'You can always look better:' On norms and ideals in dental care

In Sweden one in four young people goes through some form of orthodontic treatment, and according to the Swedish Age ncy for Health Technology Assessment and Assessment of Social Services, the most common reason is the appearance of the teeth. In many cases the patients have not previously experienced problems with their teeth, rather the issue of treatment is brought up by the dentist. In other cases the dentist has perceived that there is pressure from the parents and child, who want free treatment although they do not have sufficient reasons.

"People are aware that the fashion industry creates images of what we feel is beautiful, images we have to relate to, somehow. But medicine also sets norms regarding appearances, although we are not as aware of this," says Anette Wickström, reader at Child Studies, an interdisciplinary research unit at Linköping University's Department of Thematic Studies.

For two years Dr Wickström has followed the work at two orthodontic clinics in the county of Östergötland, in a project funded by the Swedish Research Council. She has studied how young people are affected by the offer of government-funded orthodontics, what norms that dentist is informed by and how young people are involved in negotiating these norms.

The results of the study, which has been published in Medical Anthropology Quarterly, show how a medical practice with the objective of fostering young people's dental health also suggests treatment to improve their appearances. Dr Wickström has observed that the requests to improve patients' teeth have led to a shift in what is considered normal, and that perfect bites are increasingly common. She calls this "the exceptional normal." But it is not only the dental care system that sets its sights on the exceptional; often the young people themselves and their parents also want a perfect set of teeth.

The future is their own responsibility

Of the 83 young people who Dr Wickström studied at the clinics, 40 had been referred for treatment, 11 lacked sufficient reason for treatment, 29 had to wait and three were uncertain. The study showed that the young people who decide against orthodontic treatment have to withstand a lot of pressure -- the dentist's recommendation as well as the social norms of how a mouth "should" look. The responsibility for being healthy, thinking about their future and looking good is placed on the young people themselves.

One of the adolescents who refused the dentist's recommendation to undergo treatment gave the following explanation:

"I asked why I have to have perfectly straight teeth, and the dentist said 'Of course they are good as they are, but you can always look better'. I think that's a really strange thing to say, because if it had been another part of my body and I went to the doctor and we talked about my nose or ears, it would have been super weird, 'We want to operate on your nose because it's crooked.' It would have been massively offensive."

Dental care a profitable business

With the increased competition between the Swedish Public Dental Service and private sector dental care, cosmetic dental care has become more common -- it has grown into a lucrative market for everything from tooth whitening to orthodontics. Developments in the dental care sector add particular relevance to Dr Wickström's reseach.

"In the 1990s many benefits relating to dental health were removed, and once again dental health became a matter of financial and social background. One of the remaining benefits is orthodontics, which is important if young people are to develop healthy teeth. In this context we need to discuss which benefits society should prioritise, and to what degree," says Dr Wickström.