Email Info@dentistryonthesquare.co.uk or Call 0141 423 8877 (24/7)
            
as-seen-on
Dentist in Glasgow

Call 0141 423 8877 (24/7)

Discover more about how Dentistry On The Square can help to transform your smile and your confidence. Request a Complimentary Consultation today

Book Consultation

Dental Towns’ Howard Farran Interviews Scotland’s’ Pain Free Crusader Mark Skimming

Dental Towns’ Howard Farran Interviews Scotland’s’ Pain Free Crusader Mark Skimming

 

PAIN FREE DENTISTRY

 

Howard – It is just huge honour to be in Scotland with Dr Mark Skimming.  How are you doing Mark?

Mark – I’m good thank you, how are you?

Howard – So before we start talking dentistry, I would guess that probably the most famous movie on Scotland in America would be Braveheart with Mel Gibson, but what would be the most famous movie on Scotland if you asked a Scot?

Mark – Probably Braveheart, or maybe Trainspotting.

Howard – But you’re talking about Trainspotting, and three or four dentists have told me that that was a really great movie.  Now tell us about that movie Trainspotting.

Mark – It’s a slightly darker side of Scotland exposing the drug culture of Edinburgh in the 90s and a lot of the stars of the movie have gone on to big America shows, big movie stars, one of the guys Ewan McGregor was in Star Wars, one of the guys is one of the medical guys in Grey´s Anatomy, so they’ve all gone on to bigger and better things. 

Howard – And it was called Trainspotting?

Mark – Yes, Trainspotting.

Howard – So what does Trainspotting mean, like spotting the next train coming in the station?

Mark – No, that’s what most Americans probably think, but it’s actually about finding the veins in your arms so it was all about the Edinburgh drug scene in the early 90s.

Howard – So was that the drug heroin then?

Mark – Yes.

Howard – It’s amazing how many songs are about heroin, is it Rolling Stones Waiting on a Friend.

Mark – Golden Brown, Stranglers.

Howard – What was that other song, ah Sade “Sweetest Taboo” everybody thought what’s the taboo, is she with a married man or is she lesbian, but she would never tell but it turned out that the Sweetest Taboo was that she loved heroin but she didn’t want to tell anybody, so what’s the name of that movie – Trainspotting?

Mark – Trainspotting

Howard – Well I am going to have to watch that movie.

Mark – They have done a new one now, they’ve done a sequel.

Howard – It’s an honour to be in Scotland, and just before this interview, we’re not supposed to talk about religion, sex, politics or violence, so let’s start with politics.  I’m here today in Scotland and it’s all over the news yesterday here that you voted to pull out of the EU.

Mark – Well Scotland didn’t but the UK did.

Howard – So Scotland voted to stay in but England decided to pull out.

Mark – Yes.

Howard – But you voted as one country, so the overall vote was to pull out.  The average American news will reduce this to a 30-second sound bite on TV, so I’m with a Scottish dentist, tell the dentists in America, did you vote to stay or go?

Mark – I voted to stay and there’s very much a different kind of political agenda here in Scotland to the rest of the UK, so you know it could be a good thing, it could be a bad thing, we really don’t know. But what I think will likely happen is this: we will look at Scottish independence from the UK again.

Howard – So you just voted on that what about a year ago?

Mark – About a year and a half ago.

Howard – But now that England have pulled out of the Euro, out of the EU Brussels do you think if that vote for Scottish independence was held again today they would vote to succeed?

Mark – I think probably yes, but I’m not the most involved politically but it is certainly something that will be looked at again and it will be more towards independence.

Howard – And I was also hearing this morning that now Ireland is thinking about Northern Ireland pulling out of the UK and uniting to one Irish Ireland.  Do you think that’s on the cards?

Mark – I honestly don’t know there are always these things happening but mass hysteria there’s always a lot people saying  a lot of things that won’t come to fruition, yeah it will be good but we really don’t know we’ve got to see how things pan out over the next few months.

Howard – I was really honoured to get you as a guest on my show, because you wrote a book “Why I Now Love my Dentist More Than my Valentine’s Chocolate, says previously “scared out of my wits to even see him” patient, Dr Mark Skimming, which is you.  I can tell you that every dentist that I have met who has written a book said it was like having a baby; it was like 9 month’s work.   What made you write a book, what possessed you to write a book? Tell my homies why you wrote a book but firstly where they can buy it?

Mark – They can buy in on Amazon and the audiobook will be getting done over the next six weeks.

Howard – And so if you go to Amazon.com, books you would type in just author Mark Skimming, or Why I Now Love my Dentist More Than my Valentine’s Chocolates, says previously “Scared out of my wits to even see him“ patient.

So talk about your book.

Mark – Well I opened my first clinic in Glasgow 7 years ago and we tried to do dentistry slightly differently than the kind of standard that we were taught, so it was more a focus on the people rather than just the dentistry so we went in with an ethos providing dentistry as pain free as possible.  That mainly just started as trying to provide an injection as painlessly as possible and then we looked into it in more depth and looked at the 20 fears of dentistry: that may be pain from a needle, it may be choking, it may be someone who has been an abuse survivor so there are a number of points in there. 

Mark – So we looked at all those points and found a way that we could overcome each of those obstacles, it’s the biggest problem of dentistry if patients don’t come for their treatment because they are scared, or they are going to be inflicted with pain, or they are not going to be able to afford treatment. They are not going to be sure what is going on, so we worked around that ethos of trying to find a way and to find a system of making it as easy and as painless as possible for all the patients that we see so that’s when we decided to write the book.

Howard – So is this more a book for the patient or the dentist.

Mark – It’s for both, it educates the patient in terms of what can be done and what modern day dentistry involves.  Typically when you speak to someone of an older generation in the UK their experience is through the school dentists where there was no communication there was certainly no empathy provided to them as a child, so that stays in their mind.  So a lot of the patients that I see have not been for a very, very long time and they always come in and it always started with the school dentist and various bad experiences that they have had elsewhere and it’s really been a lack of empathy and a lack of explanation in terms of what’s going on in dentistry. 

