Was the Tooth Fairy Breast Fed? the Politics of Infant Tooth Decay

Was the Tooth Fairy Breast Fed? The Politics of Infant Tooth Decay Yvonne Luxford Thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy at the University of New South Wales ORIGINALITY STATEMENT ‘I hereby declare that this submission is my own work and to the best of my knowledge it contains no materials previously published or written by another person, or substantial proportions of material which have been accepted for the award of any other degree or diploma at UNSW or any other educational institution, except where due acknowledgement is made in the thesis. Any contribution made to the research by others, with whom I have worked at UNSW or elsewhere, is explicitly acknowledged in the thesis. I also declare that the intellectual content of this thesis is the product of my own work, except to the extent that assistance from others in the project's design and conception or in style, presentation and linguistic expression is acknowledged.’ Signed ……………………………………………........................... i COPYRIGHT STATEMENT ‘I hereby grant the University of New South Wales or its agents the right to archive and to make available my thesis or dissertation in whole or part in the University libraries in all forms of media, now or here after known, subject to the provisions of the Copyright Act 1968. I retain all proprietary rights, such as patent rights. I also retain the right to use in future works (such as articles or books) all or part of this thesis or dissertation. I also authorise University Microfilms to use the 350 word abstract of my thesis in Dissertation Abstract International. I have either used no substantial portions of copyright material in my thesis or I have obtained permission to use copyright material; where permission has not been granted I have applied/will apply for a partial restriction of the digital copy of my thesis or dissertation.’ Signed ……………………………………………........................... Date ……………………………………………........................... AUTHENTICITY STATEMENT ‘I certify that the Library deposit digital copy is a direct equivalent of the final officially approved version of my thesis. No emendation of content has occurred and if there are any minor variations in formatting, they are the result of the conversion to digital format.’ Signed ……………………………………………........................... Date ……………………………………………........................... ii Acknowledgements It is clearly impossible to individually name all of the people who have been both directly instrumental and generously supportive of me in the preparation of this thesis. My thanks must firstly go to all those who assisted academically in the creation of this thesis. This includes all of the staff of the School of History and Philosophy of Science at UNSW who have assisted through the provision of feedback at presentations, reviews, and providing teaching opportunities that enhanced my skills and knowledge. I am particularly thankful for the assistance of Dr Anthony Corones, who has kindly provided advice and support as Postgraduate Coordinator. Originally I was investigating a completely different thesis topic involving the medicalisation of childbirth, and I am incredibly grateful to my supervisor at that time, Professor Randall Albury, who was inspirational in my developing a fascination with the history and philosophy of medicine. My current supervisor, Dr Susan Hardy, has been patient, supportive and consistent in guiding me towards a comprehensive thesis. Her enthusiasm for my subject matter has fostered in me a closer engagement with even the more mundane research material, and I have highly valued her recommendations and direction. I also thank Susan for her generosity of both time and spirit, which have been integral to my completion of this thesis. Fellow research students have provided much appreciated collegiality, advice and support through the good and bad aspects of my candidature. Most importantly they have provided friendship, and while many have been involved in this process, I would especially like to thank Lachlan Partridge, Philip Gissing and Rae Dufty. Friends external to the university have kept me grounded throughout this process and I am also deeply grateful for, and constantly amazed by, their encouragement and constant support. My wonderful extended and blended family has been integral to the completion of this thesis. Their active and ongoing support has never wavered, and has been deeply appreciated. My greatest appreciation goes to my daughter, Sian, whose enthusiastic encouragement never wavers. This thesis is dedicated to Sian, a breast fed child with perfect teeth. iii Abstract In the mid 1970s American paediatric dentists started publishing claims that breast feeding an infant on demand and/or during the night was as dangerous to the infant’s dental health, in terms of the production of caries, as the previously established dangers of Baby Bottle Tooth Decay. It was argued by some dentists that this danger increased if the infant was breast fed for an extended period of time. Such claims have gained support from many dentists, and their professional bodies, into the twenty-first century. This thesis examines the historical, social, commercial and cultural influences that supported the development of such assertions. It analyses the ways in which expert reinforcement was gained, and scrutinises the scientific controversy as publicly fought in professional journals and other outlets. The thesis also examines the growing status of the dental profession, especially in connection with its claim to specialised scientific and medical knowledge in the production of dental caries. Further, consideration is given to the medicalisation of breast feeding and the associated commercial infant feeding dispute. The thesis attempts to redress the current lack of theoretical analysis of the construction of dental knowledge. To date there has been minimal academic contribution to the history of dentistry; however, the absence of extensive analysis has been advantageous in enabling an original approach to the material. iv Table of Contents Originality Statement i Copyright Statement ii Authenticity Statement ii Acknowledgements iii Abstract iv Introduction 1 Chapter One - Blaming the Breast 9 Chapter Two – Scientific Motherhood Puts Her Teeth In 44 Chapter Three – Pressures, Psychology and Profits 78 Chapter Four – Opening the Black Box 104 Chapter Five – But is it Science ??? 156 Chapter Six – Alternative Approaches - Assorted Assumptions 210 Conclusion 250 Bibliography 257 v Table of Illustrations Excerpt from Kotlow, L.A., ‘Breast feeding: A cause of dental caries in children’, ASDC Journal of Dentistry for Children, 44 (3), May-June, 1977, pp 192-193. 238 vi Introduction This thesis explores the process by which breast feeding became a widely accepted cause of infant tooth decay, and offers an explanation of how and why the dental profession developed and disseminated this theory. Fass’ identification of the aetiology of ‘nursing bottle mouth’ in the early 1960s triggered a change in the way that dentists and parents thought about milk and the infant feeding bottle. Isolating the problem as being the habit of putting the infant to bed with a bottle, Fass suggested that the path to preventing this debilitating and disfiguring disease was through parental education and co- operation between dentists and doctors. In the mid 1970s all of his conclusions were neatly transferred to a new culprit – breast feeding. This thesis developed from personal concern and curiosity as I became aware of the conflicting information provided to parents when breast feeding. At the same time that the World Health Organisation and various other branches of health care were actively campaigning for universal increases in breast feeding rates and duration, the dental profession was openly advising mothers to stop breast feeding. I found myself drawn to explore the reasons for this apparent anomaly and to ascertain if dentistry was in any way inherently different from other health professions. That the dental profession has maintained, and even solidified, its position over the past three decades raises numerous questions as to why it apparently contradicts the consensus view on the overarching benefits of breast feeding, and how its position has been built and bolstered. The exploration of this position has predominantly focussed upon the time span from the mid 1970s to the present, but has also delved into the historical background of both the development of the dental profession and the popularity of artificial infant feeding, coincident with the medicalisation of 1 breast feeding, over the past century. The manner in which the claims gained authority through publication and citation in professional publications is closely analysed, as is the means by which the voices of dissenters were marginalised. This authority has been dependent upon efforts to increase and solidify the prestige of the dental profession. The nature of the profession’s relationship with medicine and science is examined in the thesis, as is its interaction with the development of Evidence Based Dentistry. Geographically the thesis concentrates on Western nations, with particular attention given to the United States of America. Historically, America witnessed the fastest and broadest developments in the dental profession in the nineteenth century, easily eclipsing other countries as the ‘seat of modern dentistry’1. It was also in America that breast feeding was first

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