Your mouth in their hands: Forty per cent of adults can't even bear to register with a dentist. Rosemary Furber probes dental phobia

IT HAS NOT been a good week for dental patients. First, Panorama suggests that mercury in our fillings could be poisoning us. Then the Government's Green Paper announces that we will soon be paying more for treatment. Isn't it just the excuse most people have been waiting for to avoid ever going to the dentist again? Not for Judith Penfold, a social worker from Cornwall: 'I love it all, especially the injections. It's so penetrative. So erotic.'

Most people would not agree. South London dentist Adrian Mullish reckons that all patients have some sort of terror of their dentist. 'We see only the relatively brave ones. I'm not surprised. The mouth is a very intimate part of the body, with more nerve endings than almost anywhere else. I don't believe anyone who says they're not scared.'

More than 40 per cent of British adults cannot even bring themselves to register with a dentist. Who could fail to sympathise with Cathy Mitchell, whose courage ebbed while an injection was taking effect in the waiting-room - and got up and went home? 'Nobody had even touched me. It was stupid really, but now just thinking about it I've got goose pimples.'

Her problem started in the Fifties with a school dentist who slapped her to 'calm' her before extracting three teeth. She came round, nauseous from the anaesthetic, and cannot forget spitting blood into a bowl. Army dentists, too, are often recalled for their Torquemada manner. One ex-service dentist was puzzled when the son of a deceased patient made an appointment to see him (the son was not his patient). The young man threw the dead patient's ashes in his face.

Dentists insist that things have changed. Gone is the fashion for a bride's father to make sure his daughter had all her teeth out and a set of dentures fitted in time for the wedding. Gone are the 15 sets of false teeth in the rugger locker room. Extractions are no longer the rule. Professional emphasis is now on saving teeth at all costs, which can mean lots of lucrative digging and drilling.

Kathryn Harley, consultant in children's dentistry at the Eastman Hospital in London says that because of pharmacological advances 'dentistry can be totally pain-free'. Anaesthetic gel numbs the gum before an injection. 'Relative analgesia', or whiffs of a nitrous oxide mixture like that used in childbirth, can ease the tension that exaggerates pain. So can the use of sedatives, either a Valium pill taken before arrival in the surgery or by intravenous injection. Extreme cases, where much work is required and the patient's mouth will not open at all, are usually treated under general anaesthetic.

Hypnosis is also available, for pain relief as well as in therapy, but not many practitioners are confident with it. What good dentists do admit is that with all patients they try to speak softly, repetitively, in a manner designed to relax and distract, like a parent soothing a hurt child. Some will even pray with you if you wish.

Dr Anthony McCarthy, consultant psychiatrist and clinical director for adult mental health services at Guy's Hospital, says that irrational fears are almost universal. 'By nine months, many infants fear the dark; by a year the fear of heights is beginning. Everybody has at least one of these fears. And some degree of fear of strangers poking round in our mouths, putting things in and taking them out without explanation is innate.'

True phobia can be an indication of another problem. A rotting tooth can be such a symbol of mortality and decay that a patient even pesters the dentist for check-ups.

Dr McCarthy's treatment of phobia includes 'desensitising'. The patient lists his or her 'hierarchy' of fears. First may be the situation of being trapped in the dentist's chair, with no escape and a syringe approaching. Next could be the horror of the clinical smells or the awfulness of the waiting- room. The patient lists and imagines it all - 'the magazines, the fish tank' - and learns techniques to tolerate and reduce the anxiety.

Richard Elderton, professor of preventive and restorative dentistry at the University of Bristol Dental School and Hospital, believes that a link with sexual abuse may be more prevalent than previously thought, but he is not yet in the habit of asking. He treats the dental crisis and the fear that are presented, and patients usually beg to be knocked out before surgery. He believes, however, that 'phobics are treated badly by the use of general anaesthetic and fast filling'. Time and gentleness are the answer, he says, to the extent that 'restorative dentistry cannot be done properly under the regulations of the NHS where dentists are paid like pieceworkers regardless of time invested in our comfort'.

Professor Elderton combines patience with non-electric or atraumatic restorative treatment, meaning adhesives and delicate scooping instead of drills. It works well with anyone nursing a bad dental experience or who saw Dustin Hoffman in Marathon Man. He is also strong on eliminating dental decay with 'some changes to your lifestyle which needn't be too onerous. Dental disease is almost 100 per cent self-imposed'.

Counsel of perfection? Maybe; but one discovery has made such a difference that if you admit fear of dentists you are actually showing your age. Fluoride. Many 25-year-olds have no tooth decay, even though over pounds 4bn was spent in the UK on chocolate and confectionery last year. And according to Michael Watson of the British Dental Association, 60 per cent of children under 12 have no treated tooth decay at all, and no unpleasant dental experience. They think a dentist's job is counting teeth.

(Photograph omitted)