Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost.
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893 Dental Art Made Simple with Dr. Sigal Jacobson : Dentistry Uncensored with Howard Farran

893 Dental Art Made Simple with Dr. Sigal Jacobson : Dentistry Uncensored with Howard Farran

12/4/2017 7:22:35 AM   |   Comments: 0   |   Views: 278

893 Dental Art Made Simple with Dr. Sigal Jacobson : Dentistry Uncensored with Howard Farran

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893 Dental Art Made Simple with Dr. Sigal Jacobson : Dentistry Uncensored with Howard Farran

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AUDIO - DUwHF #893 - Sigal Jacobson



A dentist and an inventor, Dr. Sigal Jacobson from Melbourne Australia is an internationally acclaimed lecturer with more than 22 years of experience in aesthetic dentistry. The dental product report has nominated her as “this year's top 25 women in dentistry “Dr Sigal published several articles in major dental magazines and invented the world-renowned Uveneer™ system which is a template system to deliver predictable and efficient aesthetic composite restorations. Uveneer is distributed exclusively by Ultradent and is used by thousands of clinics all around the world. She is also working to create more innovations that aim to make the general dentist’s work more efficient and predictable, while simultaneously

Making it easier and more affordable on the patients. She is a fellow of the American Academy of Dento-Facial Aesthetics, member of the Australian AADFA and a key speaker for Ultradent.

Howard: It is just a huge honor for me today to be podcast interviewing Dr. Sigal Jacobson. My gosh, she was born in Russia, grew up in Israel, went to dental school in Hungary, practiced in Melbourne, Australia, and now currently is in San Diego. She's a dentist and an inventor. She's from Melbourne, Australia, and an internationally acclaimed lecturer with more than 22 years of experience in aesthetic dentistry. The Dental Product Report has nominated her as this year's Top 25 Women in dentistry.

Dr. Sigal published several articles in major dental magazines and invented the world renowned Uveneer system, which is a template system to deliver predictable and efficient aesthetic composite restorations. Uveneer is distributed exclusively by Ultradent and is used by thousands of clinics all around the world.

She is also working to create more innovations that aim to make the general dentist’s work more efficient and predictable while simultaneously making it easier and more affordable on patients.

She is a Fellow of the American Academy of Dental Facial Aesthetics, member of the Australian AADFA and a key speaker for Ultradent. Thank you so much for coming on the show.

Sigal: Thank you for having me.

Howard: Well, I called you, you didn't call me. Because I really liked your YouTube video and, my gosh, it's got like 36,000 views on it. Tell us about your journey with Uveneer.

Sigal: Okay, so I'm a dentist and I love cosmetic dentistry and I also love composite. So I had difficulty in creating the anatomy; the facial side of the veneer. It just took me too much time, it was very artistically challenging for me. So travelling around the world trying to learn, to master composite veneer, going back to my clinic I found out that it wasn't that easy. It was still time consuming, all the polishing part and creating the contour and it just took too much time. And maybe not so much cost effective for me, and I decided to go and do something about it.

I love to invent, I love innovations. I actually buy everything that is innovative in my practice. So I decided that if there's nothing that does exist, then I should make it happen. It was about five years ago. I went to an engineering company in Melbourne and I asked them to create me shells that simulate veneers, and my idea was just to put it on a patient, tooth with the composite, [00:02:48] cures [0.4] through the template, and when I remove it I will get the shine and the shape of the composite of the tooth. And yes, it happened. I thought it would take two or three months. It took about two or three years to create it. That's what's usually happening with inventions. And then when I took it to the market, I brought it to America, to the Chicago Midwinter. We went through a few friends of mine from Australia; most of them were dentists. We were at the booth in Chicago, we got the most terrible location because it was a last-minute booth. But we were very attractive, people really came to our booth, they loved it and the product was born.

Howard: That is fantastic. Where on your journey did you decide to have Dan the man Fischer, an alternate carry it and distribute it.

Sigal: So what happened is that at the beginning we distributed by ourselves. I was still living in Australia and we used to get phone calls from people over the Internet. We did some marketing in Dentistry Today and we had key opinion leaders starting talking about our product in lectures. So we started to sell about one year before Dan Fisher approached us. But we decided that it's good for us to find a good distribution company, for a few reasons. First of all, we were too far, we were in Australia, so travelling so much for every dental show around the world was a hassle. The second thing is that marketing is very expensive, so when you're doing a product it's not enough to invent and to create it, the major part of the expense is marketing. So if we could find a good distribution company that will take us from going on the stair to being on the lift --that's what I describe -- it would be much easier for us. So we found out that there are few companies that they fit to our product. We approach them -- I won't say names -- and we almost close with one of them, with one of the companies, but then Dan Fischer, which I really always wanted him but we didn't know how to approach him. I mean, he's a very nice man, but you just can't call him and say, "Hi Dan, I have a product." They get like 300 products a year to evaluate. It's not easy to get there. But the funny thing is that my booth in the New York [00:05:16] Rayno [0.3] meeting was in front of his booth and he saw me demonstrating with his VALO, the curing light. So he thought that I might be selling his VALO. Or he didn't understand why I'm playing with his VALO. He came to my booth and I didn't recognize him. I thought he was just one of the ten dentists that were in the booth and I'm starting to explain. And he was fascinated by the idea of how quick and fast and what a conservative treatment is that for the patient. And two days later invited me to Utah and since then I think my life has been changed as well.

Howard: That is awesome. My gosh, it's kind of interesting, you have a direct composite veneer instead of an indirect veneer. And you went with Ultradent, which is direct distribution instead of indirect through a distributor. So I think you were born and raised: you like direct. I think direct composite veneers are so much more minimally invasive. If my granddaughter grew up and wanted veneers, I wouldn't want to file down the enamel on her upper 12 teeth. I think that's very destructive. Are you a big fan of indirect veneers or did this come out because you're so much more pro direct composite veneers?

