Is your dental office designed to be an anxiety killer?

Dentists do recognize the importance of tackling anxiety, and there is indeed a plethora of practical strategies to help manage anxiety in the operatory, such as the use of topical anesthetics before an injection. However, from the anxious patient’s perspective, these interventions happen late in the treatment journey. Here, we discuss how conscious and considerate office design can help to soothe your patient’s anxiety from the moment they walk through the door.

Supportive design in the dental practice

“Supportive design” is a term coined by renowned behavioral scientist and healthcare architecture researcher, Roger Ulrich, PhD.(3) Ulrich describes the supportive design as the practice of:

• Eliminating environmental sources of anxiety and stress in the context of healthcare; and
• Incorporating characteristics that support the patient’s ability to cope with stress.

These supportive characteristics are designed to foster the perception of control, social support, and positive distraction, with the latter two shown to be particularly effective in reducing anxiety. (4)

While much of his research (and the subsequent research it inspired) focuses on the hospital environment, Ulrich’s findings have generated a host of evidence-based design recommendations that can be applied across various healthcare settings, including the dental practice. Here, we discuss how…

1. Removing environmental sources of anxiety  

For anxious patients, the apprehension of a dental appointment begins the moment they realize they need it. By the time they book an appointment and turn up at your office, they could have already spent weeks or even months nursing a growing sense of dread. When they arrive, they may be especially sensitive to stressful elements in the dental office environment, but you can help to ease their nerves by removing the main offenders.

Odors

The dental office has a distinctive “clinical” smell that some patients may associate with negative experiences and emotions. You can minimize unpleasant scents by using odorless cleaning products where possible, storing heavily scented products away from patient areas, and keeping the office adequately ventilated.

Some practices also use essential oil diffusers, which can mask potentially triggering smells and have a calming effect on the patient. Lavender is a popular oil with a wealth of evidence supporting its anti-anxiety effects. (5) Roman chamomile, ylang ylang, angelica, and sweet orange are also supported, (6) while another study found bergamot to reduce anxiety in women in a waiting room at a mental health facility. (7)

Noise

Noise in a clinical setting can cause psychological and physiological stress, with patients exhibiting anxiety, irritation, increased heart rate, and elevated blood pressure. (8)

In the dental office, the most obvious offender is the dental drill, but there are plenty of other noises that may be jarring to an anxious patient. Try to minimize the following to create a peaceful environment:

• Put phones on low volume or vibrate mode.
• Soundproof the operatory to minimize equipment and patient noise.
• Use low-noise equipment where possible.
• Add shock absorbers to doors to prevent slamming.
• Use quiet-close drawers and cabinets.
• Provide “quiet rooms” if you have the space.

Lighting

Ulrich cites considerable evidence of the negative effects a dark, windowless environment can have on patient wellbeing. (3) On the other end of the scale, harsh fluorescent lighting can also be unpleasant.

The ideal solution, where possible, is to flood your waiting room with natural light. Sunlight exposure increases levels of serotonin, a neurotransmitter involved in mood and pain regulation. In a study on spinal surgery patients, those exposed to more sunlight reported less pain and stress and required 22% less analgesic medication. (8)

Capitalize on this effect by positioning your seating areas next to windows and removing any obstacles to light. If your office is lacking in natural light sources, use soft wall-mounted lighting, rather than a harsh overhead light, to create a more calming ambiance.

Comfort

Anxiety can cause physiological changes that include raised body temperature and dry mouth, so make sure to provide a water source and keep your office temperature on the cool-but-comfortable side. Depending on your local climate, you might also want to install fans, heaters, dehumidifiers, or air purifiers for greater control over temperature and air quality.

On the topic of comfort, it’s also important to have comfortable seating. Hard plastic chairs are not pleasant for anyone, but patients who are already experiencing pain, discomfort, or anxiety are likely to be even more irritated by uncomfortable seating.

Space

Some of your patients will use wheelchairs or walking frames and may feel anxious navigating cramped spaces. This can also apply to patients who arrive with children in pushchairs. Make sure that your layout can accommodate them by creating spacious walkways and leaving ample space in the seating areas.

Clutter

Clutter gives the impression of disorganization and can increase anxiety. Implement a no-clutter policy if you don’t already have one, and provide your team with sufficient waste and storage facilities to maintain a tidy environment.

