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GOING TO THE CHAIR To those with a fear of dentists, an appointment with the drill can feel like a death sentence.

THE BALTIMORE SUN

John Stork looks like hell today. More specifically, he looks like someone who just had the tar beat out of him in some honky-tonk. It appears a few of the boys were swinging pool cues, too, because the left side of Stork's face is hideously swollen and his cheek is a huge knot and his eye is something you'd see on a fish after the hook is pulled out.

But Stork, 42, a route salesman for Ace Uniform Co., in Glen Burnie, didn't get this way by mouthing off at somebody's date. Actually, he's sitting here in the office of Barry Berman, an Owings Mills oral surgeon, pumped up with antibiotics and painkillers and nursing the mother of all abscessed teeth.

Right now John Stork is talking about fear, the cold, naked fear that grips him when he thinks of a dentist working in his mouth: the stainless-steel explorer jabbing cruelly at his gums, the needle that becomes the size of a javelin the longer he stares at it, the drill whining against his teeth like a body-shop sander against the bumper of an El Camino.

Clearly, despite the soft pastel walls that surround him and the giant tooth sign in the hallway proclaiming "Painless dentistry practiced here," Stork is living his worst nightmare.

"I let my teeth go and go and go because of the fear of coming to the dentist," he's saying now in a soft voice. "That's why I look like I do now. I procrastinate . . . because I know it's gonna hurt like hell."

Maybe you could call John Stork a sissy, but if that's the case, there are an awful lot of sissies out there.

The American Dental Association says that nearly half the people in this country fear dentistry to some degree. Thirty million of these are considered phobic, those with anxieties so crippling they avoid dental care completely.

Every one of these phobics has a story, too.

Here's John Stork's: It begins with vague memories of disturbing visits to the dentist as a small child, cavities the size of manhole covers to be filled, the needles with Novocaine plunging painfully into his gums and terrifying him, the Novocaine taking forever to work, sometimes not working at all.

What do you do when you're a little kid and someone's hurting you? You don't take it well. You kick. You scream. You cry.

By age 12 or so, John Stork can feel his phobia descending around him like a dark veil.

This is confirmed in a seminal moment not long after: It's a cold winter day. Johnny Stork is out sledding with his pals. He comes down a hill on his stomach, hits a ridge, bangs his face hard on the front of the sled.

The blow chips a front tooth -- badly. His mouth is bleeding, but one thought keeps running through his mind on a silent loop: I'm not going to the dentist. I am NOT going to the dentist!

And he doesn't go, either, despite his parents' urging.

Over time, the tooth gets worse and worse looking. It's your classic snaggle tooth. When he smiles, he looks like a guy who should be riding shotgun on a truckful of moonshine in the Ozarks.

Over the next 30 years, he neglects his teeth completely. He goes to the dentist only when the pain in a tooth becomes unbearable. Until finally he winds up in Barry Berman's office on a chilly Wednesday evening with this Elephant Man face and an abscessed tooth that's gone thermonuclear and become a genuine medical emergency.

"Oh, I was petrified!" he's saying now. "On the ride over here with my sister, I was like: 'Let's turn the car around and go home. I'll just suffer.' "

And here's what happens when they finally get John Stork into a dental chair:

Berman, a likable man with a soothing, irreverent manner, talks to him the way you'd talk to someone standing on the roof of a building threatening to jump. He gives Stork enough nitrous oxide to tranquilize a water buffalo. He gives him a shot of Zylocaine and Marcaine.

Finally, he makes a few incisions in Stork's gum. Then he proceeds to push down vigorously on the gum for the next 40 minutes or so to -- this is where you may want to put down that English muffin -- drain the pus out of the infected area.

The treatment, along with two types of antibiotics and painkillers, works. Within 24 hours, the crisis passes. They schedule an appointment for the following week so Berman can remove the abscessed tooth.

Maybe there are 30 million dental phobics out there, but it's people like John Stork who put an actual face on the phobia. At the moment, it's not a pretty face, either.

Here's the postscript to John Stork's story, and this isn't pretty, either: He misses his next appointment with Barry Berman, the one to have the abscessed tooth taken out. He misses three more appointments as well.

As of this writing, he hasn't been back.

