Smile Garden Pediatric Dentistry and Orthodontics, located in Emmaus, Pa, is part of the growing trend of multi-specialty practices, specifically pediatric dentistry and orthodontic combos. The two specialties complement each other well and create an opportunity to build a practice that meets consumer demand for one-stop shopping while also providing the orthodontist with a dedicated referral source. But often, the tendency is to treat the specialties as two separate practices once patients walk past the reception desk—the pediatric dentistry practice down one hall and the orthodontic practice down another.
When husband and wife Kyle and Anna Shoenberger, both DMD, set out to open their practice, their goal was to create a practice that married the two specialties and did so in a space that truly allowed them to work together.
The two, who met at the University of Pennsylvania School of Dental Medicine and married soon after graduating, started their careers as general dentists, working at a dental office in New York City. After 2 years, they both decided to further specialize. Anna, who as a child growing up in Russia had had bad teeth that required extensive dental work, opted for pediatric dentistry because she wanted to provide children with a better dental experience than she had, and because every pediatric patient is, in a way, a blank slate. “You can start fresh and educate them. You can actually make a great impact on their teeth and their mentality about how to save their teeth,” she points out. Meanwhile, Kyle gravitated to orthodontics because he loved the aesthetic focus of the specialty and the complexity of the cases orthodontists often treat.
After completing their residencies, the two did what many young dental professionals do, they worked as associates. Kyle is grateful for the time he spent as an associate. “I worked with an orthodontist in Fort Lee, NJ, who has been there for 30 years. You learn a lot in school, but you can learn a lot more through a mentorship, so to speak, to gain experience, knowledge,” he says.
Within a year and a half of completing their orthodontic and pediatric dentistry residencies, they were ready to undertake the huge commitment of opening their own practice. They had made a conscious choice to join forces because they knew that their two specialties complemented each other and that such a multi-specialty practice would help them stand out from the competition.
A Design that Works for Both
When it came time to build, the couple bought a former medical building, complete with low ceilings and dark tiny rooms. Initially they thought they could do something with the existing setup, but soon realized they needed to open up the 1,700 square feet of useable space. The couple hired Philadelphia-based Civitas Architects, working directly with Agnes Kan, to do just that. Kan drew up a design that not only rerouted the whole duct system to raise the ceilings, but that tore down walls and allowed for a spacious open bay. When it came to design the goal was to create a kid-friendly environment that would neither alienate potential adult patients nor become dated in 10 years.
“We wanted to make sure that if Kyle was seeing adult patients that [they weren’t] going to think it’s too kiddish. We wanted to create fun things with architectural panels, not stickers or decals on the walls,” says Anna, who appreciates a modern aesthetic—the IKEA look, which she describes as clean, fresh, and open.
For Kyle, the design had to be functional and more importantly safe. The first component of this safe design was the inclusion of lead-lined walls in the construction of the x-ray room, a design choice suggested by Kan. While the practice has a low-dose radiograph machine, Kyle was concerned about scatter radiation. “That was important to me and Anna because next to that room is a bathroom and a treatment area,” says Kyle. “I’m not saying you’re going to get zapped if you’re sitting next door, but if it was me, I wouldn’t want any radiation going through. So that was an important part [of the design].”
The second component of the safe practice was locating the sterilization area in the center of the office so parents and patients could see it. “I wanted an open sterilization area so people can see that it is clean—that we are doing what we are supposed to be doing,” says Kyle. “I think people nowadays have this expectation of ‘show me what you’re doing.’” The central location of the sterilization area also lends itself to better traffic flow. There’s no need to disappear down a hall to retrieve supplies.
A common office layout for multi-specialty practices is to split the space between the two specialties, with a common sterilization area and waiting room. For the Shoenbergers that wasn’t an option. The small space meant they had to maximize what they had and create a space that accommodated both of them at the same time. In terms of equipment, the couple chose chairs that could be used for both pediatric dentistry and orthodontic treatment. “[This] allows us to hop in and out of different chairs. I wanted to come up with something that would be useful for both specialties in the same space,” says Kyle, who completed his orthodontic residency at Roseman University College of Dental Medicine. The fact that Kyle and Anna can work out of any chair in the practice also makes scheduling much easier—there’s no worry about blocking out certain chairs for ortho appointments or vice versa. In addition, the centralized sterilization area provides storage for Kyle’s orthodontic supplies, minimizing the need for chair side storage.
Included in the space are two quiet rooms where adult patients or louder pediatric patients can be seen. The rooms also feature nitrous oxide gas delivery systems, which Kyle, with his general dentistry background, is licensed to use. This came into play with an adolescent patient who was referred to the practice with an appliance that had been placed by another orthodontist. They were unable to remove it as it was a bonded expander with mixed dentition. With baby teeth in play, the other orthodontist couldn’t remove it easily. Moreover, the child was not amenable to sitting through the process. Kyle ended up taking the appliance out under nitrous oxide gas.
