How did Extreme Makeover get started, and how did you get involved?
Everybody thinks that "Extreme Makeover" was my idea. It wasn't. Basically, what happened was Howard Schultz, the executive producer of "Extreme Makeover," came up with the idea and pitched it to ABC. ABC loved the idea and started to put together a team of doctors. ABC called me and asked if I could come in and meet with them, but I was busy working that day and really didn't have time. I didn't understand the impact the show would have, so I said, "I really can't do it." I had a demo tape since I had just been on Rosie and a few other talk shows, so I sent them the tape, which is basically a compilation of different things that you do in the media. They called me back and said, "We love it, and we would like for you to shoot our pilot."
Has the success of the show surprised you?
I never had any idea it would be as big as it is.
What impact has the show had on your life?
I feel so incredibly honored and fortunate to be "the dentist" on the show. They could have picked from 134,000 dentists in this country, and the fact that I get to be our spokesperson is something that is unbelievable to me. I pinch myself every morning. In addition to all the wonderful things that we do for these patients on the show, I think the thing that really makes me the most satisfied is the way that dentistry is portrayed. ABC has done an amazing job of portraying our profession in such a positive and inspirational light. I actually get emails from dentists saying, "Your show makes me proud to be a dentist." I get letters from kids in college saying, "I never thought about going into dentistry as a career, but after watching 'Extreme Makeover' I can't think of anything else I would rather do." It's the first time that prime-time TV has highlighted our craft. And we look great! Usually the dental part of the show is the best part of their makeover.
How are patients selected for the show?
People can go to ABC.com and type in the keyword "Extreme Makeover." There is a form to fill out and send in with a videotape. The videotapes and questions are then screened. We get tens of thousands of responses. Once they are screened, I would say on average 20 prospects per month are actually passed out to the plastic surgeons and me. If there is a "go" from the plastic surgeons and from me on the dental, then ABC flies the patients in for us to examine. They usually come in groups of 20. Once the patients arrive, all 20 of them come right to my dental office the first thing. If I can't give a great dental makeover, then the patients are usually sent back home; ABC doesn't even waste time sending them to the plastic surgeon.
What is your choice of products and materials on the show?
The products I use on the show are the products I use every day. If I'm going to whiten a patient's teeth, I use Zoom. I know with Zoom that I will get consistent whitening, and I will get the teeth as white as I can as fast as I can. We are on a six-week lead time, so I don't have a lot of time to be waiting for take-home or other whitening systems to work. All of the anterior cases you have ever seen me do in my career are "Feldspathic." I think it's the most natural. As far as removable, I'm using Valplast, and that is done at Galaxy Dental.
Do you offer complete treatment or just anterior esthetics?
Typically when I'm doing treatment, it's anterior. However, if the patient has a bombed-out mouth, I'm not going to let him or her walk out with a bombed-out mouth. If the patient has a mouth that has some things that we could change, we normally don't unless the teeth are broken down. We basically do full-mouth reconstruction on patients who need it. If the patients have satisfactory dental care and dental restorations that aren't esthetically displeasing, we will leave them as is. But some of these patients who come on the show haven't been to a dentist in years. They don't have money, and they end up needing multiple root canals and root cleaning, curettage, and perio surgery. It's amazing how much work we do that you never see. And I don't get paid for it, but I don't want to send these patients back into society and back to their home dentist with six beautiful veneers along with bombed-out molars and what-not. So for anything we don't do on the show that really needs to be done, we tell the patients about it so they can get it done at home. To be honest with you, there hasn't been a single patient whom we have sent home who has needed a restoration, even if it was a filling on Tooth No. 2. If they need it, we do it.
Is there any follow-up to a referring dentist in the patient's home location?
When I send the patients home, I usually call a dentist I know in their area and ask if he or she would be their dentist.
How do you sequence the treatment?
When the patients come, I break the dental into two segments: things that need to be done before surgery and things that need to be done after surgery. For extractions and things like that, we get those done right away. We get perio surgery done right away. We get endo done right away to decrease the risk of infections and all those other things. And it allows us time for maximum healing. If I'm going to do perio surgery, I push it right to the limit, because they really need to heal for four to six weeks before you start the dental work. So, almost the day the patients arrive we will do the perio surgery and everything else we need to do. That way, at the very end of their stay here, we will do their dental. I usually turn it around in four to five days. Even if it's a full-mouth restoration, we prep everything in one day and we seat everything on the second day.
How beneficial is it to have your lab tech, Danny from da Vinci, there to see the patient? What tips can you offer to better communicate between the lab technician and the dentist for a great final outcome?
Communication between the dentist and the laboratory is the most critical factor in the success of cosmetic dentistry. You need to be able to convey to your lab what it is you want and what the patient wants. I've been working with these guys for 20 years now, and they know what I like and what I dislike. I try to give them as accurate a lab slip as possible with as much detail as possible, including photographs, records, and models — as much information as I can to get the most predictable results. In my opinion, your best shot is to make your temporaries as close to what you want your permanent teeth to look like as possible. Give the lab accurate models of your temporaries and say, "Copy this."
