[Editor's note: To read Dr. Manu Dua's first-person account of his experience with being diagnosed with and treated for oral cancer and what he learned from it, click here.]
Dentists spend most of their working hours in their practices, so they usually don’t get many opportunities to see what it’s like inside another doctor’s office. Dentaltown magazine’s recurring Office Visit profile offers a chance for Townies to meet their peers, hear their stories and get a sense of their practice protocols.
In this issue, we introduce Dr. Manu Dua, who faced a lot of challenges when opening his practice three years ago. And more recently, he was diagnosed with oral cancer and underwent major surgery. With help from his friends and Townies, Dua has managed to
maintain an upbeat demeanor despite these less-than-ideal circumstances. Read on and see how he manages his practice and how has life has changed since his diagnosis.
Name and credentials:
Dr. Manu Dua
University of British Columbia, 2012
Practice name: Montgomery Dental Centre,
1,980 square feet
What inspired you to pursue a career
in dentistry and to open your own
practice shortly after graduating?
My sister, who’s about eight years older
than I am, is a dentist and was a huge
influence in my path to dentistry. At a
young age, I was always interested in helping
people and working with my hands, and
dentistry seemed the most logical pathway
to providing excellent care while doing what
I loved. The relaxed lifestyle and flexibility
in terms of ownership and having the ability
to determine my own fate more than other
professions was icing on the cake.
What obstacles did you experience when
you first opened your practice in 2016?
How did you overcome them?
I feel a better question would be: What
didn’t go wrong? I started in 2016 amidst
one of the worst recessions in our oil-driven
economy and got into a bidding war for my
space. Because it was two units and one was
zoned medical and the other retail, I ended
up having to fight City Hall with head city
planners and the original architect to finally
zone the place all medical. This took more
than six months of negotiations with the
city and lots of willpower.
When I finished construction, we went to get occupancy to start and it turns out my building didn’t get it, so I had to wait for more than a month with a full staff unable to work while the landlords got paperwork in order. Once we were open, someone broke into my practice in the first month. I went in on Saturday morning to work, but was greeted by smashed windows, police and some confused patients and staff.
Soon after, the clinic got flooded in our main ops and the server room. That was fun to take care of.
Within a few months of opening, my vacuum wasn’t installed properly by one of the big three suppliers, so it shut down and took 12 hours to rebuild. Then, my brand-new sterilizer went down. I remember it went down Friday and we had patients on Saturday. So, I called a friend and took the instruments at 6 a.m. to his clinic, had them sterilized, then drove back to my clinic so we could work. It’s been a very arduous journey, but the pride and joy of finally having my own space gave me the sheer will to overcome.
Wow! You definitely had to deal with a lot in a short period. What’s the dental market like now in Calgary? What are some of the pros and cons of the area?
Currently it’s very tough, because we are still in a bit of a recession with no end in sight. Competition is fierce with lots of nice new clinics coming up, and with corporate dentistry slowly moving in with economies of scale, it’s definitely not easy going right now.
A few years ago, Calgary was the “promised land” for dentistry, with lots of oil money and many patients with insurance. But all good things come to an end, so we’re dealing with a bust economy, which requires a lot of creativity and excellent patient care to survive. The issue with being in a recession is that during the prime times, many clinics built were not only beautiful on the inside but also invested in a lot of technology and attractive features, which makes it easy for patients to shop for dentists.
Calgary itself is consistently ranked in one of the Top 6 places in the world to live in. We are close to the Rocky Mountains, Banff and Lake Louise, which are some of the most beautiful places on Earth.
1. Edge Endo X7 Files. I find the flexibility and ease
of use very comforting and after six years of using
them, I don’t have any reason to switch.
2. BC Sealer (Brasseler). Although it’s not inexpensive, I love the
way my final radiographs look and the fact they
can bond to the gutta-percha. It gives me great
3. Palodent Matrices (Dentsply Sirona). These are my go-to for contours.
They just work in my hands, especially when doing
4. Garrison 3DXR ring. Probably the best thing I like
about these is that the rings don’t bounce off very
easily. This makes it a very versatile ring in daily use.
5. Isodry (Zyris). Love the isolation. It makes me far more
productive and efficient and allows my assistant to
do other things as I’m working.
You say you like to run a more traditional practice and focus less on all the bells and whistles of new and upcoming technologies. What exactly does that mean, and how do you achieve that?
I have found in my seven years of practice that some of the longest-lasting and most fundamentally sound dentistry has been from decades ago using more traditional materials and techniques. Don’t get me wrong, I appreciate the technology, but we have to stop and think that for most patients, especially when in a recession, they neither desire nor need all the bells and whistles. For example, a gold crown will outlast any Cerec crown. At the end of the day, what’s longer lasting, less expensive and more conservative for the patient is always the right answer. I find that over time, dentists get bored and they invest in technology—which is great, but then they get into the trap of making the patients fit the technology, as opposed to determining if the technology is right for the patient.
I truly believe that it is the carpenters and not the tools that determine the end results of good dentistry. Hand skill, proper isolation, patience and the ability to know one’s limits will always trump single-file endos, magical bonding systems or digital scanners. The foundations of good dentistry are and always will be timeless.
In addition, you like to maintain the balance between providing exceptional treatment at reasonable cost. How do you do this? Why is this one of your philosophies?
