Spa Dentistry — An Accessory, Not An Identity

By: Kent Smith, DDS July 2009

If you are reading this article, you must have at least a passing interest in the concept of spa dentistry. My job is to get you to see how it might prove to be a valuable complement to your practice. Allow me to provide a hook by stating early on that "spa dentistry" has many looks, but rarely does it cost much at all to implement. In fact, the biggest hurdle is developing a mindset among your team members that they need to provide a relaxing and sedative atmosphere for those patients who would appreciate the efforts.

Most offices are already delivering aspects of "spa dentistry." We are all trying to decrease anxieties and affect moods in a positive way. If you use nitrous oxide, play soft music, and use soothing colors on your walls, you are attempting to affect moods. We just carry that a few steps further in our practice.

What I would like to particularly emphasize is that it is not necessary to force these services on your entire patient base, because they will not universally embrace the concept. In our practice, we did not want to be exclusionary when we began implementing the spa concept in the early '90s. There is a good percentage of the population who shun any attempts at coddling. This could include the ice fisherperson, the martyr, the skeptic, or the executive who knows that "time is money," and any extra time given to deliver comfort is wasteful.

Certainly, you may wish to limit your practice to patients who truly appreciate what spa dentistry has to offer, but the majority of us are eager to attract new patients from both sides of the aisle. A healthy practice begins with keeping that schedule full and productive.

Now let's set the mood. We have gone to The Four Seasons, The Ritz Carlton, and numerous spas to learn customer service from the masters who epitomize stress-reduction. This has, over time, transformed our office into one that places our interests in a subordinate position to the patients. You can provide these services all day, but if you don't have a caring spirit, patients will know. The average dental patient is more discerning than the group that avoids a dentist completely.

I must first assume that you have a friendly and calm face for patients to see when they first arrive. That tone can be set quickly. Even though your facility may be ideal, an acerbic voice, a harried look, or a rushed atmosphere will not comport with the image you are trying to employ, and patients will view this incongruency with skepticism. As I stated earlier, the mindset of your team may be the most difficult hurdle, especially if their nature is not seeping with calm reassurance.

If you have a small team, establishing a uniform and universal attitude may be less of a challenge. In a larger practice, you will likely see your most hedonistic patients gravitate toward those team members most capable of appeasing their desires. If you offer nitrous oxide in your practice, look at those clinical members who never forget to offer it to your patients. They will most likely be your most capable spa facilitators.

Now that we have your team set (wasn't that easy?), let's go over your physical atmosphere. Soft music is a given, but you may have Jerry Springer in one op and Deepak Chopra in the next, so keep this in mind, especially if you are currently designing your operatories. This is why we allow each room to develop its own ambience, and this changes from patient to patient. If there is any system-wide music playing, this is very low, so it does not interfere with the sounds being produced in a separate operatory. Patient headphones can eliminate many obtrusive sounds but, in reality, most patients do not opt for this amenity.

The overhead lights in the hallway are always off, because the ambient light from windows and the indirect lighting from wall sconces provide a softer mood. However, as you enter a room, the differences are like night and day (pun intended). Here is a tale of two ops.

The hygiene operatory is fully lit with the cartoon channel loud enough to distract Justin and Katie while Mom gets her teeth cleaned. The hygienist is talking over the din of the television in her vain attempt to explain the nuances of flossing, while Mom yells at Justin for stepping on the rheostat.

Next door, all lights are dimmed or off except for the patient lamp. Aromatic candles are lit, the fountain is flowing, an eye mask, herbal neck pillow, and paraffin wax mitts are in place, a blanket is arranged to provide security, Enya can be heard in the background, and a massage mat is softly humming. Two distinctly different scenarios, neither of which are at all difficult or expensive to produce.

