Dental Health as a Sociocultural Phenomenon:

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• Dental Health as a Sociocultural Phenomenon
• Health Professions
• Presented by
• Ferris J. Ritchey, Ph.D.
• Department of Sociology
• University of Alabama at Birmingham

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What Distinguishes Sociology as a Science?

• Sociology is the scientific study of social
  behavior and human groups
• Focuses on behavior in relation to others
• How do humans come to agree on what is typical,
  normal behavior?
• Primarily a field of knowledge and research, not
  practice.

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Basic Subject Matter of Sociology

• 1. Social Structure Predictability of human
  actions patterned behaviors and structured
  (fixed) interpersonal arrangements. Repetitious
  behaviors, order, form, pattern, regularity,
  rigidity, barriers, restraints of authority
• Example Role The pattern of behavior
  characteristic of a social position, such as
  student, daughter, professor, spouse, general
  dentist, orthodontist.

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Basic Subject Matter of Soc. (cont.)

• 2. Social Interaction Action (behaviors,
  thoughts, emotions) carried out to meet the
  expectations of others
• Example A norm A shared conception of behavior
  that is appropriate or inappropriate in a given
  situation in a given culture. Time and place
  bound rules that constrain behavior.
• Norms are social rules maintained by sanctions

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Are we Free?

• Can you name anything that you have done in the
  past 24 hours that was not simply done to meet
  the expectations of others?
• We do have some freedom of choice
• But it is freedom to choose how we are to
  restrain our freedom

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Main Points About Sociology

• Focus on the context of behavior, the stage
  (situation) in which it occurs and the actors
  (role players)
• Do not get caught up in the notion that all
  behavior is a matter of rational choice
• External, not internal

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Work Roles

• Occupational roles and organization of the
  workplace and occupational groups is a major area
  of study in sociology
• An occupational role has
• (1) boundaries defined by the specific tasks
  associated with the role and
• (2) status (rights, privileges, rewards)
• Addresses the question What role player has
  control of what tasks?

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Work Roles (cont.)

• U.S. Department of Labor classifies work roles
  into 23 broad categories http//www.bls.gov/soc/
  soc_majo.htm
• Dentists fall under health care practitioners
  and technical occupations
• In sociology, we still use the term profession to
  distinguish certain occupations

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What is a Profession?

• Three general characteristics of a profession
  that distinguishes it from other occupations
• 1. Esoteric knowledge Human body is
  complicated practice is wrought with
  uncertainty dental knowledge is not as esoteric
  as, say, neurosurgery
• Takes years of training and on-hands experience
• Creates anxiety for the consumer

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What is a Profession? (cont.)

• 2. Service Ethic Providers of medical services
  are in a peculiar market position
• 1. Demand is created by the body. Patient
  choice is compromise by unwanted needs
• 2. To some extent, provider creates demand
  for services complicates any simple application
  of the law of supply and demand
• ? Ideally, patient is a client, not a customer

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Service Ethic (cont.)

• The consumer/patient public must trust. The
  profession itself ultimately is responsible for
  policing its own members
• Code of Ethics http//www.ada.org/prof/prac/law/
  code/index.asp

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Code of Ethics

• First 3 sentences of ADA code sum it up
• The dental profession holds a special position
  of trust within society. As a consequence,
  society affords the profession certain privileges
  that are not available to members of the
  public-at-large. In return, the profession makes
  a commitment to society that its members will
  adhere to high ethical standards of conduct.
• ? A profession has a contract with society

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Ethical Situations

• Name situations where there is a potential
  ethical challenge in the practice of dentistry
• Name situations where there are conflicts of
  interest

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Ethics is Much More Than an Issue of an
Individual Professionals Moral Character

• Not simply individual moral decisions
• ? Practice norms subject to influence by an
• assortment of actors
• ? Your contract is with society. Does this
• obligate you to consider the dental health
• of all citizens or just those that pay you
• for your services?

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What is a Profession? (cont.)

