How do dentists perceive poverty and people on social assistance? A qualitative study conducted in Montreal, Canada

Despite significant needs, people on social assistance are sometimes reluctant to consult dentists because of previous negative experience and communication barriers. They feel poorly understood by oral health professionals and sometimes complain of being stigmatized. It is thus important to know how dentists perceive poverty and this group of patients. The aim of this study was to understand how dentists perceive poverty and people on social assistance. To investigate this largely unexplored question, a qualitative study was conducted based on in-depth interviews with thirty-three dentists practicing in Montreal, Canada. Interviews were audiotaped and transcribed for qualitative analysis. The study revealed two perspectives on poverty: 1) the individualistic-deficit perspective and 2) the socio-lifecourse perspective. In the individualistic-deficit perspective, which predominated among these participants, dentists explained poverty by individual factors and emphasized individuals' negative attitudes toward work and lack of capabilities. Conversely, dentists with a socio-lifecourse perspective described poverty as a structural rather than an individual process. Acknowledging individuals' distress and powerlessness, these dentists expressed more empathy toward people on social assistance. The results suggest the individualistic-deficit perspective impedes the care relationship between dentists and poor patients as well as highlighting the need to better prepare dentists for addressing issues of poverty and social inequities in clinical practice.