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Man walks through shopping centre to represent the product. It is not made clear what his affiliation is.

Man: We’re talking to people who have switched to Colgate Sensitive Pro-Relief.

[image of product and toothpaste]

[Man asks question to a member of the public, Callum] Why did you switch?

[Caption: Callum, Switched from another potassium based sensitive toothpaste]

Callum: Cos it was a much more effective toothpaste. It worked straight away.

Voiceover [illustration of tooth demonstrating how it works]: That’s because unlike most other pro-sensitive toothpastes, the unique pro argin formula instantly blocks to the open channels to the nerves.

Fiona [caption: switched from another sensitive toothpaste]: You can absolutely say it has changed my life, definitely.

Man: Care to prove it. [points to bucket of ice]

Fiona: [puts ice in mouth] Both sides.... perfect.

Caption: 9/10 dentists who have tried Colgate pro-relief would recommend it for sensitive teeth. Switch to Colgate Sensitive Pro Relief. Proven instant relief and superior long lasting protection.

The investigation continues:

  • Study of response shift in dentine sensitivity
  • Diary study of everyday experiences of dentine sensitivity

  • Perhaps we should be considering a transformative consumer research agenda?

Exploring illness communications: unpicking the impact of social structure on communicating health and illness.

Exploration of the social dimension to dentine hypersenstivity.

Conclusions

but

  • Historically dentine sensitivity has been defined as a non-problem problem for dentists who were more interested in treating dental disease - not sensitivity.

the economic system and the scientific system were critical in this process

  • Knowledge of mechanisms emerged after the production of products therefore both commodification and scientific knowledge were determining factors commodification more important
  • The mass media plays a critical role in communicating the displacement of sensitivity from the clinic to the market place.
  • The role of the discipline of dentistry is ambiguous with professionals appearing to reinforce the displacement, or not appearing at all.

Behind all of the systemic communications the consumer is being observed as a potential reservoir of meaning

The overlap between distinctions found in narratives and advertisments concerning dentine sensitivity

Distinctions found in advertisments

Acknowledgements

Colleagues at The University of Sheffield

  • Peter G Robinson
  • Sarah R Baker
  • Olga Boiko
  • Melanie Hall
  • Jenny Porrit
  • Marta Krasuska

Paradox of pain

  • Pain / No Pain

Distinctions found in narratives

The displacement paradox

  • place / space
  • Tess Player
  • Vicky Murzynowski

Colleagues at GlaxoSmithKline

  • Steve Mason
  • Ashley Barlow
  • Farzana Sufi

Paradox of pain

  • Short/Sharp

Paradox of inaction

  • Action / No action

Paradox of self help

  • Visit / Don't visit

Paradox of age

  • Young / Old

Paradox of time

  • Before / After

Non -problem problem paradox

  • problem / no problem

Paradox of health identity

  • habit/lifestyle

Paradox of treatment seeking

  • help/cure

The paradox of performance

  • Function / No function

Dentine Hypersensitivity – A Conceptual History

Dissertation submitteed for a Masters in Dental Public Health

Ninu Rose Paul

September 2011

Paradox of endurance

  • tolerate/accept

Paradox of difference

  • (Positive) difference/change

Paradox of deprivation

  • avoid/stop

Aim:

to explore the history of the concept of dentine hypersensitivity in dental science. A secondary aim is to better understand the reason for the interchangeably used terms of dentine sensitivity and dentine hypersensitivity.

Objectives

  • Identify key literature on dentine sensitivity/hypersensitivity that focuses on the definition of these concepts.
  • Sequentially map the series of associated concepts used for dentine sensitivity/hypersensitivity
  • To explore the meaning of the current concept of dentine sensitivity/hypersensitivity

1942-2010

Dentine hypersensitivity

Differential diagnosis

Defined as "such a degree of sensitiveness as interference with proper excavation and shaping of carious cavity; or which, in the absence of dental ministrations, causes painful symptoms, as a rule reflected about neighbouring parts."

(Burchard, 1915, p. 393)

1915-Present

"Sensitiveness of dentine"

Sensitivity of dentine – in response to dental treatment

“A pressure or drawing exercised upon the aquous content of a dentinal canalicule that opens into a carious cavity is directly transmitted to the other end of the dentinal canalicule where it is loosely closed by the odontoblasts and then the odontoblasts which are abundantly interwoven with nerves feel the pressure or drawing as a sensation of pain” (Gysi, 1900; p. 866).