Sigal: That's a good question. I will say I wasn't always direct composite person. Coming from Israel, graduating '95 as well, we were the generation that were taught to do everything by extension. Extension for prevention, extension for resistant form. I remember we even have extension for prevention. So we were the generation of removing and cutting the healthy tooth structure, do elective root canals and doing full crowns, full house bridges and that was the normal for us.

I think my main change happened when I moved to Australia. The difference between Australia, I think, and America or Israel: Australia is a very conservative dentistry. They still do a lot of dentures, and when I arrived there 13 years ago the implants were not a big thing there. So I bought a clinic from a woman that, she was a big composite person, and gradually I learned that minimally invasive might be the way to go. Nothing will happen if we don't do a full crown, if we do overlays -- not [00:08:02] bolted on [0.5] of course with the back teeth. And I just found that if you are more conservative, less problems happen to the teeth: less micro fractures; teeth are not dying; the nerves are still alive. So I became more a composite.

So my practice changed from porcelain mainly to composite. I still do porcelain veneer, they are still minimally invasive. If you prep them well they are okay. But I just think that, as you said, for young people, for one tooth you don't have to do six teeth when you do composite, because the refraction of the light is very natural at the enamel of the tooth. So you can do one tooth. It's affordable for the patients, so you can help more patients when you do that.

So all of this made me learn how to work with composites. Also, I remember that the old composite -- I don't know if you remember, you probably do -- the first generation when we worked, they were horrible. They used to fracture, they used to stain. With time, when the bonded technology increased, when the nanotechnology arrived, the composite became better and better. They stain less, the shrinkage is much less and you can get really nice -- if you know how to work with them -- long lasting restorations.

Howard: Yeah, I don't remember any of that, because I'm so young. I've been practicing 30 years but I started at age three. It's very confusing. So how is Uveneer doing?

Sigal: Oh, now it's doing really well. There is more than thousands of clinic working with the Uveneer. People are very happy. In the beginning we were afraid if people like it or not, they will return it, because we gave them 30 days money back guarantee. By the way, even now we give it to them because we know they will love it. Take it, use it, if you don't like it just return it. So no returns. People love them, they do the job, they're quick, they're easy to do. There is some other challenges of course: how to choose the right composite, the shade, but it gives you the 50 percent of the work in half of the time.

Howard: Yeah that's my four finger Golden Rule. When someone pitches me a new idea, I'm like, "Is it faster? Is it easier? Is it higher in quality and lower in cost?" And if you meet all four of those finger goals, it works. And innovation -- Henry Ford said that it's not an innovation if it doesn't bring your product to the masses. You're making cosmetic dentistry faster, easier, higher quality and more affordable to the masses and doing it in one appointment.

Again, I'm just not a huge fan of veneers, because when you practice 30 years -- I've seen so many -- when the standard young lady who's 21 years old goes and gets ten upper porcelain veneers, tell these young kids listening today, what is that going to look like in 30 years? They don't have a good time. They file down this enamel, they take the impression, they send it to the lab, they make these veneers, they get them back in two weeks, they cement them on, they're just gorgeous. And it's like, "Okay, they're gorgeous. But what are they going to look like in 30 years?"

Sigal: Well, you can also say to composite veneers as well. You don't know what's going to happen in 30 years. How are they going to look? Probably they're going to be external and staining. But I think that -- I'd never promise my patients anything for 30 years. Porcelain veneers, they are long lasting. I'm sure they are more long lasting than composite in the way they look. But when I do my case selection, when I decide whether the porcelain veneer or composite veneer will be [00:12:03] inserted [0.6] to this patient, how do I know?

Well, patient comes to me: first I will use a lot of common sense. Like you said, if it's a young patient, no. But if it's a 50-year-old woman with old composite veneers and she can afford it and she's ready for porcelain, for the next level, yeah go ahead and do it. It's like a car: if you don't drive a car, you would be very happy with driving a Kia. You don't need the Porsche, right? You can always upgrade later to the Porsche. This is how I look at things.

So first, when I do my case selection: is it porcelain or composite? I want to get to know the patient: expectations, past experience. I listen, I talk to them and I use my common sense. And then I rely also on evidence based dentistry. Is it grinder? Will he de-laminate my porcelain veneers? Then I will not do it. I will go one year and do composite veneer and just observe. And then I do a mock up; I do a mock up on the patient, on a model, and I show the patient. I like to do my mock up on the patients. And I show them and if they say, "Uh uh Sigal, I want something more glamorous. I want more Hollywood smile." Then I understand the expectation level. Okay, so let's go for the next level. Can you afford porcelain?

And I always use the mother test. Whatever I will do to my mom, I will suggest it to my patients. And not mother in law, your mom, or your daughter, right? Whatever you want to do to your kids, this is what I will do to the patient. But sometimes they want more. That's why you have to listen to them. So this is how I do my case selections, and then I decide whether it's porcelain or composite. Again, they are both good. Nothing is wrong with each, you have to give your patients the whole options.

Howard: Which composite do you think is the best for your system? Which one looks the best, the shiniest? What is your go-to composite on a Uveneer?

Sigal: I get this question a lot: which composite do you prefer? Let me tell you something. A good cosmetic dentist, I think, should not use only one composite. He should use a few brands. It's not enough to have one composite, because A1 of 3M is not A1 of Vocal and it's not A1 of Ultradent, right? Because they all have different value. So it depends on the case. Regarding the shine, you're right. Some will be more shiny because of the particle size. Some will be less shiny, but there is a very easy way to overcome that. If I see that my composite that I choose for that case is not that shiny with the Uveneer, I will apply a little bit flowable composite. Not any flowable, it has to be a high fill flow. So it will not stain so much. G-aenial flow by GC Universal. G-aenial flow. Beautiful by Shofu is high fill flow. Iso from Vocal the [00:15:11] radio [0.1] is high fill. And I try it on the template and combine it with the composite on the tooth, so I'll get the shine from the high fill flow and the composite. Having said that, in my drawer I have so many composites. I have -- and I don't buy the 20 colors. You don't have to. I buy A1, B1, B2, one bleach white I have. And then some translucent from different brands and then I divide them into value: high value, low value and medium value composite. And then it depends on the case and where do I want to head? Do I want to mask something? Do I just want to change the morphology of the tooth, so I have to stay with the natural chameleon effect composite? So the question, when they asked me: which composite do you prefer? It depends on the case.

