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“Dr. Ted Talks: Smile Makeovers The Easy Way!” Part 1

Dr. Richard MadowWith special guest – Dr. Ted Siegel

EDITED TRANSCRIPT

Richard Madow: Hi this is Dr. Richard Madow and our guest today is Dr. Ted Siegel.  How are you doing today Ted?

Ted Siegel: I'm doing great Rich; thank you for having me.

Richard Madow: It is a pleasure. I'm really excited about today's interview.  I want to tell everybody how we met which is pretty funny too, but I'll just say that I am in Un-Sound Studios in beautiful Baltimore, Maryland and you are in Chicago, Illinois, so by the magic of connectivity, internets and wires and cables and all kinds of stuff here, we are together.  So thanks for taking time out of your busy schedule to be with us.

Ted Siegel: Thanks for having me.  And actually for Chicago the weather is not too bad.

Richard Madow: Good, perfect.  So I'll just tell everybody how we met which is pretty funny.  You were actually on our daily e-letter list;

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as most of our Audio Series listeners know, we send out e-letters just about every day to 20,000 or so people.  And we were telling some stories and one of them was an old standard Michael Jordon story where he got cut from his high school basket ball team as a 10th grader, and you replied immediately saying that story is false, it's been going around for years and it's false and you are a Chicago Bulls super fan and you know the story is false; or something like that right?

Ted Siegel: Yeah, he wasn't really cut, he just didn't make varsity as a sophomore. I wasn't real thrilled you printed that but I figured I'm going to get a call from Michael Jordan soon and I have to defend.  But no, he never got cut from the team, he just didn't make varsity. I think he was only 5ft 10" sophomore year and they were looking for some bigger guys and he grew a whole lot later.  He wasn't the Michael Jordan back then that he is today, that's for sure.  Today he's amazing and it's been a great season. Watching him throughout the years through his tenure, those were the best times.

Richard Madow: The only time I saw him play was when he was at North Carolina and I just graduated Maryland, so I guess that was in the early 80's I was still a Terps basketball fan so I went to some games and he was there.  Even as a college player he was incredible.

Ted Siegel: Oh absolutely, he's amazing.  One of the best, if not the best.

Richard Madow: Yep.  So anyway that started a little conversation; we were joking around with each other back and forth and I just happened to...sometimes when that happens, I say who is this crazy guy from Chicago? I want to see what he's like.  So I visited your website and saw some stuff on there that I thought that was really cool and the more I explored and we emailed back and forth a little bit, I thought you'd be one of those great guys for an Audio Series interview, because as you know, as an Audio Series subscriber yourself, many times we have lecturing dentists, the big guys and gals on the circuit.  Other times we have people that maybe aren't as well known, but are doing fantastic

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things in their home towns and things they can share with our Audio Series subscribers.  So I'm really excited to have you here.  Since most of our listeners probably don't know you, why don't you tell us a little about yourself, why you're here, where you practice, what kind of patients you see, and all those good things, so we feel like we're old buddies?

Ted Siegel: Okay, this is really my first time speaking, I don't do this I’m a little bit nervous.  To give you what I do, I consider myself your typical average dentist and I feel if I can do these things pretty much anybody can.  I graduated from the University of Illinois Dental School in 1984 and I've always practiced basically in the same area.  I'm on the Northwest side of Chicago in a little area called Logan Square for those familiar.  I am not a boutique dentist, if anything I am the opposite; patients don't get wine and cheese, there is no juice bar, no hot towels, no fresh baked cookies, just me.  I work in a low income area and during my first few years as a dentist, I was mostly seeing patients on public aid; most of my staff are bilingual Spanish-English.  And my bread and butter industry is probably pretty much like anybody's out there, composites, extractions, root canal, cleaning and crowns.  The only thing I might do a little different is I do orthodontics; I do regular braces and quite a bit of Invisalign also.  What I try to do when I practice, I try to make everything as simple and predictable as possible, that's always been my mantra, trying to just find an easier way to make (?) that I keep the same thing over and over.  Smile Makeovers can be stressful; they are paying a lot to improve their smile and they’ve usually been disappointed with their smile for a long time. Confidence might be low, they might be apprehensive and emotional and finally made the decision for change, and it rests in my hands.  That stresses me out a bit.

Richard Madow: Yeah that's a lot of responsibilityTed Siegel: It's a lot of responsibility and I get so stressed out when I

do these and yet I find this type of dentistry is emotionally rewarding.  Performing Smile Makeovers can have such a profound effect on a patient's self-image, that most of the time it has such a positive impact that it can be life

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changing.  And you know if dentists really have life changing effects on people, it's a great feeling to have.  And you get addicted to that a little bit.

Richard Madow: No question about it.  Ted, one of the things that really attracted  me to you as a interviewee was that I went on your website and I think I knew for some reason that you were in, as you say, a low income area, you're even saying that you had  a lot of public assistance patients.  Yet you go on your website, it's not a juice bar and wine and cheese kind of website either; it's very plain Jane looking, yet there are pictures of you with all these women wearing tiaras. They are beauty contest contestants, or winners or whatever.  There are all these press clippings about how you were named Best Dentist in the Chicago Tribune.  I'm looking at the picture right now: 7 beautiful women in tiaras surrounding you, I mean that's unbelievable. 

Ted Siegel: Yeah I feel the same way when I look at that.

Richard Madow: So we'll talk about this later in the interview but again that's one of the things that attracted me to you; here you are in a blue collar, real low income area, very competitive area of Chicago of course. And you're doing a lot of bread and butter dentistry which is fantastic, but you also are doing some pretty high end Smile Makeovers and that’s why one of your suggested titles for this interview that I loved is "Smile Makeovers the Easy Way," Smile Makeovers for the rest of us.  So why don't we talk about that; you have so much information that I'd like to do a 2 part interview.  And the first one, as you suggested we'll call, "Before the Bur Touches the Tooth," because there are so many things to go into: getting these patients in your door, getting these patients ready for high-end expensive cosmetic treatment. And I think people may argue that the hardest part is everything that you before the bur touches the tooth, then later, maybe a few months down the road, we can talk about when you finally clip that bur into the hand piece and enamel is flying.  But if you don't know about all the stuff to do before the bur touches the tooth you'll never have the opportunity to actually start your prep.  So why don't we do that, how does that sound to you?

