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When your teeth and gums are healthy, their contribution to your everyday life often goes unnoticed. Proper oral health enables us to chew, taste, swallow, speak, and express emotions effectively.
This indicates that the condition of your mouth can significantly influence nutrition, self-esteem, building relationships, and sustaining overall health and wellness.
Those with missing or damaged teeth, or other dental issues like gum disease, are acutely aware of this.

They may endure pain affecting their sleep, speech, and enjoyment of certain foods, and frequently encounter 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 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 from the United Kingdom, researchers showed young people photographs of the same person, modified with different levels of tooth decay.

In situations where decayed teeth were visible, observers rated the individual lower in intelligence, social abilities, confidence, self-worth, and perceived happiness — based solely on appearance.

These stereotypes can lead to bullying and stigma that scar people for life.
In a recent study with colleagues, we looked at nationally representative data on 4,476 children from the Longitudinal Study of Australian Children.

It was found that losing teeth from decay or injury is relatively common, impacting one in ten children, who then have a 42% greater chance of being bullied at school.

These stigmatizing experiences can foster feelings of shame, embarrassment, and low self-esteem. In some cases, they may deter individuals from seeking dental care, fearing further humiliation or criticism for perceived self-neglect.

Dental care is often out of reach

Tooth decay and gum disease are the most common oral diseases 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.
Yet the government’s Child Dental Benefits Schedule only covers dental care for children aged 17 and under whose parents receive government benefits.
Some states and territories also provide oral care for eligible older adults. But long waiting lists show the public system is stretched.

This means oral health care remains inaccessible and unaffordable 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 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.

Studies indicate that those suffering from tooth decay pain are more inclined to miss work or school, which can have persistent negative impacts, disrupting their education and career.

A dentist wearing blue disposable gloves and white scrubs looks down from above while holding a dental instrument.

Research shows when people are in pain from tooth decay they are more likely to take days off work and school. Source: Getty / ArtistGNDphotography

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 for dental treatments.

Research shows 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.

Recently, there has been an increase in people using superannuation to cover dental treatments for largely preventable issues, which might exacerbate financial hardship.

So, what’s the fix?

Research I conducted with colleagues this year found 96 per cent of working-aged adults in Australia believe oral health care is essential.
But there continue to be significant financial barriers in getting required treatment, particularly for people who are unemployed, have low incomes or those with disability.
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. But the burden to fix this should not be on individuals.
The main causes of oral diseases are behaviours — such as having a lot of sugar, alcohol and tobacco, or poor oral hygiene — and high levels of stress.
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 both tooth decay and gum disease and the stigma attached to these oral health issues.
Ankur Singh is the chair of Lifespan Oral Health at the University of Sydney. He receives funding from Australian Research Council DECRA Award and the chair of Lifespan Oral Health position at the University of Sydney is funded by the Rosebrook Foundation.

The Conversation
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