I pull out teeth for a living. It sounds simple. The tooth is numbed with the needle, the forceps clasp the tooth and out it comes. It is not simple.

Many things determine whether you will end up with a nicely healed gum or a complication from the mini-surgery that is dental extraction.

How old are you? Is your jaw bone dense or elastic? Are you on blood thinners which means you will bleed? Do you gag or are you needle-phobic or anxious? Will you be able to sit upright or need neck support?

My patient was complicated for some of these reasons, not least that she was terrified of dentists.

"Badly broken and decayed tooth, anxious patient, on aspirin, diabetic and hypertensive," her referral read.

"Please complete procedure on the same day."

As I shook her moist hand, she said: "I love your lounge. I am planning to move here. Look at those paintings. Where did you get them from?"

I escorted her to my room.

"Hi doctor. I'm sorry. I talk too much. I don't like dentists," she said.

"You have good taste in art," I said.

I asked if she knew she was in for the extraction of a broken tooth. She nodded vaguely.

As I started to explain on her X-ray what it involved, she shook her head and gestured for me to stop.

"It has been a pain. Just get it out," she said.

I wanted to explain the procedure and obtain informed consent.

"I will be giving you a local anaesthetic injection … and then we will try to take it out.

"The tooth may break … I may have to take it out in pieces.

"It has long curvy roots which are close to the sinus near your nose …"

I could see that she was not listening.

This is a common conflict for health professionals.

A plumber doesn't need to take informed consent that the pipe he will fix may leak or burst afterwards.

It is understood that if that happens he will be called again to amend the job, with the worst-case scenario being the pipes need to be replaced.

After all, the plumber is an expert.

But the stakes are much higher when it comes to health.

Can you get back the sensation of your numb lip from a nerve that may be permanently injured while getting a back tooth removed?

Can you get rid of the chronic pain in your jaw joint that can be a consequence of long sessions with dentists?

In health care it is imperative to obtain informed consent. ( ABC News: Tony Hill, file photo )

Talking about health is difficult

In health care it is imperative to obtain informed consent, but patients like mine are not uncommon.

They will sign an informed consent form without reading a word.

Does that signed consent form then hold any value in the court of law?

Do we ask them to repeat what they have understood and add to their anxiety until they run out of the surgery and never return?

Or perform a risky operation without sharing the complications that could occur?

I asked if her blood pressure and blood sugar were under control.

"Don't worry doctor. All good," she said.

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I would have liked to explain that if her blood pressure was high, she might bleed. If it was too low she might not cope with the extraction. If her blood sugar was low she might faint. If high, she might end up with an infection.

The aspirin she took could make her bleed more than normal. If she had an infection in the tooth, the local anaesthetic might not be effective.

Talking about health is difficult. It reminds people of all the things that are either failing or have failed or need to be fixed with drugs.

They become dismissive or perfunctory. It's as if they want to disown their kidney or heart for betraying their body.

It's difficult for them to understand that the mouth often mirrors the complexities of their body.

There is no real answer to this conundrum. My teachers and colleagues have all said one thing — do what is best in that situation for that patient. The discussion holds more value than a signed consent form.

I didn't give up and neither did she

The tooth needed to come out. It was infected. I didn't think I would have another chance with this patient.

I explained what was most important, spared her some less important information and checked her medical history with her GP.

The tooth was difficult, as predicted. It snapped the moment I put my forceps on the broken top half.

I removed it piece by piece as she tried to talk every few minutes and then apologised each time for talking too much.

But we persisted. She let me do what I had to do, and I let her talk in between.

I don't think I would have had it in me 20 years ago, but time and motherhood make you patient and persistent. I didn't give up and neither did she.

After what seemed like a long time, the last remnant of the tooth gave in.

"Congratulations! We did it."

As I tied the last stitch on her gums and asked her to relax her tensed-up body, she grasped my gloved hand and said: "Thank you. I'm sorry for all that blabbering."

"It was a pleasure," I said.

Krati Garg is a freelance writer and oral surgeon.