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Response to The Smile Gap: A History of Oral Health and Social Inequality

I am very grateful for this generous and thoughtful review. As Brown notes, this is one of the first social histories of 20th century oral health care, but I am delighted to be part of a growing international community of oral health historians, including Alyssa Picard, Claire Jones, Mary Otto, Carlos Quinoñez, Ryan Sweet, and Helen Strong.(1) I am looking forward to more work in the field, especially from a patient perspective. While I tried to include some patient voices, there is much more that could be done to flesh out the patient experience of oral health care.

I also think it would be fascinating to do more work on the business of dentistry and indeed the history of health care more generally: in the oral interviews I conducted with dentists I learned a lot about the business of running a dental practice that did not make its way into the book. In Canada, at least, where we have a system of public payment but private practice for much of our health care system, we need to understand more about the business of health care. What is it like to have a health care business, and how do these businesses impact patient care? In Canada, we often compare our health care system favourably to that of the US, where the profit-motive is even more dominant than in our health care system, but we need to recognize that much of health care in Canada (not just dentistry) is delivered by the private sector.

Just after this book was published, the Canadian government announced a dental health benefit for children who live in families below certain income thresholds. The government intends to expand this program to low-income adults.(2) This is good news, although the details of how this will work are still unclear. We still have a way to go in terms of improving oral health and especially in reducing inequities. In this review, Brown mentions that the profession of denturism may well disappear. Unfortunately, this seems optimistic. Canadians are far less likely to lose their teeth than they were 50 years ago, but rates of edentulism are still high (over 20% among people aged 60 and over) and our population is aging. Unless we do more to improve access to oral health care over the life course, denturists will still be needed. Much remains to be done to reach underserved populations such as Indigenous peoples, the elderly, the disabled, and some people living in rural communities, and the obstacles are not just financial. It is difficult for many people to find their way to the dental office because of physical and, sometimes, psychological barriers. In addition to covering the cost of dental care, we need to find ways of reducing these other obstacles.


  1. Claire L. Jones and Barry J. Gibson eds, Cultures of Oral Health: Discourses, Practices and Theory (London: Routledge, 2023); Mary Otto, Teeth: The Story of Beauty, Inequality and the Struggle for Oral Health in America (New York: The New Press, 2017); Alyssa Picard, Making the American Mouth: Dentists and Public Health in the Twentieth Century (New Brunswick, NJ: Rutgers University Press, 2009); Carlos Quinonez, The Politics of Dental Care in Canada (Toronto: Canadian Scholars, 2021). Back to (1)
  2. “Making Dental Care more Affordable” Checked 12 May 2023. Back to (2)