My practice is a cosmetic practice that just celebrated its 30th anniversary. It is mostly adult. I do treat children who have had acute problems. We don't do any of the specialties. We work with the specialists. We don't do perio or endo in our practice, nor oral surgery. The office does all restoratives both fixed and removable. My associate and I work in Atlanta, Georgia in a 2900 square foot office that has two hygiene rooms, three operatories and a staff of eight.

If you had to define three things that reflect dental success what would they be?

Success is a combination of many things. Number one, it's financial security. Two, it's the ability to come to your office and enjoy what you're doing. And three, it's to not have to worry about your success or your final product. It's having the confidence that the materials you are using are for long term and that patients are pleased with their results. Finance, results and self confidence make you successful.

I have seen some of the same patients for the past 25-30 years. I've seen things that work and things that don't work. Like the early Greeks and Romans say, "the living learn from the dead." It's like doing an autopsy when we see some of the most magnificent restorations that we thought we had placed and then they finally had deteriorated. We find the failure in the materials and the patients upkeep. We have to be realistic in our demands and our expectations. You have to learn from experience. These are the things that they don't teach you in school.

Why do you think that is?

We are working with universities. The academy is working with universities, trying to incorporate and inculcate them in the benefits of cosmetic dentistry, and the benefits of tooth whitening. I even heard for instance, a comment from a university professor, an operative dentist saying that bleaching hurts the teeth. Now, we know that bleaching materials do not cause any irreversible pulpitis, and there are millions of teeth being bleached. It really hasn't altered the teeth very much, and the benefits of bleaching have been so multi-fold and so positive throughout the world, that it doesn't make any sense for comments like that to come from educators. I am not cutting on universities at all, I am speaking in general. The graduating dentist needs to go out and begin using all of these great composite resins for bonding, laminates and veneers for their restorative work. That needs to be taught in the dental school environment.

In talking with others, like Bill Dorfman who I also know emphasize in cosmetics, they have practices that they've custom built for the cosmetic type of patient. They have very nice offices, bigger operatories, larger staff. Is that the case with your office?

Our office has always been a very roomy office. We have large halls, an open design, and a lot of light. It's a very good building. In Atlanta, we have the opportunity to get real estate at a lower price than you would in California and New York certainly. That's why you find most offices in those areas are smaller. We are geared directly for the smile design. We have the ability to show a patient what to expect and I've been doing it for as long as I've been practicing dentistry.

What gave you the inspiration or helped you decide to focus on cosmetic dentistry as opposed to maybe focusing on another specialty or area of dentistry?

When I first started practicing, I was in a practice with Ronald Goldstein. Certainly he has been instrumental in making people aware of esthetics. Some of that rubbed off on me. It's something that you don't learn in dental school.

Do you feel cosmetic dentistry has lead you to the success that you have achieved in dentistry specifically, or would you attribute that more to your personal style and the type of office you run?

I think actually cosmetic dentistry has added to my success. Not everyone who tries it is successful and likes it. You have to enjoy what you're doing. It is very timely. We're sort of in the dental olympics, somewhat like the Olympics here in Atlanta right now. What's exciting about cosmetic dentistry, is that dentists of all ages and all types of practices are learning that they don't have to deal with HMO's and PPO's today. They can do fee-for-service dentistry, and that the market for full-fee dentistry is there. Patients want to look better. Patients are interested in appearance related dentistry. So, no matter how old or young you are, how aggressive or unaggressive you are, it's sort of like being in the Olympics. You can train and learn to do cosmetic work. I'm excited about it. There are so many young dentists, and dentists that have been in practice for five and ten years now that are taking courses and attending meetings, at, for instance the American Academy of Cosmetic Dentistry, and trying to learn to participate in appearance related dentistry.

Being that Atlanta is the host city for the Olympics, have you had a change to go out and see some of the events?

Yes. I'm more of an Olympic couch potato like everyone else in the world than an event person. Actually, yesterday the bicyclists came by my building. That was exciting. It's just a real happening and once in a lifetime thing that's occurred here. As it relates to dentistry, not everyone can be a Carl Lewis at the end of their career or jump a record distance. I don't expect dentists who are finding themselves in the doldrums of average dentistry, turning around the next day and saying, "I want to become a cosmetic oriented dentist", and then in the next week altering their practices. There are mechanisms to do this. In practicing 30 years, I am happier now, and enjoying what I'm doing more than I did 30 years ago. Products have changed. The predictability of the dentistry has changed, and the components and the procedures change.