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Ted Siegel: Yes, perfect.  And I agree completely, the actual dentistry is probably not as difficult as it seems.  I'm sure everyone listening here can prepare a crown and the veneer is slightly different.  The difficult part for me is visualizing the final outcome, managing the process, meeting and exceeding the patient's expectations.

Richard Madow: Exceeding is a great word to use.  So let's back up and let's talk about the simplest challenge or maybe the most difficult challenge, which is just getting patients in the door.  What do you do to get patients to come into your practice?  I don't know if you just want to talk about cosmetic dentistry patients or all patients, but how do you do that, because it's obviously the first step to success?

Ted Siegel: Good question. Pretty much everything that I try to do with my cosmetic dentistry I really do with my general dentistry, there is absolutely no difference.  Patients who want cosmetic dentistry are little bit more difficult and we get a lot of new patients through our marketing efforts and those new patients do marketing when they are not referred by a patient. Those are the most difficult patients to convert and convince to get them to trust you and know that you have their best interest at heart.  So we have the Big Smile Dental first appointment where patients get an experience that we put them through, and everything is... how your website looks, however, whatever marketing they first get when they approach you.  How the phone is answered, how the office presents from the outside, the first impression as they open the door and see your reception area, is it clean, and I did get some pictures too of how I have it set up, I'm pushing them into cosmetic...??  I'm not pushing them into cosmetic dentistry; I'm just letting them know it's something I do.  And I feel when I work on high profile people and I let them know, even if they don't want cosmetic dentistry, I feel they say, well my dentist worked on this famous person so he must be good enough for me.  And I thought that that helped gain their confidence too, how the patient is greeted, staying on time, making patients feel understood and respected.  Delivering painless dentistry and I mean no pain at anytime; I try to get through the whole day without hurting a patient

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anywhere.  Painless financial arrangements, because I can do all those steps great, and I send them up to the front desk and they can get upset at the financial arrangements. We’ve got bad reviews about that because we're pretty tough on it.  Compassionate follow up and phone calls, assuring the patients feel appreciated, that's the hardest thing in dentistry.

Richard Madow: Yeah I mean all that stuff is good common sense practice but I think many people just get rushed and busy and they don't have the time to do all that follow through; it takes follow through.  Do you have a system for all this, a checklist or something like that, or are you just so committed to it?

Ted Siegel: No I don't really have a checklist that I go by because we're doing this every day.  One thing I want to say that's really important that it's a patient positive experience more than the clinical dentistry that will get a patient to write a positive review or make a video or recommend their family and friend.  So no matter how great your dentistry is and I'm sure everybody listening is a competent great dentist, it doesn't matter if the patient doesn't have a positive experience and they enjoy coming, that's really all that matters for getting reviews.

Richard Madow: So true; so it sounds like reviews are really important to you and it sounds like videos are really important to you, and you've got some great video testimonials on your website, so we'll talk about that in a little bit as well.  Let's just talk about smile makeovers for a second because you started to talk about this a little bit before and you were talking about what you find to be really challenging in doing a smile makeover, and I think you've come up with a good solution to it also.  Why don't you tell everybody what you think of the real difficulties in doing a smile makeover and maybe your fantastic solutions to that?

Ted Siegel: Well I think I kind of mentioned it, its 1) Managing the patient's expectation. Sometimes most of the patients come in and they may have a picture of a Halle Berry or somebody, and they are like I want to look just like this, and I'm thinking Oh God that's not really possible. 

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Richard Madow: It's so funny I remember years ago I think, I was a kid and I was getting my hair cut and there was this crazy lady next to me and she was just going nuts.  After a while the woman doing her hair said, "Hey look I'm a beautician. I'm not a magician."  It just cracked me up; I still remember 40 years later it's so true.

Ted Siegel: Yeah or they have a picture with them when they were 20 years old, and I'll tell you a little story about that later where they're 60 and they want their teeth to look like they're 20, and their Evo is closed the vertical dimension is closed.  So kind of imagine their expectations finding out what they want, telling them most of the time: hey I can’t or that's not possible, I can’t make you look that way.  And sometimes they come in asking for some things and they are super, super picky; sometimes I don't even know what they're asking.  And if I can’t figure it out, I turn them down with patience, I just say I don't know that I can make you happy, I'm not sure what you're saying and I'm sorry. I turn them down, that makes my life a lot easier too.

Richard Madow: Well it sounds like part of your formula of making sure that you meet patient's expectations is getting rid of the ones who have impossible expectations.

Ted Siegel: Right, exactly, and it's definitely my call and I definitely turn down a lot of people.  And I think my staff enjoys it when I fire a patient every now and then because usually they are the ones most frustrated with that because they get all the heat in the front.  The other thing is making sure that the patient understands everything that relates to them; they'll come in and say, hey I saw you do this and this on the internet and that's what I want you to do.  And their case has absolutely nothing to do with the one they were looking at, and so I explain to them the different possibilities that will happen to them, making sure that they completely understand.  And then the other part that's stressful for me is delivering the dentistry that I promised that I could deliver.

Richard Madow: Okay Ted I'm going to throw a tough question at you because one of the things that we were excited to talk about in this interview was how to simplify everything, how

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to simplify cosmetic dentistry.  It's a pretty broad question but how the heck do you simplify cosmetic dentistry; it's not a simple science or simple art, it's pretty complex, how do you simplify it?

