Written by Renee Brush, Ph.D.

Last Sunday I should have been writing a blog post for you all to enjoy, but my tooth was hurting. Actually, I wasn’t entirely sure which tooth was hurting. At one point, I thought it could have been one of three teeth on the left side of my mouth. The pain was so much that, at times, it radiated up to my temple. Tylenol and CBD oil barely touched it. And plans to write reports and a blog post went out the window.

The pain had started the Friday before that. Not terrible pain. Just shooting pain, here and there. And certainly not constant. By the end of the day Friday, it was becoming a bit more constant. Saturday morning, it was bad enough I knew I wasn’t working on writing reports. Instead, I started searching for an emergency dentist.

And that was a miracle. I don’t like to make phone calls. My primary care doctor has been encouraging me to see a dentist for the two years I have seen her. With no success. I had purchased dental insurance two years ago when she first started encouraging me to go but had never moved past the resistance to find a dentist and then to make the phone call. Recently, a friend had started going to a dentist near my work and she thought he took my insurance and so I had written his name down, but just had never called.

So, a bit of back story. When I was around 17, my dentist had taken out all of my second molar teeth to make room for my wisdom teeth. Apparently, it was what they did back then to try to prevent the painful removal of the wisdom teeth. Then, in 2016, I had had my second molar removed from the bottom left side of my mouth. I still had the wisdom tooth and the second premolar left. After that molar was removed, I was supposed to return to have an implant put in and then get a crown. But that was right before I was separated and then divorced. So, I lost my dental insurance. During the time since then, both the wisdom and the premolar tooth, which had fillings in them, had chipped off. Please note: If it sounds like I’m some kind of dental expert here – know that I am looking up the names for the teeth on dental websites!

Because of the chips in my teeth, I figured that the pain was because of those chips. I felt certain that I would go into the dentist, and she would tell me that I needed to get a cavity filled in. That describes most of my childhood. I had a lot of cavities as a child. And so I have a lot of fillings. Of course, because I am in my 50s, they are the silver kind which are not supposed to be healthy for you. But that is what it is.

So, last Saturday morning, I was searching for dentists that are open Saturday morning and could possibly get me in at the last minute. I only found two. I called one as soon as they opened. It was a children’s dentist office with multiple locations. The person who answered the phone found a location that took adults and said she sent a message to that office and they would call me back within two hours. They never called me back. I initially had been waiting for them to call back, but when it seemed they wouldn’t call back, I started looking again. That’s when I found the second one. I never got through on the phone, but when I didn’t leave a message on the voicemail, I received a text message from them. I sent a text message back asking if they could get me in. But I never received a response to that message. So, the only two open dentists did not respond to me.

I found another dentist office that said they would do Saturday appointments for emergencies, and they took my insurance. I called the number and of course, the message said, “for clients of record.” I was not a “client of record,” but I left a voicemail anyway and prayed they would call me Monday morning first thing. And they did.

And they were able to get me in for an 11am appointment that very same day! I was thankful because I had not been sleeping at all that weekend.

That was a Monday – and a very busy Monday for me too, with seven clients scheduled. Oddly enough, my first client (who had been rescheduled from another day) forgot that we had the appointment and the second client overslept. I then had to cancel my client at 11am so I could go to my appointment. I am fortunate that I have understanding clients. I speak to them so much about taking care of themselves, that they are good about speaking that back to me.

It has been seven years since I was at the dentist. That was part of the reason I had not gone to another dentist. I did not need someone trying to shame me for not going. My history is full of people making me feel bad for things I did or did not do. And, of course, one of the first things they ask is, “When was the last time you had an examination?” I was pleasantly surprised and very happy that the hygienist AND the dentist both said, basically, “No worries, you’re here now.” When you already feel bad, you don’t need someone adding to the guilt.

I wish I could say that I just needed to have a cavity filled that day… After they took x-rays and did a thorough exam of my teeth, the dentist came in and said that I had cracked my wisdom tooth all the way down into the root. That’s why it hurt so bad… and I couldn’t tell which tooth was hurting because it was on a nerve. And it being on the nerve explained why the pain was radiating up to my temple.

And the only way to resolve the issue was to have it pulled. Oooof.

Before the dentist told me about the chipped tooth, they had already said that my teeth needed to have a deep cleaning because of how long it had been since I was at the dentist. That was not so surprising to me. But, since they had to pull the tooth and use anesthesia, they recommended that I at least get the teeth on my lower left side deep cleaned at the same time. That did make some sense. I had heard recently that, when you don’t see the dentist, the tartar and plaque that builds up on your teeth can include bacteria that then negatively affects your health – and I am trying to be healthier, even if I’m not actively making the motions for that.