Howard: Well said. Gosh, I wish you would contact Dr. Howard Goldstein and make an online CE course for this. Have you ever thought about that?

Sigal: I'm actually doing here in San Diego workshops for Uveneer, me and Dr. Jack Riner, he is a great guy. He's doing the porcelain part and I'm doing the composite part. So it's a full day in workshops. It's called San Diego Dental Hub. People come from all over the world. It's a one day and we train them to do composite veneer, with Uveneers. We create composite bridge, we create individual shade tab for composite, because I believe that individuals -- from Uveneer --I believe the individual shade guide, they really good for you if you like to work with composites, because the Vita shade guide will not really show the proper composite. So we do all this and it's fun. So I travel around the world now to give lectures where Ultradent sends me, but my passion is doing hands on courses and I want to stay at home. Look, I have three kids --

Howard: Well next time you have a course, just film one hour of it. Because if you put it on the Dental Town, they'll be watching it in 220 countries.

Sigal: Yeah, I will. Tell me how to do it and I'll do it.

Howard: What website should everyone listening go to hear about your courses? You have the

Sigal: Yeah we have [00:17:39] inaudible, [1.7] San Diego, so it's

Howard: And how often do you give hands on, over the shoulder courses?

Sigal: Once a month.

Howard: Wow, you are a busy woman.

Sigal: We just had one on Friday. It was really nice.

Howard: On Labor Day weekend?

Sigal: Yes. People like to come to San Diego. San Diego's amazing, you should come here.

Howard: Oh I love San Diego. I live in Phoenix, so that's my go-to place. I can leave here in the summer and it'll be 118 degrees and get to San Diego and it'll be under 85.

Sigal: I heard you just come back from Melbourne though.

Howard: I did just come back from Melbourne and I wanted to ask you about that. When you talked about the Hollywood smile, when you travel around the world, is the Hollywood smile universal? I mean, you lived in Russia, Israel, Hungary, Melbourne and now San Diego. Is cosmetic dentistry pretty homogenous around the world? Or do different cultures and customs and people have different views of what they want their teeth to look like?

Sigal: Oh no, no. In Australia -- In Russia; I was 9 months old when I moved to Israel. But in Australia people -- and also in Europe -- they will want you to do the most natural cosmetic treatments. They want to look like nothing was done. They are not after the Hollywood smile. Actually, when I want to bleach their teeth they say, "Sigal I don't want it to be too white." Yeah, in Australia they ask it not to be too white. And they don't want it to look fake. Everything is very natural and that's why composite looks more natural than porcelain. So composite is very strong there.

But I think that as a dentist working in Australia, and working in other countries, we're all facing the same issues, same challenges. We have insurances if no influencing there in Australia. We have dental corporation taking over private clinics. So we all have the same problems. But you're right, the audience is asking something else from us.

Howard: Yes I completely agree that if you wanted to look natural, direct composite is just far better than porcelain veneers. And there are so many world-famous porcelain cosmetic dentists saying, "Look how natural that is." And it's like, well I don't know if it's because I'm a dentist or what, but I can tell those are veneers across the room. So agree or disagree?

Sigal: Depends. If you use a high-quality lab, very static veneer and you work with the European labs, I can tell you that some porcelain veneers can look very, very natural. Although today porcelain veneers are not so static anymore. They're not handmade. They make it from the E.max and it’s more machine made so they look a little bit less natural. But companies working on the value and to make it more natural, those [00:20:51] England [0.4] and now they also have the cat cam machines and they're coming with a lot of composite as well; indirect composite. So I believe that porcelain will look more natural than today and I believe that it's just really the matter of do you want to grind so much teeth for that? Or, can a patient afford that? Or is it something that you can postpone to do it later? That's the question.

Howard: So how long you been in San Diego now?

Sigal: I've been in San Diego for one and a half year.

Howard: One and a half years, and you were 22 years in Melbourne. What is really the main differences between Melbourne and San Diego, from Australia to America?

Sigal: You talking about the lifestyle?

Howard: Well, do you have a lot of interesting facts about Melbourne?

Sigal: So let's see. I don't think people know that Melbourne wins the most livable city award six years in a row. And this year is the seventh year. We have very good coffee. If you had the latte and the flat white there -- I miss the coffee. People think that we are on the beach surfing. No, Melbourne has four seasons a day. It's quite cold there all the year, it's like San Francisco weather. But the life there -- I miss Melbourne. But San Diego is quite similar in the matter of people are nice and relaxed there and the beaches, and it's nice. I love the weather here.

Howard: Yeah, I just lectured in Melbourne and Sydney and taped a dozen podcasts, and I just love Australia. My brother moved there and he was on a three-year job visa, and about six seconds after he got there he applied for permanent citizenship and got it. I mean, he just -- well he came from Kansas. It's hard to go from Kansas to Sydney. You know, San Diego and Melbourne, I could see you thinking back and forth, but you can't go from Kansas to Sydney. It is truly -- and what's so neat about it when I go down there is, he doesn't even have a car. The public transportation is so good he thinks a car is a pain. And my god, I just love that lifestyle. I'm in boring suburb Phoenix. So I could go out and sit on the street in front of my house and no one would probably even know it or -- he walks out his door and every block is a restaurant, a bar, a bookstore. The life is just so much more fun. I just think he has the most exciting life and I have the most boring life.

