by Sean Presant

Fish tanks not only provide colorful decor—they actually calm stressed-out patients

A lot of people get tense before they go to the orthodontist. Relax, it’s nothing you’re doing. It’s just that the idea of lying on their back in a cold, sterile chair while someone in a mask hovers over them with sharp metal objects doesn’t make them want to hum show tunes.

But what if you could change that? What if you could make a trip to your office something that people look forward to like a trip to the beach or a day at the zoo—or any other place that lowers their blood pressure and doesn’t make them rationalize that crooked teeth are a badge of individuality?

Enter the fish tank. That’s right, the fish tank.

Long considered a mere flashback to the disco era, the fish tank is making a slow but marked comeback in medical offices everywhere, thanks to new developments in aquatic technology. Where a live reef tank filled with yellow tangs, purple blennies, and orange clownfish once required a small bunker of loud pumps and hoses, now all the equipment can be quietly packed away in a cabinet or even hidden in the aquarium itself.

And the cost? Well, it’s still expensive, but the trade-offs can be dramatic—not just in patient stress, but also in patient numbers.

“From a practical experience, there’s no question it has helped,” says Larry Kawa, DDS, an orthodontist in West Boca Raton, Fla, whose four-physician operation sees on average 300 patients per day, a number he says is due in some part to his elaborate display of fish tanks. “The patients feel like they’re coming to an aquarium with a dentist,” he says, “rather than a dentist’s office with tanks.”

And while his setup is what even the biggest aquarium fanatic might call, well, big—15 tanks ranging in size from a 6-gallon desktop cube to a 1,500-gallon walk-through tunnel—his results are not so different from those found by physicians with smaller setups.

Your Own Private Ocean

Jeff Boschert, CEO of Some Things Fishy in Los Gatos, Calif, provides medical offices with an invention he calls “The Rolling Sea,” a self-contained, 55-gallon freshwater tank where all pumps, filters, and ultraviolet sterilizers exist within a locked system. You simply roll it where you want it, and it’s good to go.

The results, Boschert claims, are visible and immediate. Put the aquarium in front of patients, and you have more relaxed patients.

“You have a captive and stressed audience,” he explains. “In a patient room you have nothing but TV, and TV these days is not relaxing. If you can get [the patients] away from a fight-or-flight response, they are more relaxed. They have a better subjective experience.”

Boschert started working on The Rolling Sea after a friend was quarantined in a Respiratory Isolation Room at the University of California, Irvine Medical Center. Boschert wanted to put an aquarium in the otherwise sterile room, but he met resistance from hospital administrators and physicians alike. Finally, after 2 weeks of negotiating and showing how the unit would not compromise the sterility of the room, he was able to roll one in. The results were so favorable that the attending physician asked for a similar aquarium to be placed in the room on his next case.

The Facts About Fish

Boschert continued to perfect the design of this self-contained, sterile tank for a 1999 Purdue study on the effect of fish tanks on Alzheimer’s patients.1 The study, led by Nancy Edwards, PhD, RN, of the Purdue University School of Nursing and Alan Beck, ScD, DVM, Director of the Center for Human-Animal Bond at the Purdue University School of Veterinary Medicine (W Lafayette, Ind), looked at the ways to coax dementia patients, who are predominantly either extremely lethargic or irrationally excited, into a sense of calm conducive to eating.

The effects, Edwards says, were immediate and lasting. After parking the aquarium in the patients’ rooms, they found the anxious pacers slowed down and the lethargic patients perked up long enough to eat. And the results weren’t fleeting. “We were looking to see if there was a novelty effect,” Edwards says, “but we found it didn’t wear off.” Within a couple of weeks, almost every patient in the study gained weight.

Why the sudden change in mood? There are varying theories. One is that the high-contrast colors of the fish, combined with their quick movements, distract the brain, thereby reducing stress. Another is that the sound of running water lulls the mind into a state of relaxation. And yet another, called “biophilia”—a term pioneered by biologist EO Wilson—suggests that a relaxed state comes as a result of innate social attractions we may have to the animal world and to natural landscapes. Call it a genetic nostalgia we have for anything reminiscent of our days roaming the African plains. If you bring a little of that nature into the office environment, we experience an organic calming effect—a mental return to a time before headgear.

Fish tanks, some argue, offer the same effect—only with less effort than, say, rolling in a lion. “It’s nature on demand,” Beck says. “It fools us into thinking we’re in a natural environment. But in a humane way.”

Boschert has yet another theory for why a slice of the natural world might bring calm to an otherwise harrowing experience. He says we might just be conditioned to follow.

“We’re still very instinctual,” he says. “We think of dogs and cats as being more in tune with the dangers around us.” Consequently, “If you have a cat or dog around, and that animal is calm, you put your guard down. The same is true with fish. If they’re not stressed, you won’t be.”

He says this is particularly true in the case of dental and orthodontic offices, where he likens the position patients take—lying in a chair with a masked person looming above them with a metallic instrument—to being “prey.” He says that the ability at that point to look up and see fish swimming about, not at all phased by the situation, tells the patient that there’s no real danger.

“You’re getting the cue that you’re not being preyed on,” Boschert says.

In 1984, Beck put a similar theory to the test. “We had originally looked at how watching dogs and cats made people feel relaxed,” he explains. The complication was how to test that in a way that wouldn’t have people buying dogs and cats and then abandoning them when they realized that keeping them was also a good deal of work.

