Dental shame is a widespread phenomenon that quietly exists in the shadows, with inadequate research and awareness of what it is and how dental practitioners can support affected patients. Whereas dental anxiety is a well-covered topic, online searches for dental shame reveal many posts and discussion forums where people are looking for advice, but finding limited academic research or professional solutions.
A dental implant can restore function and aesthetics to patients, giving them a second chance at their dream smile, particularly those ashamed of their current dentition. But dental shame may also discourage patients from attending a dental practice, making it essential that clinicians understand the factors and consequences of the mindset. This way, vulnerable patients may be better supported and guided towards treatments that restore their smile and their self-confidence.
Causes and consequences
Dental shame can present in three ways:
- As a direct consequence of poor oral health issues or the aesthetic appearance of the teeth – this covers carious, stained or edentulous smiles
- As part of a broader social vulnerability, compounded by economic deprivation, trauma, abuse, food poverty and low health literacy (it is not exclusive to low-income areas, however)
- As a relational phenomenon – dental shame can be experienced on behalf of others, such as a parent with their children[i]
Because of the various manifestations of dental shame, dental practitioners and patients may struggle with how to address oral health issues. This can build a stigma around poor dentition; an unspoken problem that impacts relationships, self-esteem, access to the labour market and potentially social services.[ii]
Dental shame can have a considerable knock-on effect on a patient’s life. A deeper understanding can alleviate some of the devastating consequences of oral health problems, especially those that impact general health. Moreover, if dental shame is an explanation for dental avoidance, it may also mean broader healthcare avoidance, putting patients at risk of unaddressed harm.
Shame competence
Restorative dental treatments give patients a fresh start, but they cannot be successful unless the patient’s oral hygiene is at an acceptable, stable level. Dental practitioners may unintentionally incite shame in their patients when motivating them to follow a consistent daily oral hygiene routine and improve their oral health. However, this may only demoralise patients further and must be avoided. Shame competence is required; dental practitioners should position themselves as collaborators – rather than instructors – and guide patients to the recommended outcomes, as well as showing emotional support and belief in the patient’s journey.
Older worries
Dental shame as a treatment barrier also extends to older patients, who may have a greater need for restorative treatments. An investigative case study on an elderly patient found that, rather than use the word ‘shame’ or ‘ashamed’, the patient expressed more regret and a feeling of stupidity in the way they neglected their oral health.[iii] The patient then divulged their dental narrative, implying the role that social relations, healthcare encounters, economic implications and aesthetics all had in causing their oral hygiene to crater. Whilst not representative of all patients who may feel dental shame, the case underlines the variety of emotional experiences that, layered on top of one another, leads to the neglect of their oral hygiene.iii
Older patients are a notable demographic for restorative treatments. Improvements in oral hygiene quality means teeth are kept for longer, increasing the frequency of oral diseases – particularly when somatic or cognitive illness inhibit daily dental care. As a dental implant can restore function to edentulous smiles, reducing diet restrictions, dental practitioners must highlight the role of consistent oral hygiene in readying the teeth and gingivae for such a treatment and protecting the implant afterwards.[iv] This will empower patients with their new smile, boosting self-esteem and eliminating feelings of regret and shame.
Decision-making support
To promote the positive impact dental implants can have on a patient, the Association of Dental Implantology (ADI) provides its members with free information leaflets. ‘Titled ‘Considering Dental Implants?’, they illustrate the treatment process in a clear and concise way. As well as clarifying the risk factors, myths and FAQs around dental implants, the leaflets stress the role of post-treatment care and add an extra layer of interaction to the dental practice, allowing less confident patients to discover the treatment option in their own way.
Dental shame is a major issue, increasing the risk of healthcare avoidance. By boosting their shame competency, dental practitioners can better understand their patients and evaluate their treatment options – providing emotional and physical support that can lead to first-class restorative outcomes and a restored sense of self-confidence.
For more information about the ADI, visit www.adi.org.uk
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Author: Dr Pynadath George, GDC-registered Specialist Oral Surgeon and President of the ADI (Association of Dental Implantology)
[i] Folker, L., Dolezal, L., Jespersen, A.P., Paisi, M., Withers, L., Worle, C. and Øzhayat, E.B. (2025). Dental Shame: A Call for Understanding and Addressing the Role of Shame in Oral Health. Community dentistry and oral epidemiology, [online] p.10.1111/cdoe.70019. doi:https://doi.org/10.1111/cdoe.70019.
[ii] Folker, L., Dolezal, L., Jespersen, A.P., Paisi, M., Withers, L., Worle, C. and Øzhayat, E.B. (2025). Dental Shame: A Call for Understanding and Addressing the Role of Shame in Oral Health. Community dentistry and oral epidemiology, [online] p.10.1111/cdoe.70019. doi:https://doi.org/10.1111/cdoe.70019.
[iii] Christensen, L.F., Jespersen, A.P. and Øzhayat, E.B. (2024). Tooth Shame – An Ethnographic Study of the Choreographies of Tooth Shame in Danish Elderly Care (SSM-D-24-02581). Social Science & Medicine, p.117500. doi:https://doi.org/10.1016/j.socscimed.2024.117500.
[iv] Takefuji, Y. (2025). Dental implant prevalence and durability: A concise review of factors influencing success and failure. Biomaterials and Biosystems, 17, p.100109. doi:https://doi.org/10.1016/j.bbiosy.2025.100109.
