- Making the American Mouth: Dentists and Public Health in the Twentieth Century
On a shabby street not far from a major academic medical center, a rundown brownstone houses the practice of a African American dentist. His constituency is largely black, and many of his patients are covered by Medicaid. He makes a good living providing restorative care, but preventive services are minimal. Working with him are two black women: a part-time billing clerk and an assistant.
A few miles away a white dentist practices in a modern office. As many as six patients may be having treatment simultaneously, but there is never a wait. His patients have access not only to state-of-the-art restorative care but also to superb preventive care provided by a corps of professional dental hygienists. The dentist is the only man working among a group of female hygienists and office assistants. In a majority-black city, his patient population is mainly white, though this is not his intent. Moreover, he is socially conscious; he volunteers time to provide care to indigent developmentally disabled people.
The black dentist across town, dependent on the fee schedule set by Medicaid, does his good work simply by being available to his patients, who do not have the money or coverage needed for service in an office that caters to the well-insured and well-heeled.
We can see that some questions are raised by this interesting and true tale of two dentists:
• Does American dentistry in the twenty-first century reflect the class structure of this country?
• Does the harem-like atmosphere of dental offices speak of a society where professional dominance is the prerogative of the male?
• Do dentists—male or female; black, white, or otherwise—benignly lord over women in a subordinate profession?
• Does institutionalized racism reveal itself in the stratification of both professional opportunities and the availability of high-quality care?
• Has the dental profession succeeded in guaranteeing high income for its most successful members while becoming an instrument of social control?
Alyssa Picard's evidence is better documented than the anecdotal material at the start of this review, but the entire point of her readable book appears to be to justify a yes answer to the questions raised. The main problem with Making the American Mouth, however, is not its tendentiousness but rather its lack of cohesion and Picard's evident struggle, at times, to make her facts conform to the point she wants to make.
Her early chapters, on dental hygiene in the Progressive era, argue that American dentists used public health education as a strategy for establishing their profession as independent, with its own message and its own means of disciplining [End Page 164] the public. Later, Picard reviews the midcentury struggle over water fluoridation, again finding dentists in favor of collective action by governmental bodies, this time as a means "to renew their images as the benevolent arbiters of modern, scientific dental research" (p. 116). But ultimately, when faced with the possibility of dental insurance, dentists (at least the overwhelmingly white American Dental Association) rejected collective responsibility for fear that it would "restrict their professional autonomy and eat into their profits" (p. 115).
These stories—along with chapters on American dentistry overseas, racism within the dental profession, and the rise of cosmetic dentistry—do not fit together as a single narrative on "dentists and public health in the twentieth century." Each chapter would also have been improved by more attention to other secondary works.
The summer 2009 issue of this journal contains this reviewer's assessment of the National Museum of Dentistry. Reading Making the American Mouth reminded him of what he should have made clear in that earlier review: that the museum has an ideology. The Museum of Dentistry implicitly accepts and transmits the notions that the profession is successfully resolving its problems and that its practitioners merit the prestige and remuneration that good dentistry...