The day may come when an internet genius invents a way to deliver dental care to our homes and workplaces. Until then we won’t have it unless we get ourselves to the dentist. The trouble is, we don’t go to the dentist as much as we should, and this is harming us. Let’s look into some of the reasons people dodge this basic health measure and consider a few ways to make better decisions about it. Children, it turns out, are getting to the dentist more than ever, which is a good thing. Of course, they don’t have much choice in the matter. It’s adults who have been in a dental utilization downtrend for some years. Only about 35% of working-age Americans were seen by a dentist in 2012. We’re making better decisions for our kids, but worse ones for ourselves. Dentists have formed opinions on this issue from accumulated professional experience, and now we have access to a solid body of data that address the phenomenon of dentistry avoidance. The American Dental Association (ADA) Health Policy Institute conducted a national poll of 4,014 adults, 18 or older, in 2014. Respondents were asked whether they intended to visit a dentist during the next 12 months and if not, why not. We’ll draw from both of these sources in our discussion.

PAVED WITH GOOD INTENTIONS

The basic finding of the ADA poll is that 22.9% of the respondents said they either did not plan to see a dentist during the forthcoming 12 months, or were not sure. A positive reply was given by 77.1% of the respondents. If we compare these intentions with the finding cited above that only about 35% of adults actually go to the dentist during the year, we conclude that about twice as many adults say they’re going as actually go. Not very surprising. Most people know they should go to the dentist at least once a year if not twice, and most people intend to do the right thing for their health. We see, though, that there’s a big gap between intentions and actions in this regard.

SHOW ME THE MONEY

Zeroing in on the 965 people who said “no” or “not sure”, the researchers asked them why they didn’t intend to see a dentist. Overall of the respondents cost was the leading reason given, with 40.2% of the nay-sayers citing the financial obstacle. It’s a very real challenge, of course. Dentistry can be expensive, and about 22% of all Americans have no dental coverage of any kind. The purely financial side of this obstacle is a very big political-economic problem which is beyond the scope of this discussion. What we can look at here is the psychological-personal aspect of the decision to forego dentist visits. In the context of financial stress, does it make sense to delay or avoid dental checkups and treatment? It doesn’t pay to. Treatment delayed is more costly, often much more costly than prompt treatment or avoiding the need for treatment through prevention. In the long term it’s cheaper to have regular checkups and cleanings, and prompt treatment, than it is to wait until problems can no longer be endured. Dental checkups are not very expensive. Many people are well cared for by going twice a year. While it’s certainly true that some people simply cannot afford even this modest expense, by far the greater number of those pleading the financial barrier are acting unreasonably. It’s a very human error. Most human beings are not naturally skilled at estimating the value of uncertain events. The solution is better education and acculturation. There are encouraging signs that things are changing for the better. In the ADA survey, young people were less likely than older respondents to blame cost as the reason for not planning to get to the dentist.

DON’T NEED IT?

The second most-cited reason (32.7%) for not planning a dentist visit was “My mouth is healthy and I don’t need dental care”. That was actually the #1 reason cited by high-income respondents and those with private insurance, that is, the people who had the lowest financial barriers to overcome. Perceived need for dental care is a tricky factor to analyze because it’s theoretically possible that many or most of these respondents were correct, in the sense that a checkup would find no decay or other issue requiring treatment. Although the ADA study can’t tell us how many of these people actually did have treatment needs, we can reasonably conclude that their response reflects an “event-driven” attitude toward dental care: you go to the dentist when you have a problem that needs fixing. Dentists, though, know very well that by the time a patient feels something wrong the problem is probably well up the cost curve as far as treatment goes. The professional consensus is that regular checkups and cleanings are the rational strategy for supporting oral health cost-effectively. These visits should be scheduled at intervals compatible with the individual patient’s needs, something dentists are expert at determining.

SCARED?

Discussions of dentistry avoidance have traditionally held up anxieties, fears, and phobias as prime culprits. The ADA data don’t support this and suggest that attitudes are catching up to technological reality. Whereas 7.4% of people in the 35-49 age group cited “anxiety over visiting the dentist” as the reason for no-go, that dropped to 2.8% in the 18-34 cohort. Well, dentistry used to be much more unpleasant than it is now. Advances in anesthesia, tools, methods, and training have transformed dental care into an almost entirely painless experience, and it looks like the memories of old-school ouch! are fading from the collective memory. Fear of pain is not the only source of dental anxiety, though. Dentists know very well that some patients avoid them because they’re afraid of being lectured about their poor hygienic practices. Others are afraid of the instruments and equipment. A few are afraid of being seen to be afraid. If we’re down to 2.8% of the young people avoiding dentistry out of fear, there may not be much room for improvement in these highly personal attitudes. Dentists are well aware of these fears and know how to mitigate them. On the patient side, finding a dentist with the right interpersonal “chemistry” may be the best approach. Logistics remained a real or perceived obstacle for about a quarter of the ADA sample of no-go respondents. Time and travel. It’s difficult to evaluate how “real” these barriers are. We note that the 18-34-year-olds, the group that was least likely to pin dentistry avoidance on fear, was most likely (45.3%) to claim logistics as the reason for not planning a visit.

YOUR TURN

If you haven’t already, it’s time to do what you need to do to internalize the perception of regular dental care as an essential element of your overall healthcare. The event-driven approach is irrational and harmful, like waiting until your tire blows before getting new ones. Figuring out how to pay for your dental care is probably not nearly as difficult as you think, once it’s put in its proper place on your ladder of priorities. The logistics appear much more manageable when you realize that you’ll generally be able to plan for dentist visits months in advance. You know it won’t hurt. Let’s not find ourselves joining the 29.5% of the ADA’s 65-and-over age group who offered this reason for not planning a visit to the dentist during the next 12 months: “ I have dentures/no teeth.”