The True Cost of Dental Neglect: What Keeps Patients from Going to the Dentist?
Niki Carter, DMD, MPH
Dental Director
Delta Dental of Arkansas
How many people do you personally know who refuse to smile or socialize because they are embarrassed by the condition of their teeth? The question this raises is what keeps people from going to the dentist? The answer is not universal and varies from person to person. The American Dental Association lists the top three reasons people avoid going to the dentist as cost, fear, and convenient location or appointment times. Although classifying people into different groups that include age, household income, education and dental benefit status, these reasons become more complex and varied1.
Oral health is not only part of the equation in overall health but has a significant role in quality-of-life measures2. The terms “health,” “status of health,” “health-related quality of life,” and “overall quality of life” have been used synonymously in scientific literature for years. The concepts behind these terms are also multifactorial, complex, and ever evolving, with social, cultural, political, and practical contexts3.
Daily activities of chewing, eating, talking, and smiling are part of our oral functions that have resulted in an overall socio-environmental model of health that reflects physiological, social, and mental well-being3. Much of our confidence and self-esteem is due to how we look, feel, and act. We equate health with youth, and numerous advertisements depict big, flashy, “beyond white” smiles.
Fear is defined as a distressing and strong emotion caused by a belief that someone or something is dangerous, likely to cause pain or a threat. Fear is not all bad, as it can keep us safe from harm. The key is to distinguish if it is rational. Being fearful of dentistry can stem from an anticipated danger or an unknown danger and can be dependent on past or unknown experiences. Dental fear involves a “fight or flight” response when confronted with a threatening stimulus and is a reaction to a known danger4.
Dental anxiety is different, as it is a reaction to an unknown danger. It is also common and can involve excessive dread about an approaching appointment or anticipatory experience5. Dental phobia is an intense fear of the dentist or dental treatment. Patients who experience dental phobia are more likely to avoid dental treatment at all costs, even if this means they know their oral health will suffer. Only in extreme circumstances will a person seek treatment, and often it involves more invasive treatment to correct an issue6.
Cost can be a factor, especially if a patient does not have dental insurance. However, prevention is the goal in achieving and maintaining a healthy oral status. Neglect can be costly on many fronts, as it can produce problems when not caught early. Detecting small issues and keeping them from becoming larger ones is optimal before the dentition is affected.
What is it that frightens people about the dentist? Did a bad first experience set the tone of anxiety? Was it the fear of the unknown? There are many different elements that come into play, and they vary from person to person. For instance, the sound of a dental drill, seeing a needle, or the sight of blood is too much for some to bear. Another person may fear they won’t be numb enough and will feel pain when having a dental procedure. Many fear the actual injection, while others don’t mind the injection, but instead dread the side effects of anesthesia such as a fat lip or biting their tongue since they cannot feel it.
Surprisingly, many people who have dental benefits do not utilize them. A study completed by Delta Dental of Arkansas revealed reasons for not going to the dentist which had nothing to do with cost. The study included a series of in-depth interviews, which asked non-uniform questions, such as how often these respondents were going to the dentist or what kept them from seeking dental care. Surprisingly enough, these reasons did not include a financial one, nor did they include fear. Instead, reasons included shame and guilt of not going regularly, being judged by dental professionals, and feeling guilty for not being a good role model for their family7.
The matriarch, who usually makes the decisions and appointments for the family, often places everyone’s welfare above her own. The U.S. Department of Labor reports that women make 80 percent of the healthcare decisions in the United States8. The Delta Dental of Arkansas study found that mothers struggle with guilt, since they are not going to the dentist themselves, but they are making sure their children receive care. It’s important to these mothers that they set a good example and are a role model for their children. Another group admits their loved ones are pushing them to get dental care, and they have been experiencing guilt since they have not gone to the dentist for a long time. One group stated they know they have neglected their oral health and are worried about the state of their dentition but worry about being judged and berated by the dental team.
Of all the reasons for not seeking dental care, the fear of being judged or criticized is the saddest. Healthcare providers should not only adhere to their ethical principles; it’s their duty to treat in the best interest of their patients. The very foundation of the patient-provider relationship is the patient seeking care and asking advice should have confidence and trust that the doctor will treat them in their best interest. The patient has no alternative but to go to a skilled and experienced professional, therefore relying on the credentialed healthcare provider. This fact makes the relationship uneven. Judging or making patients feel belittled due to neglectful habits should not be in the formula, as this destroys the patient-provider relationship9.
