Content Warning: This section includes discussion of parent illness and death and bullying.

The one-page Prologue reveals a mysterious conflict: In an undisclosed town, children place a tooth beneath their pillow at night for the tooth fairy, expecting a small treasure in return; instead, they wake to find “something unspeakable” there. Live insects, dead slugs, or even worse discoveries await them. No one knows who is to blame or what their goal might be.

Twelve-and-a-half-year-old Alfred “Alfie” Griffith’s fear of going to the dentist is so strong that he simply never goes. As a result, his teeth are in dreadful shape; several are rotten, and others have fallen out. A traumatic dental visit when Alfie was six caused him great fear; Mr. Erstwhile, the elderly dentist, tried and tried to pull a rotten tooth from Alfie’s mouth, enlisting the aid of the nurse, the receptionist, and other patients to help, with no luck. The tooth eventually gave in to the pressure of the forceps, exploding in Alfie’s mouth. After the awful procedure, Alfie discovered that the dentist pulled the wrong tooth.