So, I agreed to have the tooth pulled and that quadrant of my teeth to be deep cleaned. It all felt very stressful, especially since I do not like needles. And the hygienist had a very long needle for the anesthesia, but she was funny. I told her I didn’t like needles and she was like, “Duh! Who does? I would be worried about you if you told me you did like them!” And then I wanted to laugh. I would like to say I relaxed, but it was like I would relax for a bit, tense again, and then relax. Then tense again and then relax, etc. For me, I have to work at it. And I think that is fine.

The whole process seemed to take forever. I don’t know exactly how long it took, but I know I had the time wrong in my head. I had canceled an appointment thinking I wouldn’t be back in the office in time, but then I was. And I was confused. I was on anesthesia, so I will give myself grace for that. And I was also still in a LOT of pain. And my mouth was still very numb. So, I had to give myself a lot of grace that day.

So, then I ended up canceling the rest of my clients that day because of all that. I know it was the right thing to do. But, as a people pleaser, it felt very icky. I also thought maybe I could work on the blog post. Again, the pain was too much to really think straight. So, I had to work through it in my head, but, eventually, I gave up the idea that I had to get things done. I even went home early.

The interesting thing, though, is that as I was talking about this whole situation with my friends at work… every.single.one of them talked about how long it had been since they had been to the dentist. Every.single.one of them talked about how concerned they were about being shamed about going since it had been so long. Every.single.one of them have the same type of history I do.

And then it became very clear about what my next blog post REALLY needed to be about. Dental issues. It’s a week later now and my mouth still hurts. In fact, just writing this has made my mouth hurt and I’ve had to go take some Tylenol…   

Why is Oral Health Important

 I’m sure it is a no-brainer to say that nice teeth help us to feel good and confident in our appearance. My mom had to deal with gum disease when I was a teen so she was very insistent on taking care of all things dental for us as we grew up. I did fine until I had my first divorce and had to get my own dental insurance. At some point, it wasn’t offered by my work and I couldn’t afford it. Maybe during my second marriage and so all of that hard work went to the wayside. Honestly, she would not be pleased knowing about the state of my mouth if she were alive.

So what does it matter? We know that without taking care of our teeth, we can get cavities and, if they don’t get filled, those holes can get deeper and perhaps need a root canal. But, what else can go wrong? The larger concern is the gum disease - and this is where my dentist was really concerned about the time since I had been in. In fact, I already had been diagnosed with gum disease at my last dental office… so I was letting something slide that should not have been sliding, honestly.

Gum disease is an infection of the tissues around your teeth - obviously, your gums. If you don’t brush and floss properly, plaque, which becomes tartar, can build up on your teeth. This is the yellow hard stuff on the teeth. If left on the teeth, this can cause the gums to get red, inflamed, and even bleed. Red, inflamed gums is known as gingivitis (Mayo Clinic, 2023).

The gums can then start to pull away from the teeth and start to make pockets below the teeth line. The hygienist actually has a little ruler tool to measure those pockets. When the pockets become deep, this is when the disease has progressed and is now called periodontitis. The deeper pockets can start to become filled with plaque, tartar, and bacteria. If not treated, it can begin to cause bone loss, which could then cause tooth loss. If treatment continues to not occur, even worse outcomes can occur, such as putting a strain on the immune system. The bacteria can get into your blood stream and then affect other parts of the body. The Mayo Clinic reports that periodontitis is linked to respiratory illnesses, arthritis, coronary artery disease, diabetes, and it goes on. Apparently, this is something not to be messed with….

The Effects of Childhood Abuse on Oral Health

On my Instagram page, I have talked about the link between Adverse Childhood Experiences which are also called ACEs (e.g., experiences like childhood abuse, exposure to domestic violence, divorce, etc.) and medical issues later in life. People who experienced abuse and such things in their childhood have a higher risk for kidney disease, COPD, cancer, diabetes, stroke, and obesity, you name it, as an adult. The level of risk depends on the medical issue. But I never considered – and most places back then didn’t talk about – dental health. Until all this happened.

So, I did some research into the scholarly articles. Recent research from Lee (2019) found that these negative childhood experiences have long-term adverse effects on tooth loss even after controlling for medical issues known to affect oral health including diabetes and lung disease (associated with smoking). Lee found that nearly 13% of people over 50 years old had lost all of their teeth. And, more importantly, people who continued to experience adversity over their adulthood had worse outcomes. In other words, more trauma meant a greater risk for tooth loss.

