Embarrassment is a common and ultimately necessary part of the human experience. However, the feeling can often be overwhelming, and anxieties can develop because of it. In dental care, a patient’s embarrassment about their oral health – perhaps because of its aesthetic qualities – may lead to them developing dental anxiety, and avoiding regular appointments.[i]
It is the responsibility of the clinician to manage patients’ dental anxiety appropriately, and treat them with kindness and compassion.[ii] Working this way makes the practice a more welcoming space for those dealing with such intense negative emotions, and allows them to access essential oral health care without shame.
It is expected that patients with dental anxiety also have worse oral health because they actively avoid dental care;[iii] this further fuels the cycle where patients can suffer psychologically and physically. Intervention is therefore of even greater importance.
Self-conscious concern
Societal standards of oral health and aesthetics may not be met by patients, becoming a key source of embarrassment.[iv] The expectation in western societies is that one’s teeth will be straight and white.[v]
When a patient’s condition deviates from this ideal, they may feel negatively about themselves, and believe that other people, including clinicians, will hold the same opinions. Some adults with dental phobia may feel this way because of poor treatment from a previous dentist.[vi] Others may anticipate a poor reaction based on experiences outside of the dental chair, which have then been ruminated on for weeks, months and years. Situations such as these can create ‘schemas’, or psychological core beliefs that have developed over time, which could include a belief that others will view their dental health as unacceptable.[vii]
Clinicians must observe that shame is also linked to one’s core identity, and that it can affect an individual’s sense of belonging and social acceptance.[viii] Dental aesthetics also have a significant role in social interaction, with an attractive smile being of great importance for first impressions.[ix] People with favourable dentofacial aesthetics are also perceived as more intelligent and attractive, as well as more successful.ix
When a patient believes their condition could result in social rejection, especially from a dental professional who they presume sees exemplary dentitions on a daily basis, they may perceive that their identity as a person is at risk of being judged too.
When patients anticipate a negative response – even when it is not felt nor expressed in any way – they may avoid appointments, or respond to oral health advice and instruction with sarcasm in attempt to regain control of the situation.vi Patients may not even realise the latter is related to their embarrassment, and may not have malicious intent behind it. Clinicians should exercise patience and ensure individuals can receive the care they need in the moment.
Encouraging attendance
Individuals not attending appointments are a major cause for concern. They may see their oral health worsen if they do not receive timely treatment to arrest decay or infection. As their condition continues to deteriorate, the feelings of embarrassment may develop further; the individual then falls into a continuous cycle that is difficult to break.
To actively engage with embarrassed or anxious individuals, and ensure they return for treatment on a consistent basis, dental professionals must listen to their concerns and create an environment that is welcoming. Dentists should be aware of how their tone of voice and body language might be perceived.ii They should display emotional support to alleviate patients’ fears, placing an emphasis on developing a relationship built on mutual trust.[x]
Ensuring patients feel some control over their care is essential. In the practice, this could include use of the tell-show-do technique or signalling when a patient needs a break from treatment.
Dentists can also empower individuals by recommending effective oral hygiene routines with easily implementable solutions, like the Cordless Advanced Water Flosser from Waterpik. The simple-to-use oral hygiene adjunct removes up to 99.9% of plaque from treated areas with just a 3-second application,[xi] and is 50% more effective than traditional dental floss.[xii] For the self-conscious patient, it is a straightforward step in their oral hygiene routine that can have immense benefits to the health and appearance of their dentition, supporting the journey to restored confidence.
An individual’s oral health and appearance can be a great source of embarrassment and anxiety that stops patients from receiving timely help. Dental professionals have the opportunity to provide encouragement in both regular attendance and the maintenance of oral hygiene routines. By listening to the concerns of anxious individuals, giving them control where appropriate, and creating a welcoming environment, patients that are embarrassed about their condition may be more likely to return for future oral health care.
For more information on Waterpik® Water Flosser products visit www.waterpik.co.uk. Waterpik® products are available from Amazon, Costco UK, Argos, Boots, Superdrug and Tesco online and in stores across the UK and Ireland.
Author: Margaret Black
I have more than 40 years’ experience in dentistry, qualifying as a dental nurse in 1982 and gaining a Diploma in Dental Hygiene in 1992.
I have experience in both NHS and private dental practice and spent time travelling Scotland as a Clinical Hygienist in Dental Research.
Presently, I split my working week between fixed and locum hygienist posts and was lucky to secure a role as an independent contractor for Church and Dwight in 2019.
Each role compliments the other and I enjoy meeting different practice teams.
In my personal life, I am married with an adult daughter and enjoy spending time with family and friends. I love travelling and am looking forward to a long-awaited post pandemic holiday.
[i] Calladine, H., Currie, C. C., & Penlington, C. (2022). A survey of patients’ concerns about visiting the dentist and how dentists can help. Journal of Oral Rehabilitation, 49(4), 414-421.
[ii] General Dental Council, (2019). Standards for the dental team. (Online) Available at: https://www.gdc-uk.org/standards-guidance/standards-and-guidance/standards-for-the-dental-team [Accessed July 2024]
[iii] Alenezi, A. A., & Aldokhayel, H. S. (2022). The impact of dental fear on the dental attendance behaviors: A retrospective study. Journal of Family Medicine and Primary Care, 11(10), 6444-6450.
[iv] Doughty, J., Macdonald, M. E., Muirhead, V., & Freeman, R. (2023). Oral health‐related stigma: Describing and defining a ubiquitous phenomenon. Community dentistry and oral epidemiology, 51(6), 1078-1083.
[v] Khalid, A., & Quiñonez, C. (2015). Straight, white teeth as a social prerogative. Sociology of health & illness, 37(5), 782-796.
[vi] Armfield, J. M., & Heaton, L. J. (2013). Management of fear and anxiety in the dental clinic: a review. Australian dental journal, 58(4), 390-407.
[vii] Erdman, K.A., (2023). Challenging patient behaviors: Psychological schemas and how they impact the dental appointment. Dentistry IQ. (Online) Available at: https://www.dentistryiq.com/dentistry/article/14300973/challenging-patient-behaviors-psychological-schemas-and-how-they-impact-the-dental-appointment [Accessed July 2024]
[viii] Doughty, J., Macdonald, M. E., Muirhead, V., & Freeman, R. (2023). Oral health‐related stigma: Describing and defining a ubiquitous phenomenon. Community dentistry and oral epidemiology, 51(6), 1078-1083.
[ix] Närhi, L., Mattila, M., Tolvanen, M., Pirttiniemi, P., & Silvola, A. S. (2023). The associations of dental aesthetics, oral health-related quality of life and satisfaction with aesthetics in an adult population. European Journal of Orthodontics, 45(3), 287-294.
[x] Yuan, S., Freeman, R., Hill, K., Newton, T., & Humphris, G. (2020). Communication, trust and dental anxiety: a person-centred approach for dental attendance behaviours. Dentistry Journal, 8(4), 118.
[xi] Gorur, A., Lyle, D. M., Schaudinn, C., & Costerton, J. W. (2009). Biofilm removal with a dental water jet. Compendium, 30(1), 1.
[xii] Rosema, N. A., Hennequin-Hoenderdos, N. L., Berchier, C. E., Slot, D. E., Lyle, D. M., & van der Weijden, G. A. (2011). The effect of different interdental cleaning devices on gingival bleeding. J Int Acad Periodontol, 13(1), 2-10.