Many experts and industry leaders say that managed care is going to put many dentists out of business in the coming years. What do you think the impact of managed care will be on dentistry and individual practices?

I worry about it. As a matter of fact, it's part of my communication with my patients. This week, I sent out my annual letter to my patients. It's not a newsletter but an overview of what's happening in dentistry and in the practice. I included a wonderful brochure that is printed up by Roger Levin, that talks about the patients relationship with their dentist and as it relates to pre-paid and post-paid treatments, PPO's, HMO's, and fee-for-service. I think it answers the questions that patients might have. We can see that PPO's and HMO's impact dentists and it's sad. We are letting insurance companies dictate our incomes and our profession, and our professional choice which is worse than anything else. For you to make a clinical decision that a full coverage restoration or a crown is the treatment of choice, and then for an insurance company to say, according to economics, a pin retained amalgam would be better rather than a bonded amalgam or a build-up, in order to save money is certainly a disservice to the profession and a disservice to the patient. As far as those things are concerned, we need to do our homework. The practices that are preventive oriented and cosmetic oriented are going to survive if they have established a good reputation in the community. They always will maintain their nucleus of patients. I feel bad about dentists, just beginning, who are signing up with these companies because I believe they are selling themselves short.

What advice would you give to someone who is faced with the decision of joining either a managed care organization or marketing their skills?

They have to get excited about the profession. Once they're excited about dentistry and what they're doing, then it becomes an issue of economics and setting up their own practice. It's the old adage, location, location, location. You need to find a good place to be in and set up a fee-for-service office. Not everybody can do it. There are a lot of practice management courses out there now. You need to listen to these people. Some of the recipes work and some of them don't work. There are two types of people. There are some personalities that could survive anywhere. They can sell pots and pans, or they can do dentistry. They can make a living, support a family and live well. Then there are other people that are going to depend on others to feed them. A lot of it is based on personality. There are self starters, people that are ready to learn, that look over the shoulders of others and try to pick their brains. There are a lot of post graduate courses which can help an active practicing dentist change the direction of their practice. They have to make that life decision as to which direction they want to go and go that way.

Many dentists are of the opinion that one of the reasons that they decide to work with managed care is because the promotion, marketing and advertising of professional medical services (dentistry) is unethical. How do you feel?

There is a difference between marketing and selling. If you teach the benefits of a procedure when you teach for instance, the benefits of bleaching, or when you're marketing yourself, that is not against the law according to the FTC or the ADA, or the local dental society. We're beyond that now. We are beyond measuring the size of people's names on the doors. We've grown a little bit.

Many dentists feel that national advertising is needed for dentistry- How do you feel?

National advertising is excellent. To tell you the truth, I've been on the media a lot. As a matter of fact, I was on CNN yesterday and I didn't know it until I got a few calls from colleagues. It was about nutrition as it relates to vegetarians and osteoporosis. Some of the things we've done in Glamour magazine with smile design council, some of the articles that have been written have been very useful. It's good for everyone. It may not necessarily bring patients into my office or to Jeff Gobb's or to Bill Dorfman's office when we're on television, but it helps everyone. If anyone can get on the media and make people aware of what a nice smile is and what a good functional healthy mouth is it serves a purpose of sharing knowledge and marketing our profession.

Who are your dental heroes?

We all have dental heroes and there are dental gods. I think Gordon Christensen, as most do, is a dental guru who has filled the void that the American Dental Association has left open in being able to be a clearinghouse for products. I'm excited about people like Bill Dorfman who have made it in areas where other people have been. He's a young dentist who came into Hollywood in Beverly Hills where there were such magnificent and qualified people doing cosmetic dentistry, one of course was Charlie Pincus who was the father of esthetics, and probably one of all of our heroes for those of us in cosmetic dentistry. Bill is excited about dentistry. He is excited because he is successful of course. Once one gets successful it just sort of keeps on going. He is one of the more enthusiastic dentists out there and has a lot to say about it. Even though he is in Beverly Hills, what he has to say about dentistry can be utilized anywhere.

What are your future plans in dentistry?