RECENT MASTER'S THESES AND DOCTORAL DISSERTATIONS
 

McNally, Mary Elizabeth. Beyond Who gets what? Looking for justice in seniors' oral health care
MA Thesis. Dalhousie University, 2003.
    The philosophical question providing the focus for this thesis is, "what is the right conception of justice to address oral health needs of elders?" To respond to this question and to work toward developing an ideal conception of health care justice for elders, two models of justice are considered. Norman Daniels' influential liberal approach uses the Rawlsian principle of "fair equality of opportunity" to provide a basis for socially supported health care. This argument rests on the premise that health care needs warrant special consideration as a social good because of health's influence on opportunities for members of society. Identifying measurable needs and the social support required to address those needs becomes an important part of the practical activities of health care. Alternatively, Joan Tronto argues that conventional liberal theory, founded on the "ethics of justice and rights," is an inadequate account of public morality and proposes that we should transform liberal thinking toward an expanded vision of "justice as care".

Stern, Judiann. A study of decision-making strategies for resolving common ethical dilemmas encountered by fourth year dental students
M.A. Thesis. Concordia University (Canada), 2003
    The purpose of this study is to explore the decision-making process used to resolve ethical dilemmas experienced by undergraduate dental students. Various pedagogical approaches were considered and a modified decision-making strategy based upon a synthesis of current models was suggested. The research methodology included a literature review of articles obtained through a Medline search. Data collected from student essays over a four-year period provided a list of common ethical dilemmas encountered by undergraduate dental students. A survey tool was designed using four of these situations and distributed to third and fourth year students and dentists having more than five years of clinical experience to determine the underlying ethical principles used in resolving ethical conflicts. Two main conclusions can be drawn from this study. Dental programs have an obligation to include the teaching of ethics and are most successful when it is a part of the curriculum every year. The second conclusion is that in general, experienced clinicians more than students, and men more than women, tend to take into consideration context as well as professional principles when resolving ethical dilemmas.

Picard, Alyssa. Making the American mouth: Dental professionalization, dental public health, and the construction of identity in the 20th century United States
Doctoral  Dissertation. University of Michigan, 2004. Can be purchased at: http://wwwlib.umi.com/dissertations/cart?add=3122024
    The professionalization of dentistry in the 20th century United States was linked to changing constructions of what standards of dentistry and dental appearance were “American.” In turn, debates about oral health care constituted an important site for the construction of national identity.
    This dissertation treats American dentists' professional writings as a body of cultural history source material, examining them for evidence of how dentists participated in the construction of professional, national, and other identities in the twentieth century. Where possible, I also elucidate patients' responses to dentists' concepts of appropriate patient and citizenship behaviors.
    In the early 20th century, American dentists used travel writing to represent “American dentistry” as entailing uniquely high levels of skill, intellect, and scientific savvy. However, in their discussions of the “American diet,” dentists debated with considerable anxiety what it meant to be “American,” and whether that was good or bad for oral health.
    Dentists' shifting professional and entrepreneurial interests also shaped their ideas about the delivery of dental care—particularly the provision of public funding for dental public health measures, including public school dental hygiene programs and the fluoridation of public water supplies. By the end of the twentieth century, pressures from within and outside the profession left dentists increasingly suspicious of public health programs they had previously supported. In response, they developed and expanded treatment measures (such as orthodonture) that required long-term time and financial commitments on the part of the individual patient.
    By the end of the twentieth century, “good citizenship,” to most dentists, came to mean the promotion of private practice, and opposition to publicly-funded health programs (and to most dental insurance). Increasingly, good citizenship was marked in patients' mouths by evidence that they had obtained costly esthetic dental interventions: absence of these markers was often attributed to lack of individual ambition, or to an inappropriately low valuation of personal appearance and its role in business and social life.

Palma, Patricia Alvarado. Oral health among a group of homeless individuals from dental professional's and patient's perspective.
Doctoral Dissertation. Karolinksa Institutet, Sweden, 2007. ISBN: 978-91-7357-051-0.
Available on-line at: http://diss.kib.ki.se/2007/978-91-7357-051-0/
    The homeless are a vulnerable group in society. They are frail, in poor general health and tend to have difficulty expressing expectations and needs. While poor oral health is clearly an added burden for people who struggle daily to survive under miserable living conditions, there are also many barriers to dental care. There are currently approximately 17 800 homeless people in Sweden, of whom 3 900 are in Stockholm. The overall aim was to describe the oral status of a sample of homeless adults, to analyse their perceptions of oral health and the consequences to focus on adequate dental care for the homeless. Both quantitative and qualitative research methods were applied.
    In Paper I, the study population comprised 147 homeless individuals. All subjects underwent oral examination, including registration of periodontal status and caries data. The results showed that homeless adults in Stockholm had fewer remaining teeth than the general population. Heavy plaque accumulation will also have an effect on caries progression, expressed in this study as high DMFT (Decayed-Missing- Filled Teeth) values. Loss of teeth is likely to create dental and chewing problems, eventually resulting in increased dental and medical treatment needs.
    In Paper II, the perceptions of homeless people concerning their oral health and perceived consequences of dental treatment were analysed. Open, tape-recorded interviews were conducted in conversational style. A phenomenological-hermeneutical method was used to analyse the subjects' stories. All narratives revealed expressions of loss as well as recovery in the informants' life- world. Both aspects highlight the fact that being homeless means loss not only of a permanent residence but also of many values and similarly, oral health was described and interpreted in terms of loss and recovery.
    In Paper III sentences related to the homeless individual as a person, the underlying meanings of what the text talked about, were interpreted as codes and subthemes labelled as two themes, "Struggle to retain integrity" and "Need for freedom without responsibility". In sentences related to the homeless individual as a patient in dental care, the underlying meanings of what the text said were likewise interpreted in codes and subthemes labelled as two themes "Meeting the patient where he/she is" and "Future dental care". A common complaint from the homeless patients was disrespect from care providers. There were many ways of facing the dilemma, e.g. to keep a distance, to try to act normal. Ordinary regular dental contact could be seen as one way back to normal life
    In Paper IV 147 subjects were interviewed with a specially designed structured interview covering attitudes to oral health. 93.8% considered that the teeth are important, 86.3% experienced pain or soreness of the teeth.92.5% report ed chewing difficulties due, to pain, 68.4% subjects expressed embarrassment about the appearance of their teeth, 93.8% refrained from dental treatment due to economical reasons, and fear of dental treatment was confirmed by 70.5%, 74% subjects reported dry mouth, 67.4% had no toothbrush. 91.8% did not have a address or at least a poste restante, 92 % were drug abusers, 85% were tobacco smokers. The median number of teeth was 18.O.The median duration of homelessness was 5.0 years, the interval since previous dental treatment varied between 0.5 and50 years. 115% of the individuals had known HIV-infection, 20.4% reported known heart disease.