A potent sense of shame is a significant and overlooked reason why many people avoid seeking dental care, creating a vicious cycle of worsening oral health and deepening emotional distress. This feeling, distinct from the more commonly understood “dental anxiety,” is not just a fear of pain or procedures but a profound sense of personal failure and fear of judgment that can lead to social withdrawal and significant health consequences.
A new commentary by an interdisciplinary group of researchers argues that “dental shame” should be recognized as a critical factor in public health. This perspective reframes the problem, suggesting it stems from a complex mix of personal experiences, societal biases, and systemic inequities in healthcare. The authors propose that addressing this shame directly through more sensitive and empathetic practices is essential to improving oral health outcomes and reducing deep-seated health disparities.
The Cycle of Shame and Avoidance
Researchers describe a self-reinforcing dynamic where shame and deteriorating oral health fuel each other. The cycle often begins with negative dental experiences, which can lead individuals to delay or completely avoid routine check-ups. This avoidance allows minor issues like cavities or gum inflammation to escalate into more severe, visible, and painful problems. As a person’s oral health declines, so does their self-esteem, leading to powerful feelings of embarrassment and humiliation.
These stigmatizing experiences can make individuals less likely to seek care precisely when they need it most, as they fear being blamed or shamed by dental professionals for the state of their teeth. This fear is not unfounded, as social perceptions often link poor dental health to a person’s intelligence, social skills, and overall worth. The mounting shame reinforces the avoidance, trapping the individual in a pattern that is difficult to break and which can ultimately impact their general health and quality of life.
Understanding Patient Fears
While shame is a complex social emotion, its foundations often lie in the more primal fear associated with dental procedures. A 2022 study involving over 2,200 participants sought to identify the primary triggers of dental fear. It found that the sound of the dental drill was the single greatest cause of fear, cited by nearly 38% of respondents, followed by the anticipation of pain, which was the main concern for 25%. The study revealed that for the majority of people with dental fear, the feeling of “annoying pain” was the ultimate motivator to finally overcome their anxiety and seek treatment. Around 70% of participants waited until they were in significant discomfort before making an appointment.
From Anxiety to Shame
Dental anxiety has long been recognized as a barrier to care. Research from 2018 highlighted that more than 10 million adults in the United Kingdom experience some level of dental anxiety, which is closely linked to lower income and education levels. However, the new commentary argues that shame is a distinct and equally important factor. While anxiety is a fear of the event itself—the drilling, the needles, the pain—shame is a fear of being judged as a person. It is the feeling of being flawed or inadequate because of one’s dental condition, a sentiment that can have profound psychological and social effects.
Five Areas for Deeper Investigation
The authors of the commentary on dental shame identified five key areas where the phenomenon requires more focused research to develop effective interventions.
Clinical Encounters
The interaction between a patient and the dental care team is a critical moment where shame can either be reinforced or alleviated. The researchers call for a better understanding of how practitioners’ language, attitudes, and behaviors contribute to patient feelings of shame.
Daily Health Behaviors
Shame may influence a person’s private oral hygiene routines. Feelings of hopelessness or low self-worth could lead to neglect, while fear of confirming one’s own negative self-image could prevent someone from even inspecting their own teeth. More research is needed to understand this connection.
Systemic Inequities
Dental shame does not affect all populations equally. It is often intertwined with social and economic disadvantages. Limited access to affordable care, lack of dental insurance, and the inability to take time off work can all lead to preventable dental problems that become sources of shame. This creates a barrier where people with the greatest need are often the least likely to seek or be able to afford help.
Psychological Trauma
For some individuals, especially those with a history of other forms of trauma like abuse, the dental chair can be an intensely vulnerable setting. Researchers suggest that past trauma can heighten the experience of dental shame, making avoidance a protective, albeit harmful, strategy.
Care and Social Services
The study also calls for exploring how social services and other healthcare settings can play a role in addressing dental shame. Integrating oral health promotion into other social support programs may help reach vulnerable populations and mitigate the sense of isolation.
Social and Economic Consequences
The impact of avoiding dental care extends far beyond physical health. Poor oral health is deeply connected to social status and can carry significant stigma. A 2010 study from the United Kingdom found that when participants were shown photos of a person with modified levels of tooth decay, they rated the individual lower on intelligence, social skills, confidence, and happiness whenever decay was visible. Another study focusing on Australian children found that those who lost teeth due to decay or injury had a 42% higher risk of being bullied at school.
These social penalties have tangible economic effects. The 2018 report on dental anxiety found that people who feared dental visits were nearly twice as likely to be in a lower income bracket. The associated lack of self-confidence can hinder career advancement and social relationships. Furthermore, untreated oral health problems can lead to systemic health issues, such as heart disease and diabetes, adding another layer of burden.
Toward Shame-Sensitive Dentistry
The ultimate goal of identifying and understanding dental shame is to transform dental practice and public health promotion. The researchers advocate for the adoption of “shame-sensitive” practices in all health care settings. This approach involves training practitioners to recognize and manage shame in patients, a skill they term “shame competence.”
This new model of care would also focus on designing more empathetic and inclusive clinical environments. It requires addressing the systemic barriers that contribute to poor oral health, such as cost and accessibility, so that the burden of maintaining oral health does not fall solely on the individual. By understanding the powerful role of shame, the healthcare community can better support patients, reduce health inequities, and improve overall well-being.