Sunday, 10 July 2011

Sociology Oral health behaviors & dental hygienists

Gallagher and Moody wrote an article in 1981 Dentists and the Oral Health Behavior of Patients: A Sociological Perspective. They state:
Dentistry has long had an interest in the prevention of oral pathology, but without remarkable effect and without widespread professional consensus as to how this interest is to be implemented. [i]
Dentistry  developed in the mid to late 1800s. Dentistry arose out of the public health movement. Adams (2000)[ii] tells us that in Canada the public health movement centered around the belief that there was direct connection between physical health, cleanliness and morality. Dentists were very active in these movements and they worked to improve the health, cleanliness and morality. Nettleton’s (1992) genealogical study looks at the relations between dental power and the establishment of dental knowledge.[iii]  In her text Nettleton examines the circumstances, techniques, and events such as regular 2x daily tooth brushing, professional cleaning, that led to the mouth and the teeth becoming the focus of a distinct discipline called dentistry. She demonstrates how in Britain, the dental profession established its object,- teeth subject to decay, by allying itself with public health. Public health helped dentistry justify the need for monitoring children’s mouths to ensure the prevention of infectious disease.
Dental hygiene was created in the early 1900s as ‘dentistry’s agent’ to provide education and ‘mouth keeping’ to ensure the prevention of decaying teeth and infectious disease. “ Dental hygienists it was suggested, could work either in schools or dental offices, performing the unremunerative  but important public health and preventive dental work, for a fraction of the cost and with little training” (Adams 2000)[iv] Dentistry was more interested in extracting and  filling teeth than teaching children or treating gums. So dentistry assigned the ‘mouthkeeping’ tasks to the female dental hygienists.

In a 1981 article Gallagher and Moody state that: “Many dentists delegate most of their prophylactic and preventive work to dental hygienists and assistants” They pose several questions for researchers. ‘Does the dentist’s role become diluted if he delegates to paradental personnel those preventive functions where his own influence and prestige might be most effective?’ And 'Who can best influence the patient’s oral behavior in the long run?'[v]

Dentistry became an official profession in Canada in 1867. Society gave to dentistry the authority and professional autonomy to be the dominant profession in oral health care delivery. Dentistry views itself, as does much of society, as the profession that has control over professional oral care, the restoration and   maintenance of the teeth and tissues in the mouth.  Dentistry possesses power as expressed in the social organization of oral health care delivery, power they worked hard to establish.
 The mouth, and the practices that surround the mouth, are   ordinarily mundane and academically unexplored areas. However, the oral cavity provides an opportunity for sociologists to examine multiple processes.  These various processes create the conditions for the possibility of reorganization of oral health care delivery.  As networks of professions, consumers, bureaucrats, and politicians oscillate between the curative, medical treatment model and the preventive wellness model of health, new knowledge of oral health should emerge.  
Dental hygienists have been part of oral care delivery for more than 50 years in Canada. Primary prevention seeks to maintain a healthy mouth and functional dentition, a healthy mouth for healthy living.  Dental hygiene was created to meet these needs, to encourage primarily young children to adopt and maintain healthy behaviors.
Dental hygiene appears to be occupationally stabilized in 2011.  Dental hygiene is self regulating in most of Canada, and self initiating in many provinces. Dental hygienists are recognized by many as the professional who provides consistent preventive care and education in healthy behaviors.
Now that the profession is ‘stabilized’ do dental hygienists improve the oral health behaviors of patients/clients? 
Examine the social landscape of oral health care, beyond the confines of the dental hygiene cubicle in the dental office to take a different perspective of the world of dentistry, oral care, and evolution of dental hygiene. The mouth, and its multiple processes often taken for granted, considered  mundane topics provide opportunities for sociology researchers.
L McKeown July 2011          

[i] Gallagher, E. B.  Moody, P.M. (1981) Dentists and the Oral Health Behavior of Patients: A Sociological Perspective
Journal of Behavioral Medicine  4(3) 283-295.
[ii] Adams, T. L (2000) A Dentist and a Gentleman Toronto University Toronto Press p90
[iii] Nettleton, Sarah (1992) Power, Pain and Dentistry.  Great Britain: St. Edmunsbury Press.  p123-4  
[iv] Adams, T. L (2000) A Dentist and a Gentleman Toronto: University Toronto Press p.122
[v] Gallagher & Moody (1981)p295


  1. Dentistry possesses power as expressed in the social organization of oral health care delivery, power they worked hard to

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