Dentistry has moved on an awful lot in the UK from then so it’s really to get the idea across of how dentistry has moved on and how better we are a as a profession and try and individualise some of the things we do in my clinics. 

Howard –  I think a lot of dentists think that it’s just money,  money,  money and if you tell someone that they need a root canal the first thing the patient thinks is how much is it, it’s a thousand bucks or will my insurance pay or I don’t get paid until Friday.  But you are saying that you think pain and fear is more important than price and money.

Mark – Pain and fear are mentioned in the book predominately, but money is a problem. You and I have spoken a lot this morning about the cost of dentistry going up and up, there is such a big value that people place on that but there is often the fear that puts them off and creates a small problem developing into a massive challenge and a lot of these dental problems when we see patients regularly we can fix quickly. It’s the patients that have not been seen for a number of months or years that we have to do the most work on; they are the ones that we actually find are more grateful and stay with us longer because you have saved them in a particular way. 

Howard – So you said there were 20 fears?

Mark – Yes.

Howard –Do you want to talk about that?

Mark – Well there are 20 fears that we kind of boiled it down to and when I say ‘we’, I mean my full team of dentists and the practice were involved in getting an idea out.  It actually took me two years to put the book together so a lot longer than I had originally planned and a lot of time. 

Way beyond the time that I suspected when I first did it.  Once we could break the fears down some patients came to us with 5 to 10 different versions of those fears and when we broke them down into manageable chunks it was then that we found that dentists could put something in place that would keep their patients comfortable and keep them happier. 

Like I said it’s not just for patients it’s for dentists as well and it would be great if the dentists that I work with and my associates would make sure that part of their on-boarding programme is for them to read the book and come to our kind of ethos of providing dentistry.

Howard – So I do agree that the most common thing that you have to do is a painless injection.  What are your thoughts on the painless injection and by the way, I have been in so many dental hospitals in my life, I can’t even count how many dentists that when they give a shot and the patient is holding on and the patient is arching their back, the dentist is holding their breath and when it’s done it’s like he’s put the needle and stands up and then he walks towards the hallway where I am standing and he exhales and I just look at him and I’m like holy shit man, I mean that looked horrible for the patient arching their back you’re holding your breath and you are both just so damn glad that the shot is over and I just think that you can’t live your life giving or receiving injections like that.

So what would you tell that dentist that gives a shot like that?

Mark – There are loads of different systems out there, primarily I look at number one, getting the tissue nice and dry, get some topical anaesthetic on, leave that on for at least two minutes and then we look at making the tissue nice and taught and then at a digital injection system.  So the system I use is the QuickSleeper.

Howard – QuickSlepper?

Mark – Yes QuickSleeper, it’s an intra-osseous injection system.

Howard – So who makes that?

Mark – We get it through General Medical in the UK, I think S3 Dental is the company that make it.

Howard – You say it’s made by whom?

Mark – I think it’s S3 Dental that makes it.

Howard –Can you find it on there?

Mark – Yeah it comes with training DVD’s and things.

Howard – So what’s the website?

Mark – I think its GeneralMedical.com or .co.uk

Howard – It’s General Medical, in what country is the company based?

Mark – It is based in the UK I’m sure.  If you just Google General Medical QuickSleeper it would come top of the list.

Howard –How much was this?

Mark – At the time I think it was about £3,000, obviously there are other systems that can be used, most popular probably being the “Wand” but I wanted to get away from providing any blocks at all, I’ve not done any blocks for a number of years now. 

Howard – I’ve heard of the Wand and 81% of our audience have probably heard of that one too.  What’s the difference between the QuickSleeper and the Wand?

Mark – I’m not so familiar with the Wand purely because I moved straight onto the QuickSleeper. I felt certain from when I looked into it there were more things it could do. The intra-osseous injection manages to avoid the numb face which is actually one of the fears in the book -being numb afterwards, patients don’t like that. Therefore, being able to give a localised injection and making sure that it works every time, that’s the intra-osseous injection. 

Howard – So it’s an intra-osseous?

Mark – It doesn’t have to be it does infiltrations and tips, intra-osseous is just one option.

Howard – So what’s the difference between that and say a periodontal ligament?

Mark – Certainly in my experience intraligamentry injection is pretty uncomfortable.

Howard – With the handheld periodontal ligament?  You think those are more painful?

Mark – Yes, so what we do for an intra-osseous injection: we can put some topical anaesthetic around the papily leave it for a couple of minutes and let it dry, after which the patient doesn’t feel the tip of the QuickSleeper; doesn’t feel the injection.  We can then numb up the papily after 20 seconds that blanches, we can then carry out an intra-osseous injection from there by the tip of the QuickSleeper which will vibrate. 

Howard –So after the papily is numb, explain how you do an intra-osseous injection? Explain what that means, the needle goes straight into the bone?

Mark – The needle drills through the bone to the cortical bone.

Howard – Are you talking about the needle going through the periodontal ligament or into the bone?

Mark – No you can do it into the periodontal ligament but what I find is far easier is going into the bone and we can get through that cortical bone and we can put a lot of anaesthetic in there and we don’t have to use as much, it works 100% of the time unlike a block where you can have a failure or a block where you can damage some nerves but we don’t have those issues with it at all, so for me to be confident with it and for me to be able to anaesthetise for the types of surgery that I do, it just makes me 100% confident that I can do a comfortable injection.

Howard –So if you were working on a lower mandibular molar and you worked on 100 how many of those would you give a block or how many of those would you use a QuickSleeper on?

Mark – None, I haven’t given a block for many years now. 

Howard – So this way you would forget now?

Mark – Yes, I would be terrible.

Howard – And what percentage of those would be using the Quick Sleeper?

Mark – I use QuickSleeper every time.