Our menu of spa services has grown over the years, but it all started with the massage mats in the chairs. Other than the post-anesthetic milkshake, the massage is still the most-requested item. This is one area where cost should never be a concern. Over the past 10-plus years with the mats, we have spent a total of about $200 per chair. However, the real difference is seen when purchasing patient chairs. When we did this a few years ago, we were able to stay on the lower end of cost, because we knew they would be hidden by the mats anyway.

We added a tanning booth in 1992, but had that removed later to concentrate on less cancer-producing spa elements. Soon after, I coined the term "stealth dentistry," and the emphasis became one of disguising the fact dentistry was being practiced here. Most patients do not feel that is possible, but we try very hard to prove them wrong. We eventually adopted the term "spa dentistry" because that had a better connotation.

Years later, we added milkshakes, and this has always been a big hit. Every patient who receives anesthesia is offered his or her choice of chocolate, vanilla, or strawberry. These are stocked in our freezer weekly, and are placed in the microwave near the end of the patient visit. As I am finishing last-minute patient instructions, the chairside assistant uses her radio headset to relate the patient's choice of flavors to the front desk. After the shake is prepared, it is placed on a tray, along with a hot towel, an ibuprofen tablet, and a cup of water, and then brought to the operatory.

The milkshake serves several purposes. Its cool taste helps alleviate discomfort from the stretching exercises through which we have just put the oral cavity. It neutralizes any unpleasant tasting materials with which we have insulted their taste buds. The immediate caloric load helps delay the desire for sustenance, allowing the anesthetic effects to dissipate. Patients love to get something for free, especially something they weren't expecting. If they are returning to work, the shake is often the topic of conversation rather than the cost of the treatment. We know this because new patients often ask if they will be getting a milkshake (so much for the surprise).

It would be difficult to discuss spa dentistry without mentioning sedation dentistry, as the two complement each other so well. If you are not currently offering these services, get the necessary training, and you will be surprised by the number of large cases that suddenly walk through your door. OK, don't hold me to that, but it happened in our practice!

Although any facility can be used to implement spa dentistry, there are a few things to note if you will be designing a new office or making leasehold improvements. It is important to note that your wiring needs to allow for room lights to be off while the patient lamp is on. Many office designers tie these together, unfortunately, so if you are in the design phase, keep this in mind. The dimming or absence of room lights is often enough to significantly calm the anxious patient. Additionally, carpeting throughout the office helps attenuate the sounds that can be distracting, so at least consider this when making your next flooring decision.

I need to mention something you will not see on our menu of amenities, but which must accompany any service you provide. In all your actions, you must strive to make the patient's visit the most pleasurable experience possible. Seeing patients on time is a given, but little things such as allowing them to check out from the operatory can make a big difference in the "exit mood." This exit mood is something upon which we place a big emphasis, but every patient has different needs. The executive likes to check out and preappoint his or her next visit with a PDA from the operatory, where we also transmit the insurance claim, after which the patient quickly exits. The sanguine patient enjoys hanging around the front desk to catch up on office gossip and show off photos from his or her vacation to Disneyland. The important thing is that you recognize the moods of each patient, so patients leave with positive thoughts about their experience.

Once you have developed the atmosphere and have the systems in place to make sure the patient is pampered to his or her desired level, you might think of how you can get the word out. You might not be able to get television cameras to chronicle your improvements, but there are many ways to spread the news. I won't get into all of the marketing techniques, but I would like to mention a source many of you may be discounting — your Web site.

Many patients feel that finding a dental office that suits their emotional makeup is a difficult task, and one not left to a casual conversation with the guy in the next cubicle. What better resource is there for getting a glance at a large complement of offices than using a search with Yahoo! or Google? We regularly have new patients schedule after finding us on the Internet. If our primary emphasis was before-and-after photos, many would never bother to make the appointment.

As I mentioned earlier, it is not necessary to exclude that section of your patient base that would feel uncomfortable with the spa concept. Be careful not to alienate a valuable portion of your practice but, at the same time, realize that spa dentistry can make your services more appealing to a group of patients you have not yet seen