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I went to a ‘dental bar’ that offers TVs, blankets, and massage exam chairs, and it showed me that medical providers are really starting to get competitive to win patients

I went to a ‘dental bar’ that offers TVs, blankets, and massage exam chairs, and it showed me that medical providers are really starting to get competitive to win patients

The exterior of DNTL's office at 26th Street and 6th Avenue in NYC's Chelsea neighborhood.

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The exterior of DNTL’s office at 26th Street and 6th Avenue in NYC’s Chelsea neighborhood.
source
Lydia Ramsey/Business Insider

The exterior of DNTL's office at 26th Street and 6th Avenue in NYC's Chelsea neighborhood.

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The exterior of DNTL’s office at 26th Street and 6th Avenue in NYC’s Chelsea neighborhood.
source
Lydia Ramsey/Business Insider
  • I went to DNTL, a “walk-in dental bar,” to get a semi-annual teeth cleaning.
  • Booking an appointment was easy – there was even availability on the same day I was booking – and I’d never had so many amenities at the dentist, from a massage exam chair, to a blanket, to a TV screen playing “The Office” during my cleaning.
  • My visit was covered under my insurance plan.
  • It reminded me that there is a future in which getting care doesn’t have to be high-tech or high-cost to still be comfortable and as easy to use as any other service.
  • The visit was part of an experiment to get all my healthcare taken care of via companies aiming to make the experience more convenient.
  • Visit Business Insider’s homepage for more stories.

I set out to get all of my healthcare taken care of through companies that promised to make getting to the doctor easier and more affordable.

During my reporting, I hadn’t seen many startups trying to disrupt the dentist visit. Eventually I heard about DNTL, which calls itself a “walk-in dental bar.” To me, it sounded like a blow bar or nail bar – as if cleaning your teeth was as simple as getting your hair styled or a manicure.

The practice opened in January, founded by dentist Dr. Ben El Chami. It’s funded by CityMD cofounder Nedal Shami, who is El Chami’s cousin. El Chami’s goal after 14 years in dentistry was to create a place that people wanted to go, not felt like they had to go. For people who walk in out of curiosity and want to get a cleaning right away, DNTL keeps an open chair available.

“We’re making it so it’s super convenient for the patient and really easy to get in and do their preventive care,” El Chami said.

Ingrid Lindberg, the former chief customer experience officer at health insurer Cigna, said she’s been observing the shift toward focusing on consumers (here, patients going to the dentist) since the early 2000s. As patients have started to get exposed to more of their healthcare costs, their expectations for care have risen alongside it.

“It’s not just that we have high expectations, it’s that we share them,” said Lindberg, who now runs the customer-experience consulting firm Chief Customer.

Patients won’t stick around if they don’t like their experience, or if they can get something taken care of more conveniently through a different visit.

“We’re not nearly as brand loyal and not nearly as people loyal,” Lindberg said.

I’m a good example of that: So far, I’ve been to now three dental offices in NYC, very infrequently with the same dentist. I’ve switched mainly based on wanting to go to an office closer to my work – and now to carry out this experiment.

DNTL's reception area.

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DNTL’s reception area.
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Courtesy DNTL

Hotel lobby vibes, massage chairs, and a speedy visit

I booked my DNTL appointment online, which was easy – I saw I could even go in later that day. Instead, I decided to go the next week.

It was the first time I was able to book a dentist appointment and have the option not to do X-rays. I had done a set with my go-to dentist just a few months before, so I figured it wouldn’t be worth it right now.

The exterior of the building matched that feeling of going to a blowout bar. I anticipated going upstairs, something I’d gotten used to in New York. Instead I turned the corner and was surprised to see the storefront. It was replete with magazines I didn’t get a chance to browse. I only sat in the empty waiting room for as long as it took to fill out an iPad with paperwork. I even had the option of filling it out ahead of time, but I didn’t because I didn’t have time.

The goal of DNTL’s design is to make it feel as little like a dentist’s office as possible. Ideally, that’d make for a more inviting and comfortable experience, El Chami said.

“Thinking about going to the dentist instills discomfort and fear in a lot of people,” he said.

Inside the exam room, there was a screen playing episodes of “The Office.” A blanket sat on the chair so that I could drape it over my legs, and the chair itself had a massage feature.

Unlike some visits where I had to wait to be seen, I was never on my own. After checking in on the health of my teeth, the cleaning began. That felt pretty standard, but there were some fun twists I’d never come across before, like tea tree oil for my gums and hot towels after I was done.

A little less than an hour later, my visit was over and I was sent on my way after confirmation that my visit was covered through my insurance.

For those who are paying in cash, the prices are listed on DNTL’s website. The menu even includes services that you might not often associate with a dentist’s office. For instance, a “date night” service that offers “polish, floss, and go.”

