Making the American mouth: Dental professionalization, dental public health, and the construction of identity in the 20<super>th</super> century United States.

Abstract

The professionalization of dentistry in the 20<super>th</super> century United States was linked to changing constructions of what standards of dentistry and dental appearance were American. In turn, debates about oral health care constituted an important site for the construction of national identity. This dissertation treats American dentists' professional writings as a body of cultural history source material, examining them for evidence of how dentists participated in the construction of professional, national, and other identities in the twentieth century. Where possible, I also elucidate patients' responses to dentists' concepts of appropriate patient and citizenship behaviors. In the early 20<super>th</super> century, American dentists used travel writing to represent American dentistry as entailing uniquely high levels of skill, intellect, and scientific savvy. However, in their discussions of the American diet, dentists debated with considerable anxiety what it meant to be American, and whether that was good or bad for oral health. Dentists' shifting professional and entrepreneurial interests also shaped their ideas about the delivery of dental care---particularly the provision of public funding for dental public health measures, including public school dental hygiene programs and the fluoridation of public water supplies. By the end of the twentieth century, pressures from within and outside the profession left dentists increasingly suspicious of public health programs they had previously supported. In response, they developed and expanded treatment measures (such as orthodonture) that required long-term time and financial commitments on the part of the individual patient. By the end of the twentieth century, good citizenship, to most dentists, came to mean the promotion of private practice, and opposition to publicly-funded health programs (and to most dental insurance). Increasingly, good citizenship was marked in patients' mouths by evidence that they had obtained costly esthetic dental interventions: absence of these markers was often attributed to lack of individual ambition, or to an inappropriately low valuation of personal appearance and its role in business and social life.