By Darren Buford
Originally published in Massage & Bodywork magazine, February/March 2004.
There are many reasons why I drive my son to a dentist nearly an hour away from our home. Not only do I think this pedodontist is the best in the area, but he provides a certain je ne sais quoi unavailable elsewhere.
Through a little creativity, he has transformed a dreaded experience for many youngsters into a positive encounter. Upon entering his office, children find video games and a play set that includes a “tree house” and slide. Once their name is called, they are escorted into the hygenists’ area where they can watch their favorite cartoons while sitting in the dental chair. Finally, the visit ends with a trip to the toy drawer where children may choose from an assortment of goodies.
Wouldn’t it be great if there were dentists who catered to assuaging adult dental fears the way my child’s dentist pacifies his clientele? A dentist who actually pampered his clients rather than treating them like a number? Well, luckily there is.
Adult Dental Dream
Upon entering Smile Spa in Westminster, Colo., I’m immediately overwhelmed by a feeling of comfort, rather atypical to a dental appointment. Besides the aromatic candles, flowing fountains and pleasant music, there’s the cheerful face of Dr. Gary Belenski, who some might consider the dentist of the future. Belenski, who has been in “traditional” dental practice for nearly 10 years, shifted within the past year toward a more nurturing environment. Monday through Thursday he still conducts general dentistry, which, according to Belenski, means a “needs-based practice” and which is heavily insurance-based. Friday through Sunday he operates a dental spa, better described as a “wants-based practice” that is virtually insurance-free and driven almost entirely by cosmetics.
This shift in attention allows Belenski to proceed with what he calls “the right way to do dentistry.” Instead of treating numerous clients per day, most of whom are handled by a host of hygenists, Belenski has one client per day and runs the office with just the help of his “guest concierge” (also known as his assistant) Kerry Kerstiens. Belenski promotes this practice as quality dentistry versus quantity dentistry.
“If we are supposed to be in the business of helping people, then let’s help them,” he explains. Belenski arrived at his personal dental epiphany when attending the Las Vegas Institute for Advanced Dental Studies where he met dental visionary Dr. Bill Dickerson, who permanently changed his view of traditional practice. Dickerson helped Belenski see customer service in the traditional dental arena as merely window dressing.
Before that meeting, Belenski was becoming jaded. He felt he was working for the insurance empire instead of his clientele. Today, Smile Spa emphasizes customer service “combined with technical and interpersonal skills.” Belenski writes on his website (www.coloradosmilespa.com) that “over the past five years the only way that I have found that this can be accomplished is by spending time with my patients. The doctor has got to be willing to schedule enough time in order to get to know his patients, and to schedule enough time so that the patient never feels like the doctor is rushing through their procedure in order to get to another one.”
This led to a new dental strategy that includes creating value through the “little things,” such as being picked up for your appointment in a limousine, having your lunch catered to you by your favorite restaurant, aromatherapy eye masks, blankets to warm you during procedures, a relaxation room, and, of course, massage therapy. All this is part of what Belenski calls making a shift from a tooth doctor to a mouth physician.
“Dentistry is a stressful job because you’re always hurting people,” Belenski notes. “Working on patients year after year can take its toll.” Now, he spends a lot of time getting to know them and hopefully relieving customer concerns about dental work.
Belenski’s assistant discusses their clients like she is catering to old friends rather than customers. She explains that one recent patient was a single mother for whom she bought flowers and wine; she gave another her personal cell phone number to call just in case there might be any questions or concerns. Kerstiens has worked in other dental offices and mentions that Belenski’s shift toward a more personal, nurturing environment has made all the difference in both her life and in the patients’ attitudes.
In the short term, Belenski has the tough job of transforming his insurance-based clients toward the new dental spa because the money is out of pocket and must be paid in advance of treatment. He has had to reestablish himself in the field again by marketing anew. But he has faith that the more knowledge the public has about his type of dentistry, the more the public will be interested and the quicker he can phase out his “needs-based” practice.
A Less Tense Office
The Dental Day Spa, in Honolulu, Hawaii, has adopted a similar dental approach to Belenski’s. “We are an exclusive type of office because we do aesthetic work,” says practice manager and dental assistant Julie Brum. Function, health and beauty are the three elements the practice has adopted toward teeth. “So how does the spa fit in?” Brum asks rhetorically. “Well, we may see only one patient all day long. They come in early in the morning, and they leave at the end of the day. With that, we wanted to find a way to make things as comfortable as possible for them and have it be a place they don’t dread coming to.”
Brum explains that at its inception the dental spa began with DVDs viewed through virtual-reality glasses to distract clients who were having work done. Other amenities like special pillows were gradually added, and before long there was a full-fledged spa amidst their dental practice.
Patients also receive massage upon request. They might have their feet, or head and neck, massaged just prior to the appointment. “Our massage therapist finds that she can see a huge difference in clients’ muscle tone from the time she begins her massage and relaxes them to when their treatment begins,” Brum says. “If the patient does not have a massage, they are in knots because they are tense.”
Brum believes the spa helps make doing dentistry a lot easier and helps avoid some of the more traditional options for relieving customer tension. “We can give them Valium, we can medicate them, but we want to make their experience as relaxing as possible without having to do those things.”
