Shame can lead people to avoid getting treatment for dental issues, potentially worsening oral health inequalities, a new study warns.

A better understanding of dental shame could encourage more people to seek help, researchers and practitioners have said.

It would alleviate some of the devastating consequences that oral health problems can have on overall health, disease and even risk of death.

Researchers warn that health care practitioners can incite shame in patients both intentionally and unintentionally. When shaming is used purposefully with the intention of attempting to motivate positive health behaviors, there is no guarantee this will result in beneficial change.

Those working in dentistry and other health care and social settings should be trained in shame competence. This approach includes addressing systemic barriers and designing empathetic and inclusive care environments.

Dental shame can stem directly from oral health issues or the aesthetic appearance of the teeth. It is often found more in those who are vulnerable because of deprivation, trauma or abuse. It is also found in relation to drinking, smoking or eating habits.

It can lead to lower self-worth, social isolation and unfavorable oral health care behaviors.

The study, published in Community Dentistry and Oral Epidemiology, is by Louise Folker, Esben Boeskov Øzhayat and Astrid Pernille Jespersen from the University of Copenhagen, Luna Dolezal, from the University of Exeter, Lyndsey Withers, a community volunteer, Martha Paisi, from Peninsula Dental School, University of Plymouth, and Christina Worle, a dentist.

The academics from the University of Copenhagen are working on the project Lifelong Oral Health, which aims to identify barriers to oral health in Danish elderly care—and have identified dental shame as significant in elderly care settings. Professor Dolezal is leading the Shame and Medicine research project at the University of Exeter.

Professor Dolezal said, “Shame can help explain why some people don’t like to expose their teeth to dentists or tell them they smoke or have a poor diet.

“As the study explains, dental shame is both a consequence and a determinant of oral health issues. It is a consequence because oral health issues can cause shame, and it is a determinant because it can act as a barrier to both daily dental care and engagement with dentistry. This can turn dental shame into a self-reinforcing spiral, where shame about oral health can lead to unfortunate oral health behaviors, which can potentially intensify oral health issues and inequities, leading to more shame.

“Because our teeth are highly visible and central to our overall appearance and well-being, dental shame affects self-esteem, social interactions, access to the labor market, care systems and social services. This downward spiral concerns not only oral health but also various other aspects of life.”

“It is important to have non-judgmental environments where patients feel trustful and empowered to prioritize their oral health.”

The study says systemic inequities in dental care significantly contribute to dental shame and health care fee structures can increase dental shame.

Practitioners in oral health care and social settings should be trained in shame competence in order to be able to identify shame, to be aware of how it circulates between individuals and within institutional culture, to manage shame dynamics, identify shaming in policy and practice, and reduce the potentially damaging and anti-social effects of shame.