  • The sensitiveness of dentine referred to the inflammation of dentine which led to a pain response (Chapin Harris; 1885).
  • Sensitiveness was greatest at the dentine enamel junction because the nerve in the dentine joined the enamel here and hence incipient dental disease was disputed to be the source of sensitiveness (Harris, 1885, p. 290).
  • Sensitiveness of dentine was a consequence of the innervation of dentine.
  • Note that sensitiveness was associated with dental caries and not enamel loss due to acid attack and gum recession.

1882-1900

"Sensibility" of teeth identified as a result of loss of enamel due to the action of acids.

  • loss of enamel "sensibly affected the tooth" in response to the slightest application of cold.
  • In this publication not only was this condition addressed as a difficult problem, but also the possible aetiology and treatment was suggested.
  • Acid in the mouth was suggested as the reason to cause this problem.
  • Chewing on Cheshire cheese and Perry’s essence was recommended as treatment to reduce the associated pain. (Paul, 2011, p. 57-58)

The impact of dentine sensitivity on everyday life: a qualitative study*

B.J. GIBSON, O.V. BOIKO, S.R. BAKER, P.G. ROBINSON, University of Sheffield, United Kingdom, D. LOCKER, University of Toronto, Canada.

1827-1900

Methods

Conceptual history following the work of (Koselleck, 2004). Involving:

  • Synchronic (current use of the term) and diachronic (historical study of terms) analysis of language (Richter, 1987).
  • Seismological analysis - the study of all the different meanings of a word, term or concept, and,
  • Onomasiological analysis - the study of all the names and terms in the language which stands for the same concept (Hampsher-Monk and Tilmans, 1998; Richter, 1995).

Dentine hypersensitivity and the mass media.

Are these distinctions a consequence of the the social production of knowledge about dentine sensitivity?

International Association of Dental Research, Miami Beach Convention Centre, Miami, 1-4th April 2009.

Previous work illustrates the distinctions used in everyday talk about dentine sensitivity.

Paradox of treatment seeking

  • help/cure

Paradox of pain

  • Short/Sharp

Paradox of health identity

  • habit/lifestyle

Or are we looking at processes associated with consumerism or commodification?

Paradox of deprivation

  • avoid/stop

morality

Paradox of endurance

  • tolerate/accept

non-problem /problem

Paradox of difference

  • (Positive) difference/change

the imperative of sensitivity

bother/no bother

Form analysis

Aim: to explore the relationship between distinctions embedded in advertisements about dentine sensitivity and communications about the patterns of consumption associated with the condition.

The problem

Semiotic analysis

Emotional impact

Why did almost everyone describe extensive impacts from dentine sensitivity but then go on to define it as a relatively minor problem in their everyday life?

“Just that’s it and get on with it. I don’t roll about or anything.” (S1.8.p.3).

“You just don’t pay attention; it is just like going through.” (S1.23.p.3).

“I just try and get on with it really.” (S1.10.p.3).

"It is annoying, it is annoying, and it feels like I am not getting the full benefit, I am not enjoying food like probably other people who haven’t got sensitive teeth.” (S1.19.p.5).

“I wish I’d looked after my teeth better and I think ‘why don’t I go to the dentist’, so I do get annoyed but it is mainly with myself.” (S1.9.p.4).

  • the study of important distinctions in advertisements.
  • involves looking for repetition of key terms and discovering what distinctions enable the advertisements to continue.

- Representational meaning

People, places and objects depicted in images convey specific meaning.

Dentine sensitivity - was a problem but it was actually a non-problem problem!

Note the impact is individualised but also leads to social isolation.....

Materials and methods

- Interactive meaning

looking at relations between viewers and the image, i.e. eye contact etc.

  • visual analysis of 27 television and 11 print advertisments, looking for key paradoxes and operating distinctions.

- Compositional meaning

The information value of items for example, where are elements positioned in advertisements, whether elements are separated or connected, their promenance etc.

  • advertisements were analysed from a range of perspectives incorporating semiotic analysis and form analysis.

Social structure and communications about dentine sensitivity.

Illness accounts and social structure

  • "The challenge is to define a paradigm and methodology for handling the problems related to the social structure. This entails working out theories about the interrelations, reciprocal effects and feedback between subjectivity, cultural factors and social structure" (Pierret, 2003, p. 16).