Ted Siegel: It is complex but it actually is predictable and can go through the same steps over and over, and like many things it started from necessity.  When patients were disappointed with me or my work, I was forced to take a hard look at what I did wrong or what I could have done better.  There were too many times I've gotten a bad review on the internet and I couldn't believe that was how they felt.  I mean why they are writing this, why they hate me so much or seem to, what I was doing wrong.  So I figured somehow I wasn't listening to what they were saying, or not giving them the information they wanted that they felt was important to them.  Let me tell you about some of my mistakes and some of the problems that I had; that makes you better, when you screw up enough, you try to make a way to get better.  I had a patient who I thought loved me, she did love me; she was great, she brought me little gifts and food to almost every appointment.  We had great conversations, we laughed a lot together and she came in to fix her smile.  So money is an issue like it often is, and ideally she needed restorations from canine to canine, but she settled on fixing her 4 front teeth.  I think it was 3 veneers and crowns lateral to lateral, slam dunk easy case, or so I thought.  Since I wasn't touching the canines, the lab had no problem making the centrals the correct length and width, didn't do any mock ups or provisionals, just boom, canine to canine, make them the right height and width; there's nothing more to do.  The case came back, they looked perfect: the color and shape are spot on, the restorations are gorgeous; I tried them in the patient's mouth because we ought to get approval before I cement them, she looked at them and she started to cry.  I told her don't worry, whatever you didn't like, we'll change them, no problem, they are not cemented in, we'll just send it back to the lab, tell me what you don't like.  Well it all went downhill from there, she wanted her front teeth longer like she was when she was 20 and she kept bringing in pictures and showing me pictures of how they should look.  I told her they would look funny unless we

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made her canines longer and I reminded her that she declined my preferred treatment that included the canines.  She didn't care.  So that day, no charge to her, I spent the next few hours building up her canines, making them longer with composites to establish a longer length.  Then I added composites to her provisionals or temporaries to make them look longer to the point where she was happy.  I took a dual alternate impression of the provisionals that I've just made longer with the longer canine, sent it to the lab and have them redo the length to the new set up that we have.  All good, right?

Richard Madow: So far

Ted Siegel: So far. She actually got more upset and she asked me why I didn't explain the length issues to her before, and of course I said I did and I reminded her that she did not want to include the canines for financial reasons.  She said I never gave her the choice to place the composites on her canines and if I had, she would have fixed her canines more permanently at a later date. I figured everything is good after she left. I had the restorations remade, everything was ready to be sent in, I spent an ungodly amount of time with her and expense to have these made.  I received an email from her saying she lost all confidence in me and she wanted all of her money back and she was going to have them done by another dentist.  So the new dentist gets my preps, my provisionals, my new canine length; he was the hero, I was the goat.  Now my lab guy, my assistant, ladies at the front desk said, look you didn't do anything wrong, there was nothing you could do to make this unhappy patient happy; sometimes patients are just going to be his way.  But I kept thinking, you know you guys are wrong, there was something I could have done. I just felt I didn't take all the steps I needed to make sure the patient and I were communicating, because obviously when she got the veneers, she was expected something different from what I gave her even though I thought they were perfect.  So that's really what got me started on creating a step by step, color by number approach for all of my future cases.

Richard Madow: Wow, what’s a color by numbers approach?

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Ted Siegel: Well that's going through every step...do you want me to start going through the steps that we've taken through?

Richard Madow: Why not, it sounds pretty valuable.

Ted Siegel: So the first appointment, what do I do there?  So they come in the door and it's their first appointment whatever, they go on the website or wherever, my assistant will show instructional videos based on what treatment the patient is interested in and what we feel they can benefit from.  The might see videos on veneers, ortho, Invisalign, whatever we could think of.  Now we use (KZ?) but it doesn't matter what type of video you show or who makes it. I'm sure they're all great, that's just the one we have.  I couldn't imagine practicing without showing my patients videos and this is when I haven't met them yet, I haven't walked in the room.  So when a patient comes in for veneers they already know what a veneer is, they see how it is, they see my before and after, they see other things.  If my assistant thinks, well they might need ortho, here they’re going to show them an ortho video. Long before I walk in the room my assistants get their chief complaint and then they call me in at this point.  So before I walk in the door now, the patient's been prepped, they've seen a lot of areas of dentistry that I don't even need to go over; when I do go over it, they're aware of what I'm talking about.  So I get buzzed. I go in. I greet the patient by name, I make eye contact and I start building the relationship.  I try to discuss or ask them a little bit about themselves and then I say, how can I help you, and this is the hard part for me, I try to listen without interrupting. 

Richard Madow: You and me both.

Ted Siegel: Most of the time I already have the answer to what I'm going to say, and the worst thing I can do now is cut them off, and listen to what they want because even if I'm here right now, they know I don't listen to them, I'm in a hurry, I don't care, here's what I do, goodbye.  Again that is the hardest part, just sitting there being quiet, counting to 10 whatever, mind drifting. I hear them talking and I am paying attention. I'm being a little facetious here because

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every now and then they do say something, I'm like whoa I didn't know you were going there, good thing you said that.  So at this point I explain all the possible treatment options. I make sure I always address the reason they came in. I give them a lot of information; I don't want them to think I'm not listening to them,  or not addressing the reason they came in to see me.  They may come in for veneers because they see the website, and I will say, well your teeth look great you got good looking teeth, they're just all in the wrong spot, why don't you consider just putting them in the right place and bleaching them.  And sometimes they come in wanting ortho and I say, hey your teeth are in the right spot, you just have ugly teeth and if we put them in the right spot, you're still going to have an ugly smile.

Richard Madow: Don't say that

Ted Siegel: By the way, I never say that anymore. I did think I was cute and funny until I got a review on the internet that said I was a jerk, and now I just say, your teeth are fine but they are probably not as beautiful as you would like, and I can make them look better for you.

Richard Madow: Much better, much better.

Ted Siegel: Yes, again I learned the hard way, so I think I have made every possible mistake you could make, and I try not to make them too many times.  So on this consult appointment I will take any necessary x-rays we need, my assistants will take a photo of them smiling as big as they can, the assistant will grab a tooth shade.  Now when I come in, if they need a quick composite mock in their mouth (and I'll explain that step a little bit later because I don't want to get too off track) I will do that.  I discuss with the patient how they want their teeth to look in detail, not like I did in that one instance where I told you I got in trouble with that patient.  So now we do this right away, right at the very first appointment. I want to know if they want to be 20 and if they have pictures, I want to see it now.  You could show them photos or drawings of teeth, how they look, shapes and sizes. I don't really do that but I think it would help if you're just getting started with it to

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have an idea.  I ask them if they would like their teeth wider or narrower, some people want their 2 central teeth to be bigger than their laterals and I particularly don't like that, but I've been asked to do that before.  I ask if they want their teeth shorter or longer, and again I sit back and I give them as much time as I can for them to express their opinion, and that takes the pressure off the final veneers almost at this very first appointment, because the patient now feels they have a say in the final outcome of how the veneers and their smile will look.  And the truth is, they really do because I'm listening, and what I'm trying to do now is give them exactly what they want; and if I feel again that I can’t do this, then I tell them straight up, hey I can’t do this, and eliminate that problem.

