DT News - UK - Interview: “Social dentistry goes further”

Brendan Day, DTI

Tue. 11 September 2018

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As dentistry has grown more focused on biological processes and surgical treatments, the social determinants of health—the conditions in which we are born, grow, live and work—have become less emphasised. To discuss this, Dental Tribune International spoke with Dr Christophe Bedos, associate professor in the Division of Oral Health and Society of McGill University’s Faculty of Dentistry in Montreal in Canada and co-author of a recent article on social dentistry.

Dr Bedos, in your article, you provide a suggested framework for conducting social dentistry. How does this differ from the current attitudes and practices that are prevalent in Western dentistry?
In current Western dentistry, clinicians mainly provide surgical procedures and promote patients’ healthy lifestyles. Social dentistry goes further. Socially engaged dentists—as we termed them in the article—also try to address the social determinants of their patients’ oral health and access to care.

Social dentistry thus implies that, at the individual level, dentists understand the causes of the causes, so to speak, of their patients’ illnesses. For instance, they need to know how patients’ health-related behaviours, such as oral hygiene and diet, can be shaped by their living conditions, such as their job, income, social network and housing. I believe that many dentists nowadays understand the importance of social determinants of health, but it is rare that they try to tackle those determinants. With social dentistry, we invite dentists to conduct upstream interventions, or to prescribe social interventions that address the social determinants of their patients’ oral health.

At the community level, socially engaged dentists try to respond to the specific needs of the local population. This means that they need to know the social, demographic and epidemiological characteristics of their community well, and organise their professional activities accordingly. For instance, in an ageing community, dentists should consider providing mobile services in addition to traditional clinical care. This differs, in my opinion, to what is prevalent in current Western dentistry where dentists are encouraged to work in silos.

At the societal level, socially engaged dentists should be strong advocates of healthy public policies, including addressing poverty and inequalities. In my experience, this is not currently the case.

Is this social perspective being either endorsed or practised in other aspects of healthcare?
In North America, medicine has been much more active than dentistry to promote such approaches. In recent years, for instance, I have observed a growing number of articles promoting social medicine, upstream interventions, structural competency, and critical consciousness. These approaches are even taught in several prestigious universities in the US.

Is it possible for social dentistry to function alongside certain current treatment modalities, such as motivational interviewing, that seek to empower individuals to take charge of their own oral health?
Yes, empowering patients is central to our approach. My colleagues and I have also proposed models of person-centred care that describe the relationship between dentists and their patients. I believe in more balanced relationships and patients’ empowerment.

Thank you very much for the interview.

Editorial note: Dr Bedos’s article, titled “Social dentistry: An old heritage for a new professional approach”, was published online in the British Dental Journal on 24 August 2018 and can be found here.