus on building skills to produce general dentistry that was done to a functional and aesthetic standard I could aspire to achieve. After all, noone asks for poor appearing dentistry, do they? So why not make it appear as though it’s not there? For me, this was my motivation.

Can you tell us about your interest in bonding and wear management? Have there been any new developments in either field?

Tooth surface loss (TSL) is something I believe is vastly underdiagnosed in this country. At an undergraduate level, we were trained to primarily look for caries, periodontal disease and oral lesions. TSL was poorly taught at undergraduate level and indeed at postgraduate level was not consistent in theory and management.

Adhesive dentistry always interested me in terms of the sheer ability for the techniques to actually work and when combined with TSL, seems to produce a very complimentary partnership. Granted, it is not always the best solution; however, I firmly believe the interceptive management of TSL is best managed using composite, and it is down to us – the general dentist – to recognise and diagnose embryonic TSL when it presents.

I have seen some extremely invasive techniques when managing TSL by highly regarded national and international clinicians, and hold true to the fact that patients should have the choice at a far earlier point in their TSL whether to manage, monitor, or leave their forming dental complications.

In terms of new developments, composite restorative materials are improving all the time. Clinicians must be able to understand the differences in the materials they are using and not simply listen to the trade reps. With regards to composite, polish retention, strength, aesthetics, and handling appear to be key players, especially in terms of TSL. Management techniques have developed to more formalised protocols of late now that longevity studies exist for up to 25 years using composite resin.

What have been some of your most memorable experiences and biggest achievements as president of the BACD?

This year has been a very enjoyable one. I have been part of the BACD for quite some years now and have had the pleasure of working with some great people – most of whom I would class as friends now. I had a set of objectives at the beginning of the year – they were clear objectives that aimed to bring greater value to our existing membership and work on bringing greater relevance to our members and their patients through a number of different ways. In talking to many members about this, I feel we are well on our way to achieving this.

However, it does not just stop with me. You can only achieve so much in a year and you need a great team and like-minded successors to continue carrying this forward.

My year as president was about no-nonsense academic support, free courses for members, patient information, setting standards for our membership to ensure they know what is expected of a BACD member, and of course, growth of the academy. This is not always as easy thing when there are several other issues in the background that need managing, as well ensuring the BACD financial framework is stable and predictable.

As a result, I hope my biggest achievement this year has been to stabilise the academy, bring greater identity of the BACD to the profession, and provide more support to our loyal membership.

Why are academies and associations important for the profession?

This is an interesting question. A couple of months ago I was speaking to Matthew Hill from the GDC. He was clear in saying that the GDC is not responsible for setting standards within UK dentistry, although it does regulate the profession as we all know.

As a result, the GDC looks to other professional bodies to assist the profession with setting standards and providing support of an appropriate nature. It is for this reason above others that I feel such bodies are crucial for the profession.

Strength in numbers achieves many things with relevance to academies such as the BACD. This means education can be provided at a high standard, annual general meetings can be held that bring together a consensus of opinion, and advice and information can be provided that is impartial and constructive. 

What are some of the biggest changes you have witnessed in cosmetic dentistry over the years?

The biggest change I see has been the approach that the UK has taken in terms of not fully adopting the invasive approaches that other countries have done in the past. In fact, in some ways, the UK is now being listened to more than ever in terms of minimally invasive dentistry (MID).

MID is being practised in this country with great consideration for a host of different reason; however, it is this that has changed cosmetic dentistry when once it was defined by some simply as the placement of porcelain veneers (which was never correct!). I see this furthering in years to come with the skills and techniques of dentists advancing to obtain predictable results with MID in terms of aesthetics, function, and longevity.

I also see the horizon and application of dental photography has changed hugely in the last decade. Our results and assessments are now captured so much more accurately, even to the point where it is an art in itself. Some photographic techniques used in cosmetic dentistry today are truly inspiring.

How do you see the landscape of cosmetic and aesthetic dentistry changing over the next 10 years?

I see it changing in a few different ways over the next decade. Firstly, I think the MID drive will continue, although it may modify to offer more stable results for longer. This is only a good thing.

Secondly, I think the evolution of scanners and printing will change the way we communicate with our patients. This will be from records through to smile design. We are at the tip of the iceberg with these concepts and they remain certainly not to be mainstream at present, although I am sure this will change.

Another way will be a modification of the way we engage patients into such treatments. Consent and record keeping has always been a core part of what we do. Part of these more novel techniques involve trends that show themselves over a period of years. When they work, they become the industry standard; when they do not, everyone is held to account and as such, regulations become tighter and more demanding. It has certainly changed in my time so in another decade I can only imagine this becoming even more of a beast.

Do you have any advice for dentists looking to focus their career on aesthetic and cosmetic dentistry?

For this question, I am going to present my answer as a list as I feel it is best summarised this way:

  1. Learn the basics of general dentistry first. Make some mistakes and learn how to manage them and in the process, understand how you cannot always control a situation
  2. Communicate verbally and non-verbally with sincerity and empathy. Understanding someone’s needs by listening first is one of the most important aspects of management. Remember, it is not just what you say, it is also what you do not say and how your body language also intimates your message
  3. Don’t try and do everything at once. A Jack of all trades is a master of none, so ensure you become consciously competent at a skill before trying to master another
  4. Try not to hop between job appointments. I do see ‘staying power’ to be less these days. Some have such an urge to become the clinician they want to be or carry out treatment they believe they are made to carry out, without remembering that those who have achieved this have only done so by committing to the same place for years. Getting to know your patients, them knowing you, them trusting you, them referring to you, analysing your successes and failures by recall appointments, and self-critiquing when your treatments are observed every six months for 10-20 years. There is no substitute for this knowledge, as well as the trust that is then gained from one person to another. How can you develop a true sense of your clinical successes if you change practice every one or two years?
  5. See education as a must. Focusing yourself and surrounding yourself amongst like-minded clinicians will enthuse and inspire you. Remember that all dentistry has a cosmetic consideration and that this is just part of the jigsaw puzzle. Familiarise yourself with the basics of cosmetic dentistry and incorporate this into your general dentistry
  6. Enjoy what you do! It is a great career that needs time, wisdom, humility, and a sense of humour to succeed. Take the time to self-critique and do not worry when things do not go to plan, as the success is deemed by how you manage it. Patients will see your integrity if you are upfront and say when something is not right but you will correct it
  7. Believe in the power of strength in numbers! The BACD is a family of members who share a common belief and passion in ethically minded dentistry that has a cosmetic consideration. Being part of such a group from a support, education and wellbeing perspective is a must.

This article was originally published in the October 2017 issue of Aesthetic Dentistry Today. Read more articles like this in Aesthetic Dentistry Today and gain three hours’ verifiable CPD with every issue. Click here to subscribe or call 01923 851 777. Get in touch via Twitter @AesDenToday.

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