KNOCKS and Rubs of Dental Spas

By Patrick Wahl, DMD, MBA,
Ginny Hegarty,
and Lorraine Hollett

Everyone likes to feel important. So pampering patients is a good idea, right? Women keep their appointments at the salon as they cancel visits in our office because they like to be pampered. What better idea than to turn our dental offices into "dental spas?"

It turns out that making the dental office more spa-like is not an idea immediately embraced by every dentist. In fact, you might say the idea is controversial. Is the dental spa a growing trend we should all heed? Or is it like a cancer, adding to overhead and causing dentists to lose focus on what's really important?

We hope this article will help you decide how to position and enhance your own practice. We've compiled spa dentistry "knocks" from seminar attendees, consulting clients, colleagues, and friends. For each knock, we offer a "rub" designed to get you to think through the idea from a fresh perspective. We think we can all learn from both sides.

The knock: "A spa-like atmosphere sounds good, but in dentistry, it's a good way to go broke. It's just not cost-effective because patients don't want to pay for dentistry, let alone for added services."

The rub: Lots of inexpensive things can make visits more pleasant, such as offering movies, lip balm, and other amenities. The best way to create a spa-like atmosphere is free. It's about a feeling — how people are treated. True, not every patient is willing to pay for good service. Who cares? The surest route to failure in any business is trying to be all things to everyone. You'll find it easy to compete on service because most of your competition isn't interested in it. Ask yourself and your team, "What can we add to the experience in our practice to make patients more comfortable?" Is good enough really good enough? Remember, if there is no difference in service, then the only difference is price. We've noticed when service matters, people are happy to pay a premium. Customers don't leave a business when the price is too high, but when the service provided is not commensurate with the fee charged.

The knock: "You say 'customers don't leave a business because the price is too high, but when the service provided is not commensurate with the fee charged.' I disagree. Cost is a reality for my patients, and they won't spend more than they have to even if I throw in a warm towel and neck rubs."

The rub: You can embrace the concept of spa dentistry without spending a lot of money. What do you think the warm towel costs? What about the neck rub? If a hot towel is a good idea for a $40 meal, why not after a $900 root canal or crown that leaves a tired, powdery face? What do patients say? "Wow! It's like when I flew first class!"

Dr. Kent Smith (www.21stCenturyDental.com) shares his ideas.

"There are many inexpensive methods you can employ to calm the senses," he says. "Offer a blanket for warmth. This serves as a 'security blanket' that gives the patient a refuge from the externally troubling dental environment. Whatever you do, make patients aware you care about their comfort. Showing compassion is inexpensive and never turns a patient in the wrong direction.

"Your patients won't tell you, because they really love you, but there are many sights and sounds in a dental office that put them on edge. You live with these sights and sounds every day. They don't, and they haven't accommodated their senses. Whether you embrace spa dentistry, try your best to block these images from your patients. It can be as easy as offering an eye mask to block the light of the operatory. Add a pleasant scent to it, and they may not gag on the smell of an infected tooth."

The knock: "I'm already stressing about my overhead. I just can't see increasing expenses for these fluff services. If I'm going to increase expenses, I'm going to invest in staff or supplies or treatment-related materials and CE. That would have a positive effect on patient care without all the smoke-and-mirrors tactics of spa dentistry."

The rub: "I would not characterize spa dentistry as smoke and mirrors," Dr. Smith says, "but most all dentists practice what I call 'stealth dentistry' to some degree. Do you hide the needle before insertion? Do you cover blood-soaked gauze so patients won't see it? Do you employ nitrous oxide to divert the patient's attention away from the task at hand? We spa dentists just carry this concept a bit further, and it easily slides into the approach known as spa dentistry. Our hidden mission statement is, 'We want you to believe you are anywhere but the dental office.'"

If you're already stressing about overhead, create a strategy to increase revenue and bring your percentage overhead back in line. An increased focus on patient comfort and five-star service will increase case acceptance. Keep it simple but patient-focused. If you don't believe your patients deserve anything special, your patients will sense it. If you believe that cheapest is best, your patients will sense that, too. You won't be able to provide your patients with anything you don't think you deserve yourself. A scarcity mentality will be self-perpetuating. Create a thoughtful strategy and action plan to incorporate a few stress-reducing amenities along with the continuing education and investment in staff. The combination will be magic.