Often, Brum jokes, it is the massage therapist who gets all the praise after procedures. “Patients will sit up at the conclusion of their appointment, even if it’s only 45 minutes long, and say, ‘My god, that was such a great help,’ and they begin to hug the massage therapist. And I’m saying, ‘Hey, what about me? I was working in your mouth.’”
One of the Team
So, what’s it like being a massage therapist in a dental office? “It’s extremely rewarding,” says Barbara Shirland, massage therapist for Dental Day Spa. “As a registered nurse, part of my awareness is public health. I know there are so many people who avoid going to the dentist because it’s unpleasant. As time goes on, more things of general health are tied to, or correlate strongly to, oral health. By making the experience of dentistry a more pleasant one, people tend to come to get the work they need. And this influences their overall body health.
“I know they have found that good dental health correlates to good cardiac health. And that’s the No. 1 killer in the United States. By working here in the dental office, I am helping to make a contribution to the public’s health. And that’s satisfying.”
Dental Day Spa has spa quarters where full body massage and other services are offered, but often Shirland works right alongside the dental team in the operatory. “If a patient is here for full-mouth rehabilitation, which means they are here to get nearly all or a large part of their teeth done, I’ll get the patient into the spa room first. I’ll massage their back — usually for half an hour. Then, we’ll seat them in the operatory. During treatment, I’ll be on their feet. Before lunch, I’ll do their shoulders, neck and head again. Then, they’ll go to lunch. After lunch, they’ll be back in the spa room for more back massage before getting seated again. And then a little bit of shoulder, neck and head massage at the end of the day. So they’re getting quite a bit of massage throughout the day.”
Shirland says she watches her clients’ body responses as she works, often checking both respiration and pulse, something she describes as “second nature” in RNs. “I’m actually checking the pulse rate in their feet, the pedal pulse. As the day goes on, they tend to get more relaxed.” Shirland replies that it’s not uncommon for patients to fall asleep. In fact, she relates that one patient sat up and said that between the movie and the massage, she was barely aware of what was going on. And for dentists and massage therapists alike, that’s exactly the point.
The dental environment continues to serve as an education model for Shirland. “I’ll never stop learning greater refinement. Really understanding where people are and how my work is affecting them, just by feeling their tissue.”
Because patients can’t communicate with Shirland, she says she has to be more alert to what their tissues are telling her. “Tissues respond to everything. I notice, for example, that when someone is extremely fearful, even the tissue on the bottom of their feet feels tight. As they relax, that tissue softens.”
Shirland suggests that before working in a similar environment, massage therapists should clarify their intentions. “If it’s truly to make a contribution to the public’s health, and if they’re not afraid of the dentist, it’s really an opportunity for selfless service for society at large.” Shirland says this is much more rewarding work than any other massage therapy she’s performed.
A Growing Trend?
From New York to California, dentists are coming to terms with a growing percentage of Americans who fear having their teeth worked on. It is estimated that anxiety likely keeps more than half of the public away from dental offices each year. In order to stave this trend, many offices are introducing calming music, aromatherapy and massage services to entice clients into the dental chair. With promises of touch and other amenities, who could refuse?
“I really like watching the response of the patients,” Shirland says. “I like watching their fears calm. I like after the treatment when they ask, ‘That was wonderful, can I do that again?’”
A Dental Spa Surge?
With the rise of medical spas over the past couple of years, it’s not hard to imagine that dental spas will follow suit. The International Spa Association reported that between 1997 and 2002 medical spas grew upwards of 140 percent and accounted for $205 million in revenue, the fastest growing segment of the spa industry. Since Americans are already spending hefty amounts of money on cosmetic dentistry (between $5,000 and $40,000 per treatment and often out of pocket) adding the comforts of spa to an already booming business could likely result in greater revenue.
Dr. Lorin Berland, of the Dallas Dental Spa, was the first dentist in the country to use the term “dental spa” nearly 10 years ago. “I hired a massage therapist and used to include her in my lectures to dentists and in my writings,” Berland says. “People were laughing at me and making fun of me. Then, I added the spa thing. Now, the people who laughed at me are my biggest supporters.”
Berland hired a massage therapist full time in 1996. “At the time, I needed someone else in the office — another set of hands, ears, someone to talk and listen to patients, answer the phone, clean the instruments. I was getting a massage and thought, ‘Wow, this is what I really need. I need someone to help make my patients feel better.’”
Always interested in non-traditional methods of medicine, Berland remembered studying Chinese meridians, patterns and lines in the body, and how they related certain parts of the hand to the teeth, hence releasing pain in the mouth. Berland came to the conclusion that by doing massage during anesthetic, the worst part of the dental appointment, anxiety could be reduced.
“We’ve always monitored blood pressure and pulse during procedures. And there was always a spike in the blood pressure during the anesthetic. And part of that is caused by the epinephrine, because most anesthetics have differing or varying amounts of concentration. But still, it’s shock and fear and all that kind of stuff. We noticed there was much less spike on the blood pressure with massage. In fact, many patients never even felt the needle.”
Berland insists that even with the addition of his spa services, he’s still primarily a dentist. “I’m only into the teeth,” he says. “We incorporated massage just to do better dentistry. A more comfortable patient is a better patient. And the more comfortable a patient is, the better dentist I am.”