Vol. 3 • Issue 1 Time to Develop Social Dentistry
109
© International & American Associations for Dental Research 2017
INVITED COMMENTARY
Knowledge Transfer Statement: We
are calling researchers, educators,
and dental professionals to be at the
forefront of actions addressing social
determinants of health. We indeed
argue that 1) it is the dentists’ and
other oral health care professionals’ role
to tackle social determinants of health
and 2) as researchers and educators,
we need to help clinicians in this
endeavor and lead the development of
a “social dentistry” movement.
Keywords: social determinants of
health, social justice, social medicine,
professional competence, dental educa-
tion, interdisciplinary studies
H
ow long will we tolerate the strik-
ing social gradient of health that
affects our rich societies? Or have
we already given up and accepted the
unacceptable? Have we accepted that the
less affluent of our fellow citizens are at
higher risk of feeling unhealthy, being
sick, and dying early? Have we accepted
that being poor often means experi-
encing dental caries in early childhood,
suffering from recurrent toothaches or
impaired smiles, and having teeth pre-
maturely extracted? There is an exten-
sive body of literature on the importance
of addressing the social determinants
of oral health and modifiable common
risk factors. Watt (2007), in particular,
called for a shift from the “biomedical/
behavioural downstream” approaches
to approaches that are “upstream.”
Unfortunately, it seems that many den-
tists still feel powerless to address the
social determinants of health: “it is
not our job.” In this commentary, we
argue that 1) it is the dentists’ and other
oral health professionals’ job to tackle
social determinants of health and 2) as
researchers and educators, we need to
help clinicians in this endeavor and lead
the development of “social dentistry.”
The social determinants of health are
the “conditions in which people are
born, grow, live, work, and age” (World
Health Organization 2017). They refer to
our income, working conditions, literacy,
and access to care; they also relate to the
ways that society treats us, depending on
our gender, social status, ethnic origin,
or religious beliefs. Because these factors
are related to “social structures,” we
expect governmental bodies to address
them. It is indeed public institutions’ duty,
with the support of dental public health
(Watt 2007), to develop various upstream
actions, such as eliminating absolute
poverty, reducing material inequalities,
and combating discriminations.
Does it mean that clinicians have no
role to play in this process? On the
contrary, they are well positioned to
address the social determinants of health.
This is why several voices in the United
States have encouraged the development
of “social medicine” (Westerhaus et al.
2015; Sklar 2017): doctors should
become “structurally competent” to
develop mid- and upstream actions,
in addition to producing individual-
level patient care. This approach is not
new: it revives an old tradition that
Rudolf Virchow, a German physician
and politician of the 19th century,
made famous by stating that health
professionals were the natural advocates
of the poor and social problems largely
within their jurisdiction (Lee 1999).
In Canada and the United Kingdom
as well, voices have called on health
professionals and researchers to tackle
health inequalities through action on the
social determinants of health. Allen et al.
(2013) recommended training clinicians
to identify the structural forces that shape
their patients’ health, to acquire knowledge
about their communities, and to develop
partnerships within and beyond the
health sector. This would allow them, in
addition to providing clinical individual
care, to refer patients to a range of services
addressing the causes of illness. In the
same way, clinicians should advocate for
change in local and national policies.
Implementing such approaches
implies important changes in academic
curricula. As Westerhaus et al. (2015)
stated, “medical education, in its noble
drive to educate the young clinician in
the intricacies of human anatomy or the
wonder of the biochemical processes
that sustain life, has failed to link
the interplay of important biological
processes with the social space their
hosts inhabit.” Professional schools thus
JCT XX X 10.1177/2380084417738001JDR Clinical & Translational ResearchTime to Develop Social Dentistry
research-article 2017
DOI: 10.1177/2380084417738001.
1
Oral Health and Society Division, Faculty of Dentistry, McGill University, Montreal, Canada;
2
School of Public Health, Université de
Montréal, Montreal, Canada;
3
Department of Epidemiology and Public Health, Dental Faculty, Paul Sabatier University, Toulouse, France. Corresponding author: C. Bedos,
Oral Health and Society Division, Faculty of Dentistry, McGill University, 2001, McGill College Avenue, Montreal, QC H3A 1G1, Canada. Email: christophe.bedos@mcgill.ca
Time to Develop Social Dentistry
C. Bedos
1,2
, N. Apelian
1
, and J.N. Vergnes
1,3