ABSTRACT
It is a routine practice, albeit seldom mentioned in print, for individuals awaiting cardiac surgery to be referred to dental surgeons for a declaration of dental fitness in advance of their scheduled surgery. Dental fitness, as a normative judgement, refers to the desired state of pre-operative suitability for cardiac surgery that is believed to minimise the risk of infective endocarditis. In this chapter, I set out to trace the conceptual development of the metaphor ‘dental fitness’ in relation to cardiac surgery, beginning with its historical origins in focal infection theory. From this vantage point, I describe how the military language of dental fitness became affixed to the vestiges of focal infection theory, supplanting the connotations of cardiac surgery with those of warfare. I then undertake a critical analysis of dental fitness as the diagnostic manifestation of a societal norm, and consequently make a preliminary sketch towards a theory of iatronormativity. In doing so, I elaborate the philosopher of medicine Georges Canguilhem’s theory that health and disease are independently normative concepts which do not simply correspond to normal and abnormal states of being. Tooth extraction with the intent to achieve dental fitness can therefore be seen to assume the role of a dramaturgical act: a performance that functions symbolically as a ritual of purification and anticipates the embodied conflict of cardiac surgery. Without clinical guidelines for achieving dental fitness, I argue, these iatronormative judgements will continue to be enacted and sustained by an informal surveillance network of tacit and codified practices.