I worked hard to develop a supply-chain management system to keep inventory reasonably low. I researched extensively to find quality materials at reasonable prices to provide the best care without passing supplier markups to patients. Materials have advanced so much in our time that it’s not necessary to always shell out for big brand names when other manufacturers provide excellent products at more reasonable prices. I also built the clinic to be efficient in terms of carts for procedures, for us to set up quickly and do as much same-day dentistry as possible.
What’s an average day like at your practice? What does your patient population look like?
I wish I had some form of system and block scheduling but it’s more like the Wild Wild West, anything goes. We can start with an implant, bounce to a molar endo, then take out some “wizzies” all within a few hours. I have a lot of older patients; many have a lower income with lots of challenging restorative needs. In fact, I would say my restorative is more challenging than my endo, crowns, implants and extractions. I know most people glamorize the latter but good quality restorative in mouths with poor hygiene is very difficult in my opinion.
How is your practice laid out? How did you go about designing it to make it more inviting to patients?
I wanted it to be fresh and new but without intimidating the patients. I found teal to be a very soothing color and I really wanted it to transition throughout the clinic. One of the unique features in our clinic is a wave that goes down the hallways. It has texture, starts a light teal and transitions to a darker blue similar to the ocean. We get a lot of compliments, as not only is it unique, it really provides a great effect of distracting and soothing patients. All our cabinetry is custom, and we kept the clutter in the rooms minimal, coupled with 12-foot windows and multiple TVs. The ambience is quite unique and minimalistic.
How do you market to new patients?
When we first started, we did the traditional route of mailers, website and AdWords. But as we grew over the years, I’ve found Google on its own and word-of-mouth are the most effective. We have never advertised any promotions and we don’t do new patient offers. I figured my best and most cost-effective bet would be good ol’-fashioned word-of-mouth.
What gives you the most professional satisfaction?
I would probably say doing things that patients didn’t conceive as possible by saving teeth that had no business being saved and yet lasted for years. We call these “Hail Marys,” and by far they are my favorite procedures. I also love to get patients out of pain. I prefer the functional and pain management aspect to dentistry over the cosmetic. I find the appreciation of patients for the most part genuine and sincere and it warms my heart.
What’s something you’d like to see dentistry do differently, as a profession, within the next 10–15 years?
I would like us to shift back to a more pragmatic approach, and provide tools for newer dentists on how best to manage difficult restorative and save teeth as much as possible. I place implants, but I still think we are shifting far too fast toward not giving teeth a chance. I think with some tips and techniques, we can service patients’ teeth for much longer than we might even think possible.
What are some of your hobbies? What do you like to do in your spare time?
Usually, I would play sports, including rugby, squash and golf, badminton. I also like working out. We are surrounded by the gorgeous Rocky Mountains, so I take my kayak out to the lakes and have great little trips out there. It’s very serene and relaxing. Sometimes I like to cook and bake, and have been known to make the occasional cheesecake or brownies for my staff. A well-fed staff is a happy staff.
You were diagnosed with oral cancer in July. What support did you receive from the Townie community once you got your diagnosis? Was anybody particularly helpful as you worked through this difficult time?
I mostly kept quiet about my diagnosis, but a few close Townies who’ve become friends over the years were quick to give their support and offer any help they could.
I wanted to give a huge shout-out to my friend and oral surgeon in Calgary, Dr. Lee Darichuk (“IcedOMF”). He unfortunately was the person who had to give me my diagnosis, and since then he has been nothing but amazingly supportive and compassionate, even visiting me multiple times in the hospital. He will always be my brother for life. Also, I wanted to thank Dr. Fayette Williams (“toofache32”), who is famous on Dentaltown. Dr. Darichuk put me in contact with Dr. Williams, who was amazing in taking time out of his day to take my calls and address my fears and concerns and be supportive during the process.
• Voco X-tra Fil
• Voco Grandioso
• Digital X-rays and panoramic
• YAPI paperless dental software
How did you go about notifying your staff and instituting a plan while you’re out for recovery? What measures did you have to take?
I basically had to have a staff meeting at the end of a normal workday and drop the bombshell. Some staff had noticed my lesion and knew something was wrong, but nobody was aware that it was oral cancer. I have a lot of local friends who were key in posting a locum position for me, and eventually I was lucky enough to find a great dentist I’d worked with before and trusted.
How will your practice run while you’re in recovery? How did you come to this decision?
Probably the only blessing of this whole ordeal is that it has taught me to let go, which is hard for most dentists. I was lucky in that not only do I trust my staff but also my locum is a friend and his work is exemplary, so that allows me to sleep at night. I tried to do the bookkeeping and payroll at the hospital and mostly just do a little admin work as I heal. I didn’t really have too many choices, so I did the best I could do and let fate take care of the rest.
What does the road to recovery look like? When do you plan to return to practicing full time?
The surgery was difficult. They took out half my tongue and transplanted skin and the radial artery from my left hand to my left tongue. They then grafted skin from my thigh to cover my arm. The good news is that I am recovering well, and I retained most of my speech. My left arm still gives me sharp pains and discomfort from the graft, but I am working through physical therapy for that. The biggest factor will be my ability to eat and get my range of motion in my neck back after the neck dissection. I am hoping to take about two months off and then slowly ease into things.