What follows is one of two interviews with my dear friend, Professor Rajiv Verma from Mumbai, India. He is one of the most renowned dentists, professors, in that country, in one of the biggest countries in the world, one of the most exciting countries in the world. There's so much going on in that country. I want to learn more about what is going on in India, in the dental business, and what is going on with digital dentistry in India.
Click here to watch the Coffee Break with Christian Coachman - Episode 5 part 2 with Dr Rajiv Verma
This interview was originally taken from Coffee Break With Coachman, a series of interviews with the best dental brains and the best personalities, in short, the most influential people in our dental industry today. From business to marketing to clinical to research, academics, laboratory technology and digital, each of the interviews is a conversation with a thought leader in their field, sharing their knowledge and experiences.
CHRISTIAN: So, what I want to do first Rajiv, so people understand 'who is Rajiv Verma?' I want you to give us a quick background, a quick summary of who you are professionally, your achievements, and your education.
RAJIV: I am, of course, a dentist. People in India call me both a dentist and an artist, because I'm a dentist, and although I am not a qualified dental technician, I am a ceramist. I've been doing ceramic work for the last twenty five plus years now and taking courses in different parts of the world. I am a speaker, so I give lectures at conferences across India and in Southeast Asia. I do all three circles of dentistry - clinical dentistry, dental restoration and cosmetic work, and I am a speaker at conferences and give courses and lectures.
This year I completed thirty two years of practice, and it was absolutely fun. All these years in dentistry were truly fun, hard working no doubt about it. And I’m sure I’ll enjoy another five, six, or even ten or fifteen years.
CHRISTIAN: You told me that initially you wanted to be a physician, but something happened?
RAJIV: In India, and I think it's going to be quite close to what is like in Brazil, we have an education system which is up to twelfth grade, so tenth in school, and eleventh and twelfth in college. In India particularly, everybody has one of two paths - if they do not go into commerce or the arts side, they aspire for either medicine or engineering. So I was similar, I had applied for my medicine degree, but this is one hugely populated country. For every one place, there are more than 400 aspiring students, so I just missed my admission to the medical side. Can you believe it - point thirty three of mark, that's it?
So the next option which remains in India is dentistry. Because if I was going to take dentistry, the ladder was further down to pharmacy and physiotherapy and the other branches of medicine.
So I chose dentistry with no regrets today, but trust me the day I entered college, I actually wanted to run away in a months time. Putting my ten fingers into somebody mouth was itself a big no no.
CHRISTIAN: How long did it take for you to fall in love with dentistry? And what made you fall in love with dentistry?
RAJIV: I think the third year of dentistry, when the clinical work started and we started doing our first extraction, our first amalgam filling. I guess it was the experience that I probably wanted. The first two years troubled me because it was all theory, and models of elasticity and coefficient of thermal expansion. I wanted to leave all this math behind, I was in medicine, and here I come to figures again. So, first two years were really difficult but the third year was clinical. And I am, I think, a practically oriented man. If you really ask me what is the definition of chamfer, I don't know. You ask me, show me how to do a chamfer, then give me a minute, and I can show it to you. So, I’m completely practical. So, third year, onwards, life changed in the industry.
CHRISTIAN: That’s a similar story to me, because it took me until the third or fourth year of dental school to find myself in dentistry. First and second year, I was desperate. I was 100% sure it was not for me, the profession.
RAJIV: I don't believe you because you come from a dental family. I mean, it is infused in you! You should be not taking any other option, ideally.
CHRISTIAN: I didn't. I insisted, and I was able to find myself in the profession. But there's another passion of yours which is education. How did that start? Why did you decide that you wanted to teach people?
RAJIV: Doing dentistry, I passed out in 1985, and then I worked with senior dentist and then chartered my own clinic practice in a very small place. I had a childhood hobby of photography, so I had this DSLR camera of my father that I was using. I used to click every case of mine, whether it's absolutely bullshit, or great. It was like that learning phase, you can imagine how the picture quality would be and everything. But slowly, the momentum started building and I remember those days we had films, so no digital dentistry. I used to buy these films with the exposure of, I think, 35, and print them and make slides. Slowly, some young dentists started coming to me and observing me for how to work. Then one young dentist actually told me, 'Rajiv, you have more than ten thousand slides, I think you need to start teaching'.
I was like, 'Are you mad?' I had never ever spoken in public. You wouldn't believe it now but I am a shy guy, I am a thorough introvert. If you throw me in a party I wouldn't talk to more than two people, and here he comes and tells me, 'I'm inviting you to… a state conference, and people should hear you.’
CHRISTIAN: How old were you?