So what do you think about when dentists are referring to themselves as cosmetic dentists? You know, the American Dental Association only recognize nine specialties and then some dentist started calling themselves specialists in implant dentistry and they sued them and lost. So now specialty is kind of blown open. Basically, the courts told the American Dental Association, “You're a private membership club, you're not a state regulator.” So there's a lot of dentists on their websites that say, "I'm a cosmetic dentist." What do you think of that?

Sigal: Well I agree with the word cosmetic dentistry, but I'm not a big fan of the term cosmetic dentist. Because what does it mean that there are some non-cosmetic dentists among us? I think that all dentists should finish their restorations aesthetic. And I think a driving force should not be the aesthetic outcome. So I think the driving force should be: preserve the tooth structure, keep the path alive, work with material to simulate the properties of the tooth as much as possible and the aesthetic will follow. If I will grind a tooth and I will lose the nerve, there is not going to be any aesthetic, it's just going to be dark and then there's going to be dark line. So our main concern is not going to be: yes aesthetic, not aesthetic, I'm cosmetic, I'm not cosmetic. How we preserve the tooth structure and learn to work with materials that would mimic the tooth's structure. The aesthetic will follow that. And really I believe in that.

Howard: So I'm at your website: Interesting, beautiful website.

Sigal: Thank you.

Howard: I love that picture of San Diego. Are you very sad or do you not care that they're losing, the San Diego Chargers?

Sigal: I don't know what you mean.

Howard: The football team.

Sigal: You have to ask my son. I'm not involved --

Howard: Is your son into football? So tell us the journey, how did you hook up with Dr. Jack Ringer?

Sigal: Jack Ringer is a very nice guy. He's not far from me. He's actually from San Diego originally. We met in the American Academy of Cosmetic Dentistry, I think I was even in his lecture and I liked his lecture. And then I gave him the Uveneer, when the Uveneer just came, it was still hot from the oven. I gave it to about 30 dentists, key opinion leader to evaluate it before we came to the market. I believe that if you have an innovation, give it to people to evaluate before, because you think you have a good idea but maybe other things people think it's not a good idea.

So he was one of those people that I gave them and he was so excited about the Uveneer and he gave us so many good testimonials and everything free, never ask anything in demand back. So we became friends. And when I wanted to do the course, I wanted to do a whole day of course on -- and he's a porcelain veneer guy -- so I wanted to incorporate Uveneer in the morning, composite veneer, and then the second level. If you want to do porcelain, yes you can learn and do that in one day.

Howard: And once a month, that's a busy schedule.

Sigal: Yeah we will come with 2018, we're working on a schedule and it will be a once a month. And we get insured quite quickly. I'm surprised how quickly people -- probably people looking for workshops. There is a lot of lectures but not so many workshops.

Howard: Hands-on, yeah. About 30,000 dentists are in the AGD trying to get their fellowship in the academy of general dentistry and that's like 500 hours and you can take it all lecture. But when you try to get your mastership in the academy of general dentistry, it's another 600 hours, but they want 400 of that hands-on, over the shoulder. And those courses are hard to find. The rarest one to find, to try to complete your MAGD, is a hands on pediatric dentistry course or a hands-on denture course. I remember back in the day when I got my MAGD, there was about ten of us dentists that every year the ADA had a hands-on workshop for dentures that was participation credit courses, and another one for pediatric dentists. We took the same course by the same lecturer every year for like five years to get those requirements.

Sigal: So you keep listening to the same thing?

Howard: Oh yeah, because you had to have a certain number of hours of hands on and you couldn't find it. And it was so hilarious because when he would start his lecture, he knew like ten of us, because he kept seeing us over and over and he goes, "Okay, how many people have already seen this course and came back for their MAGD?" And like half the hands went up. And he goes, "How many are here for the third time." And like half the hands were still up. And then he was going through it and I think the winner was five times and he just laughed. I mean it was very hard. So hands-on participation courses are rare. How do you think dentistry has changed since you graduated in 1995. I mean, that was two decades ago?

Sigal: I think almost every technique or material that we learned in school is not existing today. And as I said, we learn to prepare teeth with more extension than doing more conservative dentistry. And I think this dentistry in 1995 when I graduated, we actually destroyed a lot of teeth. We became the enemy of teeth. I remember when people were talking about better then or minimally invasive dentistry, the tunnel preps. I remember there was sandblasting. You remember instead of drilling. They were all looking like Masunaga, a little bit weirdos, but now I understand that with the bonding that we have today, that's the way to go. So I think the adhesive technology changed a lot in dentistry. That's the biggest change is what I see.

Howard: If you go to Dental Town there's over five and a half million posts. So we have a search bar and if you type in Uveneer, there's lots of threads on Uveneer. I think it would be huge, that townies would love it if you'd go in there and say, "Hey, I'm the founder and inventor of this." They're talking about Uveneers; composite veneers with Uveneer; Uveneer kit by Ultradent; Uveneer by Ultradent; easy, unique, affordable; another thread, has anybody seen this? It goes on and on and on.

Sigal: I didn't know. That's good

Howard: Well that's the difference between Dental Town and Facebook. The difference is, all the social medias like Facebook, Twitter, LinkedIn, they're just a continuous news feed. So there is not really organization. Whereas if you go to Dental Town, it's not a news feed, it's a message board by category. So there's 50 categories, from root canals, implants, cosmetic dentistry, pediatric dentistry, or you can just go to the search bar and type in Uveneer and it's right back there.

But let's say you posted a Uveneer case on your Facebook page, or a certain case, it's hard to go back and find that. You know what I mean?

