Who's More Uneasy? The Dentist or the Person In Recovery?

It can go both ways - persons in recovery as well as dental providers can have many false preconceptions.

For people in recovery, oral health can be the final frontier of healing. Unfortunately, the dental chair is also one of the last places they want to be: studies show severe dental anxiety rates of 25–46 % among recovering patients—double or triple the general population.¹ Meanwhile, some clinicians worry about drug‑seeking behavior, infection risk, and prescribing liability. Left unchecked, this two‑way tension keeps mouths untreated and trust broken. The good news? A handful of practical, trauma‑informed changes can dismantle the loop for good.

Who’s Really More Afraid?

	Persons in recovery	Dental providers
Prevalence of fear	Up to 46 % report severe dental phobia on the Modified Dental Anxiety Scale	About 17 % describe anxiety about treating substance‑using patients
Top drivers	Shame, stigma, fear of relapse triggers, past negative care	Concern over deceptive drug requests, infection control, prescribing risk
Behavioral impact	Missed or delayed appointments, crisis‑only care	Shorter or avoided appointments, guarded communication
Consequences	Worsening oral disease, reinforced self‑stigma	Professional stress, risk of undertreatment, amplified patient mistrust

Bottom line: the patient’s fear is deeper and more prevalent, but both sides contribute to the stalemate.

Why The Person In Recovery's Fear Often Wins Over The Dentist

1. Stigma Layers – Beyond needles and drills, recovering patients brace for judgment about past substance use.

2. Relapse Risk – Opioid prescriptions (or the fear of refusal) feel like a minefield.

3. Power Imbalance – The dentist controls anesthesia, medications, and even basic dignity.

4. Learned Threat – Memories of being labeled “drug‑seeking” or denied care keep anxiety high.

Why Would Persons in Recovery Have Distrust of Dental Providers?

Persons in recovery from substance use disorders often have complicated, mixed, or negative perceptions of dental professionals—rooted in both past experiences and broader social stigma. These perceptions are shaped by issues such as judgmental attitudes, lack of trauma-informed care, and gaps in understanding about addiction.

Here are key insights supported by research and real-world experiences:

1. Perceived Judgment, Shame, and Stigma

• Research Insight: A 2017 study in Substance Abuse: Research and Treatment found that many individuals in recovery reported feeling judged or labeled by dental providers. Common complaints included being called “drug-seekers” or receiving less care once their history was disclosed.

• Quote from patient: “I stopped going because they made me feel like I didn’t deserve the work—like it was my fault.”

• Impact: This perception leads many to avoid dental visits altogether, worsening oral health and reinforcing cycles of shame and disengagement.

  
  

2. Fear of Discrimination and Mistrust

• Fear of being denied pain medication: Many recovering individuals anticipate confrontations over opioids, especially if on medication-assisted treatment (MAT) like methadone or buprenorphine. This fosters anxiety even before the appointment.

• Survey Example: A 2020 Canadian study in BMC Oral Health showed that individuals in recovery often withhold information about their substance use history for fear of being treated differently.

  
  

3. Lack of Empathy or Understanding

• Patient Experience: Many persons in recovery report feeling that dentists lack compassion or are uninformed about addiction. This includes not recognizing that poor oral health may be tied to past trauma, homelessness, or withdrawal symptoms.

• Real-world Quote: “They talked to me like I was dirty. Like my teeth were a punishment.”

  
  
  
  
  
  

Summary of Common Perceptions:

Perception	Root Cause	Result
“Dentists judge me.”	Stigma, lack of training in SUD	Avoidance of care
“They don’t understand recovery.”	Few dental programs teach addiction care	Miscommunication, fear
“I don’t trust them to treat me fairly.”	Past negative interactions	Delayed treatment
“This dentist treated me like a human.”	Empathy, trauma-informed approach	Better outcomes, return visits

1. People in Recovery: Heightened Sensitivity to Financial Ethics

   • Distrust magnified: Many individuals in recovery have experienced economic instability, past exploitation, or systemic neglect, making them particularly sensitive to perceived dishonesty or upselling in health care settings.

   • Gallup Polls: Dentists consistently rank below doctors, nurses, and pharmacists in public trust regarding honesty and ethics. In Gallup’s 2022 poll, only 61% of Americans rated dentists as having “high” or “very high” honesty—compared to 79% for nurses.

   • Common concerns:

     • Recommending expensive procedures that may not be strictly necessary

     • Lack of price transparency

     • Pushy sales tactics (e.g., cosmetic upselling or proprietary products)

   • Real-world sentiment: Some patients view dental care as “profit-driven,” especially in private practices where out-of-pocket costs are high and insurance coverage is limited.

   • Specific challenges:

     • Being offered expensive cosmetic or restorative treatments without discussion of low-cost alternatives.

     • Feeling “written off” unless they can pay up front or have insurance.

     • Distrust when payment seems prioritized over pain relief or urgent care.

   • Qualitative studies: In focus groups from the Oral Health and Addiction Recovery Initiative (2021), participants shared statements like:

     “They acted like my teeth weren’t worth fixing unless I could hand over a few thousand right away.”“It felt like they saw a ‘bad mouth’ and a ‘bad person’—not a patient.”

   
   

   What Can Shift These Perceptions?

   • Transparency and clear communication: Practices that openly discuss cost, provide written estimates, and explain why certain procedures are needed see higher patient trust.

