If you haven’t had a dental checkup in a while, you’re not alone. Research shows that nearly half of Americans have put off visiting the dentist due to fears about COVID-19.

Unfortunately, people who have delayed their treatment and those who are still avoiding the dentist’s office may be in store for some unexpected dental problems…and sticker shock.

Even though dental offices were closed except for emergency procedures earlier in the pandemic, they now are operating under extensive infection-control guidelines to minimize any risk. In fact, when dentists resumed treating patients, they reported extremely low rates of COVID-19 infection (less than 1%), which was attributed, in part, to standard safety protocols that dentists already follow. Now, even greater precautions are being taken.

What you need to know about resuming your dental care…

Routine checkups are crucial

No matter when you last saw your dentist, it’s important to remember that preventive dental care, such as regular cleanings and exams, is the best way to avoid unpleasant (and expensive) surprises in the future.

Many people try to get by with annual dental cleanings and checkups, but you’re less likely to get a troubling diagnosis or a big bill if you make regular six- or nine-month appointments. These routine visits are great for identifying the most common dental problems—dental decay and/or gum (periodontal) disease. Most dental ­insurance plans cover such routine care on this schedule.

Frightening statistic: One in every four American adults has untreated cavities, and nearly half of people age 30 or older have signs of gum disease, according to the Centers for Disease Control and Prevention. If left untreated, these conditions can lead to tooth loss and more.

What you don’t realize about teeth…

Dental problems don’t always cause pain. Even if your teeth feel fine, that doesn’t mean they are healthy. Here’s why: The nerves that would alert you to pain are buried deep within the tooth beneath the enamel and other protective layers. This means your tooth can become significantly damaged before you feel it. You also can have advanced gum disease that causes bone loss and even loose teeth—all without pain.

Once tooth pain occurs, the problem often is so far along that extensive dental treatments, such as root canal, bone grafting or an extraction, may be needed. These all are expensive. So don’t be surprised if your dentist recommends treatment for a tooth that feels perfectly fine to you. Also important: Your nerves shrink inside your teeth as you get ­older, which means that even more damage can occur before your teeth finally ­become painful.

Your medications may cause “silent” damage. Antidepressants, ­antihistamines and some blood pressure drugs are among the medications that can cause dry mouth, which increases your risk for tooth decay. That’s because saliva helps neutralize acids created by bacteria in your mouth and even can help repair tooth enamel.

Helpful: If you take a medication that makes your mouth feel dry, ask your dentist about getting a prescription for high-fluoride toothpaste. This may help strengthen teeth and reduce the risk for significant dental decay.

To see if a medication you’re taking can cause dry mouth, look on the drug’s package insert for the word ­“xerostomia” (the clinical term for dry mouth) as a possible side effect. If you take a ­nutritional supplement, check the drugs, herbs and supplements on the National Institutes of Health’s website—go to MedlinePlus.gov, and click on “Drugs and Supplements.”

Do you really need that treatment?

If you’re behind on your routine visits, be prepared for your dentist to ­recommend unexpected tests and treatments. This is especially true if you’re seeing a new dentist for the first time—a trend that’s emerging as increasing numbers of dental professionals now are retiring or closing their practices due to the additional protocols necessary to help prevent the spread of COVID-19.

Here’s how to ensure that recommended tests and treatments are necessary…

Keep track of your X-rays. Your dentist relies primarily on X-rays to help identify problems, such as cavities, bone loss and infection. Most adults with no ongoing dental issues may need X-rays only every two to three years, while those who have gum disease may require them more often. What’s important is knowing that you have access to your X-rays if you switch clinicians.

If you’re seeing a dentist for the first time for any reason, it’s wise to get your dental records and past X-rays so that he/she will have a baseline to help identify any developing problems and won’t have to do a new set of X-rays. Note: You may have to pay a small fee to your former dentist to digitize or copy your printed records.

Ask the right questions. If your ­dentist doesn’t tell you why your teeth need the treatments he is recommending, don’t be shy about asking. To prompt the conversation, you can say something like, “Can you please explain to me what the problem is you’re seeing in the imaging? And why are you recommending that course of treatment?”

Similarly, if your dentist recommends that a filling needs to be replaced, it’s perfectly reasonable to ask why. Generally speaking, you don’t need to replace an older filling that’s still intact simply for a newer and “safer” material. Dental fillings should be replaced only if they are chipped, broken or there is leakage underneath the filling that’s causing decay and deterioration. Important: As with other dental problems, a filling doesn’t have to cause pain for damage to occur.

Don’t downplay “aesthetic” work. Many people assume that treatments designed to fix crowded or misaligned teeth are done to simply improve one’s smile. But that’s not always the case. Some orthodontics work is recommended to help prevent future problems, such as increased dental decay, jaw pain, gum disease or tooth damage, all of which can occur if your bite is not aligned properly or if teeth are crowded.

Get a second opinion. If you think your dentist’s diagnosis is extreme—or he can’t adequately explain why you need the work he is recommending—you should feel comfortable seeing another dentist to confirm that the ­diagnosis and treatment are appropriate. This recommendation applies mostly to very complex situations that often require multiple extractions, numerous restorations or many implants. In these situations, the treatment may be costly and time-consuming, giving a greater justification for a second opinion.

You can ask the staff for a copy of your records and the X-rays to take to the second-opinion provider.

Try to space out the dental work over time. If the recommended dental treatment would create a financial hardship, ask if you can schedule the work over a longer period of time without compromising the outcome. Alternatively, ask whether a payment plan can be set up so that you can pay in ­installments.