Unfortunately, it’s not just tooth loss. Other research shows that children with these types of negative experiences in childhood are also twice as likely to later deal with gum disease (Oral Health Foundation, 2015 May 5). This type of outcome is especially likely if the parents do not get the child adequate dental care in childhood such as having cavities filled or getting braces if needed. In fact, another epidemiological study (meaning they included a lot of people in their study) found that as the number of ACEs experienced increased, so did the number of years since the person had last been to the dentist (Akinkugbe, Hood, & Brickhouse, 2019). This association continued to the number of teeth lost as well.

In a review of the literature in this area, Sartori and her colleagues (2023) found 19 article examining ACEs and their effect on adulthood oral health. They found that abuse (i.e., sexual, physical, and emotional) and neglect had much more significant affects on poor oral health and tooth loss than dysfunctional family patterns such as divorce, alcoholism, or parental incarceration. Nineteen articles all finding the same thing that I am summarizing to you here. Sartori and her colleagues pointed out that they are still finding out other things that are related like dental anxiety and such. But, the link is clear - and oral health is part of the body so it probably should not be that surprising.

Effects of Toxic Stress on the Teeth 

Something else my dentist mentioned that is not about fillings or gum disease has to do with toxic stress – that is, being under stress all the time because of someone who is hurting you. I have written in another post about how I brace my whole body. Well, apparently, that affects my teeth too. Why wouldn’t it?

For the teeth, this is known as bruxism, which is the involuntary clenching of the teeth. This can be overnight – or all the time, honestly, which feels like my case much of the time if I’m not careful. Research has shown that people with a trauma history have a higher risk for experiencing bruxism as adults (Yagci, Tasdelen, & Kivrak, 2020). Clenching your teeth can cause pain and stiffness in the jaws. And without treatment, it can cause the teeth to get worn down and even crack.

This is what my doctor thinks happened with my tooth – that clenching caused it to crack. It didn’t help that I never had strong enamel so many of my teeth have a lot of fillings in them. Part of my doctor’s treatment plan for my teeth includes strengthening those teeth with crowns so that this will not happen with my other molars.

Trauma-Informed Care

The Akinkugbe et al. (2019) study included well over 16,000 participants in 10 states and the District of Columbia. What is interesting about their study is that 67% of their participants had experienced at least one ACE. That is a high number. The authors concluded that it will be very important for dentists to consider trauma-informed care because 67% means that the chances of the next client sitting in the chair having a trauma history is extremely likely. And for us as clients, we NEED a provider who is going to provide us with a safe person who is not going to shame us and who will treat us with gentleness and respect and take the time to build a rapport with us. Someone who will take the time to explain to us what we need and what they are doing. My dentist took the time to show me x-rays so I could see the crack in the tooth so I would see the need to have it extracted.

This has not been a fun week. A week later and my mouth is still hurting. But, at least I have a dentist who has a plan to get me back on track. If I am not already diagnosed with periodontitis, I was on my way to developing it sadly. I actually have been remembering quite vividly the day my mom first came home and told us about her problems with periodontal disease. I am sad that I am learning in the same way she did.

So if I can help someone else not get to this point, I will. There is no shame in all of this. You are not alone and you deserve to have a good dentist like I have found. And if you go to a dentist who causes you to feel shame about it - walk out and find someone new! I want all of us to have teeth and smiles we can feel proud of!

References

Akinkugbe, A. A., Hood, K. B., & Brickhouse, T., H. (2019). Exposure to adverse childhood experiences and oral health measures in adulthood: Findings from the 2010 Behavioral Risk Factor Surveillance Survey. JDR Clinical & Translational Research, 4(2), 116-125. doi: 10.1177/2380084418810218.

Lee, H. (2019). A life course approach to total tooth loss: Testing the sensitive period, accumulation, and social mobility models in the Health and Retirement Study. Community Dentistry and Oral Epidemiology. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1111/cdoe.12463

Mayo Clinic (Feb 24, 2023). Periodontitis. Retrieved from https://www.mayoclinic.org/diseases-conditions/periodontitis/symptoms-causes/syc-20354473

Oral Health Foundation (2015, May 5). Destructive childhood experiences “toxic stress” on health inequalities. Retrieved from: https://www.dentalhealth.org/news/destructive-childhood-experiences-toxic-stress-on-health-inequalities

Sartori, L. R. M., Pereira, D. H., Baker, S. R., & Correa, M. B. (2023). Association between adverse childhood experiences and oral health in adulthood: A systematic scoping review. Journal of Violence, 38: 1607-1624. https://doi.org/10.1177/2380084418810218

Yagci, I., Tasdelen, Y., & Kivrak, Y. (2020). Childhood trauma, quality of life, sleep quality, anxiety, and depression in people with bruxism. Noropsikiyatri Arsivi, 57(2): 131-135. doi: 10.29399/npa.23617