Written by Lloyd Jerome, BDS
Last updated on October 31, 2022
In this article, trend-setting dentist Lloyd Jerome describes how he uses the environment to make people feel at ease. If you’re looking for creative ideas for making your dental practice a more relaxing and fun place, read on…
The Art and Science of Distraction
In 1994, I created a dental practice that was intended to appeal to all, including, and especially, those people who have a deep-seated fear of dental treatment.
Having combined my dentistry with hypnotherapy for dental anxiety for several years, I understood the factors behind the triggering of anxiety-laden events, and I tried hard to re-design the whole dental environment from first principles in order to minimise these so-called “anchors”.
So now, I have ten years of feedback, adjustments and monitoring from which I can draw conclusions.
This is what I have discovered: the five basic senses all have roles to play in the refreshment of a person’s memory, as well as informing them of the current surroundings. The unconscious mind interprets the information, and “advises” the emotions accordingly. This is never so true as in the sense of smell.
Smell
A smell that we find pleasant, especially one that our memory associates with a positive experience, will uplift our emotions, often without any conscious input (we won’t necessarily know why we feel like we do). The same connection exists with negative emotions/smells/reactions, and anyone who has a fear of dental treatment will react in a negative way to the smell of oil of cloves (or eugenol as we dentists like to euphemise).
So what can we do? In my case, I installed aromatherapy heaters in all corners of the practice and sourced materials that didn’t contain any strong-smelling chemicals. This in itself makes more difference than any other technique that we use, subtle though it is! Now when people step through the door, their very first reaction is that they cannot possibly be at the dentist’s!
Visual Stimuli
Visual stimuli have, needless to say, an important role in informing our conscious mind of our surroundings. So I didn’t want the practice to look anything like a dentist’s. Obviously, this is not always possible, bearing in mind that dental treatment is, in a sense, engineering on a microscopic level, and the equipment that we use has evolved slowly over nearly 200 years of refinement. Instead, I chose to create a strongly visual environment in the waiting area (otherwise known as an art gallery!) and extend this to all corners of the practice. The colours we use are calming, the lighting muted, projectors throw abstract and constantly-changing images on the walls, and none of us wear traditional (and, to my mind, unnecessary) dental uniforms. Instead, we chose our clothes for comfort and practicality, and our own taste.
The most memorable item in our visual distraction (and audio, too) is the virtual-reality headsets that we have incorporated into the dental realm. These are really just miniature televisions with a series of lenses to make the picture look big. They are very useful as a way of allowing our clients to escape to another world whilst we can work around them without interrupting the video. Some people love them, and some find them “one distraction too far”, but they certainly can help, especially to ensure that an impatient child stays happy and relaxed. Everyone is given an opportunity to try them for themselves, and decide if they suit them.
Sound
Sound, too, is an important anchoring stimulus, and anyone who suffers dental anxiety will show all the signs of “fight or flight” if they hear the infamous air turbine whine (a.k.a. the drill). Once again, other than doing without what is an essential piece of kit in painless dentistry, distraction is the key. In this case, well-fitting headphones, and a pleasant soundtrack can go a long way to help, and if the VR headset is not wanted, a distracting monologue (you’ll note that I don’t ask questions whilst I am working!) can work wonders.
Outside of the treatment room, in the Gallery, the soundproofing of the walls ensures that the waiting for an appointment is not an exercise in apprehension.
We try to choose ambient music to play in the practice that delights many without offending any. We sometimes succeed, and are helped greatly in this regard by one of our clients who owns a music shop, and pays for his treatment in well-selected CDs!
Taste
Taste and smell are closely linked, and we can even distract with flavour! We offer a wide range of drinks from the refreshing (water, fresh juice) via the stimulating (tea and coffee) through to the soporific (beer, wine and spirits). All of these, in their own way, help the more anxious client focus on something beyond their fears. In addition, sitting and having a drink with the dentist before an appointment has a bonding influence on both people, allowing for greater communication and trust, allaying some of the fears.
