by Chris Bertram on December 22, 2023

I don’t know about you, but my relationship to dentistry is somewhat infantile. I went this week. I go every six months (hygienist too) but though I brush twice a day with an expensive electric toothbrush, I’m very bad at all that interdental work you’re supposed to do. But then when I notice that the appointment is coming up, for ten days or so, fearful of being told off by the dentist, I work hard with those little brushes – red, blue and yellow – in the hope that I won’t be admonished this time round.

It never really works. There’s always some plaque here, some bleeding there and I get the lecture on what I have to do. Often it seems to be the opposite of what I remember from the previous time: use the thinnest brush first or last? And there was a period when the hygienist was keen on interdental brushes and the dentist was pushing me to floss instead. But they seem to have converged on the little brushes now.

I’ve been going to same dental practice for over thirty years, though the personnel has changed. The guy I first went to in the 90s, Mr S, crowned two of my front teeth after they had greyed and blackened following a painful abcess when a graduate student in London (not quite the worst pain I’ve experienced, try gallstones for that). As many of you know, while they are making you some permanent crown, the dentist fits temporary ones. Mr S advised me not to eat French bread, but I had to attend a meeting in London of the New Left Review editorial committee, of which I was then a member. There was food: sandwiches made from baguettes! I was hungry and that was all there was. So I thought, I’ll be carefell. But the caps came straight off and there I was looking like Count Dracula with those sharpened pegs.

Generally, Mr S seemed somewhat flakey and possibly intoxicated, although certainly jovial and friendly. But I have that deferential British habit of giving professionals too much of the benefit of the doubt so I stuck with him until his partners prematurely retired him “to pursue his interest in Indian classical music”.

I’m now onto my fourth. Mr P. Mr S’s great-grandchild as it were, who seems pretty good, or at any rate has the gift of seeming pretty good. What do we who are mere patients know of the truth about our ailments and treatments?

Some of my infantilism at the dentist’s is doubtless down to my character: a tendency to only study really hard when the exam is imminent but also a fear of being ill-thought of by the teacher. But I suspect many of our responses to dentists are set in childhood when the visit was a matter of fear and apprehension. We went to a Mr B in Nottingham, who seemed to drill and drill away and may have even been paid per filling by the NHS, back when NHS dentistry was a thing. Over the past ten years or so his work has caused me no end of problems as the metal then used for fillings expands and contracts at a different rate to the tooth, causing cracking and chunks to fall off. (This usually happens when I’m far from home: once at a conference in Canada, another time in France.) Once there’s enough disintegration, then root canal and crown get recommmeded and that’s several hours in the chair and the whole wallet has to come out. Thank you Mr Bain, your profits when I was ten are my losses at 65, in two senses.



engels 12.22.23 at 6:39 pm

My last contact with my dentist was 4 years ago. When I told them I was running 5 mins late for an appointment they told me to cancel it. Little did I know that by doing so (perhaps coupled with lockdowns) I exceeded the interval required to keep my NHS registration with them. They refused to let me back in except as private patient paying several times as much as before for the same services and according to the NHS website the nearest practice I could register with now is two hours away.

At least you can buy pliers on Amazon.


Suzanne 12.22.23 at 8:58 pm

In the US dental care is pretty much like medical care – if you’re employed and have a generous employer, you probably feel pretty good about your coverage. If not, well….

I have sensitive teeth but a good job and a trustworthy dentist who doesn’t recommend anything I don’t need, so I feel fairly fortunate. The issue with plaque is that you can’t get rid of all the buildup in frenzied brushings and flossings a week or so before your appointment. Attention must be paid continuously. That said, after a certain time without a professional cleaning I always seem to end up bleeding from the gums like a flailing boxer no matter what.

I went for a few years without seeing a dentist and my teeth were in decent shape when I went back, but I realize now that was dumb luck.


Matt 12.22.23 at 10:32 pm

The traditional/historial availability of dental care in Australia is no doubt well reflected in the relatively large number of middle-aged and older (and even a surprising amount of younger) people with missing teeth. It’s possible to find good dentists with up-to-date equipment, but relatively few services are covered by Medicare, and even the private insurance coverage isn’t great – I pay more, for less coverage, than I did in the US, and I pay as much as I can – my fund doesn’t offer a higher rate of coverage. Still, the best dentists I’ve been to here have been fairly good.