The roots of fear

Who knows exactly what causes the white-hot, crippling fear that overwhelms so many dental phobics, a fear so deeply rooted and primeval that people will suffer for years without seeking help?

L According to the ADA, three of the biggest contributors are:

Vivid memories of painful experiences with the dentist, often in childhood.

Horror stories of bad visits to the dentist passed on by family members, friends and co-workers.

Unflattering depictions of dentists as incompetents and sadists in the media, along with lurid tales of dental procedures gone awry.

Hollywood sure hasn't helped matters, say Berman and a lot of his colleagues.

Think of the smarmy dentist played by Steve Martin in "Little Shop of Horrors," who at one point breaks into this charming ditty:

I am your den-tist

And I enjoy the career that I picked.

I am your den-tist

And I get off on the pain I inflict!

I'm thrilled when I drill a bicuspid!

It's swell, though they tell me I'm mal-ad-justed!

Baby boomers still cringe at the memory of "Marathon Man," the '70s thriller starring Laurence Olivier as an ex-Nazi war criminal and Dustin Hoffman as a young graduate student who stumbles into a diamond-smuggling plot and is tortured with dental instruments.

The scenes of Olivier jabbing maniacally in Hoffman's mouth, and Hoffman shrieking, are excruciating to watch. The dialogue is equally chilling, such as when Olivier turns to a terrified Hoffman in the dental chair and says calmly:

"Please don't worry. I'm not going into that cavity. That root is already dead. An alive, freshly cut nerve is infinitely more sensitive."

Recently, HBO ratcheted the anxiety level even higher for dental phobics with a movie called "The Dentist," which stars Corbin Bernson as an unhinged dentist seeking revenge on his unfaithful wife.

The dental scenes here make "Marathon Man" look like "The Sound of Music." At one point, a wild-eyed Bernson administers nitrous oxide to his wife and pulls out all her teeth and her tongue, leaving her mouth a bloody husk.

Say, there's an image the dental phobic wants to tuck away in the mental scrapbook.

Condition normal: Anxiety high

Imagine this. Imagine you can't stand anyone putting anything in your mouth. Tongue depressors, floss, fingers, medical instruments -- they all make you gag violently. You feel as though you're going to flip out, lose consciousness, maybe even die.

Now imagine this. Imagine every time you go to your dentist, dragging this psychological ball and chain with you, the first thing you see is a funeral home.

This is exactly what happens to Arthur Jacob each time he turns off Reisterstown Road and into the strip mall that houses Bruce Barr's dental office. Right across the street is the Sol Levinson and Bros. Funeral Home, dishwater gray and somber in the morning light.

And if you're Arthur Jacob and big on symbolism, this is not the sort of thing you need to see on a day like this.

On this Tuesday, Jacob, 37, an accountant and attorney from Reisterstown, arrives in Barr's office nine minutes early for his 10 o'clock appointment, looking anxious, which turns out to be a normal state of mind for him.

He's here for a cleaning and post-operative checkup. To many people, a cleaning is no big deal. But to Jacob, it's a completely unnerving experience, a vast midway of sensory horrors to be negotiated.

This morning he awoke at 4: 10, tiny frissons of fear already rippling through his mind. By 5: 45 a.m. he was in his office, trying to lose himself in his work so he wouldn't think about the cleaning.

Now, standing in Bruce Barr's waiting room, he's monitoring his physiological signs: "Let's see . . . I feel the usual jitters. Very nervous. Butterflies in my stomach. Can't eat anything, 'cause it'll be all over everyone."

After Barr leads him to the dental chair, Arthur Jacob tells you his story. You could call him a recovering phobic. His paralyzing fear kept him away from the dentist for a long, long time.

But a painful abscessed tooth a few months ago, which resulted in an emergency 11 p.m. appointment with Barr, lots of screaming, and the tooth finally being extracted by Barry Berman, has shown Jacob the folly of neglecting his teeth.

Now he white-knuckles his way through checkups and cleanings, fearing another tooth deterioration and another buffet horrific pain spread out before him.

"I didn't take care of my teeth for 35 years; now I'll pay for it for the next 35 years," he says ruefully.