I think Facebook and Twitter and LinkedIn are -- the continuous news feed is great if you want to go a mile wide, an inch deep. But if you want to go an inch wide, something very focused like Uveneer, and go a mile deep, the posts have to be categorized on a message board. Maybe I'm old school. I started Dental Town in '98, but my god, the message board format for me is how you really do deep learning and problem solving. Where Facebook and LinkedIn and Twitter is more just almost like today's newspaper: just a continuous news feed, what's up, what's not, things like that. And I think the difference between Facebook and LinkedIn is dentists on Facebook are more likely to post what they did for Labor Day, whereas dentists on LinkedIn, it's always business, it's always dentistry, marketing, it's very little personal stuff.

Sigal: I think Instagram is also one of the biggest thing now. A lot of dentists they go on Instagram. I learned that as well.

Howard: Yeah, and Mark Zuckerberg, did you know the owner of Facebook bought Instagram? And did you know his dad's a dentist?

Sigal: I met him. He was next to my booth one time, he's a nice guy.

Howard: Man, we've had him on this show three times. I love that guy. Can you do layering with Uveneer?

Sigal: Layering, yes. People think that you can only do -- so let me explain you how actually Uveneer is working, and then we talk about the layering. The Uveneer is autoclavable, so you can reuse them as many times as you want. You buy the kit one time. You have premolar, second premolar, up to upper teeth and then lower teeth as well, in two sizes. So you have the large and the medium, and they will pretty much fit to 95 percent of your patients. This is a point the smile design rules.

So what do you do? You just etch and bond a tooth if you want to do, let's say, composite veneers, you apply the composite on the tooth on the template and you press the Uveneer, then you lacquer.

A lot of people they think, "Yes I like to do my layering techniques, so why would I use Uveneer if I only use one layer?" And I'm telling him, "No you don't have to. You can do layering technique." Apply your first layer, press the Uveneer, cure then remove the template. And then you just cut back and add the second layer. You can do even three, four layers with the cutting back technique. So yes, you can do layering technique, although I like simple -- I think the simplicity is the best. The more steps we have, the less predictable things can happen. So I can prefer to do one single layer, and I found that with the Uveneer, because of the shape of the template, which is like that, and you press, you're going to get different thicknesses of composite. So for one composite you will get different shades because of the different thicknesses. Different thicknesses give you different shades. So one layer will be enough, but if you want to do two layer, three layers, by all means you can still do that.

Howard: So going to dental school in Hungary, I bet that was fun.

Sigal: Well the best time of my life.

Howard: Oh my god I bet so.

Sigal: Beautiful city. Have you been in Hungary and Budapest?

Howard: Yeah. Oh my gosh. But I always get mixed up. There's Budapest, Hungary and Bucharest, Romania. Right?

Sigal: Yeah, that's different.

Howard: And which one did Michael Jackson do his concert at? The big famous one?

Sigal: I think Bucharest.

Howard: Bucharest, Romania? That is my favorite concert in the world. Did you ever see that video or movie or whatever? I think that was the epitomal peek at the -- but how was Budapest, Hungary?

Sigal: So we went in a program that was in English. So it was an English program, we were one of the first. Now it's very popular. It's only four hours flight from Israel. So it's okay, it's like if you study, you live in San Diego and you learn in New York. It was fun because it's to live in Europe and it's a beautiful city. The study were really high level. On the first two, three years I didn't come out of the house. But then I relaxed. Fourth, fifth year were much nicer. And just a very good school and I'm very happy I went there. It's only for foreigners. And there were also Americans went there. So we were Israelis, Greeks, some from Kuwait, Saudi Arabia, Canada, America, and we still keep in touch with the students. And it's fun. It was good times.

Howard: Now I'm just curious; you lived in Israel went to dental school in Budapest, Hungary. Could you actually have driven there if you wanted to? Are there roads and bridges all the way across from -- could you have driven a car there if you wanted to?

Sigal: You are talking about drive from Israel to Hungary?

Howard: Yeah.

Sigal: No, no. There is a lot of enemy country that surround Israel. So that will not let me.

Howard: But if there weren't enemies and if there wasn't a war could you drive there? Like I can't drive to Rio de Janeiro because south of Panama, you get areas there where there's no roads.

Sigal: Oh I never tried it. I guess you could. But there is too many -- nobody can travel out of Israel with a car unless you go to Egypt and Jordan because they have peace with us. Anything else, no you can't.

Howard: Yeah. I always thought they're probably -- I wish they would do that down in Panama because I bet a lot of Americans and their RVs would drive all the way to Rio de Janeiro, if you could get a RV to go down there.

So what other inventions are you working on now? You're an inventor, you're in your prime. What's got your mind going now? Where are your passions lying?

Sigal: My passion lying in doing things for dentists that will make their lives easier, faster and will be more affordable for the patients. All in the area of minimally invasive dentistry. Now, I do believe that isolation is very important and a lot of us do not put the rubber dam. So in my opinion the rubber dam clamps, the metal clamps they are pain, very hard to put. So my next invention called the Novel clamp.

Howard: The Novel clamp.

Sigal: The Novel clamp is the new clamp and it's going to be purely silicone clamps. So you just floss, floss and then there is two wings and this will hold them and then you can just throw it. No need to numb the gums, very good for kids. You know how we have to numb the gum for the metal clamps even if we don't need to numb the tooth. So there is no numbing there, it's much less scary. So I'm very excited for that. I'm doing it with a guy from Guatemala. His name is Pedro, he is a dentist. Great guy, we thought about this idea together.

Howard: I just texted Dan Fisher a couple of minutes ago and said I'm podcast interviewing Dr. Sigal Jacobson, are your ears burning? And he just text back, "Super. What a great product subject from a great inventive lady who is self-made. Our vision is about improving oral health globally with an emphasis on quality affordable dentistry for the masses. Dr. Sigal you are a champion. Keep that good stuff going. Howard so are you. I admire and respect you immensely. With love and hugs to you both. Dan."