It seems to me that finding a good dentist is a lot like finding a good mechanic – it’s hard to know yourself what really needs to be done, they make money by doing more things, and you want one who has the proper balance between doing too little and too much. But, it’s hard to know before hand. I’ll admit that I still have fond memories of the dentist I went to in my teens, who is the only one I’ve ever gone to who used laughing gas. That stuff really was great, though I understand why it’s rarely used. He was, perhaps, a bit too relaxed on pushing for things to be done, and his smoking habit was a bit annoying, but I’d be willing to over-look that for the gas again. Oh Well. And, I’ll admit, I don’t understand the adversion to flossing. Especially if you buy dental tape (which doesn’t fray as much as floss) it takes just a minute or two and isn’t hard at all.


KT2 12.23.23 at 12:17 am

My first dentist visit was a nightmare. 3 by demonic dental nurses – Gidets in black winged nun style headress – to hold me down. And the dentist both drowning and suffocating me with ether. Ah… the ’60’s. Revenge by way of vomiting from chair to car and Mum, as she had to drag me all the way. I said no to braces after that.

Wierdly, a family nember with the same lame diet got no caries nor a grey hair until their late twenties.

Luckily (awaiting long term study), one dose probiotic genetically enhanced bacteria… and NO dental caries it seems.
“Cavities were cured in 1985, and,
no one knows it yet.”



bad Jim 12.23.23 at 6:16 am

This is going to be uncharacteristically bad.

My lower jaw was too small for my teeth, so a few had to be removed and braces worn for years, continuously lacerating my gums. In college the retainer interfered with my efforts at speaking German, so I stopped wearing it (and removed some ancillary hardware) and wound up with a conspicuously crooked grin. The worst of it was that I smoked unfiltered cigarettes, and wound up looking like a licorice addict.

I went without dental care of any sort, mostly but not entirely without occasional pain, for almost forty years, until it became clear that a broken tooth was not going to be a self-limiting affliction. The dentist cleaned it out, and disgustedly ground off a layer of blackened plaque and what not. At length I was fitted with a bridge (my mighty triple tooth!) and a couple of crowns, and eventually had a filling or two replaced, but otherwise just periodic cleanings.

My father was nearly toothless at the end, and my youngest brother has an upper plate, but the rest of us seem to have inherited my mother’s formidable dentition.

I long for the day some president proposes “a health care policy with teeth!”


Neville Morley 12.23.23 at 9:05 am

I can’t imagine that anyone actually likes going to the dentist – unlike the doctor, there isn’t a scenario in which they’re going to say “that’s all fine, no need to do anything”, it’s just a question of whether it’ll be uncomfortable poking around or something worse. And I say this as an obsessive brusher and flosser who had wisdom teeth removed over thirty years ago and hasn’t had anything worse than plaque removal and polish since. But my associations are reasonably positive, as my first dentist was a lovely man; looked and acted a bit like a mad scientist (he’s my image of Professor Branestawm) but meticulous and not at all careless; had been long-standing district councillor as a professed communist (in Surrey!); married to an equally lovely Greek woman (possibly a refugee from the regime of the Colonels originally) who worked as office manager and receptionist, and their daughter took over the practice – and I once borrowed their flat on the Gulf of Corinth as a base for my first trip to Greece as a student. So I feel permanently obligated to keep up the flossing…


Neville Morley 12.23.23 at 9:06 am

That, plus encountering Pam Ayres’ ‘Oh I Wish I’d Looked After Me Teeth’ at an impressionable age.


hix 12.23.23 at 9:47 am

Finally, an important topic! Just went to the dentist to do my mandatory annual checkup last minute (to keep full insurance co-payment when something breaks). It will be at least another 30 Euro (90 for the recommended procedure) either way. Oddly, I was somewhat relieved to learn it is the same amount no matter how poor I am, since that is one less insurance form to fill out. For some of the more expensive repairs, you get a higher insurance payment in Germany.

To go to the outright dark point from there: Apparently my teeth are all pretty much ruined by acid damage. In all likelihood some secondary effect of anxiety/depression on my stomach, no one caught some years back. I also ruined some in the more straightforward way of just not managing to go to the dentist or brush my teeth on a regular basis no matter how bad things were during my worst period about a decade ago.

Still somewhat angry with my therapist back then. He should have just sent me to a clinic, or at least told me that option exists (i used to be very new to that part of the healthcare system, not for lack of necessity in the years before however), instead of just listening to “i can´t handle to go to the dentist even so all my teeth hurt” among other indicators his support is rather non-sufficient at the moment.

Guess we are in a comparatively good place regarding dental care in Germany*, but I am still pretty sure you cannot seriously claim my more expensive co-payments had anything to do with me behaving irresponsible out of my own free will. And I got no energy or competence to compare prices or the necessity of every dental procedure either, probably just like anyone else either.

*If we are to believe Friedrich Merz, that must be the only reason anybody would come here as a refugee….