On my way out, I was handed a goodie bag with a wooden toothbrush and perplexing charcoal floss.

The bag DNTL sent me out with and a pamphlet on their services.

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The bag DNTL sent me out with and a pamphlet on their services.
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Lydia Ramsey/Business Insider

The DNTL visit was the least tech-enabled part of my whole experience getting healthcare taken care of through new models. But it was a fun experience, and I was pleasantly surprised that I didn’t have to pay anything extra for the services like I had with other medical practices.

It reminded me that there is a future in which getting care doesn’t have to be high-tech or high-cost to still be comfortable and as easy to use as any other service.

“It’s fascinating to see the war for consumers come down to the practitioner level,” Lindberg said.

Hit 80 with 20 or more teeth, and you’re good to eat

Hit 80 with 20 or more teeth, and you’re good to eat

Despite the fact that we clean them at least once or twice a day and use them more often than that, do we really think about our teeth?

The truth is, we tend to ignore our pearly whites unless they cause us trouble, like coming loose or hurting.

This is clearly proven in the results of the latest National Oral Health Survey for Adults (Nohsa) 2010, where the most common reason for visiting the dentist over the previous two years was “something wrong” (56.6%), with the second most common reason, “time for cleaning/examination”, trailing far behind at 15.9%.

Similarly, the most common reason for not visiting the dentist over the previous two years was “no problem” (67.7%), followed by “too busy” (9.3%) and “no teeth” (6.9%).

It is hardly surprising then, that despite the general recommendation that we all visit the dentist once a year to check our teeth, only 27.4% of Malaysian adults had done so, according to Nohsa 2010.

The survey also found that just over one-third (34.5%) of Malaysians aged 60 and above had no teeth left at all, with just over one-fifth (21.7%) having 20 or more teeth left.

Going by the results of the survey, we Malaysians can expect to have an average of 9.8 teeth left by the time we hit 60.

This poses a problem as the number of teeth you have is tied to the general state of your health.

Poor teeth, poor health

Teeth, elderly, dental care, oral health, 8020 campaign, Dr Kakuhiro Fukai, Star2.com

Dr Fukai, who is also the director of the 8020 Promotion Foundation, shares that oral health is a specific part of programmes to prevent dementia, diabetes and cardiovascular disease. — Photos: FAIHAN GHANI/The Star

Japan is well-known as an ageing nation, with 27.7% of their population currently aged 65 and above, and an average life expectancy of 83 years.

According to Fukai Institute of Health Science director Dr Kakuhiro Fukai, “The goal of the Japanese government and health professionals is to not only expand life expectancy, but also to expand healthy life expectancy.”

Health life expectancy includes life expectancy, activities of daily living, social participation, healthy ageing and quality of life.

“The main cause of decreased healthy life expectancy is disease,” he says.

“As you know, the major killer of human beings is non-communicable disease, so the most important thing is prevention of non-communicable disease.

“And the other is addressing the causes of long-term care, e.g. dementia and stroke.”

As it turns out, research has shown that maintaining good oral health is associated with increased life expectancy, as well as prevention of diseases such as dementia, diabetes and cardiovascular disease.

In fact, dental and oral health are not only some of the basic elements of initiatives to promote Japanese national health policies, but are also specifically included in national programmes to manage cancer, dementia and diabetic nephropathy.

There are also discussions to include oral health in the programme to prevent and manage metabolic syndrome.

Dr Fukai adds that many of the risk factors for non-communicable diseases like obesity and diabetes are the same as the risk factors for dental disease, so health education for dental disease also helps to prevent those diseases.

The dentist says: “If people lose their teeth, there is a change in nutritional intake.

“Those who have lost many teeth hesitate to take vegetables or fruits, and nutritional balance is destroyed.

“In addition, in people with poor oral status, the dietary pattern is very simple and poor; a healthy dietary pattern is difficult for those with poor oral health status.”

So, Dr Fukai explains, it was due to these factors that the 8020 campaign was started in Japan in 1989.

Easy access to care

Dentist Dr Makiyo Iwata notes: “If you have good oral health when you are young, you will retain more teeth when you get old.

“So we set the target 8020 to promote keeping more than 20 teeth at the age of 80.

“The reason for this number is that if you have 20 teeth at least, you can bite, chew and enjoy almost all foods, regardless of the texture.”

The Japanese Ministry of Health, Labour and Welfare Dental Health Division deputy director says that as of 2016, 51.2% of Japanese aged 80 have accomplished the goal of retaining 20 or more teeth.

She suggests three keys to the success of this campaign in Japan.

“First of all, we provide easy access to professional care and self-care.”

