Notebook: So how much is this pain costing me?: Dentists have always been figures of fear. Now, as they leave the NHS, they're having to use new methods to bring a smile to customers' faces

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The Independent Online
MY FRIEND is looking for a new dentist. She is nervous; so nervous her hands tremble. I know she's been putting off a visit for years. 'Don't rush,' I say. 'Take it slow. Talk to your friends. And don't go to anyone unless you have a personal recommendation.'

She nods absently. Then she plucks a dentist from the Yellow Pages.

It is not immediately obvious what catches her eye in these nine sheets of unknown, untried practitioners. Certainly it isn't surgeries that specialise in modern cosmetic work. White fillings, porcelain veneers, contouring and bleaching are not what she needs right now. Nor does she want the Golders Green dentist who advertises that he speaks six languages, including Arabic and Hebrew.

Curiously, she doesn't seem to be put off by the fact that 'Dental' in the Yellow Pages is listed directly after 'Demolition'. Nor is she particularly drawn by those who pledge ardently to provide '24-hour accident and acute dental emergency service'. No. What really stops her is the word sedation.

Slowly she licks her finger and runs it down the page. Disabled and nervous patients welcome (too weak, too unconvincing). Gas sedation available (that's better). Intravenous sedation (better still). Ah, here is the best - Howard Stean offers painless dentistry. Too bad that his practice is in Kew, and she lives in Highgate.

Dentists will tell you that theirs is one of the most stressful professions in the world, second only to psychiatry for alcoholism, depression, early retirement and suicide. Cary Cooper, professor of occupational psychology at the University of Manchester, has studied this for more than 10 years. 'Dentists are enormously anxious,' he says, 'and it's getting worse all the time.' More than 800 students enter dental school in Britain every year. Most will end up in a dental practice, but their lives, it seems, will be fraught.

'Patients hate you,' says Michael Watson, secretary of the British Dental Association. 'They don't want you to do what you're doing. They can be rude. They might make you angry. But you can't take it out on them. Instead, you've got to work with them and get them to co-operate. And all this takes place in a very intimate situation. Inside their mouths. Beyond their lips. It really can be difficult.'

Jennifer Pinder, secretary of the BDA's London branch, agrees. 'There is this image that dentists are sadistic. It makes you feel very defensive.'

Never has overcoming patients' fears been more important. A record number of dentists left the NHS when new contracts were introduced in October 1990. Another exodus is expected now, after proposals by the Department of Health to cut fees by 7 per cent; in protest, the BDA last week voted to stop treating NHS patients. Those who were willing to put up with pain when treatment was cheap will simply not go to the dentist if it hurts and costs.

So provision of painless dentistry becomes more urgent. And they are doing it in a many different ways. For some, familiarity is still best. For others it is education. Then there are the New Agers, who will try to convince you that drilling doesn't hurt at all.

Anne Sherman has been working in the same practice in Hackney, north London, for 27 years. She sees 35 patients a day, a huge number for what is now largely a private practice. She has 800 children on her lists, and 2,800 adults, and hasn't turned anyone away, even though she began selectively to withdraw from doing health service work when the new contracts came into operation.

Slim, pretty, with short chestnut hair and just enough of a burr in her voice so you know she's not a Londoner, Ms Sherman has made a virtue of homeliness and continuity. She wears Dr Scholl's for the long hours she spends on her feet in the surgery.

'I think what's important is that people know they'll get a friendly, service,' she says, though that's hard when she is pressed for time. Sometimes the pressure is so bad, it seems like she still works full-time for the health service. But for patients who choose private dental care specifically to get around that problem, Ms Sherman has other things to offer. 'My patients like me because I'm the devil they know,' she says with a laugh. Indeed, she has been in Hackney so long that some of the kids whom she knew with milk teeth are now bringing in their own children.

Mervyn Druian's Camden practice is much newer. Once the only dentist in Angola, he used to sit his patients in a garden chair and operate on them without gloves. Now his surgery is new, refitted when he and his partner started to quit the health service, like Ms Sherman, in October 1990.

In place of a garden chair, Mr Druian has an easy-wipe black-and-turquoise Castellini chair. His X-ray machine can record your whole jaw at once. And his fibre optic drills have two tiny lights built into the head. 'It makes such a difference to the quality of the work if you can see what you're doing.'

For Mr Druian, dentistry has been the classic emigrant's profession: independent, respected and portable. His parents left the Baltics for South Africa just before the Second World War. 'I was the first person in my family to go to university. It was a big deal for them that I was called Dr. For me, it meant I didn't have to be a shopkeeper.' He and his family settled in Britain a decade ago. This year, he becomes president of the London branch of the British Dental Association.

The importance Mr Druian places on education is clear from the way he treats his patients. 'English people have what I call a low dental IQ. Ten years ago, if I suggested to a patient that he or she go to a hygienist, they thought I was a crook. Now, with education, they are beginning to learn how important the hygienist is.'

Ignorance, not gum disease, is the reason people's teeth fall out.

While Mr Druian goes for your brain, what's most important to Jennifer Golden and Russell Craddock are your lips. Together they run Dentics, which, they tell you, is not a surgery but a 'dental studio'. The idea was launched in Ealing early in 1990 when Ms Golden matched her marketing skills to Mr Craddock's dentistry, and the two convinced the Royal Bank of Scotland that they might be on to a winner. A year ago, Dentics came to a more natural home on the King's Road.

Dentics is New Age dentistry. It may be the dentistry of the future, for it is about seduction. First, you step off the street into a shop studded with chrome and glass cabinets. They contain curved Philippe Starck toothbrushes at pounds 7.50, little round mirrors and tongue cleansers - 'a totally fresh concept in oral hygiene'. Beside them lie the leaflets, advertising collagen replacement therapy, anti-wrinkle treatment, and another that professes to offer the latest look, the Paris Lip. The Paris Lip?

You look around, slightly confused. On the walls are photographs of lips. Pink lips. Coral lips. Pouting little moues behind which one has to assume are rows of perfect even pearls, side by side like little white babies. Teeth and lips meet at Dentics in the albums at the front of the shop. Page after page of before-and-after photographs prove that Dentics is less about dentistry than about the sanctity of smiles, as in 'You too can be blessed . . .' In case you don't get the point, in Mr Craddock's surgery there's a huge blown-up version of Helmut Newton's Le Baiser, two pairs of lips so close to meeting.

'The whole point was to discard the old imagery of dentistry,' says Ms Golden, who had her own teeth done first, before opening the studio. 'There are so many people, women especially, who dress from head to toe in Chanel. And then they don't open their mouths. Or if they do, it's a disaster. People don't know what can be done these days.'

At the back of the Dentics' leaflet is a paragraph headed 'Our approach'. It is simple and totally overwhelming. 'Treatment,' it says, 'is a pain-free experience.'

Today, after two generations of relatively cheap dental care, people are being asked to pay. Dental care has to be sold. To do that, dentists are using everything they can. Whether it's Anne Sherman's familiar smile, Mervyn Druian's solid educational message, or Dentics' offer of painless beauty, modern dentists are all in the business of dressing up an unenjoyable but thoroughly necessary part of life.

As I left, two things made me smile. The Helmut Newton photograph in Mr Craddock's office is published by a French company, whose name in English would be Disaster Editions. And as I walked out of the door, Stevie Wonder was singing, 'I love you just the way you are . . .'

(Photograph omitted)

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