Richard Madow: So as part of giving them exactly what they want, you mentioned that at the very first appointment, you might do a composite mock up, that's the case?

Ted Siegel: I don't do it all the time because it's not always necessary. But sometimes a patient may come in and they may be asking for veneers and they have an 8mm diastema between 8 and 9 of the 2 centrals, and I'm not sure that veneers will work on that.  Obviously, if you call your lab, the lab will always say yes because the labs make veneers and they don't do ortho, so they always seem to find a way they can do it, but the teeth may not look right.  Let's say the patient comes in and they’ve got a pretty deep big diastema and I think veneers will work, I will take some composite material either (flobo?) or regular composite, pretty much what the assistant throws in my hands or what I'm in mood for that day.  I make a crude reproduction of what the veneers might look like in their mouth, again it's very crude, but it's incredibly effective none the less.  I'll put them in a cheek retractor. I'll try out their mouth. I don't edge the teeth and I just start placing composite. If I need to make the teeth longer, I make them longer and I'll typically do only half of the mouth, unless I'm closing the diastema.  So I take one half, and let's say they were Bruxzirs or they (Belinec?), and they want to see how their teeth would look.  So very quickly I would just put on the composite with my fingers, and blend it in and smash it down and smooth it out with an instrument,

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and slightly carve it up, and I'll show it and they love it; they can see that right away, they get all excited, can you leave this one, I'm like, no I can’t leave it on.  But I will take a picture of it and they will see that on half of their mouth and they can turn their head and see the other half, and I can take a picture of them with both halves, and they could look at that and go, wow that is a huge difference.

Richard Madow: It's kind of like a personal before and after.

Ted Siegel: Yes, yes

Richard Madow: I like that.

Ted Siegel:  If you're not comfortable doing that or you feel that's a skill that you don't have, it's one thing I'm comfortable with composites, I would use something like a digital smile simulation where you take photo, send it to the lab... I think you can do this in office also, but again that's too much work for me to start doing that.  But there are labs that will do that, send in the photo and they'll send it back and build up the teeth so they're perfect, and you'll get a nice little before and after portfolio.  I think those are great, no problem with it, but if I can knock it out in 10-15 minutes while they're sitting in my chair, I can move on.

Richard Madow: And I think the wow factor of doing it instantly in their own mouth is huge.

Ted Siegel: Yeah I do too.  And I also tell them we could do anything on the computer, we can make them look perfect on the computer, but actually getting that to happen exactly the same way in their mouth we may or may not be able to do that.  And that being said I think you can duplicate what you see on the digital imaging I’m gonna say 95-99% of the time but you always want to be careful when that one patient comes in, when you're not able to do it for whatever reason.  Anyway I have my composite mock in their mouth and they like the length and now it looks good and I see it in their mouths and the’re speaking okay, I will now take a length measurement and put that in their chart so whatever, maybe I took it from 7mm to 10mm so I know what to convey to the lab once I have that there. That's

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pretty much it, every patient wants the same thing; they all want a beautiful smile but they all start with a different foundation.  And that's the hard part too, to figure out how you're going to get them to get that beautiful smile.

Richard Madow: Okay so we've got the first appointment; they saw the composite mock up they're excited, they are ready to rock, what do we do next?

Ted Siegel: We're still at the first appointment.

Richard Madow: Okay.

Ted Siegel: It's a long first appointment; this is the make or break deal.  In reality if I haven't done the composite mock ups, I haven't done any of the work, I haven't been in the room, my assistants have been doing it.  So they might be there a half hour, 45 minutes learning about dentistry and what they need and it hasn't taken any doctor time yet. My assistants usually talk about whitening anytime I'm doing an anterior restoration; I always talk about whitening their teeth.  Then right away, so they don't think I'm trying to sell them more procedures than they came in for, I say, “Look it's not necessary that you whiten your teeth, we can just do veneers and whatever you want, but if you are ever considering whitening your teeth in the future, that you consider it now.  Once we place those restorations in your mouth and you decide to whiten your teeth, you can but we're going to have to change and redo all the restoration and go through all the discomfort and pain, time and price again.  As long as I'm giving you all my bad stuff, here's another area that got me into trouble.  Patient came in and did several anterior composites: class 3, 4 and 5.  Patient's teeth really weren't that dark, A2, A1; they seemed nice, it never occurred to me that they'd want to whiten their teeth.  So when all these composites were done over a few week period, the patient looks at me and says, alright great, now I'd like to whiten my teeth. 

Richard Madow: Oh that's killer.

Ted Siegel: Oops.

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Richard Madow: So it sounds like you're suggesting before any cosmetic treatment, however large or small, tons of veneers, or a tiny little composite on the disc of number 8, we should suggest whitening to our patients.

Ted Siegel: Absolutely.

Richard Madow: I agree.

Ted Siegel: Here's another thing, I did a first bicuspid on a patient with decently white teeth and I'm not even thinking anterior or bleaching. I'm at the front 6 a little bit out of the patient’s smile line and they want to whiten their teeth.  Of course I said go ahead, but I worried about this and sure enough, the crown looked like an eyesore by the time they were done bleaching, and I end up changing that too.

Richard Madow: Good advice.

Ted Siegel: I consider that continuing education or get a little smarter.

Richard Madow: CE from the school of hard knocks as we say, it's the best kind. So now are we finally done with the first appointment...?

