Fear, Shame, Race, and Their Impacts on Access to Care

In the dental office, one experience, good or bad, can have a lasting impact. For too many people, negative experiences add up over time, travel through the grapevine, and lead to anxiety, fear, and shame that put up walls between entire communities and the care they deserve.

And as is the case for so many social determinants of health, race and racism are inextricably intertwined.

“We lived on the wrong side of the tracks being African American. There was only one dentist that I remember who was even available to us. I didn’t know what a dentist was. I didn’t know what a dentist did,” Carol said. “To the best of my memory, which was many years ago—in the mind of a child—I just remember his pulling on something in my mouth. Pulling back and forth with what looked like a pair of pliers. I screamed, I screamed at the top of my lungs because it hurt so much. And I didn’t want to go to the dentist anymore for the rest of my life.”

Carol’s Story

Carol had a traumatic experience in a dental office early in life that led to an unimaginable amount of pain. Pain that continued throughout childhood, perpetuated by a fear of returning to the dentist when cavities or other issues arose.

“Whenever I would have a toothache, I wouldn’t tell my mom. And if I had a cavity, I couldn’t sleep at night. I couldn’t rest well. It impacted my chewing, my swallowing, and my overall health because I would have pain in my ears and down the side of my neck,” she said. “But I was so scared. I was scared to experience the pain at the dentist again.”

In her community, Carol wasn’t the only one with a fear of the dental office.

“Stories travel. Stories travel really quickly. And bad stories travel much faster than the good ones. So not only did we know to be afraid of the dentist — and of course he was white, and we were all Black — not only to be afraid of this white man with this chair and this stuff in his office, but also that he hurt children, and he hurt adults. It really kept people from wanting to get the help they needed because of the physical pain.”

A Barrier to Access

Carol story isn’t a relic of the past. The same kind of fear she experienced as a child grips others today, and anxiety, fear, and shame around dental care is still a serious barrier preventing access.

“What I can tell you unfortunately is that there are many stories that are similar to mine in today’s time. That is true for dental care, and it is true across the board,” said Carol. “One, people are already afraid. Two, people don’t have to treat you well. This thing with Black Lives Matter, it’s not new. This thing with institutional and structural racism, it’s not new.”

But just as much as negative experiences can leave traumatic imprints, positive experiences can change entire outlooks on oral health care.

Carol said, “When I started going to the dentist here (in North Carolina), he had a sign in his office that said, ‘we cater to cowards.’ I said, ‘good, because that’s me!’ I told him about my experience, and he said, ‘you won’t experience anything like that here.’ His mannerisms were engaging, he would come into the room smiling and ask me what I had been up to. We would talk, and it was a whole different atmosphere. I started going twice a year, using my preventive care.”

Dentists can play an important role in helping those who are experiencing anxiety, fear, and shame, just by taking the time to understand the range of experiences that their patients may bring into the dental office.

A Willingness to Listen and Learn

“I think it’s really important for dentists to make sure they are getting outside of their comfort zone and their group, even if it’s a professional setting, to talk about things like structural racism,” said Carol. “It’s important to get into groups with folks like myself where we can talk openly and share stories and they can ask questions. And also, if they have patients who come in, just being willing to learn, being willing to listen, and being willing to talk.”

“Provide that openness, because when a person has been privileged, they really don’t know,” she said. “An example is in my family, education is a big deal. Everybody in my family did public speaking. So, when it was my turn and I was two or three I just jumped up and I did it too, because that’s what we do. I say that as an example of the fact that I didn’t know that I was supposed to be afraid of public speaking. I have been fortunate for something to be natural to me that may not be natural to most people. So just because someone has white privilege does not mean that there aren’t opportunities to learn. There are opportunities to learn.”

An Opportunity for Change

At NCOHC, we work to ensure that everyone — no matter their background, where they live, or who they are — has access to quality, affordable oral health care. We thought that Carol’s story was an important one to tell to highlight just how serious anxiety, fear, and shame as social determinants of health can be.

Is her story an indictment of dentists? No. But is it something we believe all dentists could learn from? Absolutely. The humility to step outside of your comfort zone and experience someone else’s truth can be difficult, but it can also help providers change patients’ lives.


Brushing Fido’s Teeth

Your furry friends need regular oral health care, just like you. Unfortunately, good information can be hard to find, care can be expensive, and too many people simply don’t know what they should be doing to keep their pets’ mouths happy and healthy.

Dr. Lenin Arturo Villamizar-Martinez, DVM, MS, PhD, Dipl. AVDC, is a board-certified dentist, head of the Dentistry and Oral Surgery Service of the Veterinary Teaching Hospital at the North Carolina State University College of Veterinary Medicine.

