Taking on dental shame and inequality in Denmark

Not many people know this, but Denmark is almost worst in the world in terms for inequality in dental health.

According to Esben Øzhayat, a researcher at the Department of Odontology at the University of Copenhagen (UCPH), most Danes have healthy teeth — but Denmark has a problem:

»There’s a huge gap between those Danes who have good teeth, and those who don’t,« he says.

If you want to see dental problems, just visit an asylum centre

Odontologist Esben Øzhayat

It is primarily older citizens or vulnerable groups — such as the socially disadvantaged or homeless — who make up the two largest groups with poor dental health, according to Esben Øzhayat. But other groups are also affected.

»Right now I’m part of a project where we visit refugees in asylum centres. They have no access to dental care — not even basic care. If you want to see dental problems, just visit an asylum centre,« says Esben Øzhayat.

Wants to make a difference

Esben Øzhayat’s research field is social dentistry — a discipline within dental science that focuses on the individual and societal consequences of dental problems and oral health, and on how diseases of the teeth can be brought under control through organised dental care.

Social dentistry suits him. Every time he spots a group in society that struggles with dental issues, he thinks: »We have to do something about their dental health.«

It is his sense of social justice that motivates him, and it stems from the compassion he developed growing up:

»At home, we talked a lot about how some people have a tough time. I became friends with many who were struggling, and I learned to be grateful for my own situation. This made me realise I had to give something back to those who suffer. You can’t just leave it to others,« says Esben Øzhayat.

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Dental shame: a disease

Working in social dentistry, he is trained not only to understand the barriers to helping others, but also to identify where help is needed the most — and it’s not always about money.

»A new research topic that I and others have delved into is the concept of dental shame. It turns out that while many may think that shame pushes people to visit the dentist, the opposite is often true,« says Esben Øzhayat, offering an example:

»If you visit the dentist and are told to stop smoking and drinking coke, but your social situation leaves you without the energy to change habits, it becomes a downward spiral. You stop seeing the dentist because the demands make you feel worse — and then your teeth get even worse.«

Dental shame can itself worsen dental health if it’s not tackled as a problem — just like any other disease.

Esben Øzhayat believes that working with the concept of dental shame in social dentistry can lead to improvements for vulnerable groups. He also hopes it can open the door to new ways to tackle the destigmatisation of various dental health issues.

»I’ve already introduced the concept of dental shame to several municipalities, and they adopted it immediately. Elderly residents in municipal care homes are ashamed of their bad teeth, and care staff may feel shame too — if they want to ask a resident to use dental floss. Staff may fear they’re crossing a line,« he says.

Bad teeth always have a backstory

Esben Øzhayat worked as a clinical dentist for 13 years after qualifying as a dentist from the University of Copenhagen (UCPH) in 2006. But his sense of social justice led him into research: He felt he could make better use of his talent at the Faculty of Health and Medical Science, and so he left clinical practice in 2019, driven by a mission to see the whole person — not just their teeth.

I hope I can inspire students to develop a social conscience

Odontologist Esben Øzhayat

»For me, it’s always about highlighting people who are struggling and insisting that their problems are never just about their teeth. Poor dental health is always tied to all kinds of other life circumstances,« says Esben Øzhayat.

That’s why it’s important to look at when dental problems begin: You need to understand the whole story.

»For most people with poor teeth, the problems started many years ago. They developed various health issues simultaneously, which is typical for the socially disadvantaged,« he says.

Black teeth won’t get you a job

Esben Øzhayat took part in a project in Copenhagen’s Nordvest district aimed at motivating unemployed people with bad teeth to visit the dentist. The project had a positive effect — once their teeth were fixed, participants moved closer to the labour market. But dental shame also played a role here.

»If you have ugly, blackened teeth, it becomes a barrier to entering the job market. People are so ashamed of their teeth that they decline job interviews,« says Esben Øzhayat — a clear example of the link between individual dental health and broader societal issues.

He hopes that, as a lecturer in dentistry, he can inspire his students to become dentists who also care for society’s most vulnerable when they encounter them in the clinic.

»If I can get some of the students to understand how teeth and society are inseparably linked, then I’ll have come a long way in my mission. Vulnerable people with poor teeth aren’t exactly popular patients in a dental clinic. I hope I can influence the students to develop a social conscience so they’ll care for the disadvantaged,« says Esben Øzhayat.