Inside a gilded Mayan-inspired skyscraper just off Union Square, there are around 150 dental offices, but you won’t find Highlights magazines in the waiting room of this one. There is, however, a “comfort menu” listing options that include a weighted blanket, an eye mask, augmented reality movie glasses and an option to have a French bulldog sit in your lap during your visit.
It’s hard to register that this isn’t a day spa but a dental practice.
450 Aesthetics Dental Group is not alone. Rather, it’s one of a growing group of dentists taking cues from hospitality, tech and wellness in an effort to make an essential part of everyone’s life less miserable and address a simple truth: Many people hate going to the dentist.
Hospitality meets dentistry
Brian Baliwas and Adam Miller met as undergrads at UC Davis, where they worked at the same restaurant – Baliwas bartended, Miller served. Before opening 450 Aesthetics in 2019, Miller spent time at Studio Dental, another San Francisco practice with a more luxurious, design-centric reputation. What the duo kept coming back to was the same frustration about their profession: It hadn’t changed. People showed up when something hurt; the dentist told them everything that was wrong and threw out a price. The process was repeated when pain returned or a card reminding them of a regular cleaning arrived in the mail.
They are obsessed with fixing this.
Dr. Brian Baliwas and Dr. Adam Miller provide a hands-on demonstration at 450 Aesthetics Dental Group in San Francisco. (Chris Partin/Special to SFGATE)
Baliwas runs an Instagram account – @sfdentalnerd – with more than 40,000 followers that mixes unboxings of dental products and equipment with dentistry memes in a way that reads more like educational beauty influencer content. Baliwas and Miller also spent years building a set of core values that includes a new patient intake process that begins not in the chair, surrounded by drills, but in a separate room.
“They don’t bring you in an operating room to meet your doctor for the first time,” Baliwas said. “And as dentists, that’s what we do – we bring people back, and it’s like, ‘Look at all the scary stuff.'”
The first appointment at 450 Aesthetics is a conversation that covers goals, anxieties, diet and whether you care about what your teeth look like or just want to avoid filings. The paperwork is intentionally extensive, inquiring about these points and others. “That way it’s not me going kind of fishing for, ‘Oh, well, do you drink juice?'” Baliwas said.
Next comes data collection: 3D scans, intraoral photos, digital impressions, X-rays. Baliwas and Miller review it all together before anything gets proposed. “We want you to pay for an analysis,” Baliwas said, “so that way, you can now take this data and go to any dentist and say, ‘Here’s my blueprint.'”
The new consultation room at 450 Aesthetics Dental Group in San Francisco. (Chris Partin/Special to SFGATE)
Though the two speak at dental symposiums across the country, old-school dentist consultants are skeptical of this approach.
“They think we’re crazy,” Baliwas said.
A canine colleague
Then there’s Xylo – her full name is Xylocaine, like the dental anesthetic.
Xylo is Baliwas’ 7-year-old French bulldog, who has been with the practice since it opened and is, by any measure, an employee. On the 450 Aesthetics website, she’s listed in the “Team” tab under Baliwas and Miller, where her various accreditations – AKC, training, rabies tag – are displayed along with a scrolling list of skills like snuggles, sleeping, sorting and fetching.
Dr. Adam Miller, Dr. Brian Baliwas and Xylo at 450 Aesthetics Dental Group in San Francisco. (Chris Partin/Special to SFGATE)
Patients request her by name, and she has her own emoji in the scheduling software. This feature was added after a snafu where Xylo was double booked.
In person, she’s velvety, inquisitive and sweet, everything you’d expect from a dog named after a medication intended to keep you from feeling pain. Her fanbase is strong. Other tenants in the skyscraper come in to say hi to Xylo on a regular basis, and a few portraits of her created by patients hang in the office employee areas.
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She’s one of the items on the complementary comfort menu, alongside a neck pillow and XREAL augmented reality glasses for watching Netflix from your phone mid-cleaning, but unlike those items, due to her popularity, she needs to be booked ahead of time. Baliwas and Miller understand that not everyone is a dog lover, and patients flag allergies and fears in their intake forms – Xylo stays out of those appointments.
Xylo, 450 Aesthetics Dental Group’s therapy dog, provides her services to Kasia Pawlowska of SFGATE. (Chris Partin/For SFGATE)
Another unique item on the comfort menu is the option for a quiet cleaning. “Some people just don’t want to talk. It’s kind of awkward,” Baliwas said. By marking it on their form, everyone gets it.
“They’re happy, we’re happy,” he said.
Their office philosophy
The overall booking system – including scheduling tags, preference notes and flags from out-of-town patients especially tight on time – are part of “Paint by Numbers,” one of the six core values of the practice. The others include “Football, Not Golf,” meaning the team picks up the fumble and nobody asks whose fault it was, explained Miller, and “We Educate, They Decide,” pointing back to the data collection and analysis during the first consult. A sheet with all of them hangs in the employee break room.
The duo spent months working on the values, though Baliwas admits that his fiancee, herself an endodontist, mentioned that maybe using a sports analogy wasn’t the best metaphor for a modern workplace.
They kept it anyway despite a slight contradiction.
Dr. Brian Baliwas pets Xylo, the therapy dog at 450 Aesthetics Dental Group in San Francisco. (Chris Partin/Special to SFGATE)
Miller and Baliwas love golf – four golf holes are hidden in the office, with plans for nine and the idea of patients booking end-of-day sessions for a quick round with the doctors. The two are constant tinkerers. The TV in the consultation room is still mounted too low from a layout that didn’t pan out, per their assessment. (The placement looked fine to me.)
“I feel like Adam and I just have these grandiose ideas,” Baliwas said, “and we just love making mistakes.”
Clinically, they always want to stay ahead of the curve. Instead of using scraping tools for cleaning, they use guided air polishing – a technique that uses a specialized powder to “sandblast” away stains and debris. A colored dye applied before shows hygienists the areas that need to be targeted, rather than have them feel for them with metal picks. The result is fewer cavities, fewer deep cleanings and lower-than-industry-benchmark rates of periodontal disease among their patients.
A portrait of Xylo from a patient at 450 Aesthetics Dental Group in San Francisco. (Chris Partin/Special to SFGATE)
Their consultants flag this regularly, believing they underdiagnose.
“What if we’re diagnosing it just fine,” Baliwas said, “but we’re actually doing a keep job or keeping people healthy?”
He said it was a terrible business model, but he didn’t sound bothered.
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This article originally published at This San Francisco dentist has an emotional support dog.