The knock: "Spa dentistry can turn off families, and families are where the money is in dentistry. I have nothing against dentists who want to do it; they just need to know it's a thin market. I'll choose a different marketing approach."

The rub: "The market for those wanting to be relaxed at the dentist is thick, not thin," says Dr. Marvin Mansky (www.personaldentistry.com). "Those who want to avoid the usual negative trappings of a traditional dental atmosphere are in abundance and will provide an excellent new patient pool. I don't use the term 'spa dentistry' in promoting my practice, but who would shy away from 'a more relaxing atmosphere?'"

Dan King, COO of Dr. Debra Gray King's Atlanta Center for Cosmetic Dentistry (www.georgiasmiles .com) agrees.

"We've decided not to use the label 'spa dentistry' as the lead concept in marketing efforts. We haven't re-named our practice 'Dental Spa' because we want our message to make crystal clear that we offer much more, such as world-class porcelain enhancements," he says. "But if there's an area crying out for reform in all types of dentistry, it is making dental visits more pleasant and pampering, and the public's perception related to dental visits. I suppose there could be a small 'S-and-M' crowd out there who likes a hospital-like, uncomfortable, antiseptic, office — a caricature of the dental office they knew as kids — but it's hard to find normal human beings who do not want more pleasant dental visits.

"Another knock is that the spa concept is limited to the cosmetic boutique. And there are different types of successful niches in dentistry. But adding spa-like amenities has been shown to significantly reduce patients' anxiety levels and their reliance on pre-sedation, sedation, and other drugs in cosmetic practices like ours, in family practices, and even in public health settings (see the December 2002 JADA).

Dr. Mansky offers his opinion.

"I do not think of what we offer as spa dentistry; I'm from the old school. Our ancillary services are offered more from the point of appreciating a person who visits us even though dental visits are anxiety-provoking for them. I think a dentally-anxious person visiting a dentist is heroic, and I tell them so. For many, it is a big relief when they make the shift from feeling wimpy or embarrassed to feeling heroic. So we have a massage chair in the reception room and a beverage center with coffee, tea, and hot chocolate. During our in-office whitening we offer a DVD with video glasses.

"We have a Panasonic massage chair in our reception room, and many patients actually come early for their appointments just to use the chair. We also have massage pads on our dental chairs, and just recently we started offering foot massages to patients during dental treatment. I have to tell you that it really surprises me when a few patients request it each week. And it is of no additional cost to the office. The patient pays the reflexologist directly. To determine which ancillary services a patient prefers, each patient fills in what we call our WOW! List. After it is filled out, the information is put in our computer and then added to the route slip that is put with the patient chart. When an assistant sets the patient up, she has access to the patient's preferences and offers them."

Drs. Wendy and James McCreight have created two remarkable practices in rural Colorado (www.yampa valleydental.com).

"I think the best place for spa dentistry is in the family dental practice," Dr. Wendy McCreight says. "For example, if the child has an appointment, instead of mom just sitting in the living room, we offer her a paraffin dip (www.therabath.com) and jewelry cleaning. We have mom remove her jewelry and we offer to clean it in the ultrasonic — exactly how they clean it at the jewelers. We use the jar solution from Wal-Mart, have the client put the jewelry in the jar, tighten the lid, and set it in the ultrasonic. What does all of this cost? Next to nothing. The kids like spa dentistry even more. If the kids have to be at mom's appointment, we offer them juice, cookies, and a movie in a room right next door to mom. We set them up with a pillow, blanket, and a wide choice of mother-approved movies."

The knock: "Spa dentistry? No way! My patients would wonder what I'm hiding and why I'm trying to ply them with drinks, flowers, and spa treatments. I know they'll think I'm just finding ways to jack up my fees."

The rub: Dr. Smith says, "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. There is a good percentage of the population who shun any attempt at coddling. This group includes the ice fisherman, the martyr, the skeptic, or the executive who knows that time is money, and any extra time given to deliver comfort is wasteful."