Ted Siegel: No, almost. Depending on, and this is still a huge part of the first appointment;  depending on what the patient needs, if it's an incredibly complicated case where there are heavy Bruxzirs and need to restore the posterior occlusion, or if they have posterior bite clamps, or they're missing back teeth.  There could be so many possible things that we need to do; or they have a lot of cavities, or they haven't been seeing anybody in a while.  There are sometimes a lot of things that I have to go over before I can get to the reason that they came in.  So when patients come in for ortho or Smile Makeover, I might spend a year just prepping them, getting them ready for what they came in for.  A lot of times these cosmetic cases turn into to just huge bread and butter dentistry, because they are falling apart and they don't know why they are, and they haven't seen anyone for a while.  These treatment plans get pretty elaborate, and I'm trying to put it together in my head what I have to do, so we go over the

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treatment possibilities, I swear to you 4 or 5 times I personally go over with them 2 or 3 times to simplify each step with them, and I try to have them repeat it as much as possible.  I look at them and I could tell they have a glazed look in their eyes, and they are lost, so I feel like alright I just lost the patient, they're not going to come back, they are not going to do, because they don't know what to do.  So I say look, this and this we have to do that now in order to get there, and then this part of the treatment I don't even want you to think about it, I'm telling you it's there we're writing it down, we're putting it in your treatments, but stop thinking about it now.  All I want you to think about is fixing these teeth, cleaning them up, whitening up and then we're going to start.  So I'll just say it over and over it till they finally can repeat it back to me when they have a good understanding.  Then when I leave the room, my assistant will go over it 1, 2 or 3 times or more until they feel...because I leave the room and they look at my assistant and go, what the hell did he say, I didn't get that.  And I'm like I just said it 5 times, really? But they still don't have it, so my assistant goes over it again.  Then supposedly the patient knows what's going on, they have a good understanding, and if my assistant brings them up to the front desk, they forget everything we said to them.  So my assistant again explains to the front desk, okay Mary was here: I need you to set her up for a cleaning appointment and she wants to whiten her teeth, and they go over the entire treatment plan again to the front desk, so they can schedule properly.  And here again patients are going to ask questions and be confused, and they run back to me and goes, patient is not sure by what you said by this or that.  I'm like oh my God, you've got to be kidding me, and I've said this so many times.  And I've walked up to the front desk many times and said, alright let's go over this one more time and again you just...you have to realize that we do this every single day and for us it's very easy.  All of us are average intelligence but our patients, they may be brilliant, but for whatever reason they are not able to digest all this information.  So if the patients appreciate one thing, it's knowing you have their best interest at heart.  And that means taking that little extra time to explain their treatment to them and that goes a long way.  I'm gonna say that many dentists do not

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spend the time with the patient and then they ultimately lose them, they ultimately wind up somehow in my chair, and what they tell me is, “I've been to these three dentists and I didn't like the first guy. He didn't listen to me, and he said he was going to do this, and that's not what I was saying, and he looked like he was in a hurry.”  So the good news is, fortunately it's a low bar and it's fairly easy to make a difference with a patient during the treatment plan phase, and let's be honest, nothing further happens if they don't accept treatment, and this is the big appointment where they’ve got to understand it, and they have to move forward.

Richard Madow: It's the big appointment for sure, how much time are you scheduling for this appointment?

Ted Siegel: This appointment, they are here typically for an hour and they might be here for 10 or 15 minutes with me.  But that is another great question because some of these patients, not all of them, some of them are like great, okay I got it, and they'll be done in 5 or 10 minutes; no time at all.  But you don't know who that's gonna be and you might have a patient that will, I don't know, they can ask me question after question, what I do at that point is I say look, I don't really have the amount of time I need to answer all the questions that you have and deserve to be answered.  So instead of rushing you through them or rushing to my other patients that are waiting, would you mind rescheduling? I will book as much time as you need, you can digest some of the information we went over, and we can sit and talk about this a later date, when I have more time, because I do want to answer all your questions, and I'm not done telling you everything you need to know.

Richard Madow: Yeah you know that's what I call a great save, because you don't want to rush the patient, you don't want to screw up your schedule, and you don't want to make somebody wait in the reception area.  And then as the patient has time to mull things over before they come back, maybe they'll understand something, maybe they'll come up with more questions, a lot can happen.  So don't rush it, some patients, as you said, everybody is different; some need 5

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minutes, some need 2 hours, so compensate for that but not at the expense of others.  Good stuff.

Ted Siegel: That's a hard part for me too, is knowing when to bail on patients.  I have this habit I'm guessing I do, squeezing in that extra filling, oh you can do that.  My staff looks at me and says are you crazy where are we going to put him, we don't even have an open chair.

Richard Madow: Listen to your staff is what I always say, they know. Ted Siegel: And I blame it on them, I go, I’d love to this today (but they

hear the staff say that we can’t do it), so we really want to what you want in a proper way, and that's not fair to you, so why don't we have you back and do what needs to be done.  And they never complain about that, they know I've tried. I've made the effort, they know it's not possible. I want to give them the extra time, they just reschedule and they’re happy with the plan.

Richard Madow: Great move.  Hey let's get back to, I think we're finally on the second appointment.

Ted Siegel: We're up to the second appointment.

Richard Madow: Okay, so now, okay you tell them they have to come back, do you tell them what they have to come back for, or just say you have to come back?  Tell us all about the second appointment.

Ted Siegel: The second appointment, 99% of the time, is for them to start whitening their teeth because even if they didn't think originally that was something that they wanted. The way I present it to them, they choose themselves: if yes, if I'm going to do this and spend this kind of money, I want a whiter brighter smile. So almost a hundred percent of the time they come in for an in-office whitening.  We do an in-office whitening and we also make trays for them so they do take-home bleaching as well.  And that is super important too, because one thing I've learned is the in-office whitening doesn't work on everyone as much as you like, sometimes we'll get 8, 9 shades lighter, sometimes we'll only get 2 or 3.  So again, making sure that we meet

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their expectations, I tell them the in-office whitening is necessary, it will give you the most bang for your buck, but you're only halfway there.  So don't look at how your teeth look after the in-office whitening, you’re going home with trays, and you’re going to spend either a few weeks or a few months until you're satisfied with where the color of your teeth should be.  And we don't start working until you're sick of whitening and you say, that's enough, I give up, I can’t take it anymore, this is where I want to be. And that's super important because I've got bad reviews again when they just come in for whitening and they are not happy with it, so I try to force that too.  Again these are all the steps that you take to make sure… the things that you say to make sure the patients are satisfied.  And skipping any of these steps just messes it up for you farther down the road.  Okay so on this appointment too, we are now going to take an impression for a wax mock-up, not a composite mock-up but now a wax mock-up, I'll get to that in a minute.  So I check to see if we took start photos at the consultation appointment. We’re supposed to, but do we always do it? No.  So I make sure we have them.  We're always supposed to take a shade at the consult appointment, do I always have them? No, so I make sure I have them.  I usually will take a portrait shot which is from just below the shoulders to just above their head, and I will also take a shot with their cheeks retracted.  Yes a retracted shot is not very appealing, but that's the point, you want the before pictures to look as bad as they can look, so your after pictures look fantastic and you can show them the before and the after pictures.  Take a lot of pictures.  We'll skip over that but I'll get back to that; remind me Rich to go back to the photos.