Dr. Villamizar-Martinez sat down with us at NCOHC to talk about animals, their mouths, and what best practices pet owners should be aware of.

What should people know about their pets and their mouths?

“The first thing that the owner needs to know is to brush their pets’ teeth daily,” said Dr. Villamizar-Martinez. “The teeth in dogs are equal to teeth in humans.”

He said that humans do tend to have more issues with cavities than their pets, but around 80 to 85 percent of dogs have periodontal (gum) disease. Regular brushing can help prevent gum disease and other issues that lead to expensive treatments down the road.

Tip sheet for caring for dog and cat teeth

According to Dr. Villamizar-Martinez, choosing your pets’ toys wisely is another way to ensure that they maintain good oral health.

“There are a lot of products on the market for chewing,” he said. “Something that we recommend is to use any toy that you can make an indentation in with your fingernail. That toy will be soft enough to not cause a fracture on the teeth—that is a problem that we see a lot of.”

Softer toys will also rub your pets’ teeth when they are chewing, helping remove dental plaque. Harder toys like bones, on the other hand, can end up causing serious issues that lead to costly procedures.

“Research shows that these kinds of toys (bones and other hard toys) are related to complicating crown fractures, and at this point the only treatment that exists is to do root canal therapy or to extract the tooth,” said Dr. Villamizar-Martinez. “And that is expensive. When we are talking about root canal therapy, that ranges between $1,500 and $3,000. You can avoid that just by picking good toys for your dogs and cats.”

Before you jump up and search for new toothpaste or replacement toys online, Dr. Villamizar-Martinez said that there is a lot of inaccurate information on the internet. It can be hard to figure out what is actually good or bad for your pets online, and it is always better to ask for advice from your primary veterinarian.

He also recommends that pet owners visit the Veterinary Oral Health Council’s website. The VOHC reviews pet products and publishes lists of everything from pet toothpastes to toys, treats, and food that meet good oral health standards.

So, my dog is no longer a puppy (or my cat is no longer a kitten) and they aren’t used to having their teeth brushed. What do I do now?

“I’m living that experience right now,” said Dr. Villamizar-Martinez, talking about his newly adopted six-year-old dog, who never had his teeth brushed before.

He recommended to start by taking your pet in for a professional dental cleaning if possible.

“The first thing I did was put him under general anesthesia and did a professional dental cleaning,” said Dr. Villamizar-Martinez. “Then I said, ‘Now I need to start brushing her teeth !’”

He said the easiest way to start brushing a pet’s teeth is to use your finger first, mimicking the brushing motions you will eventually use a toothbrush for.

“After two or three weeks, your dog will know that it is normal and good, then you can move to a toothbrush,” said Dr. Villamizar-Martinez.

What do I do if I think my pet has an issue in their mouth?

“First, go to your primary veterinarian,” said Dr. Villamizar-Martinez.

General practice veterinarians can diagnose most oral disease, and they can run any blood tests or other diagnostics that may be necessary. If your pet has an issue, the veterinarian will be able to point you in the right direction for next steps.

Dr. Villamizar-Martinez said that many general practice veterinarians are trained to do professional dental cleanings and extractions if necessary. If your pet’s needs are more complex, your veterinarian should be able to recommend a veterinary dental specialist.

If you do find yourself taking your pet in for an oral procedure, Dr. Villamizar-Martinez said to make sure to only go to specialists who offer procedures under general anesthesia. A quick Google search will reveal many specialists who offer “anesthesia-free” procedures, but they are generally only cosmetic fixes that don’t fix the root of your pet’s disease. In many cases, Dr. Villamizar-Martinez said that these kinds of procedures can even make problems worse.

What about the cost of care?

Specialist veterinary procedures can be expensive, and unfortunately there aren’t many resources available for pet owners with financial constraints.

“Prevention is the most important thing at this point,” said Dr. Villamizar-Martinez. “That is the number one thing that is going to help.”

Dr. Villamizar-Martinez said that the NCSU College of Veterinary Medicine has been planning to start a program to offer veterinary solutions for shelter and rescue organizations that can’t afford to pay.

“We were thinking of adding some kind of pet dental care for shelters and rescue organizations who don’t have financial resources,” said Dr. Villamizar-Martinez. “Dr. Kelli Ferris, one of our faculty, directs our Mobile Veterinary Hospital. Veterinary students under Dr. Ferris’ supervision perform spay and neuter procedures. We were planning to incorporate dentistry, but the pandemic got in the way, at least for now.”

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