“…4,25,38,[40][41][42] Evidence suggests various reasons for this including stigma, feelings of shame, helplessness and low self-esteem; 20,43 lack of income and health insurance; 1,20,21 dental fear, anxiety and phobia; [42][43][44][45] and restlessness in the dental waiting environment. 32,46 Mistrust towards dental health providers was an issue identified in the published work that was compounded by negative and unsatisfactory prior encounters with dental professionals and health care providers, 20,32,43 poor communication with oral health providers, 8,20,32,47,48 and PMD's confusion and 59 Clark (2009), 60 Nielsen et al (2011), 61 Arnaiz (2011), 26 Lewis et al (2001), 53 Friedlander and Liberman (1991), 31 Tani (2012), 62 Eltas et al (2013), 63 Shetty (2014), 64 Tang 201465 Lower executive cognitive function and lower awareness of oral health problems Neilsen (2011), 61 Friedlander and Mander (2002), 66 Janardhanan (2011) 67 Loss of self-interest and/or self-esteem Friedlander and Liberman (1991), 31 Griffins et al 2000, 37 Thomas et al (1996) 68…”