Stigma – The Silent Scream of Dental Phobia

Stigma can be defined as “A mark or token of infamy, disgrace, or reproach:” So; you may be wondering how this relates to dental phobia. You may also be thinking that is an overly dramatic term to use in this situation. However, the stigma i.e. Shame and embarrassment, felt by many people that suffer from dental phobia, actually prevents some people from seeking the treatment they desperately need.

A recent survey on Beyond Fear asked the question “How much does /did stigma (The shame, embarrassment, fear of what the dentist might say) affect you making an appointment” the results were staggering and give an indication of how big the problem is. A remarkable 62% of people said that Stigma played a major part and a further 21% said it played a big part.

Alongside the survey people also had the opportunity to share exactly how the stigma did affect them. There follow some of the responses.

“I was always conscious about the state of my teeth. When speaking to people my hand would be strategically placed in front of my mouth to hide them. I also very rarely smiled, as this would reveal my teeth. So not only did I feel miserable I also looked it.

The state of my teeth also prevented me from visiting a doctor especially if I thought there was the remotest chance he might want to look in my mouth.”

“I think I'm now more embarrassed by the state of my teeth and gums than anything.”

“I feel extremely embarrassed of my teeth. I am afraid of being judged for letting my teeth get in the state they are in.”

“I am ashamed to open my mouth I can’t even bear to watch the toothpaste adverts on t.v feeling embarrassed about what whoever I am with is thinking. Most of my teeth rotted and crumbled away and I have abscesses quite often and the pain is unbearable, I feel so down all the time and depressed I have never spoken about it to anyone my family, friends esp. not my gorgeous girlfriend I fear if she knew the extent of it she wouldn’t want me”

“I have felt stigmatised about my teeth for as long as I have been dental phobic.

My deteriorating teeth affected the way my family, friends and work colleagues treated me and I felt bullied by them to the extent that I became reclusive. This was the hardest part of my phobia to deal with because I felt so isolated, alone and afraid.

What people didn’t seem to realise was that the more I heard how disgusting I / my teeth were then the harder it was for me to seek help. If people supposedly close to me felt this way then how on earth could I let a stranger see exactly how bad my teeth had become? It felt like a no win situation for a very long time.”

Over the years that Beyond Fear has been helping people get to the point where they were able to seek the professional help they needed this issue was quite often at the forefront of the problem. Many of them with were unable to talk to friends, loved ones or even families because of how ashamed and embarrassed they were about the situation they were in. The stigma, they associated with their situation, was often a major hurdle that needed to be overcome before they could even contemplate dealing with the dental phobia.

What made matters worse was that because the stigma prevented them from talking about their problems they were not aware that this particular problem was common amongst people that suffered from dental phobia. This had the affect of making them feel even more of a “freak” further exasperating the problem leaving them feeling isolated and alone. It was only when they started to read, on the support group, that others also had a similar problem they realised that maybe there was help at hand.

It is a very vicious circle; the fear of how the dentist will react to their mouth prevents them for dealing with the fear that caused it. I learnt this not just from others but also from direct experience. For me the shame and embarrassment prevented me form seeking the help I needed.

For many years I couldn’t talk to anyone about my fears because of the shame and embarrassment I felt over how I had let my teeth deteriorate. For me beating the stigma was as big an issue as the fear itself.

Luckily I was able to find a dentist who did understand how I felt and when I did finally manage to have the dreaded examination all he said was “They are not as bad as you imagined, there is work to do but nothing that we cannot deal with” I was amazed, all those years of shame and pain were blown away in an instant. It was nothing like I had imagined. I wasn’t made to feel small, dirty or stupid. If I had known it was going to be that way I would have been able to seek help earlier. OK, I still had to deal with the dentally related fears I had but dealing with my self-inflicted stigma made things seem so much better. With hindsight I realised that I had worried needlessly about something that never even happened.

I have often said that if I had £1 for every time someone says to me that his or her teeth were the worst the dentist would see I would be rich. If I had another £1 for every time those same people came back to me and said “you were right, my teeth were nowhere near as bad as I imagined” then I could give up the day job.

However, until you have actually been to an understanding dentist I know it is impossible to believe that such dentists exist. For this reason we wrote to a selection of the dentist listed on Beyond Fear asking them what advice they would give to people to whom stigma was a major problem. The question was:

As a dentist what would you say to a phobic patient who was embarrassed or ashamed about the state of their teeth?

Douglas Miller - London

“I am here to help you. I will not judge you or your dental problems, but will strive to improve your oral health in a manner you feel you can cope with. You should feel proud of yourself for having come; I know it was difficult for you.”

Graham Raven - Birmingham

“I can think of no better way than to quote you what I said to a patient a few weeks ago in reply to his email. It is as follows.

1. There is nothing to be ashamed of in admitting that you have this fear. It is a result of what has happened to you in the past. Everyone is afraid of something, and dental treatment comes near the top of the list for many people.. I am also 54 (he was ashamed because of having this fear at his age) and there are things that I am frightened of too, and which I am trying to overcome. I have not been afraid or embarrassed to seek help, and you don't need to be either.

2. It is likely that you feel embarrassed about the state of your mouth. There is no need. Only I will see it (and my nurse). No-one else need know, and we will not be judgemental. Some years ago, I held a part-time post at the Dental Hospital in Birmingham, looking after patients like you. Whilst there, I saw tragic instances of otherwise attractive teenage girls with mouths so neglected that the only option for them was extractions and full dentures. That was quite a shock to the system. I have seen it all, and nothing shocks me now.

3. Very important!... The state of your mouth, because of this fear, is NO reflection on your worth or value as a person.

4. You may feel foolish or childish about this, and your inability to accept treatment at present. We all have a "child" inside us... and that child is involved in emotional issues. That is what we are dealing with here. So it is entirely appropriate in this situation that your "child" is working overtime. The emotions you feel need to be honestly expressed, because that is how they can be dissipated and dealt with.. We actively encourage you to do this. We all need to recognise and acknowledge that we ARE emotional beings (not like Mr. Spock out of "Star Trek") and not be afraid to express our emotions... even (or especially) the ones that, traditionally, we are not encouraged to express openly.

Dan Murphy – Derby

“Most patients’ mouths are not as bad as they fear and even if they are it is nothing we haven't seen before. By coming for consultation you have taken the first huge step towards restoring your smile and your confidence. This is something we have done many times and I have seen people change dramatically both in appearance and confidence, having had a successful course of dental treatment. This can be done as slowly or as quickly as you require and in many cases can be done under intravenous sedation where you are almost unaware of what is happening and your time in the chair feels as if it's only minutes rather than a long session.

As professionals we are not judging you in anyway. No matter what the state of your mouth, we look towards the future and how best we can achieve your wishes and make you smile again.”

The above dentists are all listed on the Beyond Fear database and have been awarded the Beyond Fear Extra (S)mile Award, which is only given to dentists who have been recommended by other phobic patients.

Another feature on Beyond Fear is the ever growing list of success stories and I would like to quote from one of those stories written by someone who:

“had not visited the dentist for about 30 years, at first because I couldn’t or rather wouldn’t find the time and later because I was too ashamed to open my mouth to show the dentist how bad it was.”

After visiting one of the dentists listed above he said:

“His reaction to seeing my teeth which had stopped me visiting a dentist for so many years was simply "nothing there I haven’t seen before".”

So, if you are one of those people who are unable to seek professional help take heart, there are dentists that do understand. Don’t let your life be controlled by Stigma, don’t let the shame and embarrassment stop you from seeking help. It may take a “leap of faith” to do so but if you find the right dentist when you leap the net will be there.