Dental coercion disaster

“Those best able to take responsibility for their own dental health are those who have not been subjected to dental health coercion in childhood.”
– Sarah Fitz-Claridge

From the archives: The original post was posted on 19th December, 1994

Since you are arguing about brushing and flossing again, I thought you might find this draft of a Taking Children Seriously journal editorial interesting. Comments and criticisms welcome.

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Many parents believe in letting children do what they want, when they want, so long as it is not deemed dangerous. One such parent (let’s call him ‘Brian’) recently asked what one should do if one’s child hates to have his teeth flossed and brushed, and will cry and fight in a vain attempt to avoid this. Brian takes the view that teeth-cleaning is essential, and that therefore he has no option but to force his child to submit to brushing and flossing. He said that he cannot just forget about it or wait for his child to ‘grow out of it’, as the child already has thousands of dollars worth of fillings and caps (they live in America).

It seems that Brian has the worst of all possible worlds doesn’t it? His child has cavities, and is kicking and screaming, and thousands have been spent on caps and fillings. How could it be worse? Why is he holding this up as an example of how to behave?

Before suggesting an answer to that question, let’s consider the teeth-brushing issue itself. Does Brian really have ‘no option’? Is this really the breaking-point, the issue that justifies parents in using any and every means, no matter how unpleasant to the child, to enforce obedience? Because ‘the child’s health is the overriding consideration’?

By the way, dental health is not really such a simple matter as ‘brushing’ versus ‘cavities’. Teeth-brushing is only one factor among many that are relevant to tooth decay, such as diet, general health and life-style, genetic predisposition, and (perhaps the most important) fluoride. ‘Diet’ is not a matter of how much sugar one eats, but of the amount of refined carbohydrates one eats. Sugar, which is very highly refined, causes the tooth enamel to denature instantly—brushing straight away is too late to avoid that—but the enamel can and often does re-mineralise. Constant grazing—eating little and often—is generally thought to be a more healthy form of eating in metabolic terms, but it is more damaging for the teeth than eating once a day. But eating only once a day is itself unhealthy for other reasons. So you have to weigh up the risks. In Britain some studies suggest that the incidence of cavities in 15-year-olds has dropped to less than a quarter of what it was a generation ago. Only part of that drop is attributable to known factors—and indeed some of those factors have presumably worsened over that period. Conversely, one paper suggests that there is an increase in the DMF (Decayed/Missing/Filled) scale for school children of a certain socio-economic status. What happens in the mouth is a complicated matter, which dental science does not yet fully understand.

None of this amounts to a case against brushing one’s teeth. On the contrary, the evidence strongly suggests that brushing is a valuable thing. But not infinitely valuable. It is merely one among thousands of ways in which a child may take precautions against future suffering. But when taking such precautions it is unreasonable not to weigh them against their present cost. It is quite obvious that for some children, at some periods in their lives, the cost is simply not worth the benefit.

Many parents seem to have this whole issue of health in general and teeth in particular out of perspective. The only reason people value health at all is (or ought to be) that we want to avoid pain and suffering. In those terms, what is at stake here? More fillings; or fewer fillings. How important is this compared with children kicking and screaming every day? Surely even in the narrowest sense, if you just weigh pain against pain, there is no comparison. It is not in the same league.

The real reasons for teeth-brushing coercion have nothing to do with teeth. Let’s look at Brian’s claimed justification more closely. Is it really true, for instance, that it is the cost of dental treatment that is driving him to hurt his child so badly? Surely not. If you offered him thousands of dollars—plus free dental insurance—to beat his child but forget about teeth-brushing, he would certainly refuse. Moreover, in Britain, where children’s dental care is free, there are parents who are just as grimly determined as Brian to act out the twice-daily teeth-brushing confrontation. But they give different reasons.

Brian also said that he does not want his child’s second set of teeth to become bad like the first set. If that were his real reason, he would be starting his coercion only now, when his child’s second teeth have appeared. By the same argument, what great ‘overriding’ harm would be done by waiting until the child grows up? It is hardly conceivable that Brian’s child will have lost his adult teeth by the age of, say, 16 or 18, when even Brian would presumably cede the responsibility. At worst he would have more fillings. In response to this argument Brian would probably shift his ground. People usually do when they feel an overwhelming compulsion to do something they can’t justify. He might claim that the child’s present dental health is not really the point, and that the object of all these teeth-brushing assaults is to get his child into the habit of cleaning his teeth by the time he does grow up. Really? Is that what justifies all those years of suffering? Think about it. If Brian’s child, having grown up, decides that teeth-brushing is a good idea, how long will it take him to get into the habit? A week? A month?