RAJIV: It was 1997, 10 years into practice. I was amongst the pioneers in porcelain veneers, so my first lecture was at the state conference in our state of Maharashtra in India. I did a live porcelain veneer patient and a live bonding, in the afternoon session on another patient. I think that boosted my confidence, because that was very well received.
CHRISTIAN: That's quite pioneering in the 90s to do a live veneer lecture with live patients. At that time, I remember here in Brazil, my father and my uncle were among the first ones to do that live. That was the beginning of the 90s as well. They did a conference with live transmission and live patient prep and bond and everybody was blown away. So I can imagine that that generated a lot of buzz, a lot of noise, around your name. That made you, share with me some of the numbers. You have the amount of lectures you gave in India. In India, it's like China, right? Everything is huge. Every number is huge, you know?
So share with me the extension of lecturing that you did in India, your programs, your students, the tours that you do around India. Because I travel around the world, but in India, it's a whole world inside the country, right?
RAJIV: I mean, this year, I've finished more than 800 plus lectures in India, Bangladesh, Malaysia, Thailand, in this part of the world, and more than 251 hands on programs, which I just started for fun in 2002.
CHRISTIAN: The following you have, every Indian doctor that I meet, all over the world, they all know you, and they all respect you. They talk about you with pride and with happiness, so it's an amazing achievement to be really unanimous, you know there's no doubt, really amazing. So, for me to know you, I think that's the best entrance in your country, in the dental field. For me it's an honor to have met you and to have entered India with your endorsement, with your support. That's probably why DSD has grown so much in India, and we have so many followers in India, and we always have people from India come in to our courses.
Now, another passion you already mentioned, besides dentistry, is lab work. You're also a technician, so like me. Why did you start with lab work? When did you start to really sit in a dental lab and do things with your own hands?
RAJIV: That's an amazing, interesting story. Way back in the 1990s, the trend in India was to have two dental clinics, You have one clinic here and you cater in some other area. I attempted that, but I failed because of some issues with the premises. So I had a little money in my pocket, hard earned money. In Indian, Rupees is just called one lakh Rupees in 1990. I just went to one dealer, and told him I wanted to buy a VITA furnace. So he said, 'Do you know what it is?' I said 'Yes, I think it bakes ceramics'. So he said, 'Do you know how to do work with it?' He said, 'I don't know anything', I said. So he said 'Are you sure you want to do this?' I said, 'Yes, I would love to do it'. He promised me that he would send me to Germany and give me a free course with the machine. He of course fulfilled his promise, and I flew to Germany to do this course. I came back and I started doing veneers in the refractory die material in 1991.
CHRISTIAN: Another passion of yours is dentures. I remember, when I met you, I saw many very interesting programs you were doing on dentures. I know that in India is a huge market for dentures. But all over the world, I think not only the fact of providing people with dentures, but understanding dentures, for me, is one of the most important things to make a dentist become a smile designer, to make a dentist become a rehabilitator. We need to understand the principles of dentures from A to Z, even if we never do a denture in our lives, only veneers or crowns, or implant prosthesis. I always teach the basics of dentures, because I think it was a problem for me when I realized that I knew very little about dentures.
So, what is your relationship with dentures? How did you start your courses? I know you have a relationship with Ivoclar as well, because of the dentures, right?
RAJIV: We have.
I loved prosthetics. So more than I think the hard tissue, I love the soft tissue, and making dentures. My wife Meenakshi who is an endodontist, and I, flew to Ivoclar and we did the BPS program, the Biofunctional Prosthetic System, and it was very simplified for us. It was, i think, one of the finest programs in making dentures. And then, I even purchased the laboratory equipment to manufacture dentures in my own lab, which was actually doing only porcelain veneer work, and I fell in love with it.
It was so much easier than the conventional procedure, and since 2002, non stop we have been doing it. I eventually gave it up in 2012, because now in India, things are changing. I would recommend implant supported dentures rather than spending hours on making the lower denture. So in my practice it was like, with an upper denture, we used to give a lower denture free of cost, because I believe that even if some good dentist had to make a denture in another mouth, the lower denture would be the toughest one. Even the BPS system may not help every time, you know? So as implants picked up in India, which is a huge market today, I think we, I would recommend these dentures which are supported by implants, that's for sure. But, amazing, I loved it.
CHRISTIAN: The principles are still the same. If you're going to place on a denture-less patient or a patient that needs full extractions. If you're going to go towards a removable denture, or if you're going to place implants and support the prosthesis on implants, the principles of facial analysis, vertical dimension, intermaxillary relationship, bite registration, smile design, lip dynamics, you know, 3D planning, everything is the same all the way to the point that you need to link that design to the existing bridge, to the existing bone. And at that moment, you can pick, I want to design a removable one or I want to place implants and support that with implants.
