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Embracing Comfort and Puttin' On the Ritz

March 1, 2004
Comfort and spa dentistry are synonymous. Both concepts are an important part of modern dentistry.

by Lynne Hollister Slim, RDH, BSDH, MSDH

Above, a dental hygiene operatory at the Center for Cosmetic Dentistry in Atlanta.
Click here to enlarge image

The advent of "spa-like" dental practices is in stark contrast with the sterile clinical environments of yesteryear. Clinicians worked beside stiff, metal-framed dental chairs and belt-driven handpieces. The operatories had lighting that flickered at inconvenient times, highlighting plain white institutional or brown-paneled walls. Remember the "cuspidor calisthenics" that patients performed throughout the appointment, raising themselves to an upright position every time they wanted to spit?

The "spa-like" trend is a successful internal marketing tool in high-end dental practices such as a couple I recently visited in Atlanta. Much has already been written in dental journals about the Center for Cosmetic Dentistry, but nothing has been written about the center by a hygienist for dental hygienists!

'Scarlett O'Hara would feel right at home'

A visit to the Center for Cosmetic Dentistry was truly a multi-sensory delight. From the moment I walked up the front steps and was greeted with outdoor music, and then entered an elaborate living room/reception area in a building that could only be described as a stately white-columned 19th century mansion, my senses were overwhelmed. Scarlett O'Hara would feel right at home here.

I entered the building through huge double doors and felt a bit like Alice in Wonderland who could not resist walking into the world of the unknown. As I snooped around from room to room, my observations began with the living room. Besides the armoire filled with assorted beverages and snacks and the plasma video screen atop the fireplace mantle, I noticed a curious tall metal cylinder in the corner of the room. It was a water cooler "infused with oxygen and fluoride" for clients who wished to quench their thirst, kill anaerobic bacteria, and strengthen their teeth — all at the same time!

The new client experience for adults is a series of stages along the way to the examination operatory. It begins with a stop in a treatment consultant's office. The new client is photographed, interviewed for treatment needs, and then ushered into an initial examination room.

While I was there, a new client was showing a treatment consultant a photo album of her pet capuchin monkey, dressed in various outfits. The monkey was cute as a button.

When the client reaches the initial examination room, every resource for making a client feel comfortable is available. From the water fountain décor on the wall to the dental chair with internal speakers that deliver a sound wave massage through the chair, the adult client is incredibly pampered. A massage therapist visits the new client sometime during the exam and provides a complimentary massage in a location specified by the client. For clients who are scheduled for extensive restorative treatment, a therapist will re-apply make-up for the business client who needs to return to the office looking "refreshed."

Fortunately, I was able to spend time with one of the center's three hygienists, Debbie Chapman, RDH. I asked Debbie what her role was in the new client exam. She told me that she performs the periodontal exam on new adult clients and a "tissue conditioning" (or cleaning above the gumline) for clients with periodontal diseases who need additional appointments for scaling and root planing.

Debbie has worked for the center for approximately eight years and loves her work there. "Puttin' on the Ritz" is a part of the center's vision, and Debbie commented, "Patients feel that they're riding first class. We don't ride in coach." Debbie and the other hygienists dress very smartly with three-quarter length white lab coats, and monogrammed names and the center's logo on the opposite breast pocket. In a simple, inexpensive gesture, Debbie offers her clients a tiny pre-packaged wipe designed to clean their eyeglasses.

Tranquility in the woods

A short distance away from the Center for Cosmetic Dentistry was another upscale dental practice called Aesthetic Dentistry by Design. This particular practice is located near a prestigious shopping mall in the Atlanta area and is situated on the first floor of a two-story office building, tucked away in a pleasant wooded environment. Dr. Don Harvey is another practitioner who believes in providing a tranquil, comfortable environment.

His living room/reception area is contemporary in tone, designed to appeal to the busy adult client who is seeking a new smile in a relaxed environment. The living room features a mini-wine refrigerator with complimentary customized water bottles for busy professionals.

Dr. Harvey's hygienist works as a periodontal therapist and makes treatment decisions founded on evidence-based dentistry. The hygiene dental chair features a motor back massager and clients are offered a choice of several flavored lip balms.

Dr. Harvey's philosophy for his practice includes the importance of image, which is evident in the décor, his appealing practice logo, and the "dress for success" look that he and his staff adhere to.

In speaking to Dr. Harvey's periodontal therapist, she mentioned that softening the practice's immediate surroundings serves as an antidote to a fast-paced existence. She also said that many of her adult clients feel relaxed and refreshed after their appointment and appreciate the tranquil setting.

Roman style relaxation

Is this new trend in dentistry designed solely as an internal marketing tool to attract the new "rich" whose lifestyle in the suburbs is the envy of all, or is it also a way to comfort those poor souls who are overworked and struggling to survive the All-American suburban rat race?

