Where Bad Teeth Come From: Culture and Causal Force

This study tests hypotheses about the origins of bad teeth and good teeth. In the process, we show how cultures exert "causal force" and produce what, following the lead of the dental professionals and dental patients who served as our research participants, we call "bad teeth." We conducted a mixed method ethnography that integrated narratives from one set of diverse research participants (n=39) with structured interviews from a different set of diverse participants (n=288). The population studied shares a single cultural understanding organized around the assumption that oral health constitutes a cosmetic not a disease category. Quality of life standards, however, varied with work cultures and oral health prevention behaviors reflected cultural norms that bear on appearance. This variation produces the apparent paradox that the use of oral health services increases with access but may decrease with objective need. Improved oral health may require social marketing that stresses both the socially enhancing objective of healthy teeth and gums and that bad teeth add significantly to the risk of heart disease.