The Great British Smile: An institutional ethnography of power in cosmetic dentistry

Background: Despite the expanding provision of cosmetic dentistry in the UK, there has been little critical research in this area. Aim: To describe the influence of dominant social norms in the provision of cosmetic dentistry in the UK. Method: Institutional ethnography (IE) was used to map the social relations in cosmetic dentistry. A multi-site qualitative method, IE explores beyond the boundaries of observed local activities; therefore, the social relations included actors’ activities and institutional texts. Data collection methods included participant observation at exclusive dental practices and events; contextual, in-depth, and diary interviews; and documentary analysis. Actors’ cosmetic dentistry activities were mapped schematically in relation to institutional texts to display how UK cosmetic dentistry is organised in terms of social relations. Attention was paid to discourses found within these social relations. The emergent forms of power in the mapped organisation were analysed by reference to Lukes’ (2005) theory. Results: The dominant institutional discourses found in the social relations were crime (beauticians undertaking teeth whitening), dentists’ professional standards and training, and safety. It was found that diverse actors with multiple interests have worked to create these discourses, which cultivate trust in cosmetic dentists and places them in a gatekeeper position in the provision of cosmetic dentistry. However, there were disjunctures between authorised accounts of dentists’ training, professional standards and safety, and what the public may expect. The discourse of happiness was used to link cosmetic dentistry to healthcare rather than beauty, and profit was kept distant from the public. These discourses were coordinated to mediate demand for treatments. Conclusion: Dentists increasingly play a gatekeeper role in the provision of cosmetic dentistry. The public trust cultivated in dentists facilitates the movement of beauty treatments into healthcare. However, the disjunctures and the disconnects between the fields of beauty and healthcare have consequences for public safety and people’s autonomy.