SpongeBob and Patrick are having fun chewing on some salt water taffy at the Bikini Bottom Fair. Patrick pulls some sweets his mouth when suddenly, Patrick begins to feel pain in his mouth and assumes that it has something to do with his teeth. SpongeBob suggests that Patrick should go to the dentist. Although Patrick doesn't want to because he's afraid of the dentist, he reluctantly goes.
At the dentist office, Dr. Mundane checks Patrick's teeth and finds that he still has a baby tooth. He tells Patrick that in order to make the pain stop, he needs to extract the tooth so the adult tooth can grow in its place. But Patrick refuses to let his tooth go. As they head home, SpongeBob tells Patrick about Tooth Island, a place where baby teeth are sent by the Tooth Fairy after being extracted from someone's mouth. Patrick still refuses to leave his baby tooth and claims that he knows what's best for it.
As time went by, Patrick continues to suffer pain in his mouth and finally decides to get his tooth to the Tooth Fairy. Squidward, who doesn't believe in the Tooth Fairy, rants that there is no such thing. He bets that if SpongeBob and Patrick could prove that if there is a Tooth Fairy, he would eat a bucket of raw chum meat, which disgusts them. SpongeBob suggests to have Patrick's tooth removed, but Patrick doesn't want to and runs away. SpongeBob pursues Patrick in a chase and finally catches him. When SpongeBob showed him photos of how SpongeBob's teeth were handled, Patrick finally decides that it's time to have his tooth removed.
Dr. Mundane successfully extracts the tooth and at night, Patrick puts his tooth under the pillow so he can go to Tooth Island. While Patrick is sleeping, SpongeBob sneaks in to take Patrick's tooth. However, he got caught by Squidward, thinking that he proved the Tooth Fairy isn't real. Patrick was disappointed and believed that SpongeBob had betrayed him. But SpongeBob doesn't believe that and takes Patrick and Squidward to the docks. There, he shows them the real Tooth Ferry, which turned out to be a cruise ship. Patrick is overjoyed and says good-bye to his tooth. After the ship departed, SpongeBob and Patrick punished Squidward for trying to ruin their friendship and forces him to eat a bucket of chum meat, which resulted him in losing his own teeth.