Howard – And what if it was going to be a root canal?

Mark – The biggest thing for me when I started branding my practice as a pain free dental clinic the one thing that would worry me would be the hot pulp. That pulp that you cannot anesthetise and the patient is uncomfortable, the arched back and gripping the chair we don’t have that problem with the QuickSleeper.

Howard – Would you use that if you were going to extract the tooth?

Mark – Yes.

Howard – Really?

Mark – Yeah, so we’d do an extraction and again the patient doesn’t have that numb face.

Howard – On Dental Town we put up 400 online courses they have been viewed over half a million times and dentists love taking these courses on their home computers on their iPhone, but I would love online courses.  Would you ever consider making online courses on this Quick Sleeper? 

Mark – Yes.

Howard – I’m pretty sure that if I hadn’t  come to Scotland to see you that me and my “homies” wouldn’t have heard of the QuickSleeper and I think that a lower block the dentists don’t like doing it themselves, they hate giving them.   The patients don’t like getting them.  So that would be really cool to teach.

Mark – Yes, no problem.

Howard – So painless injections, any other advice on painless injections?

Mark – It’s all about how you manage the patient and manage their expectations discuss with them beforehand any difficulties they have had in the past.  A bit of re-assurance, empathy and make sure that you are listening to your patients and that you are in tune with their particular needs, their wants any kind of fears, frustrations, desires they have about their treatment.  But that goes across all of dentistry not just injections.

Howard – You are talking about your practice as fear, that’s your niche market?   When you market and advertise what is your focus? 

Mark – I think for any practice focus in terms of your market is always women.  We have had that conversation this morning, my websites are all pink which sounds a bit sexiest now but we market to women specifically because they control all the purse strings for the house, they control what their husband does in terms of his healthcare, in control in terms of the children. So that’s our market broadly.  So we look to treat patients in particular who have had bad experiences in the past and try and give them a different experience to what they have had in the past.

Howard – Will you pull up your website for me?

Whenever Americans think of “ I want to go focus on people with anxiety” a lot of people jump straight to I am going to knock you out and put you to sleep, but when you focus on painless dentistry and you focus on anxiety and fear you‘ve been talking a lot about communicating with the patient.  Do you also focus on putting them to sleep or are you able to do this by talking to them, communicating, and empathy.  Do you use nitro oxide?

Mark – For patients who are extremely nervous, we look at conscious sedation and we cannot do any general anaesthetic in the UK outside a hospital setting.

Howard – Really, now talk about that?  Has it always been that way?

Mark – No it hasn’t always been that way, it became that way just before I become a dental student.

Howard – What year was that?

Mark – 2000, so I think May 97/98 roughly around about that time, general anaesthetic stopped in the practice setting, completely after they had some specialised centres.

Howard – So why did it stop?

Mark – Because children died.

Howard – I know children die every month in the United States, you see something on Facebook about someone dying and I just want to tell my “homies”, I know that tribal people that they don’t want to throw mud on their own leaders but if you want to fight with another tribe and you don’t like it if your dentist fights in your own tribe the bottom line is that the UK looked at the deaths per thousand of an anaesthesiologist giving anaesthetic in a hospital verses oral surgeons and paediatric dentists getting children in their office and the death rate was crazy and the UK, what year was it you said?

Mark – 1997.

Howard – And what’s hypocritical in the United States of America is that you cannot go into any hospital in America  and say I am going to do the anaesthesia and the brain surgery or the anaesthesia and the heart surgery, you have to have an anaesthesiologist.   The only place you can get anaesthesia outside of a hospital is if a plastic surgeon or a dentist does it and you see two or three children die.  I mean if I lost one of my kids it would just be devastating three out of four times, I mean that one kid and I’m talking about you Ryan!

But even a very famous American, do you remember Joan Rivers she was one of those many famous people in America and she went to some plastic surgeon for some cosmetic surgery and he did the anaesthetic in his office and she had an allergic spasm and she died. 

Joan Rivers would be alive today if she had had that done in a hospital.

Mark – It’s the number one cause for child hospital admission in the UK is for extraction under general anaesthetic.

Howard – Wow, so what do you attribute that to, is it diet, home care, child obesity.

Mark – All of it.   I think we have a system that doesn’t remunerate based on prevention in Scotland it is carrying out the surgery and in England and Wales is what they call units of dental activity so there is not a broad enough programme, although Scotland is further ahead than England as we have what you call Childsmile which is a public health initiative.  The anti-fluoridation lobby that prevent us from fluoridating the water is madness in my opinion and diet particularly, we see in Scotland, although we have made massive strides in the last 10 years diet is still a major problem. 

Howard – It’s kind of funny because Scotland is an island in the ocean and the ocean is naturally fluoridated at 4 parts per million and when you try and put half that amount in the water 7 people act like you are an alien out of space trying to kill everyone.  How can they fish in the ocean all day long at 1.4 million parts per million fluoride and eat all the fish that comes out of it and then say half that amount in the drinking water is a toxic poison? 

Mark – There is no sense in it, whenever you speak to anyone about fluoridation it’s putting rat poison in our water, you cannot create a valid argument, because if you break down all the constituents of your blood or say we are going to put this in your body then you would say absolutely not, no way are we having any of that.  They don’t realise it is already there, it’s ignorance in my opinion.

Howard – I hear what you are saying, we need to start convincing the people that they are rats.  It’s embarrassing when you see dentists and they say fluoride is a poison, it’s like everything is a poison at a certain level.  Do you realise the ocean is 1 part per million cyanide, 1 part per million arsenic and it’s not toxic until it’s a certain level.    They say the average human on earth drinks 8 litres per water at one sitting they would die.  So then is water toxic!

When someone says that a substance is poison and they don’t give you the amount they are bad shit crazy.

Mark – You cannot make a valid argument on that basis it’s got to be proven the world over and that’s in particular why the UK is in terms of America we have a history of having poor dental care and dental health and lack of fluoride is one big part of it.