DonA In Pennsyltucky 12.23.23 at 1:01 pm

My hygienist told me about floss piks. That was six or seven years ago. I get the ones from Oral B with teflon floss. I have had no gum problems since.


Harry 12.23.23 at 4:28 pm

At university I met a girl from Slough, with whom I had exactly one conversation. She said her dad was a dentist — their last name was unusual enough that I realised he must be one of the dentists in the practice we’d gone to when we lived there (and where my dad still went, several years after we’d moved away, because he liked her dad so much and his view was that if you like a dentist stick with them forever). When I commented that my dentist had been her dad’s partner she looked at me in utter horror. Apparently he was a useless drunk from whom her dad had only just managed to separate. My teeth are AWFUL, which is partly genetic, and, apparently, partly down to truly dreadful dentistry in my teen years.

I floss thrice a day minimum, and brush after every time I eat (I don’t snack or drink anything other than water between meals), and have generally come to regard them as leisure activities. A couple of years ago my hygienist introduced me to tooth picks, which I also enjoy using. People say “You take such good care of your teeth, you must have great teeth”, which shows how little they understand causation: I have dreadful teeth and that’s why I take such good care of them.


Jeff 12.23.23 at 7:05 pm

Those of you in a city with a dental school, why not go for treatment there, from the six-month cleaning to more complicated stuff? (This is in the USA, less sure about elsewhere.) Sure, it’s students and it takes a lot longer, but 1) People have to learn their trade from somewhere, and 2) They are always checked by faculty, so you get two sets of eyes for the price of one (and the price is usually lower than a usual private appointment, even if the dental school is out-of-network). Oh, and the student practitioners are less likely to be holier-than-thou when giving their verdict on your teeth. A lot less stress in my experience going to two different dental schools for cleaning & treatment.


Peter Dorman 12.23.23 at 8:47 pm

My story has a bit (oops) in common with Harry’s. About 30 years ago I was shown an x-ray of my teeth, with an accompanying analysis of how screwed up my roots were and how I was destined for a lifetime of dental trauma. I got religion and took up a rather rigorous routine: flossing, very systematic brushing (with powder), proxabrush and rubber stimulators twice a day, now supplemented by a waterpik. The result has been a difficult but not disastrous tooth history. I have a funny story about an emergency root canal in Thailand which I won’t tell, but the most significant thing, I guess, is that I needed a big reconstructive project a few years ago, and it was paid for by the buyout I got for early(ish) retirement from my college, which was in an enrollment crisis. It all works out for the best.


Chetan Murthy 12.23.23 at 10:18 pm

Suzanne: wow, you must have a generous employer indeed! I have dental coverage from my (now former) employer (COBRA’s gonna run out in a few months) and ….. it covers $2k/yr. That’s it. So when I had to get 3 teeth removed and implants put in …. well, that’s gonna cost more than my rent for the year (grimace) and almost all out-of-pocket.


Michael Cain 12.23.23 at 11:27 pm

My experience with Crest’s specialty gum toothpastes is that they do help with gum health and bleeding. They won’t do it by themselves, some sort of flossing or equivalent is needed. My dentist recommends a Water Pic or knock off.


Austin Loomis 12.24.23 at 4:20 am

String floss (I prefer mint waxed, brand irrelevant), mouthpicks (GUM brand), proxabrushes (ditto)… none of it quite makes the nut. My kindly gray-haired mother often recommends floss picks; maybe I’ll start testing that theory before my next appointment (some time Wednesday week).


David in Tokyo 12.24.23 at 3:59 pm

Japan recently downgraded their dental coverage: they used to insist you get a cleaning and checkup FOUR times a year, now it’s only three. My out-of-pocket expense for it is about US$7.00. The hygenist grinds and prods and scrapes and polishes for an hour. It’s exhausting. The dentist doesn’t like me: I only do insurance covered repairs, which include crowns. Japan does not use amalgam. My SO dislikes even the slightest hint of silver, so has for-fee ceramic crowns done (insurance covers tooth-colored repairs for front teeth only). For serious money.

(About 10 years ago I had a really nasty chipped tooth (small chip, but it cut my tongue painfully), went to a new dentist, and he fixed it lickety-split with a quick-setting polymer resin. I’ve been waiting for said quick-and-dirty repair to fail. But it refuses to.)

My molars are all crowned. They were all amalgam when I moved here permanently.

Oh, yes. I was flunking out of MIT Materials Science grad school and wangled a one-year boondogle to Tokyo. I didn’t get my teeth checked, and several of the amalgam repairs had failed and needed replacing. When I got back to MIT, I went to the MIT dentists. They “fixed” the amalgam by putting more in. Thanks, I said, and went on with my life. I dropped out of grad school, got a job, and helped out with my class’s first (5th year) reunion. AND.THEY.FOUND.ME. I got a seriously nasty dunning letter from the MIT lawyers telling me that I would be going to jail for my unpaid bills. Huh? It turns out that if you drop out, they send everything to your prior address, which was in Japan, including the dental bills (which were actually some serious money, or would have been had I not landed an overpaid programming gig).