Richard Madow: Okay I'll put it on my to-do list.

Ted Siegel: Depending on the complexity of the case, I may take a ton of photos. I may take pictures of them smiling from the left or right side, the 45 degree angle, and upper occlusal view and lower occlusal view, a left and right side of them biting with mirrors to show the buckle corridors and see how they look basically.  Kind of an ortho work-up even if you  don't do ortho, I'm sure you've see your [unclear]  probably sent you pictures of patients that they shoot, like an ortho shoot

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and then I throw in different pictures that I might need for cosmetic dentistry.  We will take an upper and lower alginate impression, port up and a bite and I'll send the model to the lab.  From the lab they will now create a wax mock-up and a duplicate stone model of that white wax.  So what's a white wax mock-up?  Another part of the color by numbers that you absolutely have to have; it’s basically how the lab foresees the final veneers to look.  I give my measurements; if I need to make the central 10mm long, etc., so they'll do this white wax based on what I tell them.  Remember whether you're doing Invisalign or whatever, you're still the boss; the lab gives you their best suggestion and the lab is actually invaluable for their input, but the final decision is always yours.  Some labs, whatever they do they want you to do it, so think about it.  Once approved they are sent back to the lab to fabricate, this is for the future appointment, so we use this white wax mock-up to fabricate a preparation guide tray and trays for making their provision.  And again these are steps that make sure that I never go off track; in other words they allow me to duplicate this white wax mock up perfectly in the patient's mouth.  So I will transfer this from the wax up to the necessary preparations I need, and provisionals I make, which look exactly like the veneers in the same shade and color, and then those are how the veneers are fabricated. Now if there are any problems along the way, the patient's already seen how the final veneers will look.  So like that first case I told you about, the temporaries will reflect that, and if the patient had a problem, I would know that right away.  It's just another way of getting that feedback, am I on the right track or am I not?

Richard Madow: It's funny because I'm just thinking; I know we still have the third and the fourth appointments to talk about.  Some dentists will see the patient for a couple minutes, then they'll be prepping and inserting in like the time it's even taken you to say hello, you know what I mean?

Ted Siegel: I've been there, that was me.  Go back and look at all my bad reviews, yeah.

Richard Madow: So many things you're doing, in a way they are cautionary, but in a way they are also informing the patient all the way

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along the procedure, and enforcing their expectations and showing them exactly what's going to happen before it's too late.  Because once the first micron of enamel is removed, it could be too late.  Do you think that's a pretty good synopsis of what you're trying to accomplish here?

Ted Siegel: That's exactly it and I keep thinking, I want this patient to write a good review, I want this patient to tell family and friends and refer people.  So are they happy with me? The more I allow them to direct treatment, the happier they are.  Here's a little side note too, if the patient comes in and they sit down in the chair and say to me, I want to be a before and after on your website, great, love to have you come in, let's take that. Doc you do whatever you think is best.  I get a chill in my spine like no, you are not putting this on me, you are going to tell me what you want.  And I literally will have some heated disagreements where I keep shoving my will on them, saying I will not do this without you telling me and approving every step of the way, I'm not just going to do this and surprise you.  And they go, well that's not what I wanted, because I don't know what they want, and they're saying, well you're the expert, you do what you think is right, and I won’t do that, I won’t work on them if they don't go through my steps and allow them to tell me exactly what they want.

Richard Madow: Okay so we're still at the second appointment, what else are we going to do here?

Ted Siegel: At the second appointment, and here is just an idea, the lab can also prepare the preps for you on a model.  So if you're doing a case, if you're new to doing veneers, ask the lab to prep them, they're going to prep them anyway before they do the white wax mock-up.  So they will make a duplicate of their prep, send them to you, and then you can see exactly how to prep the teeth within reason, again they are just a lab.  But they do this all the time; they know what they need to make those veneers look good, and that will save you from making mistakes.  I find the lab is usually very conservative with their preps, they usually give me the minimal amount of reduction I need, and I like to be a little less conservative.  I like to take just a little bit more off where there is another 10th of a millimeter or so,

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because it gives the lab more leeway for shape and color control. And ultimately you're going to wind up with a better veneer because they got more room for color that they might not be aware of.

Richard Madow: The golden lesson from my buddy Mike Ditolla that 90% of dentist under prep everything, so I'm with you.

Ted Siegel: I agree.  I feel like I verge on the, I don't want to say “over-prep”. I don't want to go there either but I feel I reduce adequately to get what I need.

Richard Madow: Unless you hit the pulp, there is no such thing as over prep.

Ted Siegel: Don't think I've ever done that yet and I don't want to say that now, but my next one will be a crash and burn.  But if you're using the proper guides and you know how deep, look if I think I'm going to hit the nerve of the tooth, I tell them you need ortho, you're tooth's too far out of line. I won’t do decay. I'm not comfortable with it.

Richard Madow: So let's get back to this, this interview is called Before the Bur Touches the Tooth and we still haven't even gotten to appointment 3 and appointment , and the burs are still sitting in the closet or on the tray table.  So what's going on here with the third and fourth appointment?

Ted Siegel: The third appointment, patient is done whitening, they finished everything that they need to finish as far as their cleaning, and any treatment they've done.  One thing you want to really keep an eye on in your diagnosis is gingivectomy, because if the tooth looks short, if you don't do a gingivectomy, I do a lot of gingivectomies between 6 and 11. I don't know if we have time for another case I messed up, but I'll try to go over this quickly.  A long time patient of mine and I really didn't take into account her high smile line, the veneers came out great, except one lateral looked a little short because it wasn't the same height as the lateral on the other side.  I actually didn't become aware of the discrepancy until a month or 2 later when she came back and said, hey how come this one is shorter, can we make them longer? I'm like oh jeez, I

