By now, dentists know by the look of them which patients are skulking in to get their first visit since the start of the pandemic over with. Some are self-conscious, others preemptively apologetic. Occasionally, patients are so flustered they have trouble even doing the “open wide” part: “They’re like, ‘Don’t look at my mouth!’” says Warren Woodruff, a dentist in West Bloomfield, Mich.

“I’m like, ‘You’ve got to take your mask off or I can’t help you,’” says Woodruff, 37, with a laugh. “I always try to tell them: ‘What I see from you, I’ve seen a lot worse.’ ”

The stragglers are returning to practices like the one Woodruff co-owns with his wife, fellow dentist Amira May Woodruff, also 37. Call them the two-year tooth truants, who diligently stayed away from dentists’ offices during the pandemic, eventually began to lean on it as an excuse and now need help alleviating their oral-health woes. They’re back in the waiting-room chairs, leafing absent-mindedly through old issues of Us Weekly and steeling themselves for the pain — and the embarrassment.

Missing a cleaning, as the Woodruffs dutifully remind us, can result in tartar buildup, which can lead to gingivitis and bleeding of the gums and eventually cause irreversible bone loss around the teeth. Before the pandemic (if you can remember back that far), missing an annual or semiannual teeth cleaning meant risking a guilt trip at your next one. Now, many Americans have missed several, from office closures or fear of virus transmission. Says Nimish Maniar, 33, a dentist in Lake Mary, Fla., “You would not believe how many people have … come back with a feeling of shame.”

Jennifer Glatz, a digital content producer for a TV station in Berlin, Conn., went to see her dentist just before Christmas for the first time since 2018. “I didn’t go all of 2019, then 2020 happened,” she says. When chewing became painful, she made the long-overdue appointment, suspecting she needed a root canal. “I was silently praying … that I didn’t ignore my problem so long that it would be a bad situation for me,” she says.

Fearing a big medical procedure that would require anesthesia (and the big medical expense that accompanies it), Glatz, 31, was relieved to hear that her problem was actually four cavities. “It was like, ‘Okay. I can do fillings,’” she says.

At the Woodruffs’ office, “Even people who typically don’t have cavities are coming in” for them, Amira says. And it’s not just from neglect. “Stress reduces saliva, and saliva protects your teeth from cavities.”

The pandemic has also altered people’s routines in ways that have negatively affected their teeth. Working from home, many are snacking more, forgoing brushing in the morning (“They’re like, ‘I’m not going to see co-workers, so I’m not going to brush’”) and falling asleep before brushing at night. “We’re also seeing a rise in people breaking their teeth. A lot of that is from stress, people clenching and grinding more, so more TMJ issues,” she says, referring to the temporomandibular joint at the intersection of the cheekbone and jaw. “It’s just, like, a perfect storm.”

As one periodontist in Bryn Mawr, Pa., told Philadelphia Magazine last year, “Some days, cracked teeth is all I do.”

Marlowe Keller, a molecular biologist in Seattle, was told once that her family history of gum recession made it likely she’d need special dental care after college. Unfortunately, that didn’t stick. “I was like, ‘Cool. This is a problem for future Marlowe,’ " she says.

Keller, 23, graduated during the pandemic. When she finally went to the dentist in November for the first time in two years, she had expected a routine cleaning, perhaps with a side of guff for having stayed away for so long. “Instead, they measured all my recession, which had gotten quite bad,” she says. “Recession is affected by stress, as you might imagine — if you’re clenching your teeth a lot, like if you’re in a global pandemic,” Keller said. “Suddenly, future Marlowe was here.”

After an hour of gum-poking and X-rays, the dentist suggested a deep cleaning. Keller gave the thumbs-up; she didn’t have anywhere else to be. Alas: “They were like, ‘Oh, no, we need to book two separate two-hour appointments,’ ” Keller says — one for the top half and one for the bottom half. Plus a third: The sealant on one of her teeth was beginning to wear off and needed repair.

“I’m not skipping anymore,” she said. “I’m not going to have this happen again.”

Brush up on how to care for your teeth with these tips from dentists

Practitioners like the Woodruffs are aware that going to the dentist, where the possibility of being chided while trapped under a lead apron with a mouth stuffed with gauze looms large, is not one of America’s favorite pastimes — and that the pandemic was a perfect proverbial fig leaf for putting it off. “The majority of my patients who stayed away are people … who’ve had previous bad experiences at other offices,” Amira says. “So they love that they’ve had an excuse not to come.”

The Woodruffs found, however, that when they posted a video in the spring of 2020 detailing their office’s hygiene procedures aimed at curbing the spread of the coronavirus, a surprising influx of patients started scheduling appointments again. “We had a lot of people, especially the older population, say that it was that video that made them feel comfortable coming in,” Amira says.

Still, for some, the risk of a coronavirus infection outweighs even a genuine motivation to get dental care. Addie Tsai, a 42-year-old community college professor in Houston, takes special care to visit their dentist every six months because of their sensitive gums — but doing so during the pandemic has been “a comedy of errors.” A February 2021 appointment was postponed to May by a power-grid failure; a follow-up was initially scheduled for September, then pushed to December by flooding in the area. When December came, they rescheduled for February because of the omicron surge.

In late January, still worried about the possibility of catching the omicron variant, Tsai rescheduled that ill-fated follow-up for March, but not without a pang of apprehension. “There’s just this building anxiety that the longer it takes for me to get back there, the worse it’s going to be,” they said, sigh-laughing. “I know I’m going to get lectured.”