My guess is that both notions are at work here. That's not such a bad thing, especially the idea of comforting individuals who feel alienated and vulnerable in our stressful world. Hygienists who work in any type of setting with various types of clients can embrace many of these marketing ideas that seek to "comfort" clients and the act of providing comfort can be relatively simple and inexpensive.

When I think about all of the items that we can now purchase to promote relaxation, I can't help but recall my visits to the historic Roman baths in England. Roman citizens could mingle and move at their leisure through a succession of rooms and pools, all with different temperatures and décor.

Their daily ritual included hot and cold plunge baths, and body oil rubs and massages followed by the scraping off of oil and grime with a special tool. Bizarre, you're thinking? Perhaps not. In dentistry, we now offer hand waxing, jewelry cleaning, massage therapy, aromatherapy, bath salts to remove dry or flaky skin, soothing eye pads, headphones, scented neck pillows, and flat screen televisions mounted on the dental unit.

Romans worshipped their bodies with an obsession for cleanliness and fitness just as Americans do. As a matter of fact, all civilizations have bathing rituals as a form of relaxation and socialization. I once read that, in Thailand, the Thai massage is considered part of a normal health regime.

Will dentistry someday adopt massage therapy at every level and in every practice setting? How nice it would be for dental hygienists to offer geriatric patients in nursing homes massage therapy to increase circulation, decrease muscular stiffness, and inflammation to enable them to extend the vitality of their lives.

A holistic approach to dental care

Are we perhaps moving closer to a holistic approach to oral health care? The concept of "holism" was introduced in 1926 as a way of viewing living things as greater than or different from the sum of their parts.

The nursing profession has really caught hold of and developed an impressive system of holistic nursing through applied research. Holistic nursing focuses on the optimal attainment of physical, mental, emotional, social, and spiritual aspects of health.

Where does "comfort" enter the picture? I have had the unexpected pleasure of emailing and getting to know Katharine Kolcaba, PhD, RN, founder of the Comfort Theory, a well-defined and validated concept that has tremendous implications and applications in health care, including oral health care. Dr. Kolcaba writes about comfort in holistic terms and believes that clients who are comforted will engage more fully in health-seeking behaviors.

She would be pleased to hear more about dental practices that seek to provide comfort through external surroundings like the two aforementioned practices.

Comfort your clients

We have read about individuals throughout history who were extraordinarily compassionate. Compassion is well documented by Dr. Kolcaba as an important aspect of delivering comfort care. One individual who immediately comes to mind who inherently possessed the gift of a compassionate nature is the late Diana, Princess of Wales. Princess Diana made all the people she met, young and old, feel uniquely special. She could relate to people's problems because she, too, had experienced the dark side of human nature, which can greatly damage an individual's self-esteem. I believe that reminders of her own loneliness and vulnerabilities helped her a great deal to relate to other people's feelings of isolation and unworthiness.

Princess Diana's ability to touch is a human behavior that dental hygienists, too, need to learn and use regularly. When Diana met hospital patients and reached out to touch them, they were given a tremendous uplift, almost like the laying on of hands. If you demonstrate to your clients that you really care about them and that you are giving them your undivided attention, you will be able to communicate much more effectively and you will become a special person in the eyes of your patients.

In reading some of Dr. Kolcaba's articles on comfort care, I have realized that a hygienist's voice and choice of words has a tremendous impact on a client's comfort. Patients obviously respond positively to a calm, gentle voice and words that are carefully chosen and reassuring. For example, it is better to ask "How is your comfort?" instead of asking clients to rate their pain from one to 10, with 10 being as bad as it gets!

Hygienists need adequate time and support to offer appropriate comfort care. An assembly line, 40-minute prophy schedule does not offer any time to provide comfort interventions, and a hygienist who works this kind of schedule is definitely not working in a desirable work environment! A hygienist working this kind of schedule is lucky to get a water or bathroom break. Hygiene burn-out is sure to follow. A holistic, nurturing work environment for hygienists leads to greater employee retention, morale, recruitment, and reduced absenteeism.

Comfort and spa dentistry go together and are not to be underrated and overlooked in modern dentistry. Think about the immediate surroundings where you work and explore comfort care on several levels. Your clients will be glad you did!

In conclusion, I want to refer to an article that appeared in the American Journal of Nursing. The article noted that, on September 11, 2001, a certain nurse was ready to mobilize emergency supplies along with medical and nursing personnel to any major disaster site in the United States. When the second airplane hit the south tower of the World Trade Center in New York City, the loaded Navy ship in which she worked was deployed immediately. The name of the ship was Comfort.

Lynne Hollister Slim, RDH, BSDH, MSDH is president of Perio-Centered Dentistry, Inc, a practice management consulting firm specializing in non-surgical periodontal therapy. Lynne has more than 15 years of experience as a conventional dental hygienist, a periodontal therapist, and teaching in dental hygiene schools. Lynne can be contacted at perioc [email protected] or at