The paradox of performance

Paradox of enjoyment

Function / Not function

Enjoy / Dont enjoy

http://www.tellyads.com/show_movie.php?filename=TA13182

Switch to Colgate Sensitive

Results

unlike

like

Man walks through shopping centre to represent the product. It is not made clear what his affiliation is.

Man: We’re talking to people who have switched to Colgate Sensitive Pro-Relief.

[image of product and toothpaste]

[Man asks question to a member of the public, Callum] Why did you switch?

[Caption: Callum, Switched from another potassium based sensitive toothpaste]

Callum: Cos it was a much more effective toothpaste. It worked straight away.

Voiceover [illustration of tooth demonstrating how it works]: That’s because unlike most other pro-sensitive toothpastes, the unique pro argin formula instantly blocks to the open channels to the nerves.

Fiona [caption: switched from another sensitive toothpaste]: You can absolutely say it has changed my life, definitely.

Man: Care to prove it. [points to bucket of ice]

Fiona: [puts ice in mouth] Both sides.... perfect.

Caption: 9/10 dentists who have tried Colgate pro-relief would recommend it for sensitive teeth. Switch to Colgate Sensitive Pro Relief. Proven instant relief and superior long lasting protection.

place

space

old

Don't Function

young

old

Function

Objectives

a) to study how various distinctions (for example between sensitivity as health and sensitivity as illness) are related to the way dentine sensitivity is talked about and

b) explore the historical emergence of the term dentine sensitivity

c) explore the overlap and difference between forms of communication in talk about dentine sensitivity and those forms that we can see in advertisements for products designed to remove or combat dentine sensitivity

don't function

long lasting

young

disproof

Function

instant

proof

http://www.tellyads.com/show_movie.php?filename=TA13182

Switch to Colgate Sensitive

no problem

don't visit

after

problem

before

problem

after

visit

before

old

no problem

young

don't visit

old

young

http://www.tellyads.com/show_movie.php?filename=TA7467

The paradox of age

Natalie

place

space

place

space

Natalie’s account begins with her sitting in her kitchen, discussing her experience:

Natalie: I can remember going out for dinner with friends and it being very uncomfortable to have any sweet drink, for example if we were having Sangria, to the point where I had to say ‘that’s it, I can’t have anymore’. The dentist diagnosed that I did have sensitive teeth. I felt like I hadn’t been looking after my teeth properly. [It flashes to pictures of her on holiday]

There is another caption: What did she do?

Natalie’s story continues:

Natalie: I started using Sensodyne. There’s the whitening version, that’s my favourite. It sits in my bathroom all the time. It ticks all the boxes really for me. It keeps my teeth clean and white. I’m not sure how it does it, but it seems to work.

A caption accompanies the image of Natalie: Helps restore your teeth’s natural whiteness.

Don't Function

Function

http://www.tellyads.com/show_movie.php?filename=TA7467

don't function

Natalie

disesteem

Function

esteem

no problem

don't visit

http://www.tellyads.com/show_movie.php?filename=TA4071

Natalie’s account begins with her sitting in her kitchen, discussing her experience:

Natalie: I can remember going out for dinner with friends and it being very uncomfortable to have any sweet drink, for example if we were having Sangria, to the point where I had to say ‘that’s it, I can’t have anymore’. The dentist diagnosed that I did have sensitive teeth. I felt like I hadn’t been looking after my teeth properly. [It flashes to pictures of her on holiday]

There is another caption: What did she do?

Natalie’s story continues:

Natalie: I started using Sensodyne. There’s the whitening version, that’s my favourite. It sits in my bathroom all the time. It ticks all the boxes really for me. It keeps my teeth clean and white. I’m not sure how it does it, but it seems to work.

A caption accompanies the image of Natalie: Helps restore your teeth’s natural whiteness.

after

problem

before

problem

after

Matt

visit

Young / Old

visit

before

old

no problem

young

don't visit

old

‘I try and visit the dentist, at least twice a year if possible. I’ve never had a problem with sensitive teeth in my life but it just suddenly developed. I particularly used to have a problem with cold drinks, working as a personal trainer, you’re constantly stopping, drinking water’.

The camera then focuses on sports medals and trophies. Describes that it was bad when drinking cold drinks.

‘It did used to stop me in my tracks’

Caption: ‘what did he do?’