Howard – On your website how many of your patients are coming to you for fear or pain or anxiety versus just regular routine dental care? 

Mark – It’s a whole evolution, we have a lot of our new patients, so we probably see about 150 new patients a month, the vast majority of them will have had a bad experience elsewhere particularly when they were younger, so people over 40 who have had a bad experience when they were kids and they have never got over that and they are looking for somewhere they can go where they can build that trust and build that relationship and we try and take them all the way through that journey. When they start off with IV sedation conscious sedation, we try to get them over a number of years to a position where they don’t need that anymore. 

Howard – When you do IV sedation you have to take them to hospital?

Mark – No, IV sedation can be done in the practice conscious sedation so they are fully awake.

Howard – You do that or an anaesthesiologist does that?

Mark – No, we do that in the practice.

Howard – But I thought you said that 1997 you couldn’t do that?

Mark – No we cannot do general anaesthetic, so we can do IV sedation in my practice we do that for adults and we can do gas and air.

Howard – So can you do IV sedation with a narcotic?

Mark – Midazolam.

Mark – There are some clinics who will offer propofol sedation but I think an anaesthetic has to be present for that.  Not something that my practice has never looked into.

Howard – Don’t you think it bizarre that Michael Jackson was addicted to Propofol, when it just turns you off and puts you to sleep, he wasn’t doing it and getting high he would just do that knock him out and put him to sleep?

Mark – I don’t know too much about that drug to be honest, in some hospitals that provide it, I know the patient can control the amount so I would presume it was reasonably safe drug.

Howard – So if you saw 100 patients for anxiety or fear what percent would you treat with empathy, talking, painless injection and what percentage would need sedation?

Mark – I would say sedation is only around about 5% if we can speak to the patients and humanise ourselves a bit and they don’t see us as the guys in the white coats, show that you understand what they are going through and ask them, let’s give this a chance without any sedation and see what we can do. The majority of them will give you that opportunity and you tell them that they have the fall back, you tell them if you don’t feel up to it or don’t feel comfortable then a conscious sedation route is always available for them.

Howard – What percentage of your practice is NHS government what we call in the United States, Medicare, what percentage NHS, what percentage private?

Mark – I have three practices and over the three of them it is probably about 50/50, in terms of our time, most of our time is taken up in treating our NHS patients.

Howard – Do you like NHS dentistry?

Mark – No, not at all, I’m not a fan.

Howard – Do you have those NHS patients coming into your practice and then you upgrade half of them to private or the private people don’t even have any NHS at all.

Mark – We have private patients who specifically would want to see a specific dentist who will not provide any NHS dentistry usually due to them having some kind of extra training or they are very much part of a niche market.  NHS patients are generally those who don’t mind what dentist they see and probably see a newer graduate, that’s certainly the situation in my practices.  The reason we provide NHS is that I do believe in some type of system of providing healthcare, just the way it is in the UK there is mindset of what healthcare costs in the UK that is way below what it really is because dental bills they get are very small so they don’t even take out any private insurance system so it’s paid out of their own pocket.

Howard – I’m in Glasgow right now, a million people, how many people are living in the whole of Scotland.

Mark – About 6 million.

Howard – How many of those people do you think are of the mindset of the 6 million that I’m just going to the government NHS and I’m not paying out of my own pocket whatever they do is good enough for me versus how many say I’m opening up my wallet and I’ll pay more for value added?

Mark – That’s a difficult question to answer because it depends, that one person could change over the course of the year depending on their needs, if they have a flare up with toothache then they will pay money to have that fixed if they cannot find an NHS dentist.  So gradually what we are experiencing in the UK is that practice costs are rising rapidly and NHS fees are not going anywhere so what’s being chipped at is the profitability in the practice so what we are experiencing now is the head on collision between practice owners and the associates because of the way that the fees are going and that associates are getting a lower fee because the practice is less profitable.  But rather than us seeing any kind of movement to try and change the payment system, there is more in fighting between owners and associates. 

Howard – How do the owners pay their paid dentists is it a percent?  What is the percentage?

Mark – It depends on what practice you go to.

Howard – What would the range be?

Mark – We start off around about 35 to 55%.

Howard – 35 to 55% that’s huge.

Mark – Yes.

Howard –But it’s of a low fee though?

Mark – Yes, so it just depends.  I have my dentists normally on about that range but it depends on their skills what they are able to do what type of dentistry they are able to provide.  So the guys who have invested in themselves they’ve gone back and done masters, self-development courses on ethical sailing things like that, they do very well.  The guys who just want to come in and do their job every day, take their jacket off do their job put their jacket back on, they don’t do as well.

Howard – So the NHS sets the fee?

Mark – Yes.

Howard – So what procedures do they not set the fee on and can charge whatever you want?

Mark – Implants, we do a lot of adult cosmetic orthodontics in my practice.

Howard – What system is that? Invisalign?

Mark – No, we use Cfast.

Howard – Talk about Cfast, so is that out of England. 

Mark –Yes it’s based in York, I am actually a lecturer for Cfast I teach the lingual orthodontic course.

Howard – What’s the local guy’s name here?

Mark – Gary Dickenson he’s based in York which is between here and London.   Half way roughly.

Howard – Could you email him and cc me Howard at Dental Town and tell him I’m here.  I’m here Saturday, Sunday and Monday so do you think he’d see me?

Mark – I’m sure he’d be happy to.  I know they are running a course today and tomorrow in London.

Howard – Send him an email or phone text, my card has got my cell phone number on it.  So talk about Cfast.

Mark – Cfast is a system of anterior tooth alignment where previous invasive techniques were created to veneers and cutting into teeth to create that aesthetic smile, and it’s that go between place for patients who don’t want invasive treatments but don’t want full comprehensive orthodontics to take them to a Class 1 exclusion.  It’s a compromise treatment it doesn’t do all the things that a full orthodontics will do but certainly in my practice for a lot of patients, it achieves the goal that they are looking for.  We have to make sure that things are assessed properly they are aware fully of what’s being done and what the difference is between going down a veneer route or going down a comprehensive orthodontic route and going down a short-term route. 

