The Master of Makeovers Thomas Giacobbi, DDS, FAGD Editorial Director, Dentaltown Magazine

We live in a culture of super-sized meals, vehicles and people. It should come as no surprise that our makeovers are “Extreme.” Veneers, bleaching, full-mouth reconstructions are certainly not new to dentistry, but the television show Extreme Makeover has introduced these procedures to our patients. Elective procedures will be debated until the end of time, but one thing is certain: the dental profession benefits from a little time in the limelight. In this case, the limelight is shining on Dr. Bill Dorfman, CEO of Discus Dental and the first dentist on Extreme Makeover. Recently, I had the unique opportunity to interview Dr. Dorfman about Extreme Makeover, Discus Dental and the business of cosmetic dentistry.

Extreme Makeover TV

DT: How did you become involved with the Extreme Makeover television show?

Dorfman: I was sitting at my desk one day and I got a phone call from Howard Schultz, the creator of Extreme Makeover. Garth Fisher, …a plastic surgeon on the show, had told me a little bit about it and he had already committed to doing it. …I was asking questions, and nothing like it had ever been done before. When we filmed the pilot in the fall of 2002, nobody knew what they were doing…we just kind of did it. They shot it with these little tiny hand-held cameras, and I thought, this can’t be that good. But then it aired nationally and the ratings were huge! Immediately ABC commissioned us for a full season, which was 22 episodes.

DT: That must take up a lot of time.

Dorfman: I found out early on that you can’t see patients and do makeover dentistry at the same time; it is just too difficult to do. I started doing all of the Extreme Makeover dentistry on the weekends.

DT: When they select patients for the show, do you have an opportunity to preview them before they are selected?

Dorfman: Absolutely, I select the patients I want.

DT: How much information is available to make the decision?

Dorfman: Let me tell you how the process works: Patients go to ABC.com, …fill out an application form and submit a videotape. If the casting department likes the patient, the back-story, and the videotape…they go ahead and send the videotapes to me and the plastic surgeons on the show. If we like what we see on the videotapes, we give them a “yea” or “nay” to fly them in or not.

I will see the patient first. If I can’t do their teeth, we send them back home because they know that without the teeth there is no makeover. If I can do a nice job on their teeth, then they go on and meet the plastic surgeon. … If I can’t do their dentistry in a six-week period and give them a clinically acceptable result, that’s also aesthetic, they don’t get on the show.

DT: Has the need for orthodontics been grounds for patient rejection in the past?

Dorfman: The need for orthodontics has definitely been one of the main reasons why I reject patients.

DT: Once their makeover is complete, do patients have to agree with you on some level that they will follow-up with a dentist at home? How does that transfer happen from finishing the makeover and returning to their dentist at home?

Dorfman: First of all, we don’t just do their teeth. … When they come in we do a full set of x-rays, an exam, a cleaning; we do everything. Once we get them done and [the patients] are in perfect dental shape, we send them home. A lot of them have their own dentist and they just go back to their own doctor. If they don’t, I’ll find a dentist for them in their area.

DT: How does the schedule usually go? Once the patient comes to California, do you see them at the beginning of their visit to perform the dental part of the makeover?

Dorfman: We only have them here for six weeks––so I don’t have a lot of time. Frequently, I am doing a full-mouth reconstruction in two weeks. The only time I get to see the patient first, is if the patient needs extractions or perio.

Discus Dental

DT: At Discus Dental, one of your main products is the Zoom II Bleaching light. Is there room for improvement in this process––would you choose to get the bleaching done faster or can the teeth get any whiter?

Dorfman: I think it is hard to separate the two. … If you made me pick with a gun pointed to my head, I would say, do what you have to do to get the best results. Results are the thing that walks out the door; results are what bring more patients in; results are what people are paying for.

DT: Do you think the flood of OTC bleaching products has affected the fee that can be charged for in-office bleaching?

Dorfman: Absolutely––here is what happened with the evolution of bleaching products. … It wasn’t until the late ‘80s that take-home tooth whitening came into vogue with trays that we started to see a real difference with tooth whitening. When people started going to the supermarket and buying whitening products, that had a real negative impact on dentistry. Then along comes a product like Zoom, now patients are coming back to the dentists because…nothing in the supermarket can get your teeth eight shades whiter in an hour––nothing.

DT: With the popularity of Extreme Makeover and the associated branding of Zoom bleaching, will Discus Dental consider selling OTC bleaching products?

Dorfman: We are really committed to dentists and we feel very strongly that the safest, fastest, most effective way to whiten your teeth is still in a dental office. We are not even looking at any plans to go OTC right now.

DT: Discus Dental has a much diversified portfolio of products including burs, impression materials, breath treatments, software and bleaching. Will you consider other product lines? For example, endodontics or orthodontics.

Dorfman: We are always adding new products. There are some things coming out in the near future that will go into some of these other fields that you mentioned, but I can’t really mention them. … We are definitely trying to branch out and diversify as much as we can.

DT: Discus Dental has a reputation for terrific marketing. Was that a high priority when you started the company?