‘So I tried sensodyne. I tend to brush my teeth two to three times a day. But since using sensodyne it's been doing the trick, and at the same time, you've got fresh and clean breath. And you think to yourself surely your toothpaste can't make that much difference. But it did!

young

Matt

‘I try and visit the dentist, at least twice a year if possible. I’ve never had a problem with sensitive teeth in my life but it just suddenly developed. I particularly used to have a problem with cold drinks, working as a personal trainer, you’re constantly stopping, drinking water’.

The camera then focuses on sports medals and trophies. Describes that it was bad when drinking cold drinks.

‘It did used to stop me in my tracks’

Caption: ‘what did he do?’

‘So I tried sensodyne. I tend to brush my teeth two to three times a day. But since using sensodyne it's been doing the trick, and at the same time, you've got fresh and clean breath. And you think to yourself surely your toothpaste can't make that much difference. But it did!

Before After

don't visit

visit

no problem

don't visit

problem

Don't Function

problem

What are the main determinants or sources of accounts of illness?

Function

no problem

don't function

Function

The non-problem problem paradox

The displacement paradox

place / space

Problem / no problem

Paradox of self help

Visit / Don't visit

Paradox of pain

Pain / No Pain

Paradox of time

Paradox of inaction

When sociologists talk about the experience of illness they often combine descriptions of sources, purposes and causes. The result is quite a complicated set of assertions drawing on different sources:

Before / After

Action / No action

The social

Normalising dentine hypersensitivity

Ageing

Very little work on accounts of illness has drawn on structural traditions in sociology.

Medical system

Aim: to capture the distinction in semantics between dentine hypersensitivity as an illness or alternatively as a health condition. This study sought to explore in more depth the findings of our previous study on the "non - problem problem" of dentine sensitivity by exploring other distinctions in a new sample of participants experiencing the condition.

Culture

Niklas Luhmann

Morality

Karl Marx

Results

Paradox of treatment seeking

  • help/cure
  • a significant proportion of the interviewees were active consumers of sensitive toothpastes
  • no one could establish if the toothpaste qualified as a medicinal product such as and over the counter drug or an oral hygiene product with a health benefit
  • the form suggested that the toothpaste can’t cure the sensitivity but using sensitive toothpaste helped
  • the toothpaste provided a stable, consistent and comfortable strategy

How far was this related to what they saw in consumer marketing we could not tell.

cure

help

cure

‘It’s quite a lot of money, but it’s some sort of, I’m not going to talk about everlasting treatment … you can’t just get rid of something, you can’t just cure something. It takes a lot longer but maybe just chewing gum, with Arginine in it, maybe some sort of everyday food, that as you eat it helps’(S2.2)

  • This form corresponds with the condition as it is described clinically - as a short, sharp pain (Dababneh, 1999) - in this way clinical knowledge and the patient experience are linked
  • The paradox of pain, therefore, could be explained by the short horizon of physiological response, which made it possible to tolerate.
  • The unity of the distinction at the heart of dentine sensitivity is that of transient pain (Melzack, 1973). The paradox is that although the pain is ‘sharp’ it is ‘short’ and in some respects then not a major life problem.

But where does this come from? Is this a case of health system dominating or simply the health system observing how dentine sensitivity can be communicated?

Paradox of pain

  • Short/Sharp

sharp

short

sharp

‘Usually, its’ relatively instantaneous and I sort of have a little aftershock for a little while, it’s quite sharp and short pain, it’s just they are sensitive, as soon as I take away whatever is causing it.’ (S1.4)

Materials and Methods

Paradox of health identity

  • habit/lifestyle

Paradox of deprivation

  • avoid/stop

‘Living with Oral Conditions’.

Paradox of endurance

  • tolerate/accept
  • Qualitative study involving interviews with 16 participants (7 males and 9 females), recruited from the general population.
  • All participants were interviewed twice with a two week time period.
  • The first interviews aimed at expanding on people’s experiences of the condition, their health beliefs and health identity.
  • The second round of interviews concerned the use of toothpaste, self-care and consumer strategies of participants.

Paradox of difference

  • (Positive) difference/change

Funded by GlaxoSmithKline July 2009.

Data analysis

  • Form analysis - the study of important distinctions that are manifest in talk about dentine sensitivity.
  • Involves looking for repetition of key terms in the interviews and discovering what distinctions enable communication to continue.
  • Longitudinal validation of DHEQ
  • qualitative exploration of the social determinants of the meaning and symbolism of the concept of sensitivity / hypersensitivity

2010-2012

  • an investigation of adaptation to changing health
  • diary study of illness-beliefs in people with dentine hypersensitivity

2009

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