Have you had any follow-up from the makeovers?
I get some of the most amazing letters, cards, emails, and follow-up from these people. I'm going to read you something that came from DeShante. DeShante is the one who was on CNN — Larry King. It says, "It's amazing how differently people treat you when you fit into their idea of beauty. It's a bittersweet thing. I've always been this person. However, few people took the time to get to know me. Now people who wouldn't even make eye contact with me have so much to say." Now think about that. Think about being a 23-year-old woman who's never had front teeth in her life. Think about walking in and doing something that just comes so naturally to you — like smiling at people and not being able to do that. And it's not being unable to do it because you don't like your teeth; it's not being able to do it because you don't have teeth.
Once a patient is selected, how do you begin treatment? What suggestions or insight can you give a woman dentist in treatment preparation?
When I do a case, the first thing I do is stop being an anal compulsive dentist and become an artist. You're doing artistry, you know. Take off your dental mask and put on Leonardo da Vinci's cap and be an artist. Forget about golden proportions and this and that. Be an artist. Make your patient the canvas. Create the smile your patient wants. I do that in composites; I do that as a mock-up. Sometimes we need to do enamel-plasty at the same time, but I do that as a mock-up for the patient and for my lab. Once the mock-up is made, I use our DISCUS Dental Clear Bite Impression. Then I use our Precision Impression Material and take a poly vinyl siloxane impression of that, which we pour up and give to the laboratory as a mock-up impression. Once we do that, I go ahead and start my preparations. When I do the preparations, I only prep if I'm doing, say, six, eight, or 10 units. I'll prep one lateral and one central to completion, and then take an impression of that with my adjacent teeth in the mock-up form. I do this so that as my lab technician is creating my case, he can take those two teeth and go back to that second model from the master model and make sure they are in perfect symmetry with the remaining two central and lateral incisors on the model. I call it my "prep guide system," because what happens is, inevitably — especially with the refractory model — a lot of times when the lab builds up the teeth, the length is not the same, the buccal thickness is not the same. It's hard to judge that when you are looking at a mock-up model and prep teeth. So if you can take these two teeth and try them on my "prep guide model" — which is where we just have a lateral and a central prep and it fits in — then that acts as a guide for everything. That's how I get absolutely consistent results every time.
You could be described as the "ultimate guru in branding your practice." What suggestions could you give to women dentists about branding, continuing education, and their career?
I never took a course in marketing. I never took a course in advertising. When I opened up my office in Century City 20 years ago, I asked myself: What do I need to do to get warm bodies in this office? I didn't have money. I didn't come from a wealthy family. I made everything. I didn't have a lot of money to go out and spend on advertising. I couldn't put big, splashy ads in journals and things like that. What I realized is that in a five-block radius of my office there were 50,000 people. And we know on average that 50 percent of those people don't have a regular dentist. That's 25,000 people! What I did was spend $300 to make a beautiful flyer with a great introductory offer. It basically said, "Come to my office and you're gonna save all this money and get great care." And it worked. I think my best advice is that every dentist out there should sit down and assess her own individual situation. Maybe you're in a small farm community, maybe you're in a big city, or maybe you're in a mid-size city. Try to determine what it would take to get warm bodies into your office. You know, people don't realize this but you can make television commercials and put them on major networks — ABC, NBC, CBS, and FOX — for just a few hundred dollars after midnight. It's not expensive. People respond very well to TV. Run TV commercials — there are so many things that can be done today. And for those dentists who sit around complaining that they're not busy, I say: Sit down and figure out what you need to do to get busy. And if you can't, make an investment in yourself, and make an investment in your education. If you feel reluctant to do it because you don't feel like you're providing the quality of care that other dentists in your community are, shame on you! Go take some continuing-education courses. Go to PAC-Live, go to LVI, go to Larry Rosenthal's course. Learn how to do the best cosmetic dentistry you can, because you won't be successful if you're not at the top of your field. And if you're not at the to of your field, it's your own fault. Get there! And once you're there, tell people about it! Do talk shows, do mailers, do advertising — there's nothing wrong with advertising. When I first started advertising 20 years ago, dentists in my area hated me. They said nasty things about me. But you know what? They weren't supporting my grandparents. They weren't supporting my sister. They weren't paying back school loans. They weren't trying to buy a car. You know what? Too bad! Let 'em hate you! If they are that close-minded, let them hate you, because you need to look out for yourself. I'm not saying do things that are unethical or in bad taste. Don't! Take the high road. Do it the right way. But if people have a problem with it, you know what? That's their problem. I have always had an open door in my office. The guys down the hall from me who are dentists are my friends. If they ever want to come into my office and spend a day there, I let 'em. And if they ask me to advertise in things, I let 'em. I don't feel like dentists are competing with other dentists. What we are competing with is the disposable income that people have in trying to decide if they should buy a bigger car or get their teeth done. We should give them the material and the knowledge they need to choose teeth.