Now I’m 71, the teeth need to last another decade or two, so I brush after meals, one of which is a brush-floss-brush session (floss picks). Also, tooth bacteria are associated with dementia, and I’m not getting any younger. And I’m clearly wacked-out-crazy. Which brings me to sugar.

Sugar is toxic. It causes obesity, diabetes, heart disease, cancer, Alzheimer’s (indirectly: people with bad teeth are at higher risk for Alzheimer’s) and all-cause early death. Corn surup is worse. And the corn surup industry funds tons of research to show how terrible sugar substitutes are. Aspartame, in real life, is the safest component of US foods. You can feed rats 300 times (per unit body weight) what a diet coke addicted 24/7 gaming nerd could possibly consume, and they show no ill effects whatsoever. For months on end. But since the diet-coke consuming cohort is dense of people who have weight problems (so they drink diet coke), observational studdies show diet drink consumers are less healthy than non-consumers. Doh!


Cranky Observer 12.24.23 at 5:19 pm

My experience from age 40 forward has led me to believe that the affect of oral health on general health, and particularly cardiovascular health/conditions, is poorly understood and greatly underestimated. Tooth, gum, and jaw infections can lead directly to serious and chronic problems elsewhere in the body. And the current US health care system and its payment process treats the basic preventative and restorative care which prevents such damage from spreading as optional and, ultimately, for the wealthy only.


Waquoit 12.24.23 at 10:28 pm

One I started to keep those little brushes in my desk and do a quick brush a couple of times a day I’ve been good. It’s really not that tough. And I was much worse than you.


David in Tokyo 12.25.23 at 6:32 am


Aubrey Flounders 12.25.23 at 10:09 am

I grew up in the time when Colgate ran an ad about a kid who went to the dentist and didn’t have cavities (look, ma, no cavities!), and the story was so preposterous that they changed it to “look, ma, only one cavity!” I was bullet-proof, though, the only kid in my school who had no fillings. When I was around forty I went to a dentist and he called people in from the next room to look at my teeth. Said they were the hardest teeth he’d ever seen. Look, no cavities!

Then an oral surgeon told me my gums weren’t right, and he sold me on a procedure where they grind the bone down so it’s flat against the tooth with no pockets for bacteria to collect in. Of course grinding that bone away exposed a lot of new and apparently soft tooth surface, and within five years most of my molars decayed through at the gum-line. I had at least ten root canals and then extractions. I believe that in fifty or a hundred years people are going to say, “they really did that?” The way we talk about bleeding and leeches, or lobotomy as a cure for depression. Don’t do it!

The good news is that after American Oral Surgery is done with you, you can get implants in Costa Rica for about twenty percent of the US cost, including the air tickets and hotel. Requires two stays of a week each, one to set the implant and one to cap it after it sets up, but you can surf or go turtle-watching between office visits.


Bob 12.26.23 at 4:10 pm

Chris: “Some of my infantilism at the dentist’s is doubtless down to my character: a tendency to only study really hard when the exam is imminent but also a fear of being ill-thought of by the teacher. ” Me too!


Doug K 12.26.23 at 5:12 pm

USA now, also underwent a number of keen drillers in my youth. All those mercury/amalgam fillings are now falling out, leaving insufficient tooth to be repaired and filled due to the keenness of my childhood dentists. My last implant was $5000 out of pocket, with what passes for good dental insurance in the USA. The root extraction was done with a small hammer and chisel and only local anesthetic as general anesthesia would have been another $2000. Quoth the dentist, wow this one’s really deep. To which I could only respond, urgh.

Now when I go to the hygienist they say, good job ! and I say, damn straight I’m going to protect my investments.

Visited South Africa last year for Christmas, and realized I could get implants there, air tickets and hotel included, for about a thousand less than in the USA. Plus, then I could see family and friends. So I’ll be a dental tourist for the next implant.


Alan White 12.28.23 at 6:25 am

I’ve had good teeth most of my life, only betrayed in my 50s by two identical parallel premolars that cracked within 6 months of each other and required bridges. But that also turned out to be a blessing, forcing me to floss and brush and rinse with fluoride every day. And in addition my new dentist is a former student–one of my best over all my years of teaching–who simply just tells me the truth about my needs and care, and encourages me to keep up what I’m doing. Were that the norm for the industry, instead of profiteering.

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