Institutional ethnography of teeth whitening industry: how professional power becomes commercial power in dentistry

Objectives

This study aimed to demonstrate how power is exercised, and by whom, to expand the practice of teeth whitening in dentistry and the resultant consequences for the public.

Methods

Institutional ethnography (IE) conducted in England that included 100 h of observations at cosmetic dentistry conferences, training and treatments; five field-site and eight in-depth interviews with dentists; 16 in-depth and 3 diary interviews with patients/public. IE analysis identified discourses recurring across field sites and interviews, traced the institutional texts they implied, mapped how institutions activated these texts and generated further texts (work–text–work sequences), then examined disjunctures between institutional discourses and the lived experiences of patients/public.

Results

Two recurring discourses were identified: teeth whitening by beauticians is a “crime” and the “practice of dentistry”, both centred on patient safety. Corporates (Ultradent and Optident) and democratic institutions wielded competing texts (EU Cosmetics Directive and Medical Devices Directive) to promote and resist the sale of higher-peroxide teeth whitening gel in the UK, but corporates failed to secure market entry. Dental institutions used scientific authority to frame teeth whitening as a patient safety issue, opening European markets to higher-concentration products, with dentists as gatekeepers. The Dentists Act 1984 was wielded to exclude competitors such as beauticians. From the patient/public standpoint, disjunctures revealed lived harms including unaffordable dental care, unsafe healthcare spaces, concerns around bodily autonomy and democratic accountability.

Conclusions

Dental institutions and scientific discourse are shaped by power relations, with ethical concepts like safety politically mobilised and functioning as transnational commercial power.