With Japan’s universal healthcare system, citizens can go to any dental clinic and receive treatment, while co-paying only 30% of the cost, which is also controlled by the government.

In addition, Dr Iwata says that local authorities provide dental check-ups for those aged 18 months and three years, school children, pregnant women and those over 75, as well as periodontal disease examinations for those aged 40, 50, 60 and 70 years.

Malaysia, according to Health Ministry Oral Health Division deputy director Dr Zainab Shamdol, has public dental health programmes covering toddlers, kindergarten pupils, school students, pregnant women, the elderly and those with special needs.

Malaysia has also achieved universal healthcare, and at public dental clinics, costs are subsidised up to 98% by the Government, with most standard outpatient dental procedures like scaling, crowning, filling and extraction only costing between RM1 to RM4.

Dr Iwata adds that self-care products like toothpaste, toothbrushes, mouthwash, dental floss, and even sweets, chewing gum and chocolates that contain the sugar substitute xylitol, which helps prevent tooth decay, are commonly available in drugstores around Japan.

Public buy-in

The second key is an evidence-based population approach.

Teeth, elderly, dental care, oral health, 8020 campaign, Dr Makiyo Iwata, Star2.com

According to Dr Iwata, the easy-to-remember catchphrase 8020 plays an important role in the success of the national Japanese oral health campaign.

Dr Iwata explains that Japan has introduced many of the recommendations for prevention of caries given by health bodies like the World Health Organization (WHO) and the FDI World Dental Federation.

“For example, thanks to the cooperation of Japanese oral care companies, almost all toothpaste available in Japan contains fluoride.

“So clearly, this has contributed to the prevention of caries effectively,” she says, showing a graph that displayed an inverse relationship between the increase in the market share of fluoride toothpaste and the number of decayed teeth in 12-year-old Japanese children.

She adds: “Also, many schools have introduced fluoride mouthwash after lunch.

“As this approach targets all the students, this helps diminish health disparities for those from socially-disadvantaged families.”

In Malaysia, about three-quarters of the treated water supply has fluorides added to it to help prevent tooth decay in the population.

Fluoridated toothpaste and mouthwashes are also widely available on the market.

Dr Zainab adds that the Oral Health Division also runs oral health promotion initiatives targeting specific groups like trainee teachers, smokers, universities and non-governmental organisations, as well as the general public.

The last key, Dr Iwata says, is the easy catchphrase 8020.

“It is important to use a catchphrase that is easy to remember, easy to understand and easy to work on.

“8020 is well-known among many Japanese because it fulfils all the criteria,” she says.

For example, school students regularly create 8020 campaign posters in art class and local Japanese authorities give awards to students with the best oral health.

“So you see that many people enjoy this campaign and try to join this national health movement by themselves.

“I think this component is very important as we need to involve all the people and make them step forward (to join the campaign).

“At the same time, the government enacts the overall promotion goals, and set other targets and details for the next step,” she explains.

While Malaysia does not have an overarching oral health campaign, initiatives like Ikon Gigi (iGG) and Transformation With 1Smile Together (TW1ST) target specific groups, as mentioned above.

Dr Fukai adds that another component to the success of the campaign is the attitude of the Japanese towards oral healthcare.

For example, the number of Japanese who brush their teeth at least twice a day increased from 16.9% in 1969 to 77% in 2016, and more than half of Japanese (52.9%) aged 20 and above reported going for a dental check-up in the past year, in the 2016 Survey of Dental Diseases.

Areas to improve

Teeth, elderly, dental care, oral health, 8020 campaign, Dr Zainab Shamdol, Star2.com

According to Dr Zainab, dental healthcare is provided by the Ministries of Health, Defence and Higher Education respectively in the public sector, while 36 of Malaysian dentists are in the private sector.

However, Dr Iwata notes that they need to improve on delivering oral healthcare to the elderly.

“Now, one out of four people is over 65 in Japan and this rate is estimated to increase in the future.

“Therefore, we need to think how to provide oral healthcare services to the elderly.

“Even if they become bedridden or inpatients at the hospital, we have to deliver appropriate care to improve their quality of life.

“So now, we are working on providing oral healthcare efficiently and effectively to them, and also, to find a way to collaborate with other healthcare providers such as medical doctors, nutritionists and other allied health specialists.”

Another issue she says, is to decrease the healthcare disparity, especially among the younger generation.

Dr Iwata, Dr Fukai and Dr Zainab were all speaking at the recent Oral Healthcare Seminar 2018 held at the residence of the Japanese Ambassador to Malaysia, and organised by the Malaysian Association of Dental Public Health Specialists, Embassy of Japan in Malaysia and Japan’s Ministry of Economy, Trade and Industry, in cooperation with the Association for Overseas Technical Cooperation and Sustainable Partnerships, Japan.

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