Dan King adds, "The fact is, half the country doesn't go to the dentist on a regular basis. Many who do go still consider it a necessary evil — a torture chamber environment. This negative perception chills patient attendance and acceptance of treatment. And many times, the perception is based on reality."

The consensus from our research is that patients don't stay away because of perceived high fees but because of fears and discomfort. Dr. Rich DeForno (www.thorndaledental.com) says his spa-like treatments help patients relax about treatment and look forward to their visits.

"There's no denying that excellent dentistry is an investment, but it can be a pleasurable experience too," Dr. DeForno says. "Offering treatments such as paraffin wax treatments, massage pads, aromatherapy, and iPods de-stress our patients mentally and physically. Patients know they are receiving top-notch care, and they can feel that it's delivered in a caring environment. Our patients don't wonder what we're hiding; they're thrilled to know we understand their concerns and are doing all we can to make their visits as pleasant as possible. Our patients love the pampering. And at the end of the day, we've given them many reasons to smile — they are healthier, happier, and more confident."

The knock: "My patients don't fly first class unless they use their miles program because they know it's too expensive. They won't pay full fare for a first-class plane ticket and they won't pay for spa services at the dental office, either. And the costs for these services have to be built into the fees. Isn't dentistry expensive enough? Patients can go to the spa on their own time and with their own dime."

The rub: "Don't be such a stereotypical 'tightwad' dentist," Dr. Wendy McCreight says. "Spend some money on your practice. In other words, start thinking and acting like a businessman or businesswoman. Why? Because you are one. And one of the oldest sayings in business is 'You have to spend money to make money.' I would ask one simple question of any dentist skeptical of spa dentistry: Do you like to receive special treatment? Many dentists are scared of change, but change is the only constant in dentistry. If you are paralyzed by fear of change — fear of the unknown, too expensive, too time-consuming — be prepared to be left by those of us who embrace it."

Dr. James McCreight chimes in: "It is all about being different. The most different wins. Spa dentistry wins. Of course, you need quality dentistry, a caring team, and a skilled doctor in place before implementing a spa-like approach. But patients assume all dentists offer high quality. To stand out from the crowd, a practice has to be different."

The knock: "Whatever happened to connecting with our patients and building relationships? Now I enter the room with a walkie-talkie receiver in my ear and my patient is watching a DVD. Where's the personal contact? I see all these spa services as distractions and a roadblock to building trust and value."

The rub: "You make a good point that we need to get our patients involved in their own dental health and futures, but you can't do that if you can't get them in the front door in the first place," Dr. DeForno says. "We connect with our patients and talk with them at their new-patient visit, their continuing care visit and during consultations. Exceptional patient-centered dentistry is more than technical or clinical skills — it's about building relationships, too. We do all of that at the appropriate times in the appropriate places. Once the patient is in the treatment chair, comfort is his or her top priority. The iPods, massage pads, lumbar pillows, and blankets support our spoken message that patients will receive the best dentistry has to offer and that we will take great care of them. If I'm the patient, I certainly prefer pampering and great music to the sound of my nerves knocking and the drone of the drill."

Dr. Mansky says, "Everything we do is based on genuine concern, open communication, and my desire to provide a service that the patients tell me they want. The real value to both me and my patients is the deeper level of connection that develops in our relationship. If a patient feels connected to me, he or she feels safe and protected and is more open to recommended treatment. If I feel connected to my patient, I want to do the best I can. And for most people, feeling connected with another person just feels good."

Dr. Smith offers his patients milkshakes, which he says have become a popular request.

"Every patient who receives anesthesia is offered one, and they have a choice of chocolate, vanilla, or strawberry," he says. "These are stocked weekly in our freezer and are microwaved 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. Then it's brought to the operatory."

Milkshakes offer many benefits to patients.

"Its coolness alleviates discomfort from the stretching exercises we have just put the oral cavity through," Dr. Smith says. "The taste neutralizes any unpleasant-tasting materials with which we have insulted the patient's taste buds. Patients love to get something free, especially something they weren't expecting. If they are returning to work, the shake is often the topic of conversation rather than treatment cost. We know this because many times we hear new patients asking if they will be getting one. So much for the surprise."

