Teeth — what are they? Pebbles in your mouth, bones you can see. The closest thing we have to proof that God doesn’t exist. Yes, it seems we’re just alone here, pointlessly dying on Earth with our rotting mouth bones. But at least we have dentists to care for us.
Or are they our enemies?
I recently underwent the search for a new dentist. It had been a fairly unreasonable amount of time since I’d seen my last dentist, because that dentist scared me. She was not very kind about a number of things, including a procedure I needed, imminently, that would have cost thousands of dollars. She seemed very unhappy with me for needing this costly procedure. “Well, I’m certainly not getting that done,” I thought, leaving her office. (The procedure was a root canal, and I did, in fact, have it done recently.) (I have dental insurance now.)
So when I eventually asked around about a new dentist, I had two qualifications: that they take my insurance and not be upset with me. “My dentist is actually nice!” I heard from some. “Mine will be tough with you, but they actually aren’t too mean,” from another. “I think my brother likes his dentist…,” from another who, I think we can agree, was reaching.
A common thread seemed to be the idea that dentists are generally upset, but that my friends were under the care of outliers. But are dentists ever actually mad about our oral hygiene? Or are we somehow mistaken about their grumbly intention?
Dr. Jessica Hilburg, NYU College of Dentistry’s associate dean for clinical affairs, was intrigued but slightly taken aback when I asked her why, um, maybe sometimes … patients might perceive … their dentists to be so angry with them about their very bad teeth?
“My question for you is …” she said. “Where did you get this from in the first place? Have you heard this from patients?”
My answer for her was mostly the story I told above, but I did think the question deserved more prodding.
On Twitter, I asked if anyone had a similar feeling. They did. To protect the innocence of the many who kindly and eagerly told me their dental woes, I will keep them anonymous.
“I’ve grown to fear judgment from my dental hygienist and in turn dentist far more than any mouth pain,” said anonymous dental patient (ADP) No. 1. “Even though I’m now flossing regularly, they always have something negative to say, like I’m flossing too hard, or I’m not making enough of a ‘C’ shape with my floss when I do it.”
“I did have a dentist who was upset about my lack of flossing and brushing habits,” said ADP No. 2. “It wasn’t just an impression I got, they were pretty upfront about it.”
“Every dentist I’ve ever visited has scolded me for not flossing, not flossing enough, not flossing correctly, not flossing after every meal, and maybe even one said something about flossing after gum.” Damn. It’s rough out there for ADP No. 3.
“I like my dentist now fine, but my childhood dentist still haunts me,” ADP No. 4 told me. “Starting around first grade I had a cavity at almost every visit. Then, he never gave me enough novocaine and, when I would cry while he was drilling, he would stop, ask me if I could feel it, and when I answered yes he would say, ‘no you can’t’ and keep going.”
“I used to go to a dentist that was horrible. The entire appointment was dragging me for not flossing.” “I very literally got yelled at by one dentist for the state of my teeth during an appointment.” “I once had a dentist get rather upset and tell me I brushed my teeth too vigorously, at which point I officially gave up and just accepted that my efforts at dental hygiene are futile.”
Et cetera, et cetera. It would seem the experience is not uncommon. So, back to the question. Are dentists actually mad at us?
“I’m a general dentist, and I was really thinking about this, but I can’t ever remember being mad or angry at a patient for — for anything, really,” NYU’s Dr. Hilburg told me. She said she could see how, sometimes, any health-care provider might be frustrated if their patient hasn’t followed through on the plan they were told to follow. “Not because they were angry at them, but because they were looking out for the health of the patient.”
“I’ve had new patients that come in and seem almost apologetic that they haven’t been to the dentist in a number of years, or months, or whatever it is,” she said. “And what I say to them always is — there’s no reason to feel guilty. You’re here right now, so let’s move forward. And that’s that.”
(For the sake of full disclosure, I had one ADP tell me their dental hygienist told them exactly this, after they hadn’t been to the dentist in many years. “After the first stretch it was mostly to avoid judgmental comments from the dentist. When I finally went last year, I was very sheepish about it being a long time but the dental hygienist said, ‘Well, you’re here now!’ and that felt better.”)
“We never, ever try to make patients feel embarrassed in any way. But it is a pretty common feeling,” Dr. Ramin Tabib of NYC Smile Design told me. “They’re worried that we may need to lecture them. My feeling is that it’s not a necessary feeling, and it shouldn’t be there.”
“If it’s embarrassing you that you haven’t flossed,” Tabib said, “we’re not about to make you feel worse about it. Just to educate you.” Hm. Then why do all the other dentists make us feel like we want to crawl into one of the holes in our teeth and die? “It is a tactic sometimes that’s been used by dentists to — I don’t know, I won’t say browbeat,” he said, “but to control the situation. They feel like by talking in a certain way to a patient they’ll have the authority, and the patients will never question anything. I think that’s the wrong approach. I do hear it, patients come in telling me about it.”
“If other dentists feel annoyed or angry at their patients, I don’t know about that. That’s certainly not me or my father.” This is Dr. Sivan Finkel, a cosmetic dentist who has a stylish dental practice called Dental Parlour in Manhattan (with his father). “But — ” he said. Yes, yes?? “What we do is not so much about blaming the patients, or scolding the patients, it’s about making the patients own their issue.” By that he means, asking a patient to be honest about their dental history and current routine so they can understand why the teeth are in the state they’re in, and what needs to be done to fix and maintain them.