• (3) Autonomy for both individual practitioners
  and the profession as a whole
• Individual practitioner practices without
  supervision
• The collective profession (as a whole) makes its
  own rules for licensing

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Medical Education/Socialization

• Dental School Education Not simply technical
  training but a socialization process
• Socialization The process by which members of
  society learn its culture
• Professional socialization The process by which
  an apprentice learns the skills and knowledge of
  a profession as well as its norms and ethics
• Producing trusted (service ethic, autonomy)
  experts (esoteric knowledge)

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Development of Professional Status Focus on
History

• How does an occupation gain control (a monopoly)
  over a set of esoteric work tasks? Two aspects
• 1. Professional legitimacy The role develops
  and gains public acceptance by providing a
  meaningful service and a set of ideas that
  justifies monopoly over services (i.e., an
  ideology).

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Development of Professional Status (cont.)

• The development of professions occurs in the
  cultural context of a society.
• (a) Pre-modern times
• Esoteric knowledge held by, for example,
  religious leaders (keepers of orthodoxy tie to
  divinity endows authority)
• (b) Modern times
• Science is the ideology that underlies health
  professions today

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Development of Professional Status (cont.)

• 2. Attainment of professional status (state
  sanctioned privileges rights)
• Involves market and political dynamics
• Market forces Demand for services and legitimacy
  (trust, acceptance) of occupational role by the
  public consumer development of symbols of
  authority and competence
• Political dynamics Gaining control of licensing
  involves competition with other role players

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What are some of the symbols of authority for
dentists?

• DDSDoctor of Dental SurgeryDMDDoctor of Dental
  Medicine
• Emblem/Insignia of Dentistry
• Shingle of dentist shop

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Totally Commercial Sign
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A Profession The Specifics

• Page 3 in your readings titled Profession.
• Characteristics of a Profession
• Consider the 3 Broad Characteristics of
• 1. Esoteric knowledge, 2. Service ethic 3.
  Autonomy.
• Match them up with the list of
• specific characteristics on page 3

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Technological Development

• Technological change drives political change
• What were some of the technological innovations
  that contributed to the development of modern
  professional dentistry?

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Technological Development (cont.)

• Viewed from a different angle, what were some of
  the obstacles to the development of a competitive
  service and what technology overcame them?
• 1. Pain and anxiety associated with dental
  treatment ? Anesthetics
• 2. Infection control ? Antibiotics
• 3. Affordability ? Cost efficient procedures and
  materials

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Professional Status

• Professions evolve out of lay practices
• To gain public state sanction, must prove that
  techniques are better (market forces)
• But better techniques usually mean esoteric
  knowledge that leads to the need for development
  of public trust (political forces) professional
  organizations

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Professional Role Boundary Maintenance

• When a role develops and its knowledge base
  expands into the arena of another role, there may
  be shifts in what occupations do what tasks
• A profession will make efforts to control its
  task boundaries
• A profession must maintain a set of valuable
  tasks that is all its own

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With whom did early dentists compete?

• In Western society, dentistry, like surgery, was
  part of a barber-surgeon role
• Dentists competed with anyone who had a good set
  of pliers

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Division of Labor Within an Profession

• As the body of esoteric knowledge and technology
  increases, division of labor increases too much
  for a single individual to handle
• What is the division of labor within dentistry?
  What are the dental specialties?

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Dental Specialties

• General dentist (restorative)
• Orthodontist
• Endodontist
• Periodontist
• Prosthodontist
• Oral surgeon
• Pediatric dentistry

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Dental Specialties Recognized by the American
Dental Association

• Dental Public Health, Oral and Maxillofacial
  Surgery, Oral and Maxillofacial Radiology, Oral
  and Maxillofacial Pathology, Endodontics,
  Orthodontics and Dentofacial Orthopedics,
  Pediatric Dentistry, Periodontics,
  Prosthodontics
• http//www.ada.org/prof/advocacy/issues/advertis
  ing_credentials.pdf)

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In Summary

• Look at the big picture
• As a practicing dentist, you will perform tasks
  with your own set of individual hands, eyes, and
  decisions on one patient at a time
• However, you are a product of the larger society,
  culture, and profession
• The patient is a product of the same as well as
  particular circumstances and statuses, such as
  social class, age, and gender

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Health Occupations

• Thank you.
• fritchey_at_uab.edu