So, I think it's so important, that more and more people are teaching young students about the principles of dentures. I always mention that, and I always suggest to all my students to read an article that for me is one of the most beautiful articles in dentistry, in aesthetic dentistry, restorative dentistry, the article from Richard Lombardi from 1973, The Visual Principles of Aesthetic Dentistry. For me, I usually call this article the birth of smile design. The guy was, in '73, talking specifically about dentures, but when you read the article, you see that is for absolutely everything.
Next, I want you to share with everyone, why you decided many years ago to attend a DSD course? You were already a successful doctor, lecturing all over, very stable, with a great dental office, you were around 50 years old already, you know? And then you decided to move things around and enter the digital world and understand Digital Smile Design. How was that?
RAJIV: The story starts way back in 1991 when I started doing my veneers, and then the lab picked up actually. Everybody started sending work to my lab for veneers and way back from say 1994 onwards, many doctors treated my lab as a very special lab for creating special smiles for the Bollywood industry of India. Bollywood is equivalent of Hollywood in India, so for the stars, the film stars and so on and who's who of India, our lab was the preferred lab, and then the story started. 'You made this veneer for' somebody in India, a big film star, and then there comes a mirror in the hand, and he looks into the mirror, and he says, 'I think this has become slightly longer, can you reduce it a bit?' And then there I go, or the doctor whose patient it is, he would say 'Rajiv, can you reduce it a bit?' And then when I reduce it a bit, and you put those veneers back in the mouth, the reaction of the doctor would be 'Oh my God, I think they reduced it a bit more'.
You came to India in 2011, February, at the IIDC conference in Worli, and I still remember you gave a lecture. I was in the audience like another 400 at least, you started speaking, and in one hour, I was completely connected with you, because you spoke about how a smile is perceived by different people. So the dentist looks at the smile with his science, the ordinary guy who doesn't see the patient and works only on the cast or image on the laptop screen, and he gets it. The main person, the patient, who holds the mirror, the most amazing thing which I learned from Christian Coachman, friends in India and all over the world, whoever has a hand mirror in his clinic, please throw it immediately in the nearest garbage can. I remember that line of yours.
This was the problem, and the fourth was the patient's friend, or relatives, especially in India, the film star's mother. Because the mothers are used to seeing their daughters the way they are, and suddenly they see a new change and they wouldn't like it. This was frustrating to me as a dental technician, as a ceramist because all the hard work happened at the back end.
I remember doing nine sets of veneers for one film star. That's 90 veneers. In the process I lost my brain, and at the end of the 90th veneer, the patient had the guts to tell me, I think the first set you made were the most beautiful set!
You came into my life exactly at that time and it hit me so hard, I said I need to follow you. That night, I couldn't sleep. And I remember during lunchtime, I was standing outside, and we were all having lunch, you were of course completely surrounded by the most beautiful girls and women of India. You were the James Bond of the day, we couldn't meet you. I couldn't shake hands with you, nothing. What I grabbed out of your slide is your number and your email.
I went home at 11:15 India time at night, and I sent an email to your office. In 15 minutes, I received an email back. My question to your office was, I love this program, I want to learn more, does Christian have any courses? So I got a reply, no courses as yet, whenever there is in the future, we'll let you know. And your office replied back after a few months to say that there is a course in Florence, Italy.
CHRISTIAN: That's when I started to partnership with Andrea Ricci.
RAJIV: 2012, October.
CHRISTIAN: So I started a collaboration with Andrea Ricci and we organized the first DSD courses outside Brazil. I think was 2010, so that was the second year that we were doing the courses. That's a great story. I still remember that lecture was my first trip to India, 2011. Huge crowd, and that was the beginning of the concept, and as you said, try to link. The patient's desires, emotional desires, to the initial project, create a test drive, be able to approve that test drive, and then create strategies to move from the test drive to the final restorations, everything analog. But creating a system to try to minimize the errors between the project and the final design, from the aesthetic standpoint, because, as you mention we waste so much time adjusting things in the restorative world, back and forth. As I usually say, without digital, until recently in dentistry, the patient's mouth was the laboratory. We test everything in the patient's mouth.