Fish tanks seemed to be the answer. The University of Pennsylvania had a program that was studying people with dental phobias, whom Beck calls “probably the most stressed group you could find.” A man named Herman Segal was making progress with dental hypnosis, but Beck and his colleague, Aaron Katcher, MD, decided to look for a more democratic approach. “Not everyone can be hypnotized,” Beck says. “Plus, hypnosis is time-consuming.”

Fish tanks had the advantage of being readily available, not exorbitantly expensive, and requiring very little effort on the part of the host office.

In the study,2 patients facing molar extractions from student dentists were sent in to surgery after either staring at a poster of a fish tank, watching an actual medium-sized fish tank, undergoing hypnosis, or simply sitting in the waiting room. An outside observer then noted the reactions—in particular how often the patient would grab the chair handles, ask for a break, or moan.

The results were clear. “We could not distinguish between those who had hypnosis versus those who looked at a fish tank for 20 minutes,” Beck says, “but we saw a big difference between that group and those who just meditated on a poster.”

Further studies were done on empty versus full fish tanks. Once again, the full fish tanks won out.

“The random motion holds your attention, and so you habituate,” Beck says.

But is it the brain’s tendency to mind motion of any kind or our remembrance of a time when we had flippers that leads to a state of relaxation? That’s a matter of conjecture. The fact that the sight of a natural landscape relaxes people, however, is undeniable. After all, when was the last time you saw a travel ad with the slogan “Relax and unwind in Detroit”?

But there are further reasons for this desire to go out in the woods and channel Thoreau every now and again.

“Things that are part of nature release serotonin and phenyl ethylamine,” Beck explains. “That’s the same chemical released by chocolate.”

  What does this mean for the orthodontist? It means that you may get the same relaxing result from a fish tank that you would from handing out a pre-exam Snickers bar—only without the unsightly mouthful of nougat or the embarrassing irony.

And to those who might argue that a well-placed television set can provide patients with a comparable experience, Boschert offers an interesting anecdote.

“There was a situation in a hospital where they had a tank under a TV and they turned off the TV,” he recounts with a smile. “It was three days before someone asked to watch Jerry Springer.”

He laughs proudly. “I say if you can go head to head with Jerry Springer, you’ve got something.”

Something that may, in the end, benefit more than just your patients.

“Sometimes, the therapy is for [the doctors],” Beck jokes, citing how many physicians get hooked on the hobby.

Kawa would admit he’s one of them. After all, he didn’t always have 15 tanks.

Getting Set Up

“We got a single fish tank,” says Kawa. “It went over so well, we thought it would be nice to have a tunnel tank.”

Now, Kawa has his own miniature version of Sea World. He hires a company to provide regular service, cleaning, and maintenance, and he even has the system rigged to page a technician if the pH drops to an unsafe level anywhere in his undersea kingdom.

The cost for all of this? Kawa estimates that he spends $2,000 per month on service, but he says it’s well worth it for the enjoyment the tanks provide both his patients and his staff. To hear him talk about his newest fish, you’d think he was talking about his latest sports car. Moray eels, sea horses, lobsters, venomous lionfish, blowfish, and a brand-new octopus are among his favorites.

In addition to it keeping patients calm, he says, his wide selection of sea life also keeps patients from complaining about long stretches in the waiting room.

“I have one word of advice,” he says to anyone considering a fish tank for their office. “Do.”

Sean Presant is a contributing writer for Orthodontic Products.


1. Edwards, NE, Beck AM. Animal-assisted therapy and nutrition in Alzheimer’s disease. Western J Nurs Res. 2002;24:697-712.

2. Katcher A, Segal H, Beck A. Comparison of contemplation and hypnosis for the reduction of anxiety and discomfort during dental surgery. Am J Clin Hypn. 1984;27(1):14-21.

The Fish Wish List

Michael SanFratello, president of Consistent Sea Inc, a wholesaler and importer in Southern California who supplies public aquariums and fish stores, advises skipping the giant pet retailer in favor of a shop that specializes in fish. Specialists will get to know your tank and keep its residents alive and happy. Most offer maintenance services for $50–$200 per month depending on tank size and type, and some will even select, install, and stock your tank.

All that leaves you is to decide if you want freshwater or saltwater. Cost aside (saltwater is much more expensive), the difference is that a saltwater tank simulates a Mediterranean reef, a freshwater tank puts you in an Asian tributary.

Fish prices vary based on popularity and availability, but it’s often worth asking if there is a tank-raised version of any given species. Tank-raised fish tend to be heartier, and they’re less strain on ocean reefs. Below are three popular choices for each type of tank.


Gouramis ($4–$10): Docile, often brightly colored fish. Many have fins that look like “feelers.” Kissing Gouramis press their lips against aquarium walls and other fish.

Angelfish ($5–$20): Thin, graceful fish with long, flowing fins.  

African Chiclids ($7–$20): Chiclids can be found in bright blue, bright yellow, orange, brown, and silver. They can be aggressive, especially as they grow.


Tangs ($20–$90): Oval-shaped and thin-bodied, with long dorsal fins, tangs come in many colors; the most popular are the Yellow Tang and the Blue Hippo Tang (Dori in Finding Nemo).

Clownfish ($20–$40): Probably the most recognizable of all aquarium fish. Most are orange with white and/or black stripes. Most popular type is the Percula Clown (Nemo of Finding Nemo). Clowns will usually pair up and should be kept one mated pair to a tank.

Angelfish ($20–$200): Angelfish come in many color combinations, and often change colors as they grow. Dwarf angelfish are smaller and easier to keep, though the Flame Angel, a bright red dwarf, can be more difficult. No more than one of any species should be kept together, as they will fight.