It doesn’t take a ton of doom-scrolling before encountering smile shaming, a name for the social stigma faced by those with visible dental health issues. Memes and skits that shame people for less than stellar oral health are frequently posted on social media. The premise of the jokes is to label the person with a missing or chipped tooth as lazy, ignorant, unattractive, and untrustworthy.
We’re Twice as Likely to Have Unmet Dental Needs
This stigma disproportionately impacts the Black community as “Black adults are twice as likely to have unmet dental needs when compared to Whites and face many barriers to accessing dental care,” according to the Journal of Public Health Dentistry. A study commissioned by Synchrony Bank found that 92% of Americans would postpone obtaining dental care because of the rising cost. Alarmingly, 83% of Americans in the same study maintained that stance even for emergencies that would threaten their overall health.
Less than 4% of dentists are Black, adding potential cultural barriers to treatment.
According to the Journal of Community Dentistry and Oral Epidemiology, the prominence of oral health stigma comes from the conspicuousness of oral health status. “It is largely impossible (under its visibility) not to disclose one’s oral health status during social interactions.”
The Cost of Dental Stigmas
They noted that other less obvious healthcare issues are less likely to be immediately stigmatized than oral health.
“This contrasts with other stigmatized conditions such as H.I.V. infection or mental ill health, which are often invisible unless actively disclosed. An oral health status that differs from the group or social norm can attract stigma through othering (negative stereotypes used to categorize the other leading to the separation of ‘us’ from ‘them’), status loss, and discrimination within the context of prevailing social, cultural, political and economic power structures,” the journal continued.
A 2008 study on the Social Perceptions of Individuals Missing Upper Front Teeth found that “a person missing visible teeth was more negatively perceived on all social traits than a person with full dentition.” Dr. Marie M. Jackson, D.M.D., a Dental Expert for LISTERINE, confirmed that visibility was a factor. “When we interact with others, we look at one another’s smiles,” she said.
Dr. Jackson, who promotes dental education to the public, advocates for empathy toward those with visible dental issues, “Dental health is so unique to each individual, and not everyone has access to the same oral care products; I always emphasize the importance of holding back judgment when it comes to what you can see from a person’s smile,” she continued.
“There’s so much “smile shaming” due to assumptions about individuals regarding their habits, socioeconomic status, and access to dental care. It’s quite unfair because you never know the whole story.”
That story can include childhood neglect or being uninsured or underinsured. The American Public Health Association found a “gap in preventive dental care between Black children and White children” that was heavily attributed to “socioeconomic status.” The National Association of Dental Plans reported that “74 million Americans live without dental insurance.” Racial disparities in access to care make this even more severe.
The University of Illinois Chicago confirmed, “Poor oral health can affect adults’ job prospects and social lives.” If one can not obtain work due to stigma, they could be held back from receiving care. Even adequately insured people can face reduced access to care for economic reasons.
Dental Insurance Hasn’t Kept Pace With Our Needs
“Dental insurance has been around for a little while, but it’s not kept pace with the needs and demands,” explained Toni Meyerkord, a dental healthcare professional with over thirty years of experience. She serves as the Senior Academic and Industry Relations Manager- Dental Hygiene for Aspen Dental Management, helping to bridge the gaps in information and access.
She cited “the rise in cost overall” as a factor.
“For example, you’ll get a thousand to two thousand dollars annually for your needs. It doesn’t match where we are as a nation,” she continued. “We know that three out of four adults have gum disease, to some degree. A way to treat that is non-surgically, but it costs money. And so, you have a disproportionate amount of cost to a minimal amount of resources allocated for dental care. So financial barriers are huge, so this has happened because we haven’t pushed up those numbers. Nowadays, a crown costs a minimum of $ $1500. Let’s say you need two of them. You’re wiped out if you only get a thousand dollars a year. And so what happens is the consumer, the patient, gets that cost.”
Finding Office Hours and Locations That Work
She noted that obstacles other than money may appear, including physical distance. “If you don’t have a dental office for 30, 40, 50 miles away. You’re not going to be quick to go there,” she said. “So we have to consider those things. One of the things that I love about Aspen Dental working for them is that many of our offices, 60% or so, are placed in federally designated healthcare shortage areas, which is critical. We have urban areas that are suffering and need to be able to get that kind of care. And we have rural areas also suffering in the same vein.”
Office hours affect patient outcomes, too. “In many communities, if people are working nine to five, if your office is only open nine to five, how will you have access to care? You won’t; you’ll miss it all the time. So, having open offices in the evening for you all weekend is important, so that type of accessibility is critical.”
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Taking Action: Refuse To Be Frozen By Shame
Attempts to avoid judgment for poor oral health have resulted in a rise in drastic efforts to seek care. Some are driven by unlicensed individuals who claim to be “veneer techs.” Some engage in medical tourism. Others leave the problem altogether because their shame immobilizes them, which can make problems worse over time. Cosmetic Dentist Dr. Brandon Mack stated that judgment and stigma can prevent some suffering with oral health issues from seeking care.
“One thing we need to destigmatize in our community is shame,” he told Black Health Matters in a statement.
“Shame is what keeps some patients from seeing a provider because they don’t want to feel judged.”
Putting off treatment out of fear of judgment or other reasons can make it less accessible. Dr. Mack recommended tackling issues before they balloon into more significant problems. “A $200 cavity can easily turn into a $3000 root canal and crown or a $6000 extracting and implant if the provider can’t save the tooth,” he continued.
“Don’t let shame keep you from seeing a provider,” advised Dr. Mack.
Raise Your Dental I.Q.
“The whole country as far as oral health is a bit behind, so it’s not going to be this two-prong approach. It will have to be a multi-level approach,” said Meyerkord.
She emphasized the need for policy changes, clinics in urban and rural areas, and the distribution of vital information for patients. “It’s important for us to push out a lot of education. I honestly think that dental I.Q. is still lower, particularly in the Black community, and there are multiple levels of multiple agencies that are trying to help mitigate that as an issue helping people to get that information,” she continued.
Dental health impacts several other systems in the body, and interventions can be taken when a patient seeks care in an area that might not screen-check cavities. “That’s important to connect the body and the mouth because they go together,” she said. “Historically, it somehow separated the mouth and the head from the rest of the body. Now, there’s tons of research out that talks a lot about oral systemic health.”
“It’s easier to build a house when you’ve seen it, like when you’ve seen the plans,” she added. You have to go in with your eyes wide open.”
Protect Yourself From Scammers
Your oral health journey should start with a professional.
Meyerkord warned against letting someone untrained try and treat your chompers. “You don’t put a veneer on bleeding, puffy, infected gums,” she said.
Unlicensed people doing illegal treatments might help you smile for the camera more, but they don’t help fix the foundations of your oral health.
“They don’t know the disease process. They don’t know how to do it correctly. Diagnose periodontal disease or dental decay when you put a veneer or something on there. You’re just putting a mask on.”
She considered having doctors who work to show patients grace and understanding as another way to fight for better outcomes.
“Everyone needs empathy in dentistry,” said Meyerkord. “Those are the kinds of providers that we need.”