2. Creating positive distractions

In busy dental practice, patients often end up waiting longer than anticipated. Nobody enjoys this, but for an anxious patient, it means even more time to worry. Positive distractions have been shown to engage attention and direct it away from stress, pain, discomfort, boredom, or agitation. (4)

Common sources of positive distraction in the waiting room include TVs, music, reading materials, and, for our younger patients, toys, and games. Practices are now increasingly adding phone charging ports and making wifi available to their patients, allowing them to entertain themselves on their terms.

When choosing TV or music, many practice owners will opt for a news channel or local radio. However, we would advise against this; news channels, while engaging, often feature emotionally charged and polarising content. And when it comes to music, one person’s favorite song can be another person’s idea of torture!

Research indicates that when it comes to anxiety and stress relief, there is a much more effective type of content: nature. It has long been known that exposure to nature positively affects physical and emotional health. (8) This concept forms the basis of a respected design field called biophilia, which incorporates natural elements to promote a sense of well-being.

You can harness the power of nature simply by showing images or videos of natural landscapes on your TV display, or by displaying artwork depicting natural scenes. Research shows that this can provide measurable stress-reducing effects similar to those of actually being out in nature. (4) Ulrich notes that looking at nature scenes has been shown to improve mood, lower blood pressure, and reduce heart rate in as little as five minutes. (3) Simulated nature scenes have also been shown to help reduce the perception of pain and promote better post-surgical outcomes. (8)

When it comes to sound, nature prevails again! It is already known that listening to music has a positive effect on stress and anxiety levels, but researchers conducting a large-scale review on the subject were surprised by one particular finding: listening to the sound of rippling water was significantly more effective at reducing cortisol levels than listening to music. (9)

It appears the only thing better than natural visuals or sounds is a combination of the two. Various studies show that when people view nature imagery accompanied by sound, the immersive effect — and therefore the ability to alleviate anxiety and discomfort — is even greater. (8)

Other ways to incorporate biophilia into your office design include plants, fresh flowers, water features, and natural materials like stone and wood. The use of color can conjure up nature, too; stark white walls create a “clinical” feel, while soft sky blues and sea-foam greens create a more peaceful atmosphere.

3. Facilitating social connection

Social support can be soothing and reassuring during times of anxiety, but the waiting room of a dental office can be a very impersonal place. Ulrich notes that the practice of arranging patient seating side-by-side in rows can inhibit social engagement. (3) On the other hand, arranging to seat in small, flexible clusters can facilitate interaction, or at least lessen the sense of isolation a patient might feel.

It can also be beneficial for patients to feel connected to the people looking after them. Consider posting smiling staff photos and humanizing biographies on the wall, offering your patients a glimpse at the real person behind the scrubs. Other ideas include photos, letters or cards from happy patients (with their consent of course), or photos from outreach events demonstrating your positive relationships with the local community.

4. Improving the perception of control

A 2019 editorial in the British Journal of Medical Practitioners highlighted how the loss of control patients experience in a healthcare setting can contribute to anxiety. (10) From the moment they seek treatment to the moment they sit in your chair, the patient experiences various threats to their autonomy. This might include being forced to take time off work, struggling to schedule an appointment they’d rather not have, or being kept waiting while your previous appointment runs over schedule. The patient can be left on edge, feeling like they have no choice but to surrender to these various challenges if they want to receive treatment.

So how can your office interior design help? Well, it won’t solve the problem of busy schedules and long waits, but it can minimize the burden on your patient and give them back some sense of control over their experience.

Potential solutions include clear orientation and signposting. It’s easy to get disoriented in larger offices and buildings, especially if the patient is distracted by pain or anxiety. Ulrich recommends using clear signage so that your patients can easily find you. (3) Within your office, make sure that amenities like bathrooms, water coolers, seating areas, charging ports, and reading materials are clearly signposted in accessible formats, e.g. large print, commonly spoken local languages.

Another important consideration is the patient’s level of control over their sensory surroundings, particularly in patients vulnerable to sensory overload, e.g. those with autistic spectrum conditions or anxiety disorders. Is there a quiet space where the patient can retreat from the noise, and is it clearly signposted? Can they control the volume of the music or TV, or are they aware that they can ask your staff?

It does take some effort and investment to turn your office into an anxiety killer, but Ulrich notes that this is often easier and less expensive than practitioners anticipate. (3) In the long run, he — along with the many researchers who have built on his theory of supportive design — is in complete agreement that there are great benefits to be gained for both the patient and the practice.