Professional Identity & American Dentistry, 1900-1950

A review of Casting for Good Will: Profession, Trade and Identity in American Dentistry, c. 1910-1950, by Stine Slot Grumsen.

Stine Slot Grumsen has written a very important critical history of American dentistry through an examination of advertisement as the locus of tension between professionalism and business within the dental field. The dissertation consists of a wide-ranging content analysis of dental journals and archives, which she argues are “tools in the constructions of American dentistry’s professional image” (p. 10) and a site where boundary negotiations around this professional image occurred.

She places her work within the context of dental history by identifying from the start that most of the historical record on dentistry falls within the narrative of a march of progress, written by dental historians in a celebratory manner, glossing over the real tensions, issues and dilemmas within the profession. Her work applies the critical perspective and methods of current historians of science, medicine and technology therefore breaking new ground on multiple fronts. First, in the choice of topic, as advertising as a site of professional boundary development has been understudied. Second, in application of contemporary methods to this field including an archival analysis of dental journals. And finally in that the very project itself is a long overdue examination of American dentistry within the historiography of health, science and technology.

Grumsen combines perspectives on the development of occupations and professions and the boundary work they do with a keen economic historical analysis of the controversial rise of advertising in dental journals over the first half of the twentieth century. Her critical analysis of the American dental profession’s dilemma between seeking professional status through idealistic service orientation and the pragmatic reality of selling services in an open market, profoundly challenges the dominant narrative within dentistry. She sums up “American dentistry did not evolve from a trade to a professions emancipated from trade, but rather, that business was a prerequisite of professional success” (p. 13).

The dissertation is organized as four separate articles, with an Introduction and Conclusion.  The Introduction places the work within a review of historical analysis found in American dentistry as well as the scant academic literature on dental history and sociology. The analysis is primarily based upon a study of early dental journals following methodology such as the Science in the Nineteenth-century Periodical (SciPer) Project (University of Leeds and University of Sheffield, 1999-2007). Grumsen simultaneously pursues an economic historical analysis, focusing on the financial motives and concerns of dentists as shown within the journals. Finally, she draws in academic analysis of professions and professionalism, looking at boundary development and maintenance, intra-professional conflicts, and the development of professional images. This contextual and methodological introduction is followed by a summary of the four separate articles, and then the articles themselves.

Chapter 1, “The Era of Whiter Teeth: Advertising in American Dentistry 1910-1950”, traces the public image of dentistry through an examination of toothpaste advertisements. She suggests that this analysis shows how this professional image changes over time, how advertisements have played a role in advancing oral hygiene of the public, and argues these advertisements are a site to analyze how both the public and professional discourses interact. She concludes that these advertisements have shaped public image as well as dentists’ behavior and practices.

The next Chapter, “Few Good Dentists Advertise: Negotiating Professional Boundaries in Early Twentieth-century US Dentistry”, turns to the struggle for authority and recognition by dentists in the period of 1910-1930, using the controversies around advertising as a lens to examine the boundary work of dentists during this period. Fearing that dental advertisements were an erosion of dentists’ exclusive rights to authority on dental care, this Chapter traces how dentists engaged with the advertising through debating the claims in journals and testing the claims in their laboratories. Grumsen provides a fascinating and insightful analysis of the rise of the Journal of Dental Research as a boundary and profession building strategy in reaction to the perspectives by some that trade was too influential in the other periodicals of the day.

In “Zeal of Acceptance: Balancing Image and Business in Early Twentieth-century American Dentistry”, the dissertation takes up the topic of the American Dental Association (ADA) Seal of Approval, which is still in use today. Grumsen explores the history and politics of the Seal, which entailed a battle to balance professional ideals, economic necessities, and organizational power. She goes beyond the standard celebratory narrative to expose the complicated and intertwined history of tensions within the profession and between the profession and industry.

Finally in Chapter 4, “Dental Business: The Making of the Professional American Dentist”, a revised historical analysis of American dentistry’s emancipation from trade is presented through an analysis of the magazine Oral Hygiene. In this Chapter, Grumsen explicitly examines the business of dentistry, and compares it to the image of dentistry presented in other journals of the time. The focus of Oral Hygiene is on the individual businessman, rather than the profession and its identity as a whole. The contrast drawn shows how the profession as a whole distanced itself from money as a goal, while for the individual, money was central to the identity of success.

While the tensions between business and professionalism within American healthcare have been extensively explored across many academic disciplines, the field of dentistry has largely been left out of these inquiries, both to the detriment of the disciplines but even more so to the detriment of American dentistry. As Grumsen eloquently argues, “Dental historiography is an excellent example of how a historical field develops when left to its own devices […] unchallenged by academia it reproduces the same narratives over and over again, serving the purpose of elevating the profession of dentistry” (p. 11). This dissertation is an excellent first step at remedying this situation and applying current historiographical and methodological tools to an analysis of critical inherent tensions within the professional history of American dentistry.

Elizabeth Mertz
Assistant Professor
Preventive and Restorative Dental Sciences, School of Dentistry
Social and Behavioral Sciences, School of Nursing
Research Faculty, Center for the Health Professions
University of California, San Francisco
bmertz@thecenter.ucsf.edu

Principal Primary Sources

Archives of the American Dental Association. Chicago IL, United States
Library of Odontology, Aarhus University

Dissertation Information

Aarhus University. 2012. 114pp. Primary Advisor: Peter C. Kjærgaard.

Image: Dental X-ray, Wikimedia Commons.