Mon Oct 6

Why is it so shameful to have missing or damaged teeth?

Written by: Ankur Singh, Chair of Lifespan Oral Health, University of Sydney

When your teeth and gums are in good condition, you might not even notice their impact on your day-to-day life. Good oral health helps us chew, taste, swallow, speak and convey emotions.

This means the state of your mouth can affect nutrition, confidence, forming relationships and maintaining overall good health and wellbeing.

People who have missing or damaged teeth, or other oral health issues such as gum disease, know this all too well.

They may not only live with pain that affects their sleep, speech and ability to enjoy certain foods, but often also face ^[1] discrimination and stigma.

So, why is it so shameful to have missing teeth or gum disease? And what can we do about it?

The social and psychological impact

Oral health is deeply tied ^[2] to social status. People who don’t have good teeth often face stereotypes about their health, wealth and even their intelligence.

For example, in one 2010 study ^[3] from the United Kingdom, researchers showed young people photographs of the same person, modified with different levels of tooth decay.

Whenever decayed teeth were visible, participants rated the person lower in intelligence, social skills, confidence, self-esteem and whether they appeared happy – based only on the photo.

These stereotypes can lead to bullying and stigma that scar people for life.

In a recent study ^[4] with colleagues, we looked at nationally representative data on 4,476 children from the Longitudinal Study of Australian Children.

We found losing teeth to decay or injury was relatively common, affecting one in ten children. These children then had a 42% higher risk of being bullied ^[5] at school.

These stigmatising experiences can lead to feelings of shame, embarrassment and low self-esteem. In some cases ^[6], they can mean people are less likely to seek dental care, fearing further humiliation or blame that they have neglected themselves.

Dental care is often out of reach

Tooth decay and gum disease are the most common oral diseases ^[7] in Australia and can lead to missing teeth. These conditions can occur at any age, from childhood to adulthood, but they usually worsen with age ^[8].

Yet the government’s Child Dental Benefits Schedule ^[9] only covers dental care for children aged 17 and under whose parents receive government benefits.

Some states and territories also provide oral care ^[10] for eligible older adults. But long waiting lists ^[11] show the public system is stretched.

This means oral health care remains inaccessible and unaffordable ^[12] for many Australians.

Poor oral health affects everyday life

Arguments for improving oral health almost always focus on preventing other physical health conditions. For example, one large study ^[13] of 172,630 adults in New South Wales found those with missing teeth or poor oral health were more likely to die from heart disease.

Yet when people can’t afford to fix their own oral health issues or their children’s, there can be other serious flow-on effects for their day-to-day life and wellbeing, beyond physical health.

Research shows when people are in pain from tooth decay they are more likely to take days off work ^[14] and school. This can have long-term negative effects, disrupting education ^[15] and employment.

Parents may also need to take time off work to take children to the dentist or dental hygienist. They often face financial pressures due to high out-of-pocket costs ^[16] for dental treatments.

Research shows ^[17] when people can’t afford dental treatments they may feel powerless to control their circumstances. As a result, they may choose cheaper treatments, such as having a tooth extracted even when it could have been saved.

There has also been a recent surge ^[18] in people using superannuation to pay for dental treatments, for largely preventable conditions. This will further entrench financial disadvantage ^[19].

So, what’s the fix?

Research I conducted with colleagues this year found 96% of working-aged adults in Australia ^[20] believe oral health care is essential.

But there continue to be significant financial barriers in getting required treatment, particularly for people who are unemployed ^[21], have low incomes ^[22] or those with disability ^[23].

So, making dental care more affordable and accessible is an important step. This will encourage timely care and make sure check-ups aren’t a luxury for those who can afford them.

But while dental visits are important, they can’t provide sustainable and long-term protection from oral diseases when the social conditions and behaviours that lead to poor oral health stay the same.

Experiencing stigma because of poor oral health can be highly personal and feel shameful ^[24]. But the burden to fix this should not be on individuals.

The main causes ^[25] of oral diseases are behaviours – such as having a lot of sugar, alcohol and tobacco, or poor oral hygiene – and high levels of stress ^[26].

We know these behaviours and stress are more common among people who experience social disadvantage.

So we need broader policies that address the social conditions in which people live, work, age and grow – for example, by making access to nutritious food more accessible and affordable.

Reducing disadvantage is the key to addressing ^[27] both tooth decay and gum disease and the stigma attached to these oral health issues.