The experience of dental avoidance
Creators: name: Marshall, Elizabeth D.
Publisher: name: University of British Columbia
Year: 2008

description: A case study approach was used to investigate the life narratives of nine individuals in relation to their dental avoidance. The participants were three women and six men who had periods of 2 to 20 years duration when they avoided dentists. Of the nine participants or co-researchers, two are still in avoidant patterns. These two people differed from the others in that they both received their childhood dental care early in this century. At that time dentistry was primitive compared to present standards; little was understood about the role of prevention, and individuals often felt traumatized by the effects of dental treatment. In order to understand the circumstances which led the individual to avoid dental care and perhaps jeopardize oral health, I examined their personal experiences within the context of their lives. After interviews with each of the persons, detailed accounts were constructed. From these accounts, a common story was composed called the general story. The beginning of the general story of dental avoidance often has its origins in individuals’ formative years. Chronic influences on the development of avoidant behaviour, such as personal and family values, arise out of the historical and cultural milieu in which individuals find themselves. Acute influences from dental or non-dental experiences also effect avoidant behaviour. Growing out of these influences are emotions and beliefs which become associated with dentistry. If a person experiences violation or mistrust within a dental setting, adisequilibrium begins which unbalances the person's ability to seek care. In the middle of the general story, tendancies towards avoidance grow. For some, these tendancies are a result of slowly developing responses to dental care, for others, a single event may provide the precipitating event that triggers the beginning of an avoidant episode. As individuals struggle with the external events of pain and deteriorating teeth and gums as well as the increasing emotional responses, their lives become increasingly difficult. They may defend their avoidant behaviour in active or passive ways. In addition to resorting to defensive behaviour, people coped by seeking emergency care for the short term relief of pain. Interruption in the avoidant cycle occurs when the person's defences are shattered. The suspension of avoidance may occur as a result of an event, either dental or non-dental, or as a result of a growing awareness of the severity of the situation. The end of the story occurred as a consequence of individuals seeking help for their dental distress. With this help, they appraised their previous values and developed new ones. They also experienced improvements in their lives that were more far reaching than their immediate dental relief. For two people, the story ended differently as they chose not to seek help as a way of avoiding the greater discomfort of entering a dental office. For several individuals, the avoidant experience has been so profound that they felt that the condition of their teeth had become a metaphor for their lives. Although previous research has identified several causal factors as the reason in dental avoidance, this narrative study, by examining dental avoidance in the context of people's lives, indicates that it is a decidedly more complex phenomenon. For example, the co-researchers agreed that the issues have less to do with the procedures and more to do with how the dental professionals treat them. Three models of dental health-related behaviour, Becker's (1974) Health Belief Model, Antonovsky's (1979) Salutogenic Model of Health, and Lazarus and Folkman's (1984) stress, appraisal and coping theory, were examined. This study supports the transactional nature of the three models. As well, this study demonstrates many of the health-related behaviours identified by these model. However, it suggests that these models are simplistic in that they do not take into account the richness and complexity of the avoidant experience within a person's life. Moreover, they do not clearly identify the importance of the interpersonal relationship with the dentist for the individual. The practical implications of the study suggest the viability of the general story as a model in the study of dental avoidance. In order to affect the outcome of dental avoidant behaviour within the dental setting, this story suggests that it is essential that the dentist and dental personnel have an awareness of the issues of dental avoidance for an individual, have sufficient interpersonal skills to relay their empathy and understanding of the seriousness of this phenomenon for this person, and be skilled in empowering each person who seeks their care.