   • Sliding scale and flexible payment options: Clinics that implement income-based pricing or partner with recovery-focused nonprofits (e.g., RecoveryGlue.org’s dental advocacy efforts) are seen as more ethical and trustworthy.

   • Use of patient navigators or advocates: In programs like A.P.P.E.A.R., financial distrust decreased significantly when an advocate attended appointments and helped interpret treatment plans and costs.

     
     

   Summary Table

Group	Perception of Dentist Financial Ethics	Common Complaints	What Builds Trust
General Public	Mixed – moderate trust	Upselling, lack of transparency	Clear pricing, no-pressure options
People in Recovery	Often low trust	Dismissiveness, income bias, upsell pressure	Trauma-informed care, advocates, low-cost plans

Building a “Recovery‑Ready” Dental Practice

1. Adopt trauma‑informed, stigma‑free workflows

• Greet by name, explain each sound or sensation in advance, and obtain micro‑consent throughout the procedure.

• Display MAT‑friendly signage (“We’re comfortable treating patients on buprenorphine or methadone”).

  
  

2. Coordinate non‑opioid pain management

• Follow CDC guidance that NSAID–acetaminophen combinations outperform opioids for most routine extractions CDC.

• When opioids are unavoidable, write a written taper plan and loop in the patient’s MAT prescriber.

  
  

3. Lean on peer accompaniment and case management

• Borrow the A.P.P.E.A.R. model: first visits are short, non‑invasive, and include a trusted advocate who can translate jargon and defuse panic.

  
  

4. Offer rapid infectious‑disease screening

• Chair‑side HIV and hepatitis‑C tests calm provider infection worries and signal non‑judgmental care.

  
  

5. Educate the whole team

• The Norwegian survey found that anxiety dropped sharply among staff who had recent CE on SUD BioMed Central.

• Free modules are available through universities and, in Kentucky, through RecoveryGlue.org.

  
  

Peer Advocacy in the Dental Chair: Why Patients in Recovery Need a Wing‑Man—and How Practices Benefit

1. What Is Peer Advocacy?

In substance‑use recovery, “peer advocates” (or peer support specialists) are people with lived experience of addiction who receive training to guide others through treatment and everyday life challenges. SAMHSA’s TIP 64 notes that peers act as engagement facilitators, resource navigators, and recovery advocates across clinical settings, extending care beyond the clinician’s reach. SAMHSA LibrarySAMHSA

2. Why Dental Visits Are a Flashpoint

• Among illicit‑drug users, 50 % report moderate and 24 % severe dental fear on the Modified Dental Anxiety Scale—roughly triple the rate in the general population. PMC

• Triggers include stigma, painful memories, and worry that opioid prescriptions could jeopardize sobriety.

• On the provider side, concerns over drug‑seeking or infectious risk create shorter visits and guarded communication, which patients interpret as judgment—fueling a cycle of mistrust.

  
  

3. Seven Ways Peer Advocates Move the Needle

How the Peer Helps	Why It Matters in Dentistry
Emotional reassurance — sits chair‑side, models calm breathing	Lowers physiological arousal and pain perception
Logistics & navigation — schedules, reminders, transport	Cuts no‑show rates and late‑stage emergencies
Stigma buffer — translates recovery language for the team	Prevents shaming micro‑aggressions, builds trust
Advocacy on pain plans — requests non‑opioid bundle or taper	Reduces relapse risk; reassures dentist on diversion
Real‑time coping coaching — grounding exercises during drilling	Empowers self‑management of anxiety
Accountability & hope — “I had these same extractions last year”	Boosts self‑efficacy and treatment completion
Provider confidence — peer can de‑escalate if emotions spike	Makes clinicians more willing to treat complex cases

4. Evidence Snapshot

• Peer‑led oral‑health curriculum for people with serious mental illness improved oral‑hygiene behaviors and dental‑visit adherence within six months. PubMed

• In a hospital study, patients accompanied by peer providers were significantly more likely to pick up buprenorphine prescriptions and attend follow‑up appointments—showing that escorts translate to real engagement across healthcare settings. PMC

• Internal evaluation of Kentucky’s A.P.P.E.A.R. program found a 33 % drop in dental‑anxiety scores and on‑time attendance rising to 88 % after three peer‑accompanied visits (2024, unpublished). Program descriptions confirm accompaniment is a core service. GrinGrant.org

  
  

Programs like RecoveryGlue.org's A.P.P.E.A.R. reduce health equity barriers common to persons in recovery.

5. Kentucky Spotlight: RecoveryGlue.org’s A.P.P.E.A.R.

Since 2021, RecoveryGlue.org’s A.P.P.E.A.R. program has paired Kentuckians in recovery with peer advocates and community support associates (CSA) who literally sit beside them during dental visits. A.P.P.E.A.R. pairs each participant with a peer who has already completed their own smile‑restoration journey.

Services include:

• Pre‑visit role‑plays to disclose any concers (such as MAT status)

• In‑clinic advocacy to ensure non‑stigmatizing language and a full understanding of the recommended treatment plan

• Post‑procedure check‑ins to monitor pain‑management plans and address any concerns

• Weekly online peer-led group support meetings focused on the recovery/oral health intersection

• 24/7 online group support chat to connect all A.P.P.E.A.R. program participants.

• Optional private therapy.

  
  

The model aligns with Fletcher Group’s broader recovery‑ecosystem approach, blending peer housing, healthcare, and social support. GrinGrant.org