The knock: "Who has the time and staff to create the spa experience? My staff is already stressed out trying to stay on schedule, setting up and breaking down treatment rooms, and explaining HIPAA to patients."

The rub: "Our days can be busy, but my entire staff helps administer our spa amenities," Dr. DeForno says. "The pillows, blankets, and iPods are right there in the treatment room and take only a minute to arrange. The dental assistants are not expected to perform the dentistry and the spa amenities. Paraffin wax treatments can be performed by another staff member after the initial preparation of the teeth, and we finish the wax treatment at the end of the dental procedure. A great warm towel can be ready in seconds with the ComfortSpa (www.sharperpractice.com). Come on, everyone has a couple of seconds, and the patients really appreciate the extra effort and will let you know it; instant gratification for everyone."

The knock: "Enough already! Let's get back to basics and plain, simple, fine dental care. My daddy always taught me to keep it simple. Spa dentistry makes it complex."

The rub: This isn't your daddy's dental office. We'll bet even your daddy wouldn't want to deliver dentistry in the same way he did 20 or 30 years ago. Today's dental offices are different. The world is a different place than it was 10, 20, or 30 years ago. We're used to cell phones, microwaves, voicemail, super boxes at our sporting events, and rewards programs with our credit cards, airlines, favorite stores, and even our supermarkets. Dentists should congratulate themselves for creating a welcoming, caring atmosphere in their dental practices and for embracing technology that allows them to offer a great service to patients.

American consumers expect more and will choose more over less nearly every time. Since this is America, you get to choose the rewards you wish to offer your patients. You don't have to offer every spa amenity, but you'd better do something to welcome and reward your patients and make them feel special.

The knock: "My goal is to get the patient in and out. As a patient, my goal would be to get in and out of the office. What's more, I would be uncomfortable receiving this excessive attention."

The rub: People have different personalities and behavioral tendencies. It's good to recognize that special amenities will not be right for everyone. But treating patients nicely is not time-consuming. Cosmetic guru Dr. Lorin Berland, dentist to Troy Aikman and lots of ordinary folks in Dallas, was among the first to use the term "dental spa." He registered the Web domain www.DallasDentalSpa.com in 1998.

Although Berland's practice is service-oriented, he does not offer many truly spa-like amenities, save one. He has a massage therapist on staff, hired originally when he needed a "floater."

Dr. Berland says the massage therapist is helpful when the practice runs behind. The next patient is grateful to receive a massage. It also helps break up long, productive appointments. The team loves it, too. Having a massage therapist on staff got Dallas Dental Spa on the local television news.

"Patients rarely complimented my injections before," Dr. Berland says. "Now, they think I'm the greatest. Really, any assistant can learn simple massage relaxation techniques for the dental office."

Shortcut to riches or fast track to bankruptcy?

You may take the spa concept as far as you like. You can capture the spa spirit even if hot seaweed wraps are not your thing. If you make every patient feel like the most important person in the world, you cannot go wrong.

Customer service is about exceeding expectations, not just meeting them. Every dentist says he provides great service, but few do. Call one and see how you get treated. See how soon you can be seen. The answers may surprise you. If you were to call a dentist and ask how much he or she charges for a cleaning, which would be more appealing? "A cleaning is $45. We can see you in six weeks," or, "A cleaning is $75. We can see you today if you like." How much more profitable is the second example?

If your dental office makes you feel as though you are the most important person in the world, will you leave because the fees are a bit higher than the dentist's down the street? Fees make a statement. A high fee makes a positive, enticing statement. A low fee makes a negative, diminutive statement.

Providing exceptional service goes far beyond spa amenities and availability. To provide exceptional care and service to patients, reevaluate your patients' experiences from the moment they enter your office until they leave. Paraffin wax treatments, massage pads, and milkshakes might not appeal to you, but have you considered what appeals to your patients?

Take a walk through your practice from a patient's perspective. Enter through the front door and take note of all the sights, sounds, smells, and feelings. Our consulting clients are amazed by their own practice image evaluations.

What a great idea for a staff meeting! Create a report card for yourselves and discover your own road map to creating the ultimate patient experience. Success is a journey and the power is in the process. Enjoy the ride.