Howard – If my boys had grotty teeth and if they said “Dad I want to grind them down and do veneers,” then I wouldn’t let them.  If my granddaughter said I just want it done today I would say no you can only get braces and bleaching. I always thought it was weird that so many dentists today insist that their own children have braces and bleaching but their patients would let them talk them into filing down their teeth and fitting veneers.

Mark – We still have patients who say that they want to go down the, what we call immediate orthodontic route, and that’s to put veneers on them, so we have a lot of patients who we deny treatment to because we just don’t find it ethical any longer, well we don’t think it ever was. 

Howard – Dentists will disagree with me all day long on this but I have seen it with my own eyes.  I’m 53 years old and when these dentists back in the 80s would do ten upper veneers and when you come back and looked at those veneers a decade later in the 90s, or twenty years later those veneers would not look good.  I would say that when you do 10 upper veneers and you look at that patient twenty years later, how many of those teeth are broken and needed a full crown, died and needed root canal, but the dentist say but that was 20 years ago, new materials but it won’t happen again, you don’t know that.  Like I say if it was my kid it would be braces and bleaching. 

Mark – I mean don’t get me wrong I think there are definite improvements in the non-prep veneers or the minimal prep systems but for me I wouldn’t provide it for my family.

Howard – How do my “homies” learn more about Cfast?  So for someone who doesn’t know what it is, how do they learn about Cfast?

Mark – Cfast deliver free courses, I know they do all over the US; they do them all up and down the UK.

Howard – Why don’t they put them on-line?

Mark – I am sure they will.

Howard – They haven’t?

Mark – I’ll speak with the guys.  I think certainly in the UK you have to do a hands-on course.

Howard – Most online instructors, nobody is going to start placing implants, taking an online course, it’s teach me the concept, so right now I don’t even know who Cfast is, so why would I sign up for a course block off a weekend and fly off for two days when I don’t even know what it is?

If I watch an hour’s time on Dental Town I go “wow this is interesting”.  I always see it is a sales technique, my job is trying to get these dentists to be happy and healthy and I think they are going to do that if they learn how to do dentistry better, faster, cheaper, higher quality, lower cost and so I know how they think. I just think that when you, it’s a big leap to go from an ad in a dental magazine, fly to London and spend two days learning Cfast, so I think the ad should be on TV like you know, if you are interested then call this number and we will send you a DVD and you then listen to the DVD for an hour, and then you think I’m going to call this lady.    I call that deconstructing a sales course, putting the whole didactic course online. 

Mark – I’m sure the guys at Cfast will they are very forward thinking, very customer focussed they kind of look at it as a family business they build relationships with all the people they work with.  I’m sure they will be very happy to get involved. 

Howard – Maybe we can get a podcast in before we leave? 

So you’ve talked about anxiety, you’ve talked about pain, fear and Cfast so what else has got you excited and passionate?

Mark – I am moving towards just restricting my time on to implants, implant based practice.

Howard – So talk about that.

Mark – It’s been an evolution for me. I did a Masters in restorative that got me out of the NHS decided to open my own practice to be able to find these patients, so it’s just been an evolution over the last 7 years. Now I work with a full team of highly talented dentists and they are taking on more and more of the restorative side so I am moving more towards surgical implants; that’s why I want to continue my training and follow the guys that I highly respect.

Howard – If someone is listening to you and they have never placed a single implant how do they go from I’ve never placed a single implant ever to I have placed one and restored it.  What advice would you give on that journey?

Mark – You need a mentor, when I worked in the NHS I worked 4 and a half days and on the Friday afternoon that I had off I went and watched an implantologist and watched him place implants on the afternoon.  I must have seen him place 200 to 300 implants by which time I started to build up  knowledge and understanding of the full treatment plan rather than just the single implant and build a picture of the patient and ask the, ‘Where should I go from now?’ 

From there I started referring my patients to them. Then I started restoring the implants to get an understanding of that side, because implants have to be looked at and planned with an end result in mind, you have to look at the final restoration before we look at the surgical side.   Being able to restore the implants is the training courses that I went on and then once I got an understanding of that, I also found I did have a market in my practice for doing that. I then looked to go on some surgical courses and developed my skills from there. 

Howard – You know, I think you are so smart because some people think that I will fix my practice by buying a shiny object, a laser, a cad-cam, a CBC or learn sleep apnoea but what you did was you first recognised that there was a demand for it already in your practice. What shiny object did you get? You got the one that you already had a demand for which was placing implants and then to double down on street smart, instead of flying across the country and going to some brand name implant course you were smart you found some guy up the street that you could go watch. 

You know, I see these dentists in America they will fly clear across the country to take a root canal course and they will have five endodontists in their own town that if you were to call up and say, “I don´t have patients on a Friday, can I come sit next to you on Friday and watch you?” (Who have done 30,000 root canals do endo.) Six out of every five endodontists will say “hell yeah”.  All dentists want a friend; all specialists want a referral why are you flying across the country when you have got an endodontist, periodontists, and oral surgeon in your own city. 

Mark – We need mentors.

Howard – And that’s street smart.

Mark – In every aspect of dentistry, I mean I have mentors just now clinically and they probably don’t even know that they are mentors of mine, but whenever I do anything I will follow them, I will go to see them but as your skills improve you have to broaden your horizons, but just starting off stay local.  Don’t spend money.  In particular in Scotland you tend to have to travel to London to do a course that has any reputation, but there are loads of guys around here doing this already. 

