Sixty percent of the people who sit in dental chairs say they are afraid and, the joke goes, the rest are lying.

Sixty percent of the people who sit in dental chairs say they are afraid and, the joke goes, the rest are lying.

"Fear and dentists come hand in hand," says Dr. Jim Catt of Medford. "It's mainly about pain they've had in the past, as children, most of it, so we try to figure out its origin. What's behind the experience? It's usually about pain."

Although not all dentists are clued into painlessness as job No. 1, many like Dr. Len Gerken in Ashland are dedicated to it and won't go any further if patients raise their hand — the "whoa" signal — or show any signs of anxiety, such as grimacing or foot twitching.

"The biggest thing is to look at the patient," says Gerken. "You get a pretty good read on the nerve twitching and the anxiety level. It's in the eyes and face. Sure, some fall asleep and have had nothing but good experiences, but some get pale, sweaty and emotional in the extreme."

One of Gerken's patients, Betty Fitzsimmons of Talent, brought a friend to sit by her for an extraction and was still "very nervous, scared, crying and shaking," she says, so Gerken reacted with full empathy.

"I slowed down," he says. "That's the first thing you do. I put the (dental) chair above me, so the patient is not below me in a position of weakness. I'm not going to be above them and make a bad situation worse."

If there are any grimaces or foot shuffling, Gerken says he instantly stops to tell the patient what he's doing, how far along it is and what's next. In the process, he employs some of the tools of hypnosis, gaining confidence and relaxation in the patient by letting his voice lower into a reassuring, resonant rolling sound and referring to the outcome, how it's going to be all better and you'll be on your way with a healthy mouth.

"I explain to them I don't have an agenda; I'm not going to power through it to get it over with, and I'm going to make it as pleasant as possible."

It was no walk in the park, says Fitzsimmons, but "he made me feel I'm somebody. Other dentists didn't do that. He took time, showed me the X-rays and made sure I understood everything and that it was all my decision. I felt confident."

The two things that unnerve patients, says Gerken, are the sound of the drill and the sight of the needle for injecting local anesthetic. Gear-driven drills with batteries soften the sound, and there are the familiar techniques of gum massage and topical anesthetic for easing the needle bite. It's also fine to have a loved one come in and hold your hand, he says.

A thorough education of patients before treatment is essential to instilling confidence and diminishing anxieties, says Dr. Mindy Beck of Ashland. Patients, she says, must be told about all of the options and their likely outcomes, so they get involved and make all decisions.

Oral sedatives and nitrous oxide gas are good for lowering anxiety levels and, says Beck, "patients know they can raise a hand to signal the need for a break; they're not prisoners here. They need to feel they're in complete control of their surroundings."

The best tool to counteract the whole "fearful patient" syndrome is to get regular checkups and take care of problems, says Beck, rather than thinking nothing feels wrong, so "I'll wait." With procrastination, mouth conditions get worse, more expensive, more extensive and more painful to fix — thus more fear.

"Get the beast before the beast gets you," she says, to which Gerken adds, "You can pay me now, or you can pay me later."

Taking time with fearful patients, says Gerken, does mean he sees fewer patients and exceeds fee levels set by insurers, but it's about quality of life, service and getting to know the patient.

"If I had one thing to say to my profession, well, you see the frenetic pace of the dentist flying in and out (of treatment rooms), and I would say, 'Treat patients as individuals and slow down.' "