F. Zeynep Kaval Kabakaş

Yes, and the best answer to this question is the picture we see in our clinic every day: decay usually starts silently. By the time a tooth begins to hurt, the problem has usually long outgrown the limits of a small filling.

The point of a regular check-up is not to keep the patient busy at the clinic; it is to catch the problem while it is small, while its treatment is short and while the tooth's own tissue is still in place. Between decay noticed early and a tooth left too late there is a serious difference, both in the procedure and in what the patient goes through.

I explain it to my patients like this: coming for a check-up is not coming to have something done. The finest outcome of a check-up is seeing you off with 'everything is fine, see you next time', without doing anything at all. If my patients and I get to live that often enough, it means we are both doing our jobs properly.

I would ask you to think of it the other way round: you do not have to defeat the fear at home on your own; that too is part of our job. Dental anxiety is nothing to be ashamed of or to hide; a great many people sit down in the chair tense, and I have known how widespread it is ever since I took part in a research project on the subject in my student years.

When I work with an anxious patient, spending the whole of the first session simply talking is not a loss to me; it is an investment. I explain step by step what I am going to do, I say from the outset that my patient can raise a hand and stop the process at any moment, and I keep that promise. Once patients know the control is theirs, the tension usually shrinks by itself.

There is no such thing as a cowardly patient; there is a patient to whom the process has not been properly explained. Fear is not a reason to go untreated; it is information that shapes how we will carry the treatment through together.

A patient arrived for their first appointment, came into the treatment room and did not sit in the chair. They pointed to the chair by the door and asked whether they could sit there instead: they had only come to talk. They told me they had been putting off the dentist for years, and that what had happened at their last visit was still with them.

That day I did not so much as look into their mouth with a mirror. We sat on the chairs and talked about why they had come, what they were afraid of, what kind of process they wanted. On the way out they asked for the next appointment themselves. At the second session they sat in the chair, but on one condition: I would only look. That is what we did. We began treatment only at our third meeting, and we carried every step through by explaining in advance what was going to happen.

I have never forgotten what they said to me when the treatment was over: 'It turns out I was never afraid of the treatment; I was afraid of having no say.' That patient reminded me of the measure of my profession: speed is not always the mark of good dentistry. Sometimes the most correct clinical decision is to do nothing at all on the first day.