“Leave my teeth alone” - the use of participatory drawing to widen inclusion in a community-based study of dental service-related knowledge
This study utilized participatory drawing to successfully include individuals with complex needs in dental research, revealing that while participants often conceal their fear and vulnerability regarding dental care, they are willing to express negative feelings about systemic injustices through visual narratives.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Most people understand that knowing how to care for one's teeth is important, but the path to getting that knowledge is rarely a straight line. It does not happen only in a classroom or through a pamphlet handed out by a doctor. Instead, people learn about dental care by talking to neighbors, watching family members, and sharing stories over coffee. This informal exchange of information, often called "dental literacy," shapes whether a person decides to visit a dentist or avoid them. For decades, researchers have tried to measure this knowledge using surveys and questionnaires, tools that ask people to read questions and write down answers. However, these standard methods often fail to reach the people who need to be heard the most: those with complex health challenges, limited ability to speak, or deep-seated fears that make them withdraw from conversation. When a person cannot easily articulate their thoughts, their perspective on healthcare often disappears from the record, leaving scientists with an incomplete picture of how communities truly navigate the dental system.
To fill this gap, a team of researchers in Liverpool, England, turned to a different kind of language: the language of drawing. They wanted to understand why, how, and when ordinary people seek out information about dental care, and they specifically aimed to include individuals who might struggle with traditional interviews. The study took place in a community center that serves a diverse group of residents, many of whom face significant social and health difficulties. Instead of asking participants to fill out forms, the researchers invited fifteen people, ranging in age from 24 to 92, to spend two hours drawing. They were given a simple prompt: to depict their own and their family's experiences with dentists. The group included people with Parkinson's disease, learning disabilities, and severe anxiety, as well as their family members and caregivers. The researchers provided various art supplies, from paint and canvas to a papier-mâché skull and a mask shaped like a human face, allowing the participants to choose how they wanted to express themselves.
The results of these drawing sessions revealed a hidden emotional landscape that surveys had missed. The artwork showed that for many participants, dental care is tied to intense feelings of fear, shame, and intimidation. Yet, a striking pattern emerged in how these feelings were handled. Most participants, even those who drew vivid scenes of terror, described a habit of hiding these emotions from their loved ones. They called this behavior "putting on a brave face." One middle-aged mother, who drew a mix of dark and bright colors to represent her feelings, explained that she never told her children about her own anxiety because she did not want to pass that fear on to them. Another participant, a 92-year-old woman who relied on her daughter for care, rarely spoke about her dread of dental visits, even though her daughter was always there to support her. The drawings suggested that people often swallow their distress to protect their families or to maintain a sense of dignity, creating a silence around dental fear that keeps it from being shared or addressed.
This silence was even more profound for those with complex needs. One participant with Parkinson's disease, who had difficulty speaking and moving, could not draw a detailed picture herself. Instead, a community leader who knew her well created a piece for her based on what she had shared. The artwork featured a human mask with the words "Leave my teeth alone" written boldly across the forehead. The image captured a deep sense of vulnerability and a feeling of having no control over what happens to one's own body during a dental procedure. Another participant, a man living in isolation with learning difficulties, drew a figure labeled "Bag of nerves" to describe his constant state of anxiety. For these individuals, the overwhelming challenges of daily life, such as managing other serious illnesses or surviving without money, often pushed dental care to the very bottom of their list of priorities. Their drawings showed that when survival is difficult, the specific fear of a dentist becomes just another burden to carry in silence.
While the personal emotions of fear and shame were often kept private, the participants were much more willing to speak up about something else: the unfairness of the dental system. When the group drew together on a shared canvas, they did not hide their anger about the cost of care. One man drew his picture in black and white to show that he felt there was no middle ground with dentists, only high prices and no compromise. Another participant, who was born in the 1950s, expressed confusion and disappointment that dental care was no longer seen as a basic part of health that the government would cover for everyone. Unlike their personal fears, which they buried, these feelings of injustice were shared openly and frequently within the community. The drawings revealed that while people might suffer in silence about their own anxiety, they are quick to bond over the shared frustration of a system they feel is too expensive and inaccessible.
The study concluded that using drawing as a method allowed researchers to reach people who would likely have remained invisible in a standard interview. The act of creating art gave a voice to those who felt unable to speak, revealing a complex mix of hidden vulnerability and open criticism. The researchers found that the emotional barriers to dental care are real and powerful, often leading people to hide their true feelings even from their closest family members. At the same time, the community is united by a clear perception that the system is broken and unfair. By listening to the stories told through paint and pencil, the study offered a deeper understanding of the human experience behind dental health, showing that for many, the journey to a dentist is not just a medical decision, but a struggle with fear, dignity, and the cost of living.
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