“Tooth worms”, poverty tattoos and dental care conflicts in Northeast Brazil

• Published in: Social science & medicine (1982) Vol. 54; no. 2; pp. 229 - 244
• Main Authors: Nations, Marilyn K, Nuto, Sharmênia de Araújo Soares
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 2002; Elsevier; Pergamon Press Inc
• Series: Social Science & Medicine
• Subjects: Attitude to Health - ethnology; Biological and medical sciences; Brazil; Ceara; Ceará; Communication; Dental Care; Dental Care - standards; Dental Caries - ethnology; Dental Caries - psychology; Dentist-Patient interactions; Dentist-Patient Relations; Dentistry; Dentist–patient relationship; Developing countries; Discourse; Ethnographic research; Facial bones, jaws, teeth, parodontium: diseases, semeiology; Fear; Health; Health Behavior; Humans; LDCs; Low income groups; Medical anthropology; Medical sciences; Medicine; Medicine, Traditional; Non tumoral diseases; Northeast Brazil; Oral Health; Otorhinolaryngology. Stomatology; Patients; Poor people; Poverty Areas; Practitioner Patient Relationship; Professional-Family Relations; Quality of care; Quality of Health Care; Rural areas; Rural Health; Social Class; Social Constructionism; Social dentistry; Social dentistry Dentist-patient relationship Quality of care Northeast Brazil; Social sciences; Socioeconomic Factors; Teeth; Tooth Extraction - psychology; South America; Brazil; America; Ceara Brazil; Northeast Brazil; Dentist–patient relationship; Social dentistry; Quality of care; Belief; Human; Rural environment; Stomatology; Dentist; Dental disease; Anthropology; Care; Physician patient relation; Social interaction; Cultural environment; Quality; Public health; Northeast
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/S0277-9536(01)00019-3

While medical anthropologists have studied doctor–patient clinical conflicts during the last 25–30 years, dentist–patient communication clashes have received scant attention to date. Besides structural barriers and power inequities, such conceptual differences further dehumanize dental care and lower service quality. Potential for dentist–patient discordance is greater in developing regions—such as Northeast Brazil—where there exists a wider socio-economic gap between professionals and laypersons. A critical anthropological evaluation of oral health services quality is undertaken in two rural communities in Ceará, Brazil where the PAHO-inspired Local Oral Health Inversion of Attention Program was implemented in 1994. This 6-month qualitative field study utilized ethnographic interviews with key informants, participant-observation and projective techniques to probe professionals’ and patients’ explanatory models (EMs) of oral health. Despite the recent expansion of services into rural regions, the authors conclude that the quality of dental care remains problematic. Patients’ culturally constructed EMs of teeth rotted ( estraga) by “tooth worms” ( lagartas) differ substantively from dentists’ model of dental decay by Streptococcus mutans. “Exploding chins” ( queixo estourado), “spoiled, rotting teeth” ( dente pôdi) and “false plates” or teeth ( chapas) tattoo and stigmatize the poor, reinforcing gross class inequities. Dentists’ dominant discourse largely ignores lay logic, ridicules popular practices and de-legitimates, even castigates, popular healers despite their pivotal role in primary oral health care. Poor parents are not only barred from clinics but are blamed for children's rotten teeth. In sum, universal access to dental care is more a myth (even nightmare) than a reality. Dentists all too often “avert”—not “invert”—attention from poor Brazilian patients. In order to improve oral health in this setting, both “societal decay” and bacteria-laden plaque deposits must be removed.