He says he doesn't know what caused his phobia, which seems to encompass far more than a simple gagging reflex. Unlike John Stork, he remembers no disturbing childhood incidents with the dentist, no sessions where he ended up howling at the ceiling.

He says he hates the impersonal nature of today's health care. And to Jacob, there is nothing more impersonal than a stranger with a face mask and latex gloves rooting around in your mouth and . . . doing things to you!

If you stood behind a partition and just listened as Arthur Jacob had his teeth cleaned, you'd think you'd stumbled on a secret police interrogation.

Despite Bruce Barr's obviously gentle touch, Jacob squirms constantly. He groans. He yelps. He has a death grip on a wad of Kleenex. Each time he rinses his mouth, he makes a face, as if the little plastic cup contained raw sewage.

"The noises are horrible!" he says at one point. "The sound of the drill is horrible. And that other thing you use . . ."

"The ultrasonic scaler?" Barr says helpfully.

Aside from the noise, he can't handle a lot of cotton swabs in his mouth. He can't handle the saliva-ejector. He can't handle the grittiness of the toothpaste Barr uses for polishings.

As the cleaning ends, Jacob is pale and perspiring noticeably. His blood pressure is still soaring, and the butterflies are still doing strafing runs in his stomach.

Strangely enough, his new vow to take better care of his teeth has unleashed a new paranoia rattling around in his closet of fears.

"Now," Jacob says softly, "I'm deathly afraid of getting cavities. I'm afraid I'm going to wake up and have teeth all over my pillow."

Teeth all over the pillow? Isn't that a tad, um, extreme?

"Well," Jacob says with a smile, "Maalox is an after-dinner drink to me."

Taking the cure, if there is one

In recent years, dozens of dental anxiety clinics have sprung up across the country, where fearful patients like John Stork and Arthur Jacob are taught behavioral strategies so they don't wig out while their teeth are worked on.

They're taught progressive muscle relaxation. They're given biofeedback training to help them monitor and control their physiological responses to the stimuli sparking their fears. They're exposed to systematic desensitization -- for example, if the patient fears needles, he or she might first be shown a needle sheathed in a sterile pack, then later the needle itself at some distance, and so on.

But Kim Harms, a dentist in Farmington, Minn., and an ADA spokesman, says dental phobia hasn't yet been studied enough to know how exactly how many patients have been helped by these treatments, although thousands obviously have.

Harms stresses that the profession itself has made great strides in trying to help people like John Stork, with better equipment, better anesthesia, and open, airy offices, among other things. In a 20-minute phone conversation, she mentions a "trusting relationship" between the dentist and patient a half-dozen times as the key to helping patients overcome their fears.

This is Barry Berman's credo as well. Berman has been an oral surgeon for 22 years. About 20 percent of his patients are phobic. He is, therefore, used to winning the confidence of patients who initially regard him as the Great Satan.

Certainly that was the case a few years ago, when a man in his 50s, a bricklayer, appeared in his office one day. The man was obviously in intense pain and in desperate need of help.

There was just one problem: The man was so petrified, he wouldn't let Berman examine him.

In fact, he wouldn't even sit in the dental chair, insisting on standing in the hallway as he spoke to Berman.

After vaguely alluding to horrible experiences with the dentist in his past, the man ticked off the ground rules for this visit.

"You can't touch me. You can't touch anything in my mouth. And no picks!" the man said, referring to the dentist's explorer. "If I see a pick, I'm outta here!"

Ohhh-kay, Berman thought. What are we doing here, faith-healing?

"What we'll do is this," the man continued. "I'll open my mouth, you look, find out what's wrong. Then I'll leave and come back in a few days and you'll put me to sleep and fix everything."

Finally the man opened his mouth, revealing a soupy, festering morass of gum disease and broken teeth lying about like rotting tree stumps.

End of visit.

But sure enough, the man returned the following week. Berman knocked him out and removed a total of 25 severely damaged teeth.

Most people would wake up from such an ordeal, look in the mirror and scream long into the night -- perhaps while speed-dialing a personal-injury lawyer.

But from this man's expression, you'd think he'd just woken up on a beach in the Bahamas with a mai tai in one hand.

"His attitude was: 'OK, now I'm going to get dentures and I'll never have to see the dentist again,' " Berman remembers.

"It's amazing what fear does to certain people," Berman says with a smile.

