Expert Q&A with: Dr. Kalyan Voruganti
Kalyan qualified in 2005 with Merit from Cardiff University in the UK, as one of the top ten students in his year. Not long after graduating, he did further study and gained the prestigious Member of the Faculty of Dental Surgery (MFDS) in 2006 from the Royal College of surgeons of Edinburgh. With a thirst for learning, he has also completed a 2 year orthodontic diploma (with Dr Derek Mahony in 2017) which focuses on early interceptive orthodontics. This tries to prevent problems and treat them early. He has been placing Dental implants for almost 10 years and often mentors colleagues and graduate dentists to plan out their own cases. He has also worked in Liverpool Dental hospital and in Community specifically treating highly anxious patients. His focus is making his patients’ dental experience as pleasant as possible and communicating very clearly to ensure patients understand their treatment.
He is actively involved in Dental associations as well as multiple Dental forums. Training younger Dentists is something Kalyan really enjoys. He has also completed a teaching certificate in 2017 at the University of Melbourne and has been involved in training Dental Therapists and Hygienists as well as general mentoring of younger Dentists with the General Dental Residency (GDR) scheme.
You are an expert in managing anxious patients. How did you go about that and how have your techniques changed over the years?
Treating anxious patients is one of the most rewarding, yet also the hardest parts of our job. During my time as a maxillofacial senior house officer working in hospital, I would introduce myself to patients as a head and neck Doctor instead of a Dentist. The difference in patient anxiety levels vs introducing yourself as a Dentist is noticeable – you’ve all heard the phrase “It’s nothing personal but I hate Dentists”.
After graduating I went into hospital rotations doing Maxfax and general dental. This included special needs, severely phobic patients, IV sedation and GA. This allowed me to hone my skills. It’s the simple strategies that work. You’d be surprised how often these patients can be managed with conversation and comfortable Dentistry.
Technique wise, a lot of people jump to RA, IV or GA. These are options that should be provided but don’t need to be used as your first port of call. It’s important to look at the patient journey, especially as a practice owner – every little thing needs to be considered. Often these patients experience anticipatory anxiety and have been thinking about your appointment for the whole week beforehand. When they walk into your clinic (and even the phone call before), how are they greeted? What does the patient lounge look like and smell like? Are there any pictures which would increase their anxiety? When they come into the surgery, how do you greet them?
With experience, I have found that by working all these touch points out and making sure everything is set up to support anxious patients, they are getting the best experience possible. At the end of the appointment, I also ask how it went and make a note of what we can do better next time. Some patients want extra anaesthetic right from the start. By doing this, I get referrals and more anxious patients and the more you see, the better you get at treating them.
Even if you use oral sedatives or IV sedation etc the basics still apply – use topical on dry mucosa for 2 minutes, use hypnosis / distraction techniques while you are giving local, your DA can give the patient a gentle hand squeeze or a touch on the shoulder. These don’t sound like much but to a nervous patient it can make a massive difference. When I give an ID block, I check the tooth due to be worked on with ethyl chloride to make sure the patient is numb before I place dam on and start drilling. This ensures there are no shocks after you start drilling! I also check and ask how they are doing each step of the procedure as well, giving them updates e.g. “I’ve removed the decay / I’m filling it now about 20 minutes left”. This gives the patient something to look forward to as otherwise they have no idea how things are going.
Tell us more about your teaching. What do you enjoy the most and what do you find to be the most challenging aspect of it?
I’ve been very lucky to have some great mentors. They were generous with their time and very patient with their teaching and I’d like to think that I’ve picked up some of this generosity from them. Teaching is something that I genuinely enjoy, there’s a phrase “rise by lifting others”. I honestly find it so rewarding to watch people I teach gain confidence and implement things they’ve been taught. To watch newgrads go from being nervous about their first DO, their first prep, their first “big” treatment plan to then consistently doing them couldn’t make me prouder.
The most challenging aspect of it is probably the student / mentee. Mentees vary a lot and I’ve noticed in more recent times, there can be a lot more confidence (quite often misplaced) in people who are relatively newly graduated and inexperienced. They want to place implants and do big cases in their first year or two of graduation. I really do believe the first 2-3 years should be spent on mastering the basics, especially communication skills before venturing on to more complicated things.
You have worked in both Australia and the UK, did you find the transition to be smooth or what were the main differences you faced when moving here?
That’s a very interesting question. I’d been brought up and lived in the UK my whole life so it was a momentous change moving to Australia. A lot of things surprisingly fell into place. Despite a tough job market, I found a job and accommodation etc quickly and when that happens I always think it’s a good sign.
It was relatively lonely I guess when I first moved though, I lost my friends and my dental network overnight. It was daunting not knowing anyone. Thankfully, I had a great group of people at my work, including my now business partner who helped me settle in. I was introduced to the DPR facebook group when it only had maybe a thousand or so people in it and met so many people who are now my close friends.
The main differences I found are that in the UK people are happier to sue their dentists and it happens quite frequently over very minor things. The NHS also devalues dentistry in my opinion as people expect everything for free. Here in Australia, you can earn well whilst doing really good quality work. The risk of getting sued is a lot less and so you can actually enjoy your Dentistry. I love it over here and honestly don’t think I could ever go back, thanks ‘straya
After a decade of planning and placing implants, what is one thing you wish you knew back when you were first starting?
Also, a great question! This is an easy one – learn to say no. When you first start placing implants, you want to place them in every gap you see, every fractured tooth or post crown that debonds. You may also place them in places where there isn’t much occlusal room or oral hygiene isn’t quite right.
Implants are a long game – they can have issues and they are complicated and expensive to fix. Unfortunately, the longer you’ve been doing them, the more of this you see including failures. I have actually added a long section to my consent form about peri-implantitis and other complications because I want my patients to know what they are getting themselves into right from the start. Implants are great and can be truly life changing but you have to pick your cases – make your life easy!