Dorfman: My whole concept with Discus when we first started the company was this…: there are a lot of whitening products out there, but none of them were great. The packaging wasn’t great, it wasn’t user-friendly, the product could have been flavored …, it wasn’t easy to use and it was a big market. But you know, …in those days selling the product for $800 to the patient, I was embarrassed with what the patient was walking out with. Even the directions for use were really shoddy. I tried to approach it with all the big companies in dentistry and say “look guys, let’s build a better mousetrap”…they were all just kind of shoving me away. At the same time, I met my business partner, Robert Hayman. Robert grew up in the cosmetic industry and he knew how to market and package cosmetics. If we can take his marketing and packaging and my ideas for dentistry and combine them together, we could have a winning team. That is exactly what we did. … We were the first product to be flavored. I wanted the product to look like a cosmetic and not like a medical procedure. I wanted it to have easy directions for use. I wanted it to supply all of the ancillary marketing materials for counter cards, statement stuffers, and brochures. Everything that you need to make this product move on the shelf; so when you ask me was it my goal to make our product and our advertising the best in dentistry…absolutely.

When we shot our first model shot, I looked in a magazine and saw a beautiful ad from Benetton; with five beautiful models, …clean, fresh, young, multi-ethnic. I said you know what, that’s what we need in dentistry. So, we shot our first model shot that way and we made quite a controversy in the dental industry. Nobody had ever marketed dental products like that before. I’ll never forget one of the early things that Robert said. I said to him, “Robert, these models are all so young, they are in their early 20s and our demographics, our market is much older, the 50s.” I said, “don’t you think we should use some models who are older.” He said, “Bill, middle-aged women don’t purchase cosmetics from middle-aged women. They buy it from young beautiful supermodels.” And he is right.

Cosmetic Dentistry

DT: What do you think is the most important skill for an accomplished cosmetic dentist?

Dorfman: I think the most important skill is communication. It is kind of like the sizzle on the steak. I mean you have to have a lot of sizzle to get the patients to the restaurant, but if the steak doesn’t taste great, they don’t send their friends. I think it is truly two things that you have to have to be a great dentist. First, you have to have great communication skills; you have to be able to talk to your patients, understand what it is they want you to do and you need to make them feel comfortable. Second, you need to do it. I think if you can combine the communication skills with great clinical excellence, you’ve got a winning team right there.

That’s why it is so critical that dentists continue to take continuing education courses. If you don’t feel that your skills are up to par with cosmetic dentists in your area you’ve got to take hands-on courses. You’ve got to go to LVI, you’ve got to go to the Pankey Institute, take Ross Nash’s course or Larry Rosenthal’s hands-on courses or any of the great courses where they can bring you up to speed and teach you how to deliver the steaks.

DT: Aside from Discus products, what are three instruments or materials that you can’t live without?

Dorfman: The three things that I couldn’t live without is number one, Expa-syl by Kerr––that replaces retraction cord in 99% of all the work I do. I absolutely wouldn’t want to practice dentistry with out that. Number two, I would say is probably the Wand, especially for TV dentistry. You need to be able to make your patients comfortable and have the ability to smile and articulate afterward without appearing numb…and then I would probably say a laser: Biolase, electrosurge, whatever you need to cosmetically alter tissue to create a smile with the symmetry that it needs.

DT: Who are your idols in business?

Dorfman: Number one – Robert Hayman, my partner. The guy is brilliant. One of the luckiest, and now in hindsight, one of the smartest decisions I ever made in my life, was bringing him into dentistry. He is unbelievably gifted; he has an incredible knack for comprehension above and beyond anything I have ever seen. …

My grandfather, Arthur, was a huge mentor in my life. He was…one of the most dynamic and articulate speakers of all time. He was a real trendsetter for modern-day marketing. Just his techniques for motivating his sales reps and getting people to buy a product were revolutionary. I wish my grandfather would have written a book. He was out there teaching his reps not to take orders, but to make sales. That was something new in the ‘40s and ‘50s because people were used to writing orders. That is one of the things we did that was really unique in dentistry too; we didn’t just hire order takers; we hired sales reps that were able to educate the doctors and help them understand the need for buying other products as well as the one that they were calling to order.

Makeover Dentistry As An Industry

DT: Do you think cosmetic dentistry should be some type of a degreed specialty, and if so, what would the requirements be?

Dorfman: I would like to have cosmetic dentistry be a recognized board specialty; our profession is so antiquated in the way it progresses through these things that I don’t see that happening. For the time being, let’s just try and be content with getting accredited or a fellowship in the American Academy of Cosmetic Dentistry and going through the Pankey Institute and that is the best thing to do at this point.

DT: When a dentist, with the best of intentions, performs a bad makeover; where do you find they go wrong most often?

Dorfman: I think that most often the dentists don’t listen to what their patients want, and that is where they go wrong. … When people are going to you and paying you a lot of money to have something done, especially something that is elective, if you don’t listen, you are going to end up blowing it. ... One of the things that I find really makes doing cosmetic dentistry predictable is doing a great, accurate mock-up and making sure that the patient leaves with temporaries that approximate as closely as possible what the permanent ones will look like. Because if you can’t make temporaries look the way they want, how can the lab know how to make the permanent one look?