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missed the gingivectomy.  And I was afraid if I redid the gingivectomy, I have to redo the veneer because the tooth would be dark between the veneer and the raised gum, and that’s exactly what happened.  So I wound up doing a free gingivectomy and redoing the veneer; thankfully the lab was nice enough not to charge me for redo, and again call it continuing education. So the third, fourth appointment are the last time you can make any changes to the treatment plan that you might have.  So that's the third appointment; we’ll shoot over to the fourth appointment.  Patient comes in, show them the white wax mock-up and 99% of the time the patient wants them just the way they are, the way the lab made it, and they are actually super excited like, oh my God that's fantastic, that's exactly what I want.  They approve the wax mock-up or not, and if they don't, we make what necessary changes need to be.  So we've taken so many precautions, almost 99% of the time, I can remember a couple times we tweaked a little bit here and there.  From there we send it back to the lab and now they make a tooth preparation template and a provisional tray; we take a new shade now after they're done bleaching.  And if the patient is pressed for time, sometimes they are, and I don't have time to get all this back from the lab, because I have cases where people come in from another country or from far away, or they're running out of time, or they need it for a certain event.  I will just take a polyvinyl siloxane impression of the wax-up and will use that to make the temporary. It's decent enough; it's not perfect but it's good in a pinch.  So this is the tooth preparation template, this is part of the color by numbers.  Now you have a mock-up of exactly what the veneers are going to look like, so a tooth preparation template is a clear stent that looks like a bleaching tray. It’s made out of .03 or .04 ethics material and it's basically an impression made from the stone model of how the vinyl veneers will look. We always did this in-office, when it comes back, my assistant… we have a pressure machine that will suck down whatever and make them a bleaching tray.  In that bleaching tray my assistant places 7 holes over each tooth in stent, and they are placed on the facial aspect of the stent at the gingival, middle, and incisor third, 1 is inside the ledge and 3 more holes on the ling walls, the same kind of gingival middle. 

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And I take a perio probe as I'm reducing and I can measure the amount of reduction I need for the final veneers.  It's way more important for me to use this preparation template if the teeth are way out of line or specifically if they're rotated. Because if they're rotated, part of the tooth you're going to be taking of a lot more that that half a millimeter, you might be taking off a millimeter, a millimeter and a half, almost 2 millimeters, hopefully not too much more.  And then on the part that's rotated in, you're not going to take off anything; basically you're just going to put a finish line there.  I don't always need the prep tray as sometimes their teeth are in line and I'll do a depth spur where it stops at .5 millimeters, and I will just take that part of the tooth and just go crazy all over all the teeth, but I always use the tray no matter what. It's a safety net, it's my training wheel, it's to make sure I don't screw up, it’s color by numbers; there it is, just reduce your half millimeter all the way round wherever you can measure it.  My eyes get a little foggy, my back gets a little sore and I have to step away, take a break, sometimes I can’t even see what I'm doing, my eyes get glassed over.  Then I walk away or I just throw the stent back on. I re-measure and I go okay, good, or I need a little more, and I just move on.  Once I have proper reduction I take a deep breath, sit back and relax.  And this is the scary part, you have the teeth prep right, and we can go over that next, I've given the lab what they need in order to create fabulous veneers, I can relax they got everything they need.

Richard Madow: And I think one of the main reasons you can relax is because you know the patient's not going to flip out and say, that's not what I thought they were going to look like; they've had gazillion opportunities to have input and to see what the finished product will look like, so you're definitely resting easy now.

Ted Siegel: And I gave the lab enough room to get that finished properly, that's what the preparation template is for.  Like okay, they like that but the other scary part is actually delivering the dentistry, now you got to cut into these teeth that most of the time look pretty good.  Sometimes I

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have a little difficulty getting my hand with the bur onto these teeth to actually make that first cut.

Richard Madow: Let’s get back to getting the patient to say, I want Dr. Ted Siegel to be the one to do my Smile Makeover, and that's one of the things that really made me call you in the first place.  I was looking at your website, you've got tons of before and after pictures, you've got really good video testimonials.  How you put all this together, what's you strategy, how do you get patients to do this? Let’s talk about that for a little bit because it's something that anyone should be able to do.

Ted Siegel: I agree.  Photography and videography are very important. It's documenting your work and letting other people see what you're doing.  I wanted to take a course from a dental photography class and it was really expensive, it was a 2-day course.  I thought wow, how many thousand dollars do I have to spend for 2 days to learn how to take a picture? I know how to take pictures; I'm not a complete moron. I thought wow what are they going to teach me and not to say those classes aren't great, I'm sure they are.  I found a local photography class that trains students to become trained photographers for half the price in my area, and 20 times the content and it went for an entire year.  The place I went locally is called Chicago Photography Academy: they can be found at ipaschools.com if you're interested and their phone number is 312-543-8087.  The owner's name is William Benson; he's old school; he's got all the photography that you need to know.  That being said, here's what I found out too about educating myself with photography: you don't need to be in expert photography, you don't need an expensive camera, you just need to take pictures.  Rich, the pictures you were looking at on my website, nearly all the before and after photos that you see were done with a point and shoot camera. I swear to you it's over 15 years old, it doesn't have a modern USB port.  If I lose that cord I'm going to have to try to find someone that can buy those old USB cords; there is no backdrop, I just shoot it or have my assistant shoot it, there's not a lot of magic that goes into it.

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Richard Madow: But I got to tell you Ted, you do something that I've been saying for years, never ever, ever, ever do this.  But I'm looking at your website and I think I'm going to have to say it's really effective, and that is using the old retractors.  You mentioned this before but you kind of like, a little technique here where you use the ugly retractors on the before, and then you do the full smile with regular lips on the after, and it's a really cool effect.

Ted Siegel:  And patients don't mind because they might ask if I have a handful of patients with their cheeks retracted. I have that in the bottom part, then I have the beautiful smile on top.  I now don't show their whole face looking ugly. I show only the retracted ugly version and then I show the beautiful smile after, and that makes a great impact.  Patients have to see what did you start with, and where do you end, and then I could talk about how I got there.  And when patients come in I say, hey remember the one you were looking on up front, or remember that picture on my website, that's you, this is exactly what we're going to do: the same thing for you; and I got over what I did for that.  I basically use that as my (dream?) plan and I take them to the website and I say hey, if you want to see this video again, go to my veneer page, watch the video; if you want to see this case to show a loved one what we did, here's what we're going to do for you, and I bring it up every time I talk to them.  That's their guide. I take them back to my website intentionally; that's my education for them, they can always go back to that.

Richard Madow: And how do you get these great video testimonials on there?