Howard – Yeah but don’t let the brand name fool you.  Some of the great endodontists and implantologist and oral surgeons in the world nobody knows there name expect for the few dentists in their village. And some of the biggest brand names in the world are not because they are the best dentists in the world but because they have the best marketing department. They have a machine behind them pushing out their name and if you want to learn endo then there is probably an endodontist within walking distance of your office who would love to meet you, love the referral.  Specialists are awkward in the fact that, are they supposed to send you chocolates on Valentine’s Day to get your business, it puts them at ease when you call them and say I’d like to be your friend, I’d like to meet you.  I think the fear and scarcity that the endodontists don’t want to help you because they are not going to refer to him. 

But specialists with the exception of orthodontists who live in fear and scarcity, all the other specialists live in hope, growth and abundance and figure well you’ll do endo but I’m sure there will be molars you don’t want to do. The oral surgeon who says I am sure I will pull teeth, but there are wisdom teeth that you want to do and implant cases I’m sure there are single tooth implants that you will place but I am sure there are full mouth reconstructions that you don’t want to touch.  I mean I don’t like getting around the inferior alveolar nerve and I don’t like the science labs but I did it all and I cut my teeth, I did all that stuff, but I’d rather have the easy single tooth replacement.

So back to your implants.  If you placed 100 implants, how many of them are one tooth single placement at a time versus more complex cases like over-dentures?

Mark – I don’t know I’d have to look at that.  I do a lot of single placements and in Glasgow and Scotland we have quite a few denture wearers so we do a lot of full arches as well, so probably done one full arch a week. 

Howard – And when you do one arch per week is that full on the floor or do you put six or twelve in a bridge?

Mark – I aim for six implants in each arch, whether that’s the case or not it varies, maybe an overdenture, my preference just now is the fast and fixed where we do some immediate loading and then use a final composite bridge after four or five months on a bio HPP frame and for me that’s the most aesthetic work that I do.

Howard – Do you ever document these cases?

Mark – No, because my photography skills really are not up to it. You see a lot of these guys posting cases especially on Facebook right now, but I think geese my photography skills certainly aren’t up at that level.

Howard – It’s fine about your photography skills but not your Photoshop skills.   I have a magazine and we have a deal that you have to sign that these are not Photoshopped and most of that stuff coming in is all Photoshopped. 

Mark – No I’m not so good with that. 

Howard – I just want to tell people that, I know you’re looking at me right now and thinking that this is all Photoshopped and this is all natural.  I know you don’t believe me but it’s true.  Ryan, vouch that you are not Photoshopping my videos right now.

Ryan – Yeah it’s all true.

Mark – It’s all natural; you’re not even wearing make-up!

Howard – No I’m not even wearing make-up, I swear to God.   I’m wearing a girdle but that’s the only part.  You guys know what a girdle is? 

So you talked about painless, you talked about Cfast, you talked about implants, what else has got you excited?

Mark – Something that you said not to buy this morning, but I do have a laser.  I have a soft and hard tissue WaterLase – my implant journey kind of took me into that.  Trying to be less invasive and watching a few guys and how they treat the bone so when they cut the osteotomy a lot of necrotic bone cells around the osteotomy so I can put my laser down there.

Howard – You do that for implant placement?  You’re doing the osteotomy with a laser?

Mark – No I do osteotomy with a drill but I clean my osteotomy site with my laser, so it’s nice fresh bone so they don’t have all those necrotic bone cells.

Howard – Now is this because you are a rich boy and this is your toy?

Mark – No (laughs).

 Howard – Is this a good return on investment?

Mark – I think when you get to the stage of placing a certain number of implants there is a tipping point there, I do have patients that come to me that do want laser.  One of the biggest reasons for going away from implants was actually for periodontal patients and I was able to see the bone regeneration and the management of these periodontal patients who I could not stabilise before and would only be able to assist with the help of a specialist. Now I am sure that my work is still not to the same degree as a specialist periodontist but I can for a vast number of these patients now stabilise them whereas I would always have to refer. 

Howard – With the WaterLase?

Mark – Yes.

Howard – Alan Horningman? I have to give kudos to him as he started doing this LANAP procedure 20 years ago and everyone in Phoenix in their back yards said, “That’s crazy!”  10 years later he got like another periodontist, a couple of guys and now, I’m telling you he’s the leader of the pack.  I would say a quarter of those periodontics believe it and using laser and then there are other people saying, “There’s no research for that.” But the bottom line is that when people don’t know what’s causing disease or they can’t prevent it then how are they sure that it’s not going to work and there’s a lot of people in this field.

So my question specifically is this.  The number one problem with placing implants is peri-implantitis.  Now have you ever used your WaterLase around peri-implantitis?

Mark – Every time, I use it to clean the implant surface, I use it to clean the bone surface around the implant surface and I also use it around the granulation tissue.  So the removal of that granulation tissue lets us then get some graft in and everything just heals up and a lot healthier. 

Howard – Do you think that WaterLase is effectively treating peri-implantitis?

Mark – In my practice the protocol that we follow is working the vast majority of the time.  Whether that is purely down to WaterLase, I’m sure there are guys that are not using WaterLase that are getting just as successful results, but certainly the protocol that we follow, yes we are getting better results with the WaterLase than when we didn’t use it. 

Howard – So when my “homies” go to a dental convention there are 175 different implant systems, my question is how do you help them pick an implant system? When you’re seeing peri-implantitis and you’re treating it do you think some implants have a better surface that is more resistant to peri-implantitis when the surface is smooth? It’s this, it’s that, or not really or do you not think the implant brand and surface is that related to peri-implantitis?

Mark – I think that nowadays with the kind of microstructure of the surface we’ve walked into this era of peri-implantitis due to trying to increase the surface area of the implant and so it’s just going to attract more plaque, but we have better interbrasion so there is a balance there.

In terms of somebody choosing an implant system, choose an implant system that is not based on price, it should be based on service, support from the implant company and when you are starting off you don’t understand all the components, you don’t understand how all of the mechanics fits together so choose a system that someone who does a lot of them has recommended to you.  Once you are educated you can then change from there.

