My name is Gary Dickenson and I’m CEO of CFast, which I founded along with [Dr] Biju [Krishnan] in 2010, which now is the biggest laboratory in the UK. I’m also the CEO and one of the founders of SmileFast which is a system for dentists to provide accurate composite veneers for patients, both here, and in the US and Australia.
When you set up CFast, what was the landscape like then for cosmetic dentistry? And where do you see it now?
There’s a lot of parallels between that time and the time that’s coming up for us now. Before the big crash in 2008, dentists were living a really good life. Patients had lots of equity in their houses, the economy was good and patients were coming in with blank cheque books to have a mouth full of crowns, veneers and implants. Money wasn’t really an issue. People’s house prices were increasing by 10% every year, and they were using that equity to have fancy holidays, cosmetic surgery and cosmetic dentistry.
But, when 2008 came along, there was a nation of people that knew what they wanted to achieve with their teeth, but for much less money. People found that, with a more minimal invasive approach, pushed by some really good prominent dentists like Tif Qureshi, that they could achieve the same aesthetic for a much more affordable price. That was by aligning the teeth, bleaching them and some composites to finish it off. Tif Qureshi coined the term ‘align, bleach and bond’. That really took off, and it was really driven by being what patients could afford, to achieve the aesthetic they wanted. The whole boom with minimally invasive dentistry in the last year is based on dentists having to adapt to provide what the patients wanted, at a price that they could afford.
That was the landscape that [Dr] Biju [Krishnan] and I found ourselves in, when we saw other companies that would teach dentists in one or two-day courses how to straighten teeth into the right position, to then be able to bleach them and provide some restorative solution at the end. We saw these companies having spectacular successes, but not necessarily operating in an ethical way.
With other systems, they took the approach that if you, the dentist, would prescribe it, we’ll make it, but the responsibility falls on you. But, [Dr] Biju [Krishnan] being the clinical mind behind CFast – he wanted us to have more of the onus. So we actually refused cases, and that was a novel approach. Dentists felt safe, knowing that we’d only make a case for them if we felt it was safe, and within their competencies. That’s what really grew CFast, and our reputation as a more moral, honourable company.
That culminated in our confidence with offering something called ‘ortho-assurance.’ This meant that, if on a case that we’ve made for a dentist, the dentist got in trouble or in over his head, we would actually finish the case off at no cost to the patient or dentist.
Despite our disposable incomes decreasing, cosmetic dentistry is becoming more mainstream than ever before. Are there challenges with that? Do you think there are people cutting corners in the industry or other potential pitfalls?
Yeah, I mean, we are an over-litigious society now. Dentists, a lot of the time, practice defensive dentistry. But in every sphere of society, people will take shortcuts. You see those cases all the time. I think that’s only gonna get worse as more of these ‘ambulance chasing’ lawyers with adverts out there telling patients to call us if you’ve had a problem with your dentist. That wouldn’t have happened 15 years ago, but it’s just a reflection of society. Unfortunately, with things like that, we follow America, and we know what a litigious society the Americans live in. The lawyers over there have seen that as a cash cow. They’re actively encouraging patients to go after the dentist. So it’s a very tricky world to be in as a dentist, but there’s a myriad of options available for dentists. There’s so many different products and tools and techniques that they can use.
In terms of iConsentu, and the way it works by putting the onus on patient understanding, that’s got to be the right way to go, hasn’t it?
Absolutely. Being involved with CFast and SmileFast training last year, with every course I was in, the question that came up every time was around consent. That’s what propelled [Dr] Biju [Krishnan] to look at consent, because there were no real systems out there that really give you a kind of cast-iron safety net, that protects the dentist, but also the patient, and ensures the patient is fully consenting. I’ve heard of so many dentists and GDC cases as well, where patients felt they didn’t consent properly. When you listen to lectures about this kind of stuff, the main issues come from the patient not understanding the consent. The dentist can write down, ‘patient consented’, or ‘patient was offered orthodontics and refused,’ but there was no real way of documenting or proving consent.
A lawyer could easily argue that, “How can you prove that the patient consented? You just wrote it.” I think that was really the catalyst for the years of work [Dr] Biju [Krishnan] spent in developing iConsentu. iConsentu puts the onus on the patient and proves that the patient has understood all the different aspects of the treatment, the risks, the benefits. It is as cast-iron as you can get, in terms of ensuring you can sleep at night. I know so many dentists and they’ll see these GDC cases and panic and say, ‘My God, I never did that perfectly in the past.’ iConsentu is a real way that dentists can avoid those sleepless nights.
You’re right at the cutting edge of dentistry. What can you see for the industry in the immediate future or more distant future?
I talk to hundreds of dentists every month. We’re definitely in a lull at the moment while the cost of living has impacted people’s pockets. With energy and fuel bills, customers aren’t going to spend £300 a month on that payment plan for their teeth. This is just what happened when COVID-19 came along. Dentists didn’t work for three months, so all that work was just bottlenecked. So dentists were busier than they’d ever been. Every dental company or dentist I speak to said that after things opened up after COVID-19 that it was the best 6-12 months they ever had. Now, people haven’t stopped wanting their teeth to look nice, they just didn’t want to commit to that extra spend because they never knew when mortgage rates were going up or utility bills. So I think once we get some good news, and inflation lowers around 2024 from the spring onwards, I think 2024 will be one of the best years that dentists have had. There’s a huge crop of patients that for the last year have kept that money in their pocket and put that smile off. I think next year will be fantastic.
But as the industry as a whole, we’re an industry that’s rapidly advancing in terms of digital dentistry and 3D printing technologies that have come on so far over the last five-to-ten years, and the next few years are going to see really accelerated change. As first-generation technology is improved and the second or third generations of systems come out, more people will adopt the technology.
Then the advances in AI are just unbelievable to watch as to where things will go. With AI-based treatment, it’s there and it’s going to mean a real big shift. New graduating dentists too; these are all tech-savvy millennials, these guys are right up on it. There’s some amazingly talented dentists out there that are at the older end of the cohort that might struggle to grasp the new technology, but it’s the way it’s headed. It’s always evolving, but I think in the next five years, we’ll see the most rapid changes in dentistry for a long time.