That whole emotional experience of the patient, trying to understand and asking for changes, and for me, I always thought that we could try to find a better solution, that's the reason we started with PowerPoint and Keynote, all the drawings. The key reason why I invented that little yellow digital ruler and the caliper, and trying to guide the wax ups. Trying to guide the wax ups, and then creating all the guides to move from wax ups to ceramics, and for many years that was the workflow, before we entered the 3D digital world. But I was, for many years, very happy to see that the system, the DSD, we call it today the classic DSD. Pictures, Keynote, PowerPoint, Digital Ruler, Caliper, wax up, Silicone indexes, mark up test drive, preps, impressions, models, silicone indexes, final restorations. Still, a lot of room for errors, but already a little bit better in terms of bringing facial references.
And as you said, you know, working with celebrities in Bollywood, our actors and actresses, I can imagine how demanding and how much pressure you were going through.
RAJIV: Highly stressed, to be very frank, highly stressful. All the doctors who sent me these patients, they all knew that it was hard work, definitely.
CHRISTIAN: And that's maybe why, and I know this is a tough topic, but you told me that in 2007 you had a big health problem, maybe because of all the stress, and other things. But I think it's interesting to share with people, first that life is not always going up, and second, we need to understand how to go through tough moments, and if you can explain to us a little bit of this moment and how this changed your life.
RAJIV: So, let me put it this way, I'm sure all over the world, the story is the same. But in India, it is like this, a boy needs to stand on his own two feet to get two more feet in his life. So the concept of boy standing on his two feet after his graduation, post-graduate education is complete, means he should be starting to earn money. Once he starts money, then he can get his spouse, so in that case came Meenakshi into my life. So now we have four legs, two stomachs, and life goes on in the direction of earning money.
Then these four legs together intermingle and produce two more legs! So that's how my elder daughter was born, and then we had three stomachs. And then, you know, in three years time in India, you need to have a brother or a sister, and so came my second daughter, in 1993, so now I have four stomachs to feed. So four stomachs, four schoolings, four everything. So life went in one direction, which I'm sure everyone in India will relate to, your brain automatically goes into the mode of earning money. It only thinks about how to pay the monthly EMI, how to go through the house expenses and all, plus the expansion in the business.
Life was like a graph which was going up, up, up, up, up. In 2007, January, I was giving a lecture in the national conference in Pune, and I was talking about shade taking, because at that time there was this complicated 3D master shaped like the honeycomb guide and I doubled up the formula for that. I was giving that lecture, and I started perspiring heavily, and some of the people sitting in the first few rows actually said, 'We could see your inner-garments through your clothes', that’s how much you were perspiring. I had this terrific pain in my back for around 20 seconds, it just came, then went off. I was talking, Ihad a sip of water, I continued for the lecture for another maybe half an hour or so, finished, happily went out and there one young Dr from Pune, he said, 'Sir, I think you have a massive cardiac problem'. I said, 'Are you joking?' He said, 'No sir, my uncle is a cardiologist and you need to show him immediately', and he just bumped me into the car, with Meenakshi, and we went to the doctor, and he said 'My God, you are alive? It's a miracle, you would have gone very fast within another five, ten seconds, so I think you need to get admitted instantly, and you need to get operated instantly'. So there I am, lying in a bed for eleven hours. Same day they took me from Pune to Mumbai to the best heart hospital, Asian Heart, and under the renowned doctor, Dr Ramakanta Panda, the heart surgeon for the president of India. They did not perform the surgery the same day because I had to deposit money. So they put me on medicines for two days, and after my wife deposited the money, they opened me up and then they did it.
The surgery went well. The best part about this story was, six months after that, I was in bed, because this was a big surgery so I was, at least for three months on bedrest, and I extended the bedrest to six months. Every day, mornings and evenings, looking at that ceiling fan that is rotating, it just made me think, think, and think. Because since 1987, that's where I started my practice, to '97, I had become a speaker and a technician, and in 2007, here I am, looking at the ceiling, and the fan is revolving. And then suddenly things flashed, what am I doing it for? Is it the way to earn the money? Is it to look after the family? Or, what's exactly happening?
So one day I remember having a discussion with Panda's associate doctor, cardiologist, and he sat with me with a pen and paper and said, 'You need to make two columns, professional and personal, and you need to start writing what gives you maximum stress'. So I started with my personal, and the first one, of course every one the whole world will surely write, it has to be the wife, sand he took the red pen and he struck it off, he said 'This is the only thing which you have to learn to live with', strike that off. 'You can't change her'. And then children, and then father, and mother, and then friends, and the other side was very interesting. You know, the second side, the first thing I wrote was dental laboratory. High stress job. And after that was clinical work, the last was speaker, that was absolutely fun, and that's where he looked at me, he said 'Why are you doing all this now? There is no need to'.
