Craig, Maxine

Professor of Sociology,
University of California, Davis (USA)

The United States is known for the perfect “Hollywood” smiles of its people, and, indeed, the smiles of well-off adults in the U.S. are remarkably uniform. Orthodontic treatment, which sometimes corrects functional problems, and always addresses appearance, has become a routine part of late childhood and early adolescence. Multiple factors, each one at least partially arising from government policy, increased aesthetic dentistry in the U. S. In the 1970s, the Federal Trade Commission removed bans on advertisements of medical services to consumers, increasing the commercialization of medicine. Most U.S. dentists and orthodontists work in private practices based on a fee-for-service model. The high cost of dental education, borne by students through loans, and the need for dentists operating in private ractice to equip and staff individual offices, pushes dentists to orient their practices toward providing the most profitable services to patients who are able to pay for them. Dentists and orthodontists urge their patients to straighten their teeth as children, and whiten and re-straighten them as adults.

In a nation in which individuals must use private health insurance or their own wealth to cover health care expenses, dental care is even less accessible for lower-income people than medical care. In the context of wide economic inequality, an irregular smile has become a harsh stigma of poverty. Where the state abandons the public, the market rushes in. Into the gap between the cost of orthodontics and the means of many to pay enter low-cost options, entirely focused on improving appearance. Aligners, produced via three-D printing, straighten teeth at a lower cost than traditional orthodontics. Internet companies provide aligners to consumers, by-passing direct contact with a dentist or orthodontist. 100 years after the medicalization of smiles through the development of orthodontics, orthodontists are fighting the de-medicalization of teeth straightening. They turn to the state to protect their interests.

The dentists, orthodontists, and aligner technology companies who fight for control of the business of teeth straightening pitch their battles in the name of access to care and patient safety. In 2020 the American Association of Orthodontists, California Dental Association, and the California Society of Pediatric Dentistry united in support of AB 1998, legislation that would require aligner patients to have x-rays reviewed by a dentist prior to treatment. Opposed by over 30 organizations, including the California NAACP, the California Black Chamber of Commerce, and the California Hispanic Chamber of Commerce, AB 1998 failed. Framing access to aligners as a matter of racial justice, African American basketball star Draymond Green (and investor in a direct-to-consumer aligner company) wrote, “I can’t see this any other way than blocking access to minorities.” This paper will examine how the state became an arbiter among the competitors who straighten teeth. Their disputes further entrench the necessity of a perfect smile for somatic belonging. The paper is part of a larger study that combines interviews and archival research to examine how the normalization of a form of aesthetic medicine leaves the mark of poverty on the untreated.

Short bio:
Maxine Leeds Craig is a professor of Sociology Department at the University of California, Davis. She is the author of Sorry I Don’t Dance: Why Men Refuse to Move (Oxford University Press 2014), and Ain’t I a Beauty Queen? Black Women, Beauty, and the Politics of Race. (Oxford University Press 2002). She is the editor of The Routledge Companion to Beauty Politics (2021).