Sigal: Aww, send him my hugs again as well.

Howard: You know, that message is just not the same when he's not standing in front of you punching your shoulder. Every time you talk -- if you talk to him for more than 30 minutes your right arm won't work.

Sigal: Did you ever try following him? He's just running, you can't follow him. I have to take off my heels and just run after him he's so fast.

Howard: Well, that's a good question. I'm glad you said heels, because that's a common question that, now that half the dentists coming out of school are girls, that was a question I didn't hear guys ask 30 years ago. But a lot of girls are asking, "If I want to be a cosmetic dentist or an implant dentist or I want to be all that and a bag of chips, can I wear scrubs or do I need to put on heels and a dress and a lab coat over it?" What do you think about that.

Sigal: I don't think that scrubs is the way to go. We always looked good. We didn't have -- the men or the women, we always wear lab coats, we looked white. I don't know, I'm coming here to dental clinic and can they all look like, sorry, but these scrubs need a good wash. So no, you have to be respectful. Heels are not -- heels is up to the woman. I'm used to go with heels. I think women should look feminine. I think it's okay to look feminine. Nothing to be ashamed of. As long as it is not too provocative and it's respectable, yes, put some makeup and heels and go and do your thing. But if it bothers you and it's aching, of course, don't suffer for that.

Howard: So what is Novel? N-O-V-E-L clamp. When is that coming out?

Sigal: Novel, novel, like new, Novel clamp.

Howard: Right.

Sigal: The Novel clamp will come out in about two or three months. We are just doing the packaging now.

Howard: You will distribute that with Ultradent too?

Sigal: Yeah, I think so. Whatever -- when we get there, we'll get there. We will offer it to them of course and we would love if they work with us.

Howard: So that will be your second product invention?

Sigal: And I'm working on another Uveneer with more shapes. It's also coming very soon. More natural, we scan real people teeth and we are going to get extra contour teeth for the one who wants very natural looking and not the Hollywood teeth. So those templates for that -- we have square teeth now, long teeth. So there will be more shapes coming. So for now that's what I'm doing.

Howard: There's probably a few people driving to work right now listening to you thinking, "I got a product idea." What advice would you give someone as a product designer? I don't want to tell my homies something I don't do. Ever since I started a magazine, Dental Town magazine in 1994 and the website '98, at least every month someone sends me a nondisclosure agreement and they want me to sign this legal contract, this nondisclosure agreement before they can pitch me their idea. And I always tell them, "Dude, watch Shark Tank for an hour. If you think your product is going to be successful because you have some legal racket with the NDA." I said, "First of all, I don't date attorneys, I'm not going to sign any contract and start telling your attorney what I've agreed to. I don't do it." And I said, "And in my 30 years, every single person that sent me an NDA, I never saw their product come to market. But every single dentist who flew down here and walked in my Today's Dental Office or Dental Town and demoed me their product, they spend all their time getting plastic injection molds and designs and they came in with a prototype and was ready to show it to me on a live patient. Those guys oftentimes hit a single, a double, a triple or a Grand Slam."

But the ones who -- I mean, my example to them is this: look at McDonald's. Do you need a NDA to go to McDonald’s? They're on the intersection, they have a drive through, they sell hamburgers, French fries, Cokes. How many people were able to bring a hamburger and a fry and a coke to market to compete against them? You can count them on your hand: Burger King, Wendy's, In and Out. There's hardly any. So it's never the idea, it's the execution of the idea. So I don't sign NDAs. But what's your advice? You've taken two products to market. If someone is listening to you right now and had this great idea what advice would you give them?

Sigal: So I agree to what you say, but in another way I think that before they come to the market with an idea they need to patent or at least a patent pending so then they can go and tell it to everybody.

Howard: Did you have a patent on Uveneer?

Sigal: Oh yes.

Howard: And when does that expire?

Sigal: It just started. We were patent pending until last month. Beginning just now.

Howard: Well congratulations.

Sigal: Thank you.

Howard: So is that your first and only patent so far?

Sigal: We have the Novel clamp which is patent pending as well. That's why I was able to talk about it. So I have two.

Howard: Well you have one patent, and one patent pending.

Sigal: Yes.

Howard: That is a hell of a feat to get a patent. It is not an easy process to get a patent and I have never got a patent. I've applied for a patent three times, and one time they dug up something in Japan from like 1940. So that's a hell of a feat. Congratulations on getting a patent.

Sigal: Well, I have to tell you as well. If a dentist wants to invent something and do the patent and do the registration and do the boxing and everything, it's very hard when you work in a clinic. I had help from my husband, he is an accountant. He actually retired from his job to do all of this. This is a full-time job. So it's not so easy as it sounds. And he has experience with reading contracts and understanding.

But I really think that if dentists want to do an invention, we are the one that know what we need. We are more aware of the obstacles and we can come -- the best invention come out from the people that are inside the profession. So yes, you have to protect it with a patent. It's very important I think.

And I think also a lot of dentists they think that their idea is a game changer, and that's fine, and it is the best idea in the world. But I think that they should show it to their peers. They should show it to their colleagues and get their ideas. Because maybe he likes what he invented, but the other ones they don't really going to use it. So spending time and money on something that maybe something people will not buy. Everything, you think it's easy, it's easy to come up with an idea, it will take me one month, two months, three months. No, it takes two years. Minimum two, three years. And there is so much funds doing that that you need to put. So much money and especially in marketing. And unless that you're sure and you completely believe in it, don't do it. It's an expensive journey. Or you want to join a company and give them your idea and they will take and help you. Otherwise think twice. Show it to your peers. Because coming up with the idea is the easy part. You know, I heard that in order for a company to bring -- I read that in order to a company to bring a product to a dentist, and dentist have to hear about it two to three times before they commit to buy, it costs the company $300 per dentist for marketing. So, not that easy.