It took me five years, because the lab was making business, it had a great amount of profit, there was fun creating the celebrities, I never realized that this is stress creation. It took me five years, until in 2012, 31st December, I suddenly shut shop on the lab. I said, 'I am not doing it anymore', I'm going to concentrate only on what my cardiologist has suggested. And that's where the third phase of life went into bloom, and that was becoming a speaker. That's what I was doing earlier, but then now, the last phase, I could say, of my life, in the remaining years, I would love to only give in life, not take anything.
So life is in full on, I give more now, every weekend, Friday, Saturday, Sunday, whoever comes, it's only give, give, give. That's a message to everybody. This running behind something was worthless.
So actually this is my second life, and I think I need to, I deserve, and I should give, others deserve my services, I feel. So even DSD, I am learning DSD at this age. I first met you when I was literally 49, 50, this year I've already booked 10 days with you. If you remember, DSD residency one, I'm coming for four days, DSD residency two, four days, and DSD instructors program, two days. So many of these dentists in India ask me 'Why are you doing this? Because you're hardly now doing any clinical cases, you're doing only big cases', no lab, which I handed over to one of my technicians, who is doing a fantastic job, 'Why are you doing it?' So the only answer was for me was, ‘I want to learn from Christian, I want to be full on digital by February 2019', and 'It's only to give it to the next generation'. I have no motive behind it.
I may not earn a single Rupee out of all this, but I will see that you guys learn, and you guys go ahead with the DSD concept, because it has changed my life forever.
CHRISTIAN: Amazing, that's an amazing story. Six months laying in the bed looking at the ceiling. We hear those stories once in a while how these bad health moments, they make you stop and reflect and introspectively reorganize the priorities of life.
It's interesting to see, and sad sometimes, that if life doesn't give us these super hard moments, we don't stop, right? We just keep going. We think we are superheroes, we think we can do anything.
I think I was there always on this path towards craziness that we see ourselves going without balance and without prioritizing and without really focusing on what really matters, there's the ego as well. I always think that our ego is one of our worst enemies if we don't control it, and I usually say, you know, we think our egos are under control, and that's the problem. And usually, many of the decisions we make to do crazy things and to do more and to achieve more, it's beyond the money. Beyond the money, there's the ego. We want to be recognized, we want to be remembered. We want to do something special, we want to prove ourselves to other people, we want to shut up the haters. And that's the ego and then the problem I see is that we have a tough moment admitting the ego, so usually we say 'No, I don't have an ego', and that's a big problem.
We all have an ego, and I say, if we are speakers and we like to lecture, we definitely have a ego, because if you don't have a certain level of ego, you don't like to be on stage. If you like to be on stage, it is because you love teaching, for sure, and you can do it for good reasons, but there's always a piece there that is because we like to expose ourselves. So for me the first step is to admit, instead of saying 'I don't have an ego, I'm humble', bullshit, say 'I have an ego, and I have to work every single day to control the ego'.
So, now, what I want to ask you, since we understand in depth now, why you are who you are, and why you're so admired with everything you told us and everything you’ve achieved in India. I want to understand a little bit more about the Indian market, what is going on with dentistry over there, what do you see as the next opportunities in your country. I know that many companies like Invisalign, even like DSD, implant companies, everybody's looking at India as well, because the market is huge. So what is going on from the business standpoint, and from the dental standpoint in India?
RAJIV: On the one hand, the Indian economy is growing rapidly. I hope the rapid sustained growth happens in the next ten years, the way it has been. I think it's a circle of life, it's bound to, that our economy grows in the next ten years, like heavily. And I say economy grows on one side, there is this young dentist in India with 300 dental colleges, producing almost 26,000 dentists per year for a population. That’s 26,000 dentists per year, for a population of 1.3 billion though, so that's a huge population. The problem, as of today, is only five percent of Indians visit a dentist. Only five percent. The reason is, no insurance. Dentistry's completely private in India - dentistry, independent colleges, and charity hospitals. But there's nothing from the government, and there is nothing, no insurance, so people have to pay money from their pocket. The Dentist, the most hated animal on the planet, nobody needs him, nobody wants him, nobody desires to go to him, on top of that he charges. So things are difficult, I can understand for the young generation in India, but my promise to the young generation today our economy is growing. Just be committed to the profession, keep walking, you don't have to run, like the mistake what we did, the economy's growing, people will have money in their pockets, and people will eventually start spending on dentistry.
I hope you enjoyed this interview with Dr Rajiv Verma and were inspired, as I was, to continue to learn and grow as a dentist, and to stick with things, even if they seem tough. Read the second part of Dr Verma’s interview for more insight into dentistry.
If you would like to know more about Digital Smile Design, the DSD Planning Center and the courses we offer, including our four day residency to take the first step to becoming a DSD Master, find out more here: