Tooth loss, inequality, alienation and ideology

Background: There is a wide ranging literature on oral health related inequalities. Whilst this literature is excellent, both methodologically and technically, there remains a gap when it comes to more detailed qualitative and theoretical explorations, to which this paper contributes. Objectives: To conduct a secondary analysis exploring the social and material mechanisms underpinning complete tooth loss in a sample of older people. Methods: A secondary analysis of a qualitative sample of 20 volunteers from a cohort of older people in New Zealand. Interviews explored the factors which led to an edentulous state. Data Analysis: Data were analysed by exploring these narratives for the social and material relationships that might explain why complete tooth loss happened. Results: The sample contained 12 women and eight men with ages ranging from 75 to 101 (mean age  84). Ages at the time of full dental clearance ranged from 15 to 40 (mean 26). The mouths of participants were gradually shaped to fit with the requirements of a range of different economic realities. These realities, although constantly changing and widely varied, had a direct impact on the experience of disease. Thus, concurrent with a generalised desire to keep one’s teeth, most interviews contained a counter-narrative in which tooth loss was inevitable. We argue that this inevitability was supported by a generalised ‘ideology’ of tooth loss and a profession confronting hard times. Particularly palpable is how these processes fed a sense of alienation from teeth and the desire to have them removed.  Conclusions: Explanations for inequalities in oral health and complete tooth loss should consider the role of material factors, alienation and ideology.