Howard: I know. And the other thing about marketing is we've surveyed -- on Dental Town, when you start a thread you can start a poll. So all the users have been generating polls since 1998, for 19 years, and we have a monthly poll. And it's amazing: dentists, when they want to know about a new product, something like 89 percent always say they want to hear about it from a colleague. So even though you do all that marketing, they don't want to hear from GC or Ultradent or whatever, they want to hear from their buddy. They want to hear it from Bubba. Does this work for Bubba in his hands? And if his buddy tells him it works -- and that's why you should do an online CE course, show them how, because you're a dentist. I mean, you have so much street cred by just being a dentist.

Sigal: No. I totally agree and I can see that as a dentist when I go and speak in front of an audience, and I speak not only about Ultradent products, I talk about everything I believe in that worked for me. Because I love to teach, I love to give them any advice that I have. And I see that as a dentist I have more credit and they will go and buy the product than if a sales person come and give them the speech.

Howard: Oh absolutely. In fact, the best reps that come to your office from Patterson or Shine or Benco. When you ask them a question, the best ones, they don't say, "Well you should do this." They used to say, "Well, who's your favorite endodontist? And you say, "Okay, Brad [00:48:20] Gelman." [0.3] "Well he uses this file." They're just reinforcing your colleagues that you don't know about because you're not visiting a hundred different dental offices each week. But the best reps are basically a walking social affirmation, spreading the word about what these other reps are doing.

Hey, we just had -- three months ago we just had 6000 baby dentists just get out of dental kindergarten. And this week we just had 6000 brand new dentists walk in as a freshman. This show is over-weighted towards dental students. This show is probably 20 percent dental students and the rest are pretty much millennials born after 1980. What advice would you give to the graduating class that just walked out of dental school a couple of months ago, and they're just learning how to cross the street? What advice would you give this young lady?

Sigal: First of all, I think that they have to find a mentor; a mentor is very important. I think they have to remember that knowledge comes from experience. A lot of them they finish dental school, they think they know it all. Be humble. I think the more ego, the less knowledge; the more knowledge the less ego. That's what I believe in. So experience and learn from others.

Go to workshops, trade shows, lectures, online lectures. Go to online courses, as you said. Dental Town. Join groups. If you like cosmetic dentistry, American Academy of Cosmetic Dentistry. If you like implants, you can find any group that you can join, study groups. That's what I believe.

And also another thing that I really believe that -- look, dentistry is a very hard profession. You get worn down very quickly. So what I did is I always kept my work environment fun. I was friend with my receptionist and we were friendly with the staff and the patients and I really liked the patients. And I always bought tools that would make an innovation, that would make my work easy. Buy good coffee machines, put a nice music. I mean, this is your second home. And even if you work for someone, bring your own music, get your coffee machine, buy your own instrument, buy your own composite if you prefer to work with one composite. If you will bring it to you, to the dentist where you work, it will make your life so much fun and easier. So find those ways to make long life dentistry more fun.

Howard: You know, that is profound advice on so many levels. Talking about staying humble and learn; find a mentor. But when you look at life, you basically spend a third of your life in bed, a third at home and a third at work. So you should really have a really nice bed and you shouldn't have electronics in there and TVs and it should be just a cold, dark room for sleep. And if you're getting woke up three times a night by your barking dog, get your dog a different home.

But when you go back to the home and the work, these dentists have these really nice homes that they love to be in and then they go to work and it's this mindset that every operatory should be 11 feet wide by 12 feet long and they're cramped. And some of my friends, when they built their dental office they said, "Well this is crazy." They said, "If I'm to spend half my waking life in my office, I'm going to go into an operatory where mom and three kids want to walk in and sit down, there's a sofa and a chair and cabinets." And he said, "Man, at home sometimes I just need to go lay down on the couch." And so he has a couch in his break room and he has a refrigerator and a coffee machine. It's so crazy that most dentists will spend half their waking life in like an 1800 square foot office, but then live in a 3800-square foot home. And it's like, why is your home twice as nice as your office?

Sigal: That's what I think. Same. That's exactly what I think. When I bought my clinic in Australia it was from a very old fashioned outdated, old carpets. I just took it all, make it modern, make it my taste. And I invested more than I invested even in my house, because also this would generate me the income and the money and the time that I'll spend. Maybe later will bring me the house that I want. But first invest in your clinic, make it your home, make everybody comfortable to get in, make it you. Put your character in it.

Howard: What would you say to her -- a lot of them are saying, "Well you and Sigal probably didn't graduate $350,000 dollars in debt.” I graduated 30 years ago in 1987, $87,000 in debt. But a lot of times she's feeling upset because she's like, "Come on Doc, I'm $350,000 dollars in debt. Should I work at Western Dental for 10 years to pay that off?" What advice would you give her on that amazingly huge debt load?

Sigal: Well this debt is only a thing in America. Don't get them so much so big in other countries. That's a big problem. And I think the country, the government has to do something about that. This is not normal.

Howard: But Americans won't. They don't get it. We have more guns than all the other countries combined and they don't care. So you're not going to solve that. When you talk about health care: bills are the number one cause of personal bankruptcy, and when you talk about a health care system in Australia, they say, "They're socialists, we are Americans." It's like, dude. And when you talk about education it's the same damn thing. I mean, whenever you talk in America about how great Australia is or Denmark or Sweden, they just go, "Them are socialist countries." So it'd probably be easier to convert the whole country to Hindus than to bring in socialized medicine or a socialized education. So you're right, it is -- that's what you're saying, it's just an American problem, isn't it?