What nonsense. (Incidentally, is this a reliable way of instilling a habit? Is it not just as likely to make the child evade teeth-brushing whenever he can, and finally to abandon it in young adulthood? It is in adulthood when teeth brushing has the greatest medical merit, because it can help to prevent gum disease and loss of teeth in later life.) But if Brian is not doing this for the money, and not doing it to avoid the relatively minor suffering of his child having fillings while still a child, and is not doing it in order to instil a habit, what is he doing it for?

Many parents do not exert this enormous pressure in regard to teeth-cleaning but do do it in regard to other issues. Bedtimes, say. If you ask them why, they give the same type of anguished but empty justification for bedtime-coercion as Brian gives for teeth-cleaning coercion. If we were to put to them Brian’s arguments about teeth-cleaning, they would casually agree that teeth-cleaning is important; but they would not actually go to the lengths of making their children cry over it twice a day.

Suppose that Brian happens to be easy-going about bedtimes. If these bedtime-coercers put their case for bedtime coercion to him, he would not be convinced by their argument. He might agree that getting a good night’s sleep is desirable, but it would be obvious to him that it is totally out of proportion for parents to make their children miserable for many minutes or even hours every day, just to force them into bed. So that they won’t be grumpy in the morning?! Or to get them into the habit of regular bedtimes? Or whatever. It just doesn’t make sense.

The reason Brian would not be persuaded to do that to his child, and why bedtime-coercers who are easygoing about teeth-brushing would not be persuaded by Brian’s justifications, is that parents don’t do these things for the reasons they cite. They do them because their psychology requires it. Nobody could be persuaded to cause a loved one that much suffering over such trivial issues.

There are people who coerce their children over teeth-brushing, and there are people who coerce their children over bedtimes. Their reasons are not to be found in their arguments but in their personalities. Argument could never cause a parent to amplify a very tiny consideration (the risk of possible pain of later cavities or treatment, in the case of teeth-brushing) to inform an entire way of life, which causes misery every day for years on end. What is really happening is that parents find themselves already enacting a way of life, and then they wonder why. Often they are shocked to recognise their own parents’ behaviour, which they found so hurtful and inexplicable when they were children, in themselves. So they come up with a ‘reason’ to justify it. And of course it has to be an ‘overriding’ reason, to justify what they would otherwise find unjustifiable. What is ‘overriding’ depends on the parents’ personalities. For religious people, the justification is often that it ‘says so in the Bible’. For health enthusiasts, the justification will be that ‘the child’s health is paramount’, and so on.

Psychologising like this about people’s underlying motivations must never be mistaken for an argument about the issue concerned. It proves nothing about whether it is right or wrong to use this kind of coercion. Nevertheless it is worthwhile to think about what motivates people.

Returning to the teeth-brushing issue itself, I have so far argued on Brian’s own chosen territory, that of ‘health reasons’ being ‘paramount’. Even in those narrow terms I have shown that this does not justify coercion. But consider the wider, more sinister ramifications of what Brian is doing. When you take forcible control of a child’s mouth and inflict pain, the child is inevitably going to seek strategies for minimising this pain. If he can’t do it physically then he will do it psychologically. This will certainly degrade his relationship with the parent who is hurting him. Furthermore it is likely to make him feel bad and ambivalent about his own body, because his body is being used to hurt him. This is like rape: if a child is raped, he won’t feel good about sexuality, because sexuality has not been used for his purposes, but for someone else’s purposes to his distress. It matters little that attacking a child’s mouth is socially condoned but attacking other bodily orifices is not. Whether it is being done for his own good or not, the psychological effect will be similar.

One’s self-image, including how one feels about one’s body, is a complex part of one’s personality. It does not just happen in a vacuum, one forms it during one’s childhood. And if aspects of one’s personality are not formed to meet one’s own needs, but rather as emergency defences against someone else’s needs, then those aspects will not fit in. They will not be helpful to the person as a whole. The person will not be of one piece but will have built-in conflicts which are a permanent source of suffering and failure. A person who grows up with such conflicts is not likely to be the most able to make measured judgements about his body. The kind of person who is best equipped to take responsibility for his own health, I suggest, is a person who has not been subjected to dental health coercion in childhood.

See also:

Sarah Fitz-Claridge, 1994, ‘Dental coercion disaster’, https://takingchildrenseriously.com/dental-coercion-disaster