The Choreographies of Tooth Shame

In September of last year, I had the privilege of presenting my initial findings on “tooth shame” at the Shame and Medicine Project and the Wellcome Centre for Cultures and Environments of Health. This research, conducted during my ethnographic fieldwork in Danish elderly care, was subsequently published in Social Science & Medicine under the title “Tooth Shame – An Ethnographic Study of the Choreographies of Tooth Shame in Danish Elderly Care,” co-authored with Professor Astrid Pernille Jespersen and Associate Professor Esben Boeskov ?zhayat.

With the article, we introduce the term “tooth shame” to describe experiences of shame related to oral health issues, such as missing teeth, oral diseases, or neglected care. We present as a socio-material phenomenon encompassing deep entanglements of emotions, social life, and caregiving dynamics. Our findings reveal that tooth shame is not limited to individuals but is relational and collective, impacting relatives, caregivers, and broader care systems. Therefore, we explore the concept through the metaphor of choreographies, a framework that highlights how tooth shame is enacted through movements, behaviour and interaction. On this basis, we identify three types of tooth shame choreographies: adapting choreographies, collective choreographies, and interfering choreographies.

Adapting choreographies refers to how older people modify their behaviours to adapt to tooth shame. These may include avoiding smiling, covering the mouth while speaking, or refraining from social activities to hide dental issues. For instance, one of my informants described how he stopped smiling and isolated himself for years due to missing teeth. Others avoided discussions about their teeth, downplayed the severity of their dental problems, or developed habits such as chewing on one side of the mouth to mitigate discomfort. With the article, we document that these adaptations can act as barriers to seeking care and treatment, as many older people prefer to handle their dental issues privately rather than accept assistance from caregivers or dental professionals. These behaviours often lead to social withdrawal, reducing opportunities for connection and support.

In the article we also highlight collective choreographies, showing how tooth shame extends beyond individuals to influence relatives, caregivers, and other social interactions. For instance, relatives described feelings of guilt and hesitation when confronting dental issues, fearing they might worsen the shame experienced by their loved ones. Caregivers also often reported discomfort when addressing dental care needs, citing concerns about infringing on the dignity of those in their care. These collective dynamics underscore how tooth shame spreads and amplifies, creating an environment where the issue becomes precarious and difficult to address openly.

Finally, we examine interfering choreographies, where tooth shame disrupts caregiving practices and routines. In many cases, caregivers avoided performing dental care altogether because of their ethical concerns. Others used indirect methods, such as placing a toothbrush in view as a reminder of toothbrushing instead of telling the older persons it needs to be done. These approaches to navigating sensitive tooth shame situations often result in inadequate dental care, worsening oral health and further compounding tooth shame. Tooth shame also interfered with professional collaboration, as caregivers and dental professionals expressed conflicting views on how to handle oral health issues, sometimes creating tension between different care teams.

By introducing the framework of tooth shame choreographies, we offer insights into how oral health issues affect self-worth, social interactions, and care practices. We emphasise the need for systemic changes to ensure that oral health is recognised as a critical component of overall well-being. Addressing tooth shame requires not only understanding its emotional and social dimensions but also implementing practical solutions to support both older people and the professionals who care for them. We therefore call for greater awareness and training for caregivers to navigate these challenges, including developing strategies for addressing tooth shame sensitively. We further underscore the importance of improving access to affordable dental care, as financial barriers are a significant contributor to the persistence of tooth shame among older people.

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Further, we situate tooth shame within broader discussions of shame related to the body and health, drawing parallels with experiences of illness-related and class-based shame. We highlight how shame often arises when individuals perceive their health issues as personal failings, reflecting societal narratives of responsibility and self-care. By examining the relational and collective dimensions of tooth shame, we offer a framework to understand how similar dynamics might operate in other contexts. The concept of “choreographies” thus extends beyond oral health, suggesting ways that individuals and communities navigate and adapt to visible and invisible health challenges. With this approach, we, therefore, suggest an understanding of how shame interrupts social interactions and care practices, emphasizing the importance of addressing its structural and emotional roots in various healthcare settings.

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Louise Kathrine Folker Christensen, PhD Fellow, Copenhagen University

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3rd February 2025