Sigal: Yeah and only when you live somewhere else and you come here, you realize the wrong things that's happening here. Like you said, with the health and with the loans that the kids get with very high interest rates. But I have --

Howard: You go to Scandinavia and the kids always have hopes, and they always have free college. They can go to college and get ten degrees for free. Their crime rate is almost nothing. But when a kid doesn't have access to college or he doesn't have hope, then he can turn to the dark side and start stealing and turning to selling drugs and all that stuff. And I don't understand why people think socialism is so bad? Why wouldn't a poor 21-year-old girl have a right to go see a doctor when she's pregnant. But America's a different beast.

But I'll tell you, after 55 laps around the sun, don't look for much change. Even though I did see a massive change in my lifetime with my little brother. My little brother is gay and my god, if you'd asked me when I was in high school: what's the chances that someday it would be legal for my brother to get married? I'd have said, "It'd been twice as likely to be hit by a meteorite." But they did it. And same thing with marijuana. In Kansas when I grew up, if you drink a bottle of whiskey and wrecked the truck, you're just a good old cowboy. But if you smoke marijuana, by God you are a criminal and you are going to jail and your family disowned you. And now you can marry a man and smoke pot. So I have to admit, I did not see those two things coming at all.

So this little girl; here's a problem I see with her a lot of times. You said that she needs to find a mentor. And I tell her if she wants to learn endo, to walk across the street for free, knock on the endodontist’s door. But she's got $350,000 in debt and her best idea is to fly all the way across the country and take some lecture. I can buy Pathways to the Pulp by Stephen Cohen for $200. It was 800 pages. It took a week to read that and it's pretty much all endodontic information on earth in one little $200 book. But she always seems to be spending all this money on the most expensive way to learn.

Like on Dentaltown, the online CE course is $18. Hell, your taxi from the airport to the hotel is more than $18. But specifically, how do you get her to build up the guts that if she wants to learn how to place implants that she should just go knock on the periodontist’s door and say, "I want to learn to place implants." Half of them will think in fear and scarcity and say, "No, if you want to do implants, refer them to me." The other half think, "Oh this is cool. I want to mentor you. You'll be my buddy and I'm sure that no matter how good you get there will still be cases you're going to send to me. And I'll be your friend, I'll earn your referrals." So how do you get her to go find a mentor in her own zip code?

Sigal: I don't think that mentor has to be in your reach. And she doesn't have to go to his office. For example, my mentor when I lived in Australia was Pascal Magne. Mentor means I can listen to his lecture on the internet; I can read all his article; read his books. Maybe once in a few years fly to see him, or when he comes to Australia, sign up to -- it doesn't have to be someone that you can actually see on a daily basis or monthly basis. Because you need to work as well. So you're right: use the internet, use Dental Town, use Dental XP. I used them a lot when I was busy in my practice and I still wanted to learn. It's cheap, it's quicker and you get one or two hour beautiful lectures from that. That's one thing. That's the mentoring side of what I'm saying.

Regarding, if she needs to work for someone or if she needs to open her own clinic. No way. Work for someone until pay most of your debt. But even if you work for someone, go to work in somewhere that the environment will be a teaching environment. So use the dentist next door. If he has more experience than you, walk in, see what he does. It doesn't have to be mentor one man. It can be mentors around you, you know what I mean?

Howard: So you mentioned your mentor was Pascal Magne. You're in San Diego. He's up the street in Beverly Hills. He is the father of biomimetic dentistry. Have you shown him your Uveneer?

Sigal: Oh yeah. We communicate. Yes. He says he likes it of course.

Howard: He likes it of course. That is awesome. He’s an amazing man. So is he more practice now or is he at the dental school?

Sigal: Oh he's in a dental school, I don't think he practices. He is the head of the restorative in USC department. And I love the way this University, the USC, teaching their students to do no crown, no posting, you know there must come a new thing. You know, some universities, and I will not say names, they still teach to do amalgam pins. I mean, where even you can buy those? Why to drill dentine in the tooth to make micro fractures. What is that? They still teach amalgam class two, class three. You have to know about it but this is not the main thing --

Howard: My favorite economist, when I was getting my MBA, my favorite economist was creative destructionism. Where was he from? But anyway, you can't introduce the model T car unless you destroy the horse and buggy industry. And destroying segments of the economy is what you have to do to have new growth. And pretty much most societies can only handle about five percent unemployment. So one person out of 20 unemployed is about the healthy amount of recycling people from horse and buggies to cars. And when it gets to ten percent, then the monkeys get scared. Five percent unemployment, if you can't find a job, it's all you. How come you can't find a job? What's wrong with you? At ten percent unemployment, now something's wrong with the government, the king, you know, they get very upset. It's a very tight mix. But in a dental school they can't introduce new classes unless they fire old faculty that have these operative dentistry courses that they've been giving for 20 years. And that's what colleges are worst at, they tenure their teachers. About the only way to get a teacher out of some of those universities, they have to retire. The last ten years they should have been turned out to pasture. And the universities just don't like creative destruction. They don't like some young guy coming in saying, "Okay we're going to just completely close down this subject, this book, that professor and we're going to bring in someone 25 years younger who is going to teach all this." They just don't think that way. They're more a bureaucracy.

Sigal: It's very sad. I feel it's very sad. Because they're missing so, so much: cat scan, milling machine, even Uveneer. This is new thing that will make the life much easier. Why not bring it to universities? Why to be old fashioned and -- some universities are not like that but most of them, as you said, they are

Howard: So now, if you're watching us on YouTube -- Ryan I think we should insert her Uveneer video. You have a very nice video. Can I put that at the end of this podcast?

Sigal: Yes of course. I would love if you did that. Thank you.

Howard: And I just want to tell you that was the fastest hour ever. I can't believe we're already at an hour and eight minutes. We actually went over eight minutes. But hey, I think the world of you. I asked you to be on this show, you didn't ask me. I just think you're all that and a bag of chips. Thank you so much for coming on the show today and talking to all the dentists.

Sigal: Thank you. I had fun. Thank you. And it's good to meet you at last.

Howard: All right I'll see you soon. Take care.

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