Then he tells you about a woman named Ann Gripshover.

"The worst!" Berman says. "The No. 1 super-phobic! You have to talk to her!"

Ms. Megafear

Compared to what she's been through, a dental phobia clinic would be like a Club Med vacation for Ann Gripshover.

"No one is as afraid of the dentist as I am," says Gripshover, 34, a bank teller from Eldersburg. "At least no one that I know of. Just talking about the dentist now makes me anxious. My palms are sweating."

This is Ann Gripshover's story: Four months ago, hysterical with pain and whacked out on codeine, she was literally pushed into a car by two co-workers and driven to Barry Berman's office, with one co-worker threatening to punch her lights out if she didn't have her inflamed wisdom tooth treated.

But that's getting ahead of things.

Long before she lurched into Berman's waiting room on unsteady legs, tears and mascara streaking down her cheeks, Gripshover was your basic dental basket case.

She traces her phobia to a wisdom tooth extraction at a dentist's office nine years ago.

Immediately after, she began experiencing severe pain, which was later blamed on a "dry socket," a blood clot that left the bone exposed to air.

She says the pain became so bad that evening she actually started reeling around the house, hallucinating.

"I was seeing back when I was a child," Gripshover recalls. "I remember saying to my mother: 'Where's my red dress? I need my red dress for school.' "

Gradually the pain subsided, but not the memory of that horrendous night.

"It left a mark on me," Gripshover says. "It terrified me."

For nine years, she refused to go to the dentist. Then four months ago, she awoke one night with severe pain. Somehow she screwed up her courage and went to have the tooth looked at.

The visit did not go well. The dentist gave her six shots of Zylocaine and put in a temporary filling, although the anesthesia kept wearing off during the procedure.

"He says: 'You shouldn't be feeling pain,' " Gripshover recalled. "I'm like: 'Well, I am feeling it!' Tears are streaming down my face!"

The dentist said she need a root canal. The diagnosis terrified her ("I'd heard all the horror stories"). She went to Barry Berman for a second opinion. He agreed she needed a root canal, but said it could wait a while.

Not long after, though, the tooth started hurting again. Then one evening, it went into full meltdown, a throbbing Chernobyl in the back of her mouth.

She took three prescription Tylenols with codeine, didn't sleep a wink and arrived at the bank the next morning a dull-eyed zombie.

Susan Hopper, a co-worker, recalls: "She was flying on codeine and in such pain, she looked like she wanted to commit suicide."

Hopper took one look at Gripshover's face and inquired delicately: "What the hell is wrong with you?! Why aren't you at the dentist?"

Gripshover mumbled that she was too scared to go.

At this point, Hopper ripped a page from the Carlo Gambino Handbook on Negotiating.

"I got down in her face," says Hopper, "and I said, 'I want the name of that damn dentist or I'm going to beat the [bleep] out of you.' "

Within minutes, Hopper and a colleague were shoving Gripshover into a car and driving like Thelma and Louise to Berman's office, where Gripshover was given general anesthesia and the tooth was extracted. Offhandedly, Berman mentioned that another tooth would probably have to come out, sometime in the future.

Fine, whatever, thought Gripshover. Just get me outta here! And she never made the appointment.

A couple of weeks ago, she was back at her bank teller window when Berman walked in.

He happened to be there merely as a customer. But at the sight of him, buckets of adrenalin began coursing throughout her body. Her phobia kicked into overdrive, and she apparently imagined him as the Tooth Gestapo, here to drag her off for another extraction.

The color drained from her face, and with wide-eyed customers looking on, she shouted: "OH, GOD, YOU'RE HERE FOR ME, AREN'T YOU?!"

It took Berman several moments to persuade her that he was not there for her, during which time Ann Gripshover looked as though she wanted to lock herself in the vault For several hours.

Clearly, there is hope for dental phobics. But you mention attending a dental anxiety clinic to Ann Gripshover and there is silence on the phone, the kind of silence where you can run through half the alphabet in your head and still no one's talking.

"Just give me drugs and gas," she says finally, "and I'm good to go."

She says she plans to have the other bad tooth taken out "sometime after Christmas."

She'd rather not be any more specific.

Pub Date: 12/08/96

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