The Tooth Divide: Beauty, Class and the Story of Dentistry
On the high end of the $110 billion-a-year dental industry, there are veneers for $1,000 each, “gum contouring” and more than $1 billion per year spent on tooth whitening products. A dentist tells Otto that members of his profession “once exclusively focused upon fillings and extractions, are nowadays considered providers of beauty.” And thanks to decades of deregulation, allowing medical advertising and then medical credit cards, they are doing well at it — according to a 2010 study, dentists make more per hour than doctors.
Photo
But on the other end of the spectrum, which stretches from a free clinic in Appalachia to the Indian Health Service in remote Alaska to a mobile clinic in Prince George’s County, Md., dental providers struggle to see all of those who cannot access regular care. One-third of white children go without dental care, Otto notes; that number is closer to one-half for black and Latino children. Forty-nine million people live in “dental professional shortage areas,” and even for those who do have benefits under public programs like Medicaid, which ostensibly covered Deamonte Driver and his siblings, it can be difficult to find a provider. The dentist treating Driver’s brother DaShawn, Otto writes, “discontinued treatments because DaShawn squirmed too much in the dental chair.” Medicare doesn’t cover routine dental services. Remote Area Medical Volunteer Corps, the charity that operated the temporary clinic in Appalachia, was begun to reach suffering people in developing countries, but wound up seeing Americans. “We have a very serious social problem that we are trying to solve with private means,” a researcher tells Otto.
Yet in a country where the party in power fights tooth and nail against expanding regular health care benefits, what chance do we have of publicly funded dental care? After Deamonte Driver’s death, elected officials battled to add dental benefits to the State Children’s Health Insurance Program (Schip), only to see the law vetoed by George W. Bush. Barack Obama signed the Schip expansion in February 2009; newly confirmed Secretary of Health and Human Services Tom Price voted against it.
Continue reading the main story
Donald Trump, who has promised to repeal the Affordable Care Act and who nominated Price, makes a cameo in “Teeth,” looming over the Miss U.S.A. pageant as the owner of the Miss Universe Organization, a subtle reminder of which side of the American divide — on teeth as on everything — Trump stands.
The focus on pageant competitors underlines another divide in the dental profession, one between men and women. Though more women are dentists these days, the job of hygienist grew from men’s expectations of women’s appropriate work, and it has always, Otto notes, made dentists nervous when hygienists move to be more independent. Plans to put dental hygienists in public schools, for instance, have been squashed by dentists’ associations. Yet Otto rarely brings up the role of sexism, leaving the reader to ask the unanswered questions — if the dental industry revolves around beauty, who is consuming most of these beautifying treatments? Those in the service professions, it’s reasonable to assume, most of whom are women.
In addition to the fear of competition from hygienists, Otto details dentistry’s fear of socialized medicine and how that fear kept the profession largely privatized — it is likely not an accident that the invention of still rare dental insurance came from a man named Max Schoen, who “earned the distinction of being the first dentist to be called before the House Committee on Un-American Activities.” Working with the legendary labor leader “Red” Harry Bridges, Schoen helped the International Longshoremen’s and Warehousemen’s Union set up not just a dental plan but a racially integrated prepaid dental practice to provide the care. It could have laid the groundwork for a radically different dental care system from the one we have now. Instead, the decline of union jobs in America has led to a corresponding decline in dental benefits. Like hygienists, Schoen wanted to focus on prevention and earned the ire of conservative dentists.
Continue reading the main story
Those conservative dentists used their social clout as medical providers to consolidate their own power over their industry, to control hygienists and rebels like Schoen, yet ultimately they wanted their practices to be treated more like optional services bought on the free market than social goods.
Otto does not say such things outright. A veteran journalist, she never strays into polemic even when her material screams for it. She has a knack, though, for an illustrative anecdote that underscores her point about inequality, for example that in the 1800s, poor people would sell their teeth to the rich, whose own had rotted away from the consumption of sweets that the poor could not afford. Other times, she raises a fascinating fact — such as the idea that the extraction of wisdom teeth may be unnecessary, but continues to be performed on patients who can pay — only to move on, leaving the reader wanting more.
The problem of oral health in America is, Otto argues, part of the larger debate about health that is likely to grow larger and nastier in the upcoming months. At the moment, our broader health care system at least tenuously operates on the belief that no one should be denied health care because of ability to pay. But dental care is still associated in our minds with cosmetic practices, with beauty and privilege. It is simultaneously frivolous, a luxury for those who can waste money, and a personal responsibility that one is harshly judged for neglecting. In this context, “Teeth” becomes more than an exploration of a two-tiered system — it is a call for sweeping, radical change.
Continue reading the main story
The post The Tooth Divide: Beauty, Class and the Story of Dentistry appeared first on Art of Conversation.
