“Just when you thought that middle-class parents had reached the limits of ignorance, the New York Times reports today that children under the age of five are showing up at the dentist’s office with a dozen or so cavities. Some need the kind of extensive repair that is usually characteristic of people my age. One little darling featured in the story had 22 cavities, and was due for a root canal — at the age of two and a half years. Go read it here.
My first thought was, well, these are probably parents working 3-5 jobs between them: things like toothbrushing just fall through the cracks as Mom and Dad pass each other in the hall like ghosts between day shift, night shift and swing shift. But apparently not. The kid with the root canal? Mom is described as a homemaker and Dad is in IT. Homemaker is not an easy career, I’ll grant you, which is a reason I checked the “historian” box after college instead of “baby machine.” But isn’t part of the job description of the stay-at-home-Mom “Take care of the kids?”
Commentators at TR’s blog have rightly called her (and the NYT article) out for putting all the blame on mothers. I’m going to put in my two cents as a historian of child and adolescent health. Over a decade ago I participated in a Surgeon General’s Conference on Children and Oral Health, so this problem was not news to me. My paper was entitled “From Oral Health to Perfect Smiles: Advertising and Children’s Oral Health.” You can read the whole thing at the conference website, but here are the main points:
During the Progressive Era (1890-1920), toothpaste advertisements reinforced the dental profession’s claim that good oral hygiene was essential to good overall health. Poor dental hygiene was seen as the root of other diseases, and cultivation of health teeth was an integral part of this period’s larger public health agenda. You can see this in advertisements for toothpaste. many physicians and dentists at this time believed that “without good teeth, perfect health is not possible.” Not only did poor teeth spoil one’s appearance, bad oral hygiene caused serious health ailments both in children and later in life. Public schools were the most common vehicle for teaching children good health habits. Teachers gave lessons on personal hygiene in the classroom, and distributed health “report cards” to children, who could earn points for brushing their teeth, and other good health habits such as hand-washing before meals, drinking milk, and getting plenty of sleep.
During the 1920s and 1930s, the link between oral health and the health of the rest of the body gradually disappeared from public health messages disseminated to lay audiences through advertising, and was replaced by a growing emphasis on creating “perfect smiles.” This focus on the appearance of the teeth rather than oral hygiene was fed by two trends: the growing popularity of motion pictures, and psychological theories about the link between physical appearance and self-esteem. Movie stars embodied high standards of physical attractiveness, and endorsed specific personal hygiene products that promised to impart beauty and glamour to the masses. The psychologist Alfred Adler popularized the idea of the inferiority complex, the notion that those who did not appear “normal” suffered from intense feelings of inferiority and low self-esteem. Advertisements for personal hygiene products capitalized on this concept, and warned consumers that even the most minor physical imperfection could interfere with a person’s success in life. The link between physical appearance and success became even stronger during the 1930s, as jobs became scarce, and employers preferred to hire workers who were young, healthy and fit.
During the 1940s and 1950s, this emphasis on perfect smiles continued. At the same time, advances in dental science reduced the incidence of dental hygiene problems. Before World War II, the exact cause of dental caries was not known, and it was common for even well- off Americans to lose many of their teeth by middle-age. By the late 1940s, scientists had identified the bacteria that caused tooth decay and gum disease, and demonstrated that regular dental visits and fluoridation of public water supplies could dramatically reduce the incidence of cavities and other dental hygiene problems. The reduction in oral disease led to an even greater emphasis on the appearance of the teeth and mouth.
Dental health professionals did continue to promote messages of good dental hygiene, but it was advertisers’ association of “perfect smiles” with personal success that made the most impression on lay audiences. Indeed, even dentists found themselves emphasizing how healthy teeth contributed to self-esteem and physical attractiveness. This strategy was double-edged: on the one hand, it helped sell regular dental check-ups and good oral hygiene to a middle-class public obsessed with physical appearance and its link with popularity and professional success. On the other hand, the emphasis on self-esteem and appearance made regular dental care appear to be a “luxury,” that did not need to be covered by private or public health insurance, nor did it need to be a priority for those concerned with bettering the public health. This has had made it difficult to justify federal programs that would give access to dental care to all Americans regardless of the ability to pay. Those who wish to improve the face of the child need to take a lesson from the past, and promote the idea that oral health is not just a route to a perfect smile, but to perfect health as well.