Howard –That’s so funny, because one of the first things that dentists do, and I like the way they think, lower price, lower cost, and probably want to go to some on-line implant to get the cheapest implant, but when I am in the field and I see the dentists that are questioning it, they always have a human in the field, they always have a body and it seems like everybody who is saving money buying them on-line, doing implants doesn’t place them once a month or maybe place one a month.  How many are you placing a month approximately?

Mark – 30.

Howard – Everybody I meet who is placing 30 a month, that’s a hell of a lot of implants, even 20 or 10 a month is a lot of implants, they always have a human in their tribe in their village and I look at that as their human relationship and that human relationship was the tipping point at getting if off.  So it’s not about noble bio-care or Megagen or Implants Direct, it’s about I got Sally who lives in my city. She’s on the phone, she’s helping me sometimes it’s the lady who’s setting up for a lunch with some other periodontist or oral surgeon who are putting together going to a bar after work for a chat. It’s basically with the humans in the village it gets done and then later you go to that dentist and they are successfully placing a dozen a month.

Mark – I moved away from a big implant company as their support withdrew.

Howard – What were they called?

Mark – It was Anchor Loss, which is a great implant, a great system.

Mark – All their componentry and everything is really nice and the surface of the implant was great, worked really well, but I said to them, I want to buy 300 implants off you next year and they said you will have to buy them all upfront. I said well, when I bought 250 from you last year we did it month on month because we are running a business as well, got to look at cash flow and things. They said but we don’t do that, so they put a barrier up to me to buy more off them and at that time I thought we are not getting the service and support we are looking for here. Later they went through a merger with another implant company.

Howard – Who did they merge with?

Mark – Astra.

Howard – Anchor Loss and Astra.

Mark – Yes, and things weren’t working out so well and that’s when I moved over to BioHorizons and started placing their implants.

Howard – Out of Alabama, USA?

Mark – Yes.

Howard – You know the space shuttle Columbia, you know those solid rocket boosters they were made right up the street from us.

Alabama is a really hi-tech area.

Mark – Every implant company tries to have their own individual USP but to be honest an implant is an implant, they all work, certainly in my opinion they all work, it’s the componentry and the support for me.

Howard – I would say again the support is all I see in the field.  Everybody who gets to 10 a month has a really strong human support system in their back yard and that’s most important, but after that, go to the dark side, peri-implantitis some people say 20% of implants are failing today from peri-implantitis.

Do you think it’s that high?

Mark – It’s not in my practice. It’s not that high.  We have only been placing them for the last 6-7 years so maybe need to look at that in another 20 years.

Howard – So peri-implantitis is the dark side of implants so you’re basically saying what kind of surface do you want to have the least amount of peri-implantitis?

Mark – I think you have to be careful how to answer that question because if we have a smoother surface on our implants then our integration rates are going to drop as well.  There is a balance there I’m not the most academically minded as some of the fanatic guys that I see speaking so I don’t think I am the most qualified to answer that.

Howard – Humble man!

Mark – Thanks, but you know the implants are great some of them are going back to tissue level and polished collars and things like that to try to combat peri-implantitis it’s definitely a problem, we know it’s a problem. I see it in my practice almost always in smokers we’ve got a good protocol in process to try and resolve it but you know if they continue to smoke then …!

Howard – It’s mostly smokers?

Mark – In my practice yes.

Howard – You’re talking to Americans now, so are you talking about marijuana or tobacco?

Mark – Just tobacco.

Howard – Did they legalise marijuana in Scotland?

Mark – No, it’s still illegal.

Howard – Do you have medical marijuana?

Mark – No.

Howard – Do you think it’s something that they will do in the next 5 – 10 years?

Mark – I think they are waiting to see what happens in the US, see how it turns out.

Howard – I think it’s going to be a disaster.  The dark side of marijuana was that there are about a million people in jail for something that both of our last two Presidents did for a decade, Obama and Bush.

Mark – Certainly from my point of view, and again I’m probably the wrong person to ask, but the police are not as aggressive towards marijuana as maybe they are towards some other drugs.

Howard – It was bad because you shouldn’t be in jail for something that Obama did for 10 years and Bush did for 10 years but you are sitting in a cage, which must be totally horrible and if you make that stuff available on every corner of every shop or whatever you are going to have ten million addicted pot heads that are going to be spending their whole lives trying to get off that shit. It’s always a balance, it’s always the devils of the details, it’s always the pendulum swings this way, too far criminal and I hope it doesn’t get too far illegal. There has to be some sort of effort of finding maybe not having to drive an hour to get it, but man if you’re trying to get off weed and every time you go to the grocery store there is a big bag of it sitting there.

Mark – It’s just about education or a public health scheme.

Howard – Like alcohol – it’s the only amendment where they made a constitutional amendment to ban alcohol and then they had another constitutional amendment to legalise alcohol so the only double amendment on the same issue was alcohol so banning it never works.

Mark – You’d never be able to ban it in Scotland, but it would never happen. 

Howard – Who drinks the most the Irish or the Scots?

Mark – I don’t know but it would be a good night out to find out!

Howard – So some people say that you guys invented golf?

Mark – Yes, we did.

Howard – But if you ever hear an Irishman or a Dutchman when they get drunk, they say they invented it.

Mark – No.

Howard – So who was it the Scots the Irish or the Dutch.

Mark – St Andrews gets called the home of golf, so I think it would have to be Scotland.

Howard – I have to tell you, you have to have a vacation here because this is seriously one of the most beautiful countries I have ever seen, it’s unbelievable.

Mark – and it’s not raining today either!

Howard – Here’s another confusion in America!  So when you see someone with a kilt on, sometimes they are playing a bagpipe, so is a bagpipe and a kilt Scottish, Irish, both?