Ted Siegel: Again I just ask them and they always say yes, people come in sometimes and say I want to be a before and after.  But how do we shoot them?  I have 2 cameras set up, we just put them in my room and I’ve got 2 Nikons that are shot straight on a 45 degree angle, and a professional mike that I've screwed up so many times I can’t tell you, batteries go bad or whatever.  We're going to need like half a day to talk about all my mistakes at every step of the way here.  So we shoot this video, the video, I'm with the patient probably about a half hour to an hour shooting the

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video, and I just tell them to tell the story of how you felt before, why did you have this done, how do you feel now , how was the procedure.  Then we shoot all this up, take it and I put it in Dropbox, and I sent it to who is now a patient of mine, his name is Keith Woodrow of Kam Videos, he's an independent film maker here in Chicago, but we don't see each other, he just pops up once in a while.  In addition to the work he does for me and he's put all those videos together, he writes, produces, directs commercials for other local businesses, short films, video advertising.  I'm going to give you his contact number, or of course you're always welcome to call me for all of these people that you need to know about.  It is info@kamvideos.com, reasonably priced, give him all the information and he just takes it out of Dropbox, does what he needs to do.  We have been working so long doing these videos, we've got it down to a formula also, kind of a cookie cutter how we put the videos together.

Richard Madow: Cool.  Okay so I'm going to ask you one last question and again it goes back to your website.  By the way, I think we've mentioned this very briefly but if people want to see what you're doing, your office is called Big Smile Dental, which I really like that as well.  But looking on your website, you have this banner with you and the tiara women which I keep mentioning because I love that picture. But it looks like you've been awarded a lot of things, you've written up in the Chicago Tribune,  in 2012 you're on the top dentist list, excellence in the town winner, how do you get all these things?

Ted Siegel: For my entire career I've decided what makes people choose a dentist , what's important to them, so they need a dentist they can trust, they prefer a high profile dentist that's worked on people of high caliber, and oh yeah he's my dentist.  Awards being won, we also do charity, we've done a charity in the neighborhood the last 10 years and everybody in the neighborhood knows about it.  If I order a pizza a half a mile away and say we're ordering for Dr. Siegel Big Smile Dental, they go oh you guys are the ones that do that charity every year, the whole neighborhood knows.  We don't expect any of the patients for which we did the charity to become actual patients, but what it does

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show the entire neighborhood is that we care more about the patient than we do money.  And they come in all the time saying I love what you do for the area and I want to be a patient of a practice like that.

Richard Madow: And the charity you do is Dentistry with a Heart?

Ted Siegel: Dentistry With a Heart and we've been doing that for 10 years.  And we've been on every news channel, every newspaper, every magazine, radio year through year.  We're live on Fox, we've done a lot of press, and they last forever on the internet.

Richard Madow: So do you do it on your own or do you actually use the Dentistry With a Heart template?

Ted Siegel: No we've been doing that on our own for a long time and it's very similar, I support them entirely but I don't really work with them, this is something we started doing...there was a first guy to do it's not like I made this up or anything. There was a guy, I think he's in St. Louis, that did it before Dentistry with a Heart, before I did mine too.  I can’t remember who wrote it up, but I read that I called him, and I swear for about 5 years I keep thinking, I really need to do this and I never pulled the trigger.  And a friend of mine did a charity in the area, this huge thing with the Chicago Black Hawks, Chicago Bears, and I'm thinking, wow he does this and all I have to do is basically open my door and do what I do every day; what's keeping me from doing that.  So that kind of gave me the empathy to get this started and do it, and I have all my other specialists come in, other dentists come into our office, hygienists come  from all over the area, and we try to push their offices too and give them credit.  The more I push their office...ultimately I still get the credit for bringing those offices in, and patients in this area love that too, they realize it's a big deal.  And honestly you can’t do this alone; it's a group effort.

Richard Madow: And it's a fantastic thing to do.  If you're not sure what we’re talking about you can look at the one that is well known throughout the country is Dentistry From the Heart, so that's dentistryfromtheheart.org. But Ted as you've

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show, you can do it on your own, you can kind of get publicity from others in the community and news stations, but essentially doing free dentistry on underserved members of your community on Valentine’s Day, which is the typical day to do it, and it's just a great thing to do.

Ted Siegel: You'll wish you started it years and years ago. I wish I did it from the day I graduated, and it is honestly one of the best days of my life dentally speaking.  No financial arrangements, just hug and patients love you to death.  They wait outside in the winter here in Chicago for 12 hours and they are so happy when they get in, it's just such a great feeling.

Richard Madow: I agree.  Hey anyway we've got to wind it up, but the good news is that we're going to be doing a part 2 in the next few months.  We'll be talking about more marketing and getting patients in the door, but also maybe more of the clinical art of the Smile Makeover.  So Ted, if anybody wants to get in touch with you, ask you a question, chitchat, say I want to hear more about your mistakes and horror stories, whatever they want.

Ted Siegel: Got plenty of horror stories, believe me.

Richard Madow: How could they get in touch with you? I don't know if you prefer email, phone, both or whatever. 

Ted Siegel: Whatever, I'd be happy to talk to anybody that needs some help:  info@bigsmiledental.com would be a good place to reach me on the internet, and you can certainly call my office at 773-772-8400.  I'm not great at responding, but I'll do my best, I promise. I hear everyone like oh I'm a great responder, I'll respond in 2 minutes, I'm horrible.

Richard Madow: That's quite an endorsement.

Ted Siegel: Yeah, I will eventually. I'm just saying it's not like I don't love you, I will get to that.

Richard Madow: Well I'm glad you responded to my email about Michael Jordan so that got this whole thing kicked off.  Anyway we

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do have to end things, so I'm just going to say this is Dr. Richard Madow: our guest today Dr. Ted Siegel, he is not a lecturing dentist , he's not a dentist that has articles in the journals every month, but he is a dentist in a low income area in Chicago, doing really great things.  And you're the kind of guy that we love to learn from, so thanks for spending time with us, Ted.

Ted Siegel: Thank you so much for having me; it is an honor, I can’t tell you how flattered I am that you would even want to hear my opinion.

Richard Madow: Well it's a pleasure, thanks Ted, we'll be in touch and I'll talk to you soon.

Ted Siegel: Thank you Rich.