Objectives: To obtain a deeper understanding of what social factors were driving New Zealand's historic “epidemic of edentulism” and how they operated. Methods: In-depth, semi-structured interviews with 20 people over the age of 75 who became edentulous prior to 1960 produced interview data transcripts which were then analysed using applied grounded theory to ascertain the key drivers of edentulism which were operating within the lay culture. Results: The theory of focal infection was found to have no direct influence, while dental anxiety, the impact of war and the way dentures functioned as a substitute for technological innovation were significant, but only for the small number directly affected by those factors. Minor factors related to aesthetic concerns (particularly anterior tooth loss) and periodontal disease. More pervasive major influences were rural isolation, the importance of professional authority, and how patient-initiated transitions to edentulism were ultimately facilitated by an accommodating profession. Universal factors present in the data were: (a) the way in which New Zealand society accepted and encouraged edentulism without stigma for those who had a ‘sub-optimal' natural dentition; (b) how the predominant patterns of dental care utilisation (symptomatic and extraction-based) were often strongly influenced by economic and social disadvantage; and (c) the way lay and professional worldviews relating to ‘calcium theory' and dental caries were fundamental in decisions relating to edentulism. Conclusions: The combined effects of geography, economics, the dental care system and the professional culture of the day, in the context of contemporary (flawed) understandings of oral disease, appear to have been key drivers. These were supported (in turn) by a widespread acceptance by the profession and society alike of the extraction/denture philosophy in dealing with oral disease. Supported by the NZDA Research Foundation.

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