Mark – I’d say it’s Gaelic, there is a specific Scottish kilt, we have tartans all to do with the historical clans that we have, the historical clans don’t really fit in with the fashion these days we have modern kilts.

Howard – A tartan is a kilt?

Mark – A tartan would be a Scottish kilt.

Howard – Are bag pipes, Scottish, Irish or both or Gaelic?

Mark – I’m going to look foolish now on this broadcast because my history is not so sharp, but the Picts and the Gauls, so Scotland was the Pictish tribes and the Gauls and it was over in Ireland and you know Kings and Queens marrying into families.  So Scottish kilts in Braveheart, I don’t think they were invented then in those times, it was in more recent times but when the English consolidated into the UK I think for a long time the tartan was banned for a while as a symbol of Scottish independence and all that kind of stuff.

Howard – Wow that is just so interesting.

Mark – Don’t quote me on any of that.

Howard – That I find quite interesting, when I travel around the world you go back and look at these castles that were built several hundred years ago, when there was much less money and more attention to detail, the ceilings and the sculptures.  Now all these countries are a hundred times richer and the structures are just slapped up flat, nothing.  Why when they had almost no money does every building looked like a masterpiece and today when you are richer than rich every building is just a square box?

 Mark – I don’t think we have the professions and the tradesman to be able to provide that kind of work anymore.  I live not far from where we are right now in an old building, I think was built in 1860 and we had to get some of the work done outside and some of the cornicing inside of the flat fixed up and it cost a fortune because the guys were so specialised, whereas I’m sure many years ago there were ten a penny and a good industry.

Howard – Well thank you so much for spending an hour with me. Go to Amazon.com and order “Why I Now Love my Dentist More Than my Valentine’s Chocolates by Dr Mark Skimming”.  Thank you so much.  You have to post this book on Dental Town and I hope you do a course on Dental Town. Thanks for all that you do for your patients. Thanks for being on my show.

Mark – Thank you and thanks for having me. 

Dr Mark Skimming took the brave decision to dramatically cut his wage early in his career to complete a Masters Degree in Restorative Dentistry.

This was to feed his passion to be the absolute best he can be!

And at just 27 years old he became the UK’s youngest ever dentist to receive this advanced qualification. Why did he choose a career in dentistry?

Because of the hands on approach of directly influencing the lives of his patients. Maybe it was because his dad was a Glasgow painter and decorator that he wanted to work in smaller spaces. But combined with the artistic nature of dentistry… this is the profession he has dramatically excelled in.

 

“After an unrealistic wish to play football for the rest of my days, I decided I wanted to pursue a medical and health care profession where it was achievable to be my own boss and carry out treatment in the ways I felt were most appropriate.”

Working in NHS only dentistry, Mark wasn’t happy with the length of time he got to spend with patients and so decided to open up his dental practice treating private and NHS patients which is located in an old Victorian building.

Mark is a member of the “Association of Dental Implantology” and is the publisher of three Guides including, ‘How Glasgow Women Can Now Say Goodbye to Their Twisted, Crooked and Uneven Teeth’, and ‘How To End Missing Teeth And Denture Anguish’.

Mark has also written the book “Why I Love My Dentist More Than My Valentines Chocolates”, which focuses on his pain free dentistry techniques.

Furthermore Mark has been providing CFO- Cosmetically Focused Ortho treatments for over 5 years. Mark has been a CFast instructor for over three years concentrating on the advanced treatments specifically with the hidden braces. Mark has trained over 300 dentists on CFO.

In Mark’s clinic he treats over 150 cases a year. In total nearly 1000 patients have been treated. Results improving year by year.

Better yet, Mark Skimming and the team at Dentistry on the Square, the purveyors of Pain Free Dentistry recently scooped Best Patient Care for Scotland and Best Scottish Practice awarded by Dentistry Magazine. And not only that Best Scottish Patient Care at the UK Private Dentistry Awards.

This is the first practice in Scotland to ever receive a grand slam. And this is due to his unusual attitude towards extreme pain free customer service.

‘The Dentistry Awards, one of the most anticipated events in the dental calendar designed to reward and recognise regional excellence in dentistry say the organisers Dentistry.co.uk, and go onto say, ‘These awards recognise outstanding individuals and teams who are at the top of their profession and who are continually raising the standards of general dentistry.’

Asked why Dr Skimming and his team won the award for Scotland out of 34,000 UK dentists,

‘We Are Obsessed About 3 Things When It Comes To Customer Service…

1) Everything we do is to make the experience as pain free as possible. We ask each and every patient if we are pain free, and 99% say we are.

2) We continue to re-invest in technology to make it as pain free as possible. I am one of the very few in Scotland to invest in a laser, which costs over £50,000. With a laser, most traditional drilling is a thing of the past.

3) Our phones are answered 24/7. That’s why all our calls are answered within 7 seconds. So in summary, it’s all about the patient, not about the dentists.’

 

  • The Dentistry Awards 2016:  Winner: Best Patient Care Scotland
  • Private Dentistry Awards 2016: Winner: Best Patient Care North, Highly Commended: Best Treatment Of Nervous Patients
  • The Dentistry Awards 2015: Winner: Best Practice Scotland & Northern Ireland, Winner: Best Patient Care Scotland & Northern Ireland
  • Private Dentistry Awards 2015: Winner: Best Patient Care North
  • The Dentistry Awards 2012: Winner Best Young Dentist: Dr Mark Skimming, Best Practice – High Commended: Dentistry on the Square
  • Dentistry Scotland Awards 2012: Nominated Best Practice & Best Dental Care Professional
  • Private Dentistry Awards 2012: Nominated Practice of the Year (North): Dentistry on the Square 
  • What Clinic Awards 2010, 2011, 2012, 2014 & 2015: Winner – Customer Service

Are You Ready To Take The Next Step?

Smile Advisor Team

Smile Advisor Team

Google Rating
4.9
Based on 783 reviews
Facebook Rating
4.7
Based on 163 reviews