Afraid to 'open wide'?

When Claire Lodge was 11, she visited a dentist who decided to do about 12 fillings in one session. "I had to have a lot of injections, was enormously frightened and in pain for days and days afterwards," she recalls. "I was a dental phobic for years after that, although I was still young enough to be forced to go, but I refused to have injections because they had become associated with pain. When I was older I stopped going to the dentist for good .

"I was very lucky - I didn't have many problems with my teeth; but recently a dentist friend said I really needed a filling."

Ms Lodge, a training consultant, eventually got help - from a new dental service which provides psychotherapy at the surgery. "I have to say that I was sceptical at first," she says, "The therapist made me play the scene when I was 11 back in my mind - but as though I was sitting in a cinema and watching it on screen. He told me to imagine the picture on the screen getting smaller, and in black and white. Then he asked me to play the film backwards - so the last thing that happened was the injection coming out of my mouth.

"It put everything into perspective. The therapist made me appreciate that what I'd gone through as a youngster was not a huge drama; simply an insignificant moment in my life."

Recent research carried out by dentists and psychiatrists in the US, Scandinavia and western Europe has shown that fear of dentists is listed fifth among commonly held fears. Although figures are not available, some degree of dental phobia is estimated to affect about 30 per cent of all adults, with many unable even to entertain the idea of dental work being done under anaesthetic.

As with most forms of phobic behaviour, the origins of dental fear tend to be found in childhood or adolescence. A bad dental experience, possibly with a critical and inconsiderate dentist, or unfavourable experiences passed on by other family members, can all influence adult behaviour.

"The consequences of dental phobia can be traumatic," says Vivian Ward, consultant surgeon at the Eastman Dental Hospital, London. "Over many years, a condition which was treatable can deteriorate into one which is not." Phobic patients, he says, are highly likely to suffer dental trauma or disease, to end up in emergency services or slowly lose their teeth. Mr Ward is one of a group of professionals with a particular interest in helping dental phobics, by providing psychotherapy services "on tap". Called Feelgood Dentistry, the group operate from several surgeries within Central London.

Graham Smith, a psychotherapist and tutor in neuro-linguistic programming at Birkbeck College, University of London, is a founder member. "We have discovered that neuro-linguistic programming, a 'talking cure', is an effective and friendly form of treatment, often producing dramatic results," he says. "We help patients to appreciate that their fear is not passive. It doesn't 'happen' to you. Patients can learn from their fear without feeling the need to re-experience the unpleasant feelings when referring to the memory."

Graduated, controlled exposure of patients to the feared stimulus is the guiding principle behind treatment. Like Claire Lodge, the patient first has a session, in a room near the surgery, with a psychotherapist who will work with them to help them leave their fear in the past. They will then have a consultation with the dentist. "Psychotherapy is more effective if they go immediately into the surgery, even if only for a consultation, rather than waiting several weeks," says Ward.

"We also hope to demystify the dentist and his equipment," says Graham Smith. "All dentists do not cause pain. The patient will usually come to appreciate that: 'on the occasion when I was a child, that particular dentist caused me pain. This does not mean to say that my childhood experience will be repeated.' "

Claire Lodge was 39 when she had treatment again - for the first time in 18 years. "When I finally underwent dental treatment, the original nightmare situation was back in history. I felt detached. It wasn't completely pain-free, but it was manageable.

"Until that point, the idea of ever seeing another dentist had been a major life event, one that I never felt I could put myself through again. "

The only drawback is the cost. A half-hour psychotherapy session costs pounds 50, and since all the dentists connected to Feelgood are in private practice, the dental consultation costs another pounds 50, although Vivian Ward points out that after this patients are free to return to their own dentists.

Feelgood Dentistry, tel: 0171-486 5797.