“I wouldn’t have that in a normal ortho practice,” says Kyle, who also does injections when needed. “I’d have to refer out and it’s an orthodontic appliance. It’s another provider’s appliance, but I know that appliance better than if I would send that patient to a general dentist.”
The Future of the Space
The couple chose to work with an architect on the project and looked to the offices of former classmates to find the right one. Anna loved the modern, sleek, open aesthetic she saw in the offices designed by Civitas Architects’ Kan. The fact that the firm was located nearby was icing on the cake. The couple was able to visit with her and have her come to the site. In addition, they liked that Kan, who is married to an orthodontist, could understand their needs more specifically. “She showed us how to do it right,” Anna said, who completed her pediatric residency at Montefiore Medical Center and is currently on staff at Lehigh Valley Hospital where she teaches residents.
The project took a year and half—longer than the norm; but that was due in large part to the fact they were juggling work, life, and the desire to take their time on such a huge project. Now 2 years later, they are thinking about the future. The fact is only after living in a space for a while do you realize what really works and what doesn’t. Which means there can be tweaks to the design long after the doors have opened. A year after opening for business, the Shoenbergers realized the sliding glass doors that separated the waiting area and front desk from the clinical area just didn’t work. They replaced them with solid doors that could be kept closed to cut down on both traffic and noise. And now, as their patient population grows, they are thinking about how to expand the space. Fortunately, the site they bought not only included the standalone building but also the surrounding land. That gives the couple the flexibility to expand out. First on their wish list is a larger waiting area and checkout space, as well as a play area. And down the road they have the option to add clinical space if they decide to add another specialty to the practice.
Kyle sees how consumers are all about convenience and, increasingly, that means having all their care completed in the same place. “I think what we’ll find is more orthodontists teaming up with other specialties and other providers to make the patient experience just better overall. I think we’re going away from the standalone place where you get your braces here and then we send you somewhere else to get everything else done,” he says.
The fact is, in a joint pediatric/orthodontic practice, the early years are slow going for the orthodontist. Yes, the pediatric side will create a built-in referral stream for the orthodontist, but it likely will be a few years before a trickle turns into a steady flow. The children who enter a new pediatric practice tend to be very young—and are several years away from being ready for orthodontic treatment. While Anna sees patients between 7 and 15 years of age, the bulk are in the 3 to 5 range. In the first year of opening the practice, Kyle kept his associate position at another practice to supplement the couple’s income, but now has chosen to come to the practice full time, even though the orthodontic side lags a bit behind.
The two have set up their schedule at Smile Garden to be in the office at the same time so that patients benefit from both their expertise when needed. That means a consult can be offered immediately. “[A patient] doesn’t have to come back on another day of the week to see me. I’m there and available,” says Kyle.
“People will say, ‘Well you guys aren’t staying busy enough for ortho. You should stay at another job,’” Anna says. “But for him to be in the practice to check on my patients and to be able to be here all the time, it actually [has a positive effect] on patients because when they see the orthodontist is available Monday through Friday, they are more likely to schedule an appointment and come see him.”
While Kyle is there for Anna’s pediatric patients, that’s not to say that he isn’t trying to build the orthodontic practice’s adult population; but he’s letting it grow organically. “Essentially all of our growth has really been through word of mouth,” he says, adding that Google reviews and patient referrals have had a large hand in this. “I would say I don’t actively go and look for the adults. We do get parents. They say, ‘Oh, Johnny’s getting this done. I know you do Invisalign, what do you think about this?’ So, we get that. It’s almost like, ‘Hop in the chair next door and let me take a look.’ That is very common.”
In the meantime, Kyle has taken on much of the management and financial tasks related to running the practice. They both admit that learning how to run a small business is a constant learning process. While their associateships in other practices gave them the mentors they needed to build their confidence in their clinical skills, it didn’t necessarily prepare them for dealing with the intricacies of running a business.
“In the offices, I used to work at, you never dealt with financial things like which insurance covers what percentage. You just did dentistry,” Anna says. “I will never forget, when I was working as a general dentist [as an associate], I said to [the practice owner], ‘Wow. It’s so much better when you have your own practice than when you’re an associate.’ And he [responded], ‘Trust me, when there is a holiday or there is no work, you just go home [as an associate]. That’s fine, but I still have to pay my employees.’ It’s all stuff you never realize until you’re dealing with it,” says Anna.
Yet, they’re enjoying dealing with all of it now as they watch Smile Garden grow. OP