“I can’t imagine anything worse than staring into someone’s mouth all day,” the man growls disdainfully from the dental chair. Personally I think that feet would be much worse. After quoting him the standard cost of an NHS filling, he grumbles, “I bet that will help towards your Ferrari.”

I am definitely not poor, but I am not driving a Ferrari either, nor holidaying every month on sun-soaked islands. I work extremely hard for a living, sometimes doing 11-hour days to relieve as many cases of toothache as I can physically squeeze in. And a decade before my career even began I was studying furiously while many my age were out partying. So I think it is fair to say that I have earned my salary.

Being a dentist can be fantastically rewarding when you manage to transform someone’s smile, enabling them to find a partner with their newfound confidence, or simply helping them to eat their favourite chewy foods again.

But fear is a huge theme in my job: the sooner you get that painful tooth checked out, the quicker and more painlessly it can be resolved. Some people will do anything to avoid going to the dentist, from using superglue (which is the death knell for any tooth) to one particular lady who glued false nails onto her decaying teeth so they would look better from the front. Bad breath in the chair is rarely an issue because we wear masks. Although there are definitely occasions when a second mask would be preferable.

I work for the NHS, mainly because it offers far more dentistry jobs in my local area. I would ideally carry out private work too, so I can use the skills I trained for to their full extent. Very advanced, complicated treatment is just not economical under NHS constraints. For example the NHS does not cover cosmetic treatment such as tooth whitening or a full mouth makeover. If you want the latter, the current highest NHS payment band of £233.70 will not even begin to cover the laboratory bill for artisan work, let alone the dentist’s labour time and all the surgery overheads.

However, the NHS does serve all other purposes allowing you to eat, speak and function pain-free with minimal oral disease. I can achieve fantastic results despite the financial limitations.

It’s a little known fact that both private and NHS dentists are self-employed. When people don’t show up to their appointment, we sit around completely unpaid. Yet during this empty time we still incur costs. An NHS practice can lose thousands a year from empty dental chairs owing to undelivered treatment under the NHS contract. Also, no-shows really delay the service, which is frustrating for people who need to see a dentist urgently.

Another scenario that really annoys dentists is when a patient only comes in for emergency appointments without ever returning to get the problem properly fixed. They will book long treatment appointments and fail to show up, sometimes two or three times in a row, and then nothing for a few months. One day, out of the blue, they will resurface in terrible pain, angry because you cannot miraculously restore their tooth in the five minutes before they’re due to fly off on holiday.

The current NHS system is widely accepted to be flawed. Someone with good oral hygiene who has chipped a tooth will pay exactly the same amount as their neighbour who has not attended in 15 years and needs 10 fillings, three extractions and a root canal, as under the NHS you don’t pay for each individual treatment like you do privately. The way the system works, the success of an NHS dental practice is, wrongly, measured by how much treatment has been carried out. Some patients genuinely do not need any fillings, but the current NHS system gives a perverse incentive to carry out as much treatment as possible in order to meet the annual target.

I suspect this does occur; while it is highly unlikely a dentist would drill a perfect tooth, I sometimes see excessive treatment that may not have been strictly necessary. But it’s all somewhat subjective.

One depressing new trend is the rise in hospital admissions to remove decayed teeth in children. Most parents have the best intentions but lack oral health knowledge. Frustratingly, my diagnosis of tooth decay is often met with a perplexed “but my son only ever drinks sugar-free juice, how could this happen?” There is mass confusion surrounding food-labelling claims of “no added sugar” versus “sugar-free”. Unhealthy diets and poor discipline are also an issue, with parents often saying, “My daughter won’t drink water – she will kick and scream until I give her a fizzy drink” as a justification for why their child has a mouth full of rotting teeth. I think we need stronger oral health education on a national level.

For too long the mouth has been seen as a separate compartment to the rest of the body, when actually it is the gateway to general health and wellbeing.

Like everyone, I do have days when I don’t brush my teeth for as long as I should. However, I have never had a filling and I tend to eat whatever I like. The secret is, if you have a bucket of sugar and devour it within 15 minutes or so, you are less likely to get dental decay than if you grazed on that bucket of sugar all day long, exposing your teeth to constant attack from bacterial acids. It’s all about limiting the frequency of those sugary attacks.

At the end of a long day at work, I am glad I have been able to relieve people of their pain, which is why I became a dentist in the first place. I do try to separate my professional and personal life but I often see my patients in the supermarket and it is not unknown for them to whip out their salivary denture to try to make me inspect it.

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