Non-discriminatory healthcare is one of the foundational principles of human right patient care. It is rooted in the International Human Rights law, which the United Nations Charter articulates and references “the dignity and worth of a person10.” Lastly, patients already know the neglect is entirely their fault and blaming them or calling it out in a critical manner makes people want to retreat, not listen carefully in an engaging manner11. Reassurance and placing patients at ease is key in healthcare provider behavior, as it is the way to educate and inform patients of their current state of health.
For patients who are fearful, worried, or cannot bear the thought of taking the first step toward correcting their oral health status, the good news is there are some excellent dentists who can assist them in overcoming this issue.
Sedation dentistry comes in many forms, ranging from nitrous oxide, a minimal sedation that enables you to drive after receiving it, to moderate, and general sedation. The use of distraction is also effective, such as wearing earphones and listening to music to block the various dental sounds. Many offices have TV screens in the treatment rooms, so patients can watch a show while receiving treatment, taking their mind off the procedure.
Teledentistry is another option to ease patient concerns. This type of visit is virtual, whether it involves communicating oral health issues and questions or showing an intraoral problem by way of a camera. These types of visits were popular during the height of the pandemic since offices were shut down. Patients would use their smartphones to discuss problems and show the dentist a specific issue13. If a patient’s dental anxiety is high, teledentistry might be a good option if the dental office offers this type of visit. Of course, to receive any dental treatment, one must go physically to the dental office, but an initial teledentistry visit could ease anxiety by relaying valuable information.
Dental neglect and dental phobia resulting in patients not keeping their regular dental visits are costly on many levels. Reminding patients that it is impossible to have good overall health without good oral health is important information patients need to hear from their medical providers. This collaborative and unified message from both medical and dental professionals is key in establishing the association between oral health and overall health.
References:
2. Sischo L, Broder HL. Oral health-related quality of life: what, why, how, and future implications. J Dent Res. 2011 Nov;90(11):1264-70. doi: 10.1177/0022034511399918. Epub 2011 Mar 21. PMID: 21422477; PMCID: PMC3318061.
3. Baiju RM, Peter E, Varghese NO, Sivaram R. Oral Health and Quality of Life: Current Concepts. J Clin Diagn Res. 2017 Jun;11(6):ZE21-ZE26. doi: 10.7860/JCDR/2017/25866.10110. Epub 2017 Jun 1. PMID: 28764312; PMCID: PMC5535498.
4. Minja, Irene Kida and Febronia Kokulengya Kahabuka. “Dental Anxiety and Its Consequences to Oral Health Care Attendance and Delivery.” Anxiety Disorders - From Childhood to Adulthood (2019): n. pag.
5. Beaton L, Freeman R, Humphris G. Why are people afraid of the dentist? Observations and explanations. Med Princ Pract. 2014;23(4):295-301. doi: 10.1159/000357223. Epub 2013 Dec 20. PMID: 24356305; PMCID: PMC5586885.
6. https://www.smilegeneration.com/blog/ask-a-dentist/dental-phobia-and-dental-anxiety-explained/
7. Delta Dental of Arkansas Internal Research July 2022
8. https://news.ohsu.edu/2017/05/11/women-responsible-for-most-health-decisions-in-the-home
9. https://www.ncbi.nlm.nih.gov/books/NBK538279/
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5810084/
11. Calladine H, Currie CC, Penlington C. A survey of patients' concerns about visiting the dentist and how dentists can help. J Oral Rehabil. 2022 Apr;49(4):414-421. doi: 10.1111/joor.13305. Epub 2022 Jan 22. PMID: 35032077; PMCID: PMC9306701.
12. http://historymatters.gmu.edu/d/5057/
13. Kui A, Popescu C, Labuneț A, Almășan O, Petruțiu A, Păcurar M, Buduru S. Is Teledentistry a Method for Optimizing Dental Practice, Even in the Post-Pandemic Period? An Integrative Review. Int J Environ Res Public Health. 2022 Jun 22;19(13):7609. doi: 10.3390/ijerph19137609. PMID: 35805267; PMCID: PMC9265299.