[Marxism] The Tooth Divide: Beauty, Class and the Story of Dentistry

Louis Proyect lnp3 at panix.com
Sun Mar 26 14:24:14 MDT 2017

Sunday Times Book Review, Mar. 26 2017
The Tooth Divide: Beauty, Class and the Story of Dentistry

The Story of Beauty, Inequality, and the Struggle for Oral Health in 
By Mary Otto
291 pp. The New Press. $26.95.

Politicians, journalists and researchers have a long-running problem 
when it comes to talking about class. The definitions we use are myriad 
and not always overlapping. Is the boundary of the middle class a 
college degree, a certain level of income? Perhaps a certain type of 
job: a teacher or a doctor versus a coal miner or factory worker? We 
might be missing a still more useful — and more personal — indicator, 

This is the premise, though not so bluntly stated, of Mary Otto’s new 
book, “Teeth: The Story of Beauty, Inequality, and the Struggle for Oral 
Health in America.” The dividing line between the classes might be 
starkest between those who spend thousands of dollars on a gleaming 
smile and those who suffer and even die from preventable tooth decay.

If the idea of death from tooth decay is shocking, it might be because 
we so rarely talk about the condition of our teeth as a serious health 
issue. Instead, we think of our teeth as the ultimate personal 
responsibility. We fear the dentist because we fear judgment as well as 
pain; we are used to the implication that if we have a tooth problem, if 
our teeth are decaying or crooked or yellow, it is because we have 
failed, and failed at something so intimate that it means we ourselves 
are failures.

Otto’s book begins and ends with the story of Deamonte Driver, a 
12-year-old Maryland boy who died of an infection caused by one decaying 
tooth, and the system that failed him. In pointing out the flaws in that 
system, Otto takes us back through the history of dentistry and shows us 
how the dental profession evolved, separately from the rest of health 
care, into a mostly private industry that revolves almost entirely 
around one’s ability to pay. In other words, all of the problems with 
health care in America exist in the dental system, but exponentially 
more so.

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.

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.

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.

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 

Sarah Jaffe is the author of “Necessary Trouble: Americans in Revolt.”

More information about the Marxism mailing list