“Then, if we kind of put our foot down and tell a patient, listen, you have to stay on top of this, you have to take care, you have to own your problem, it’s not about scolding them or placing the blame. But if they’re about to embark on us doing all of this beautiful work for them, and sometimes it’s expensive. So we don’t want to do something that’s not going to last.”
Sounds scary to me. Still, he said, “We certainly shouldn’t ever make our patients feel bad, or ashamed that they don’t floss, or they don’t do this.”
Hm. While I did hope to get a dentist to go on record saying she curses her patients nightly — even offering dentists anonymity to do so — I suppose it’s not particularly surprising that no one did. Part of the dentist’s code, I assume. What bridges the gap, then, between our feelings of dental animosity and dentists’ feeling of simply wanting our mouths to be less disgusting because apparently, they love us?
Perhaps it is a problem of perception. I emailed with Abigail Marsh, associate professor of psychology at Georgetown University, about the potential emotional disconnect. “Much emotional communication is inherently ambiguous, and our own expectations, learning history, personality, and current affective state can all change the way we perceive others’ emotions,” she said. If we expect someone to be angry with us, for example, we’re more likely to seek signs that they are angry, and interpret any ambiguousness as a sign of anger; if we think they’re likely to be disappointed, we might interpret the same ambiguousness as concern. “People misperceive others’ emotions all the time!” she said.
Marsh explained that even in a controlled laboratory setting, people only accurately recognize simple emotions (like happiness, anger, fear, and disgust) about 70 or 80 percent of the time. And those averages don’t show the breadth of individual variation. “People vary considerably in their sensitivity to different emotions.”
Richard Zinbarg, psychology professor and department chair at Northwestern University, backs her up. Speaking over the phone, he explained his research into whether anxiety influences the interpretation of emotions, particularly when the emotions are ambiguous.
“Our research has produced results that suggest that the anxiety level of the perceiver is associated with a tendency to read ambiguous faces as if they’re angry or disgusted,” Zinbarg said. “So if the dental patient is anxious, like, oh, I’ve been a bad boy, they wanted me to floss and I didn’t, oh, jeez, it kind of triggers some buttons leftover from childhood when we didn’t meet our parents expectations.” It could be, he proposes, that the dental professional isn’t angry at all and, instead, is just a very breezy neutral. “Can I tell you that’s for sure what’s going on? No.” But the research does provide a potential explanation.
Finally, I spoke with Lisa Feldman Barrett, professor of psychology at Northeastern University and author of How Emotions are Made: The Secret Life of the Brain. She explained that what she thinks is happening when a person attempts to perceive another person’s emotional state: Mainly, that the perceiver’s brain is just trying to reconcile its own internal sensations (like a funny feeling in the stomach, or an increased heart rate) with the sensations outside of it (like someone’s scowl or happy face).
“So a raised heartbeat or a scowl can mean many different things to a brain. So [a person’s experience] is constructed by the person making sense of their own internal sensations, and the sensations from the world.”
It’s a little heady (like teeth), so she explained further. “If you and I were face-to-face instead of talking over the phone, you would be not only getting acoustical cues from my voice, but you would also get cues from the movement of my face, and my body movements, and so on.” My brain would be, at once, trying to make sense of those cues and my own internal state.
“And my brain,” she continued, “would also be trying to make sense of my own internal state … and so on and so forth. So, my brain is making sense of the whole array, including my movements and sensations, and you’re doing the same. And the accurate perception of a person’s emotional state arises, she thinks, “when those two are aligned.”
It’s seems it’s simply very hard to be alive and interact with people, which was always my suspicion.
“I think another piece of the puzzle is that there’s a stereotype, or a belief, in our culture,” she said, “that people scowl when they’re angry and smile when they’re happy.” Sometimes people do scowl when they’re angry, but they also do other things with their face, or nothing at all. And sometimes people scowl just because they’re concentrating really hard. “This stereotype causes people to misperceive things in each other. And I think this commonly happens under high arousal states where there’s a lot of pressure, and people are feeling really worked up.”
“I’m guessing — this is just a guess, just a reasoned speculation based on what I know — my guess is that in a dentist’s office, the patient is in a high arousal state, because who wouldn’t be. And probably the dentist is concentrating really hard and problem solving. So, a scowl can be misinterpreted as anger, particularly if the patient knows they haven’t done something they’re supposed to do, like floss.”
So, what is it? Are dentists mad at us? Do they have little sympathy for the fact that many people don’t have dental insurance, and maybe that’s why they’ve stayed away for so long? Are they frustrated that we didn’t follow their instructed regimen? (Are they upset because they interpret the disrespect we pay to our teeth as disrespect paid to them, which is something I did not explore in this piece because it is already very long but would like to include in this parenthetical?)
Or are we simply misinterpreting their emotional states, due to our own anxieties and our just-trying-to-help-us-but-unfortunately-not-wholly-accurate-this-time brains?
Hm, it’s tough to know for sure. But what more could we expect from our rotting mouth bones?