DT: Let’s say someone comes in your office and wants 10 veneers on top, what is the sequence, starting with the consultation?

Dorfman: Right, the first would be a consultation. A lot of times in order to do 10 veneers we are going to have to Zoom the lowers and get them as white as we can. Next, they’ll come in and we’ll do a prep appointment and a seat appointment. The prep appointment will do the mock-up and we’ll use this technique I developed we call the prep-guide, which helps the laboratory match what my mock-up looks like to know what the teeth are going to look like. Typically, that would be a 2.5-hour prep appointment. I’ll do the mock-up, prep half the teeth and then I leave and I’ll have my associate prep the other half. The patient will leave with custom temps. A week later they’ll have a two-hour seat appointment and I’ll numb the patient and try in everything, seat everything, that will take an hour, then I’ll have my assistant come in and…clean off the excess resin and all that.

DT: Do you have an appointment before they prep and after the consultation where you review the mock-up, or the wax-up, with the patient?

Dorfman: The only time I do that is on cases where I feel I need to do that to get the case exactly the way they want it. If I have a patient who is really picky and has aesthetic concerns that I think warrant that; then I’ll have the patient come in one time before we actually do the seat appointment to review their veneers and their temporaries. A lot of times I will have the case brought back early from the lab so we can look at the case together.

DT: How do you respond to a patient who asks you how long will my veneers last?

Dorfman: The average dental restoration lasts 10 years and the reason it fails is due to decay nine times out of 10. If you take good care of these veneers and you brush and you floss, see us regularly, they could last your whole life. It depends if they take care of them, if the patient is a bruxer and they need to wear a nightguard, there are a lot of different criteria. I have patients with veneers for 20 years and they look as good as they did 20 years ago. I have other patients [who received veneers] less than 10 years ago and we’ve redone them, not because they are failing, but because teeth weren’t as white 10 years ago as they are today. … The main reason I am redoing cases today is because people want their teeth whiter, not because the veneers aren’t holding up.

DT: In your private practice, do you do procedures other than cosmetic dentistry?

Dorfman: We do everything; I just do the cosmetic stuff. I have seven dentists working in my office now; between all of us everything gets done.

DT: What clinical trends do you see for the future of cosmetic dentistry? Will there be a major shift in techniques?

Dorfman: I think that dentistry is becoming more conservative and that we are trying to preserve more of the tooth structure. You see all these ultra-thin veneers and things like that, and I bet before too long we’ll be replacing enamel with enamel, or enamel substitutes––I am sure that is on the horizon.

DT: Does the popularity of elective procedures such as cosmetic dentistry eventually result in a reduction of fees?

Dorfman: When we see a reduction in fees it’s for a mass production. When we started making Nite White kits, the cost per kit was a lot more than it is now because we do millions of units. You can’t look at cosmetic dentistry like that. It’s not being mass produced, it’s still an individual thing, so I don’t think that is going to drive the price down. The fact that there are more dentists doing it and it is more competitive, yeah possibly. I think if you are good, create a niche in your area and people get to know you for what you do; and you can, like I said, deliver the steak with the sizzle, you can demand the price that is fair for your area. You don’t have to compete on price, you can compete on quality.

DT: The AACD recently released the results of a survey on the state of cosmetic dentistry. One of the key results indicated that the prime patient concerns are cost, appearance, and longevity. You and I have already talked about cost and longevity. … Regarding appearance, do you find that that’s true for your patients?

Dorfman: I have patients where that is the number one concern––they may not care or ask about cost or longevity, they just assume [the case] will have longevity, but their only concern is, “what am I going to look like?”

DT: So in ranking those three things in order of preference, would you say that most patients would put appearance first?

Dorfman: My practice is really in a different type of area and my practice doesn’t necessarily mirror what you will see across America. In Beverly Hills, I would say it is appearance, then longevity and cost. People don’t come to me to save money. They almost expect to pay more. But I would say…that is the exception rather than the rule. A lot of places cost is [the number one] thing. Many of the cases I redo for patients, the first thing they say is: “I shouldn’t have gone to that cheap guy. I would have come to you but I thought you would be a lot more expensive and now I don’t care what it costs, just make them right.”

DT: I just want to ask you if there is anything you would like to say on cosmetic dentistry, Extreme Makeover or dentistry today?

Dorfman: In closing, I would say that the time to practice dentistry now is better than it has ever been. Dentists should be aware of how fortunate we are to be in such an amazing profession. It’s not just about changing their smiles, but changing their whole life and their well being. Being able to do that on a daily basis in a profession that is as highly regarded as ours, is a real honor and a privilege.

Prevention of disease is the foundation of our profession. If we immunize children to eliminate decay, will we wither on the vine? Certainly not. In fact, the focus on makeover dentistry and elective procedures is a signal that our profession is evolving, and progress is good. Dr. Dorfman, thank you for your continuing contributions to our evolution.