Medicalising the mouth: the professional oral care structure in postwar Japan
Medical history in Japan – by Rie Hogetsu
My work deals with the history of oral care in post-World War II Japan, focusing on the professional structure of oral care and the medicalisation of the mouth. In my dissertation, which discusses the history of modern Japanese hygiene, I describe how the school dentist system was established in early 20th-century public elementary schools in Japan. By 1898, in the middle of the Meiji era, the school doctor system had already been introduced. Generally, local governments designated private practitioners, who were physicians in most cases, as school doctors. More than 30 years later, the school dentist system was introduced, and the development of the system had an important part to play in the medicalisation of children’s mouths and teeth in prewar school hygiene.
In the early 20th century, it was uncommon for ordinary people, especially those living in rural areas, to spend time looking after their oral hygiene; hence, children’s mouths and teeth were not given attention in the home. Under the school dental system, however, children were regularly taught how to brush their teeth, and they routinely underwent dental checkups and treatment, all of which was noted on their medical record. This medicalisation was primarily the result of the claims and lobbying activities of dental associations, which were financially supported by toothpaste companies. In addition, fostering daily healthcare habits through physical practices – like brushing one’s own teeth – was set as the primary educational objective in a school hygiene curriculum, facilitating the development of school oral care institutions in the 1930s.
It was after World War II, however, that medicalisation of the whole nation’s mouths and teeth became a national healthcare project in Japan. The occupation authorities at the General Headquarters (GHQ) initiated a reform of public healthcare systems and, as part of this move, para-dental professionals (such as dental hygienists) were created as a stopgap measure to promote oral health. In reality, the number of people at the time who could afford to take care of their mouth and teeth was very small, and most people usually ignored a decayed tooth until it was causing them intense pain. The enforcement of the National Health Insurance System in 1961 gradually increased the number of patients in dental clinics. What differed from dental practices of the prewar period was that the scope of dental care was expanded from schoolchildren to the elderly. Moreover, other adults (including pregnant women and middle-aged people) were to become the targets of oral healthcare.
In a similar way, we see that the number of healthcare workers has proliferated in the 20th century, and our mouths have been increasingly looked after by various healthcare workers belonging to many specialities, not only dentists. This tendency seems to have arisen because, in recent years, medical researchers have frequently pointed out the correlation between the condition of the mouth and the overall state of health of middle-aged and elderly people. For example, some research results show that treatment for periodontal disease can considerably lower the blood- sugar level of diabetics. In addition, keeping the mouth and teeth clean is particularly important for bedridden elderly people and may help to prevent pneumonia. Improving oral cavity function for people requiring long- term care becomes a main objective at nursing homes. Thus, the mouth has become an arena of intervention for various healthcare workers; it is not limited to medical professionals such as doctors, dentists and dental hygienists. Nursing care workers, such as certified care workers and speech– language–hearing therapists, are also becoming oral healthcare providers.
The question of who should be the caregiver and who should be the target of oral care strongly affects the medicalisation of the mouths of Japanese people. In order to clarify the impact medical professionals and healthcare workers have had on recipients’ bodies through healthcare, we need to consider not only the traditional doctor–patient relationship but also the relationships between healthcare providers. The division of labour among healthcare professionals and workers regulating the contents and range of professional work, as well as unofficial customs or rules at workplaces, have a great influence on the medicalisation of patients’ mouths. Hence, I am now conducting research to determine how the professional structure of oral hygiene has affected the medicalisation of mouths in postwar Japan. As Andrew Abbott (1988) and Tracey L Adams (2004) show, it is the perpetual interprofessional conflicts over jurisdictional boundaries that determine the real history of professions. My research will add a new perspective to existing professional literatures by elucidating how the professional structure has been shaping the medicalisation of the mouths of the Japanese people. Furthermore, I believe that research on inter- and intra-professional conflict for jurisdiction over the mouth among healthcare professionals will shed new light on discussions of medicalisation in the history of medicine in Japan.
Rie Hogetsu is Adjunct Lecturer in sociology at Ochanomizu University, Japan, and the author of Kindai Nihon ni okeru eisei no tenkai to juyō (‘Concepts of Hygiene in Modern Japan: Evolution and reception’), 2010. This work is supported by JSPS KAKENHI 22730384.