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Five minutes with… Simon Nocton

Implant Surgery, Five minutes with… Simon Nocton, The Dental SurgeryReferral dentist Simon Nocton talks about the importance of communication, knowing your limits and the changing focus of implant treatment

 

How did you get into dentistry – and implants?

Like lots of people, I fell into dentistry. Someone suggested it to me at 17 and it seemed like a good idea.

My dad was a doctor, and I knew I didn’t want to follow him – he worked too hard and we never saw him. Now, of course, I have to be careful I don’t fall into the same trap!

I qualified in 1987, and after a few months, took a job as an associate doing NHS dentistry. After about three weeks, I realised I’d made the most terrible mistake going into general practice. I knew nothing! But that was a great thing to realise.

So I applied for a house job at Guy’s, where I had qualified from, and went on to hold a succession of different teaching hospital posts doing surgery: I was at the Middlesex, UCH and Bart’s Hospitals over the next few years, where I learnt all my surgical skills.

Like many people with surgical backgrounds, the decision then was whether I should go back and study medicine, as I had vowed I never would, or go into general practice. As an undergraduate I loved dentistry, and I had found that I missed some of that as an oral surgeon.

I had just started to encounter implants at that point. So the next step for me was looking for the right practice, where I could do good dentistry and incorporate some of what I saw as the brave new world in my practising life.

So in 1991, I went back, and became an associate at the practice where I’m now a partner. I joined on a whim: there were no patients for me to see! I had a lot of dental knowledge to catch up on too: I used the quieter moments in those early days to educate myself about restorative dentistry.

How did you build the referral side of the practice?

Accessibility has been the key to developing my practice.

It’s not about selling yourself as a highbrow discipline. I just happen to have different skills: surgical skills, and familiarity with implants, which not everybody wants to have.

When you get that right, it’s a nice way to work. You end up working with friends; your patients get good treatment. The wisest referral practices are always eager to pick up the phone and talk to their referring practices, because they are the lifeblood of what we do.

It’s not about having an ego. It’s about providing quality healthcare: our patient has to be the first priority.

You learn a certain humility the longer you do this job. Your patients are the people who matter, and as long as they’re getting the right dentistry, it’s not important who does what, as long as you’re working within your competency.

You run The Implant Surgery as a referral practice within a more general practice – how does that work? Don’t the two sides of the business interfere with one another?

The Implant Surgery is run totally separately: we have a separate telephone number, my team don’t deal with any of the Dental Surgery practice, and there is no way for patients to cross that divide.

We don’t want our general practice to pick up dentistry from our referring practices, because those practices have put their trust in us to provide an item of service for their patients. We should treat that – and them – with respect. And why should we think that the services we provide in our general practice are any better than theirs?
The human touch is clearly very important to you. Do think that’s helped your career?

Communication runs through everything we do. I believe passionately that if you have good communication between everyone involved, then you’re not likely to have too many problems.

I have a core group of probably 18-20 regular referrers, all of whom have become friends as much as colleagues over the last 20 years. It’s always nice to have someone refer to you, but they need to know our ethos of how we treat our patients as well.

I also think that you need to let patients in a little bit.

Admittedly, I have a steel core beyond which most people don’t get, but it’s buried quite deep, and I let people in a long, long way. The moment you don’t let them past a protective ringfence, you only make life difficult for yourself.

Make no bones about it: I talk to people about drilling holes in their heads all day every day. Why wouldn’t they be terrified? If you can show people your human side and break the ice early on, then you stand a reasonable chance of helping them see past the fear and understand the passion I have for what I do. And suddenly, it’s not quite such a terrifying ordeal for them.

Where do you see dental implantology heading in future?

The majority – probably 70% – of my referred dentistry is for placement only. The other 30% is made up of really complex stuff that the referring dentist doesn’t feel comfortable with.

I can’t do every restoration for every implant, and I probably wouldn’t want to. I think this is where the future of implant dentistry will sit: thoughtful practitioners will end up learning how to restore implants that are within their scope of knowledge and experience.

There is always going to be a place for full mouth reconstructions and complex cases to be shared between a surgeon and a prosthodontist. But simple, straightforward implant dentistry will end up sitting within the remit of interested and knowledgeable general practitioners, and I think that’s the right place for it to be.

How has your approach to implants changed over the years?

My greatest skill is as a surgical dentist. I taught surgery at Guy’s Hospital for 10 years; my background is in surgery.

But implant dentistry is a restoratively-driven process. My referring dentists understand that their role is probably the greater one – they’re going to use me as a service to provide an implant in the correct position. We spend a lot of time talking about treatment planning and the preliminary thinking, so I know I can put an implant in at the exact position that’s going to make that implant restorable.

It’s something that I have understood as I’ve matured – probably like everyone in implant dentistry. Twenty years ago, it was a surgical decision. Everybody spoke of the surgeon as the revered one, and you were grateful that he was even placing the implant. Now, with good implant principles, we should be placing the implant to fit within the restorative envelope. That’s been the big change for me.

Are there any things you wish you had learned earlier?

Dentists are often never taught to talk to people about value. Even expensive dentistry has value, and if you are confident of what you do, then you ought to be able to discuss it – and if pushed on it, justify it. I think it’s a real hole in our education.

There is no other walk of life where you buy something without looking at its price tag – or at least doing some research. Unfortunately, as dentists, it’s the one area of our profession that we don’t seem to do terribly well. It doesn’t have to be difficult, but you have to be able to deliver.

Is sales a dirty word in dentistry? It shouldn’t be – but done incorrectly it’s not good for anyone. If you have to talk about money, then you’re involved in sales by definition, so whatever ethical sales is, you need to address it, even if you don’t like doing it.

I don’t think there’s anyone in our profession who likes it, but it’s a necessary part of what we do. And somewhere in our postgraduate education, we ought to be able to learn how to do it.

What do you enjoy most about practising?

I get a different buzz from different aspects of dentistry.

There is an academic intrigue to the journey. Thinking about and solving a problem is intellectually stimulating.

But I do love doing surgery, whether it’s simple implants or complex grafting. There’s something about tinkering with the human body and asking it to heal in a controlled way that I still find remarkable – even after 22 years!

I review everybody post-restoration, regardless of who’s done the restoration, at three months. And at that point, I like seeing the person – it’s nice to have walked on some of the journey with them. To meet up with them at the end of that journey, to see them happy and comfortable, and realise that the time, effort and expense they put themselves through has got them what they wanted is really nice.

So there are three different bits: academic, practical, and the human. For me, I need all three of those aspects.

What’s the most important thing you’ve learned?

I’ve been so lucky that my surgical mentors – who were, or are some of the best in the UK – were extraordinarily kind and tolerant in sharing their knowledge with me.

But perhaps the biggest lesson I’ve learned is how to treat patients with dignity and respect. I learned as a young man to put things into perspective.

When you’ve looked after people with mouth cancer, or in terminal stages of disease, it helps you put things into perspective. Teeth are important, but they’re not everything.

Those early – and sobering, for a dentist – thoughts taught me a lot about the good things we can do for people. If a tooth can’t be saved, but we can replace it with an implant, that’s nice. But it grounded me – to know where I fit in the spectrum gave me a huge sense of perspective.

 

What advice would you give to young dentists?

It’s dangerous to think you have all the answers. There will always be someone with more knowledge than you. Today alone, I’ve twice called colleagues of mine to ask advice about something that’s out of my remit.

There are principles we must learn, and I think it’s only right that the GDC talks about working within your competency.

But I think you need to enjoy what you do, and to be able to have that credibility you need passion.

This article was originally published in Implant Dentistry Today and is reproduced with permission.
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