HJAR Nov/Dec 2022

48 NOV / DEC 2022 I  HEALTHCARE JOURNAL OF ARKANSAS ORAL HEALTH DIALOGUE COLUMN ORAL HEALTH HOWmany people do you personally know who refuse to smile or socialize because they are embarrassed by the condition of their teeth? The question this begs is what keeps people from going to the dentist?The answer is not universal and varies from person to person. TheAmerican Dental Association lists the top three reasons people avoid going to the dentist as cost, fear, and convenient loca- tion or appointment times. Although classify- ing people into different groups that include age, household income, education, and dental benefit status, these reasons become more complex and varied. 1 Oral health is not only part of the equation in overall health but also has a significant role in quality of life measures. 2 The terms “health,” “status of health,” “health-related quality of life,” and “overall quality of life” have been used synonymously in scientific literature for years. The concepts behind these terms are also multifactorial, complex, and ever- evolving, with social, cultural, political, and practical contexts. 3 Daily activities of chewing, eating, talking, and smiling are part of our oral functions that have resulted in an overall socio-environ- mental model of health that reflects physi- ological, social, andmental well-being. 3 Much of our confidence and self-esteem is due to how we look, feel, and act. We equate health with youth, and numerous advertisements depict big, flashy, “beyond white” smiles. Fear is defined as a distressing and strong emotion caused by a belief that someone or something is dangerous, likely to cause pain, or a threat. Fear is not all bad, as it can keep us safe from harm. The key is to distinguish if it is rational. Being fearful of dentistry can stem from an anticipated danger or an un- known danger and can be dependent on past or unknown experiences. Dental fear involves a “fight or flight” response when confronted with a threatening stimulus and is a reaction to a known danger. 4 Dental anxiety is different, as it is a reac- tion to an unknown danger. It is also com- mon and can involve excessive dread about an approaching appointment or anticipatory experience. 5 Dental phobia is an intense fear of the dentist or dental treatment. Patients who experience dental phobia are more likely to avoid dental treatment at all costs, even if this means they know their oral health will suffer. Only in extreme circumstances will a person seek treatment, and it often involves more invasive treatment to correct an issue. 6 Cost can be a factor, especially if a pa- tient does not have dental insurance. How- ever, prevention is the goal in achieving and maintaining a healthy oral status. Neglect can be costly on many fronts, as it can produce problems when not caught early. Detecting small issues and keeping them from becom- ing larger ones is optimal before the denti- tion is affected. What is it that frightens people about the dentist? Did a bad first experience set the tone of the anxiety? Was it the fear of the unknown?There are many different elements that come into play, and they vary from per- son to person. For instance, the sound of a dental drill, seeing a needle, or the sight of blood is too much for some to bear. Another person may fear they won’t be numb enough and will feel pain when having a dental pro- cedure. Many fear the actual injection, while others don’t mind the injection, but instead dread the side effects of anesthesia such as a fat lip or biting their tongue since they can- not feel it. Surprisingly, many people who have dental benefits do not utilize them. Astudy complet- ed by Delta Dental of Arkansas revealed rea- sons for not going to the dentist, which had nothing to do with cost. The study included a series of in-depth interviews, which asked non-uniform questions, such as how often these respondents were going to the dentist or what was keeping them from seeking den- tal care. Surprisingly enough, these reasons did not include a financial one, nor did they include fear. Instead, reasons included shame and guilt of not going regularly, being judged by dental professionals, and feeling guilty for not being a good role model for their family. 7 The matriarch, who usually makes the de- cisions and appointments for the family, of- ten places everyone’s welfare above her own. THE TRUE COST OF DENTAL NEGLECT: What Keeps Patients from Going to the Dentist?