Shame over tooth loss: between psychological suffering and structural inequality in Chilean oral health

The article analyzes how tooth loss among older adults is not merely a clinical issue but a social and emotional phenomenon marked by shame, stigma, and structural inequality in oral health in Chile. From a qualitative, narrative approach with a descriptive scope and a hermeneutic (interpretive) orientation, 12 interviews were conducted in the commune of Cerro Navia, in the Metropolitan Region of Chile, between August and September 2024. The narratives reveal that tooth loss affects self-esteem, identity, and social participation. Shame manifests in behaviors such as covering the mouth, avoiding smiling, speaking in public, or attending social gatherings, leading to social isolation and psychological suffering. The testimonies show that lack of financial resources and limited access to public dental care exacerbate this distress, forcing many individuals to resign themselves to tooth loss. This condition, in addition to limiting nutrition and everyday functioning, becomes a social marker of class, reinforcing moral judgments associated with poverty and poor hygiene. The study concludes that shame cannot be understood solely as an individual emotion, but rather as a social device that reproduces inequalities and exclusions. An integrated approach to oral health is proposed, ensuring equitable access to treatment, dignity, and quality of life, while recognizing its direct link to mental health.