Within the realm of dentistry itself, we insist on using materials that, at worst, taste neutral, and we rely on pleasantly-flavoured mouthwashes, topical anaesthetics, and mould-taking materials.
Touch
Touch is the last of the senses, and it is within this category that most of dentistry falls. The watchword here is gentle. We insist that all members of the dental team are able to empathise with the anxious client, and by imagining their state of mind we can come closer to providing them with their ideal dental experience.
In addition, the materials and features of the practice and gallery are as tactile and pleasant as possible, and whilst no compromise on cleanliness is made, we try to ensure that the surroundings are as non-clinical as possible.
By using a combination of these techniques, we rapidly achieve a relationship with our clients that allows, gradually, for their feelings of anxiety to become a thing of the past, not their future.
What has surprised me is how well this combination works! I fully anticipated that I would be using hypnotherapy on a daily basis to alleviate my clients’ tension, but in fact, by reducing the “mental anchors” as we have, the need for additional therapy has been limited to the clinical skills that I make use of at the chairside, and have more to do with gentle reassurance and less formal hypnosis.
I opened the practice with the intention (I quote from my first practice brochure) of “providing high-quality dentistry in an atmosphere of relaxation, education, and enjoyment”. Ten years later, and this still holds true – but is now backed by the testimonials of many relaxed, distracted customers!
I opened the practice with the intention (I quote from my first practice brochure) of “providing high-quality dentistry in an atmosphere of relaxation, education, and enjoyment”. Ten years later, and this still holds true – but is now backed by the testimonials of many relaxed, distracted customers!
© Lloyd Jerome BDS 2004
Lloyd Jerome invented an award-winning practice and art gallery in Glasgow because he believes that it’s no longer necessary to be afraid of dentistry, and wonders why he still is… He loves ambient music, visual art, and all kinds of gadgets, and hates having to read instructions for any of them. Since he wrote this article, Lloyd has moved to New Zealand, where he works in Kerikeri.
More ideas for creating a friendly environment:
Lighting:
- maximise natural light where possible
- if there is not enough natural light, use soft wall-mounted lighting instead of harsh overhead light
Noise:
Create a peaceful atmosphere by minimising environmental noise by
- soundproofing treatment rooms
- adding shock absorbers to doors
- using soft-close drawers and cabinets
- using low-noise equipment where possible
Comfort:
- Anxiety can cause dry mouth, so make sure you provide a water cooler or bottled water and glasses in the waiting room.
- Provide soft and comfortable seating to set the scene.
Nature distractions:
Incorporate nature into your practice design. Nature has been shown to have a positive effect on our well-being and our emotions. 1
- Use natural and tactile materials such as plants, fresh flowers, rattan, bamboo, seagrass, stone, or wood.
- Consider a water feature – the sound of rippling water is even more calming than music and significantly lowers cortisol levels 2.
- Combine natural materials and images with natural sounds such as water for an additive effect.
- Choose nature photography or paintings for your artwork.
Social connectedness:
- Post friendly staff photos on the wall, with short bios giving a glimpse into their interests and lives. This instantly humanises you and the other staff members.
- Put up cards from happy patients (with their consent of course!)
- Arrange seating in such a way that it doesn’t create a sense of isolation. Avoid seating in rows!
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Sources of Information
- Ulrich RS, Zimring C, Zhu X, DuBose J, Seo HB, Choi YS, Quan X, Joseph A. A review of the research literature on evidence-based healthcare design. HERD. 2008 Spring;1(3):61-125. doi: 10.1177/193758670800100306. PMID: 21161908.[↩]
- Thoma MV, La Marca R, Brönnimann R, Finkel L, Ehlert U, Nater UM. The effect of music on the human stress response. PLoS One. 2013 Aug 5;8(8):e70156. doi: 10.1371/journal.pone.0070156. PMID: 23940541; PMCID: PMC3734071.[↩]