"Good teeth are a luxury only the rich can afford."
August 3, 2021 7:34 PM   Subscribe

Tiffany Ferguson (tiffanyferg) discusses [SLYT] influencer smiles, the rise of veneers, dental tourism, class implications and stigmas of our teeth, dental care as a human right, and what we can do to fix dental care in America.

Ferguson also talks about "Teeth: The Story Of Beauty, Inequality, And The Struggle For Oral Health In America" by Mary Otto.

Previously, about dental tourism. Previously, about Obamacare's lack of dental care.
posted by AlSweigart (38 comments total) 43 users marked this as a favorite

*runs tongue across two temporary crowns*

I've actually been relatively lucky, dental-wise - only three fillings and a couple crowns (two of the fillings gave up the ghost recently). I also work processing insurance claims and it is terrifying what some people end up up against, both in cost and pain (no matter how much anesthetic they pump you with, the aftermath is never painless).

Wasn't aware of tiffanyferg at all before this. Good find!
posted by AdamCSnider at 7:49 PM on August 3, 2021

> Wasn't aware of tiffanyferg at all before this. Good find!

I should have probably posted a link to her YouTube channel where she has several other interesting videos.
posted by AlSweigart at 7:59 PM on August 3, 2021

I’m not going to watch this because I have spent $3,000 I don’t have on dental work in the last 2 weeks and I don’t want to cry more, but, yeah. Teeth are luxury bones.
posted by brook horse at 8:46 PM on August 3, 2021 [18 favorites]

It is unconscionable that Medicare (and many state Medicaid programs) doesn't cover dental.
posted by gwint at 9:11 PM on August 3, 2021 [21 favorites]

(This whole thread probably needs a content warning about tooth stuff, not everyone is keen on discussing them.)

I grew up with a combination of crooked teeth, a very prominent discolored tooth right in the front, and a crippling phobia of dentists that took years of therapy to overcome. Which I could only afford because of my particular moment in space-time.

It's true that dentistry is a huge class divider, as that article about poor teeth in a rich world talks about. That it's seen as somehow separate from other healthcare is so very strange, one of those core beliefs at the core of the profession that needs to be reexamined. (It's right up there with keeping a schedule of work designed by a cocaine addict.)

Dental health affects heart health, and it's not an accident that the first question my dentist asked me when I came in after COVID lockdown was which of my teeth were bothering me. Not "Are your teeth bothering you?" It was, "Which of your teeth are bothering you?" They're seeing so many anxiety/stress-related problems right now.
posted by fifteen schnitzengruben is my limit at 9:49 PM on August 3, 2021 [7 favorites]

"For research on this video, I read a book"

I'm not going to say much, because, there's not much 32 years in the field can do to rebut an hourlong youtube video based on such a thoughtful approach, really. The thing is, it's all true, and we know it; and none of it is true, and we know that too.

I've written and erased 8 paragraphs already only to realize that I've fought this fight every day i'm at work, and hundreds of times on the green in the past 12 years.

I sold my practice 2 years ago to take a job doing public health in Indian country. Casino money has built a state of the art facility, and when a patient presents tribal ID we do whatever needs to be done at no charge to them. We are also the only practice in our county that takes medicaid. I can't save any of my patients from themselves, but very few of them will go broke getting a healthier mouth after walking through our doors.
posted by OHenryPacey at 10:15 PM on August 3, 2021 [93 favorites]

One of the things my mother said to me that resonated across all these years is that you can tell how the US economy is doing by how people’s teeth look. There’s such a premium put on having a perfect smile, yet the economic barriers to dental care, mixed with our obsession with shiny, even, white teeth creates a permanent stigma, and every economic downturn creates another generation that only smiles behind their hands.
posted by Ghidorah at 1:21 AM on August 4, 2021 [8 favorites]

It's right up there with keeping a schedule of work designed by a cocaine addict.
I am sorry to be O/T (pls feel free to flag or delete) but this caught my eye before I clicked on TFA: would you be willing to elaborate on this, fifteen schnitzengruben is my limit?
posted by peakes at 2:36 AM on August 4, 2021

I believe they are referring to William Stewart Halsted, designer of the medical residency training system. Residency requires up to 100+ hour workweeks and causes measurable harm to both patients and residents, but has not yet seen effective reform. Instead, a whole set of macho rationalizations has developed to justify a schedule clearly based on the sleep patterns of a man who was constantly high on cocaine.
posted by ourobouros at 3:05 AM on August 4, 2021 [38 favorites]

I recently got an estimate to fix my teeth. It was more than I paid for my first house. I’m actually going to be sad when masks finally go away, because I’ve been so much more confident when people can’t see my teeth.
posted by SecretAgentSockpuppet at 4:14 AM on August 4, 2021 [22 favorites]

I think the connection of dental health to general health is not well known, or at least not hammered into us like the importance of exercise and vegetables. Though like exercise and vegetables, daily tooth care is one of those prevention measures that you know you should do but for a variety of reasons people just don't: didn't get into the habit in an early age, too tired, subconsciously engaging in self-destructive behavior, stress (in the case of clenching your teeth). If you are in the habit I'm sure the not-daily-brushing must seem terribly gross to you, and indeed, that's how it's portrayed in our culture if it's brought up. But it's there and also like exercise and vegetables I dunno if saying "just do it" and blaming the individual is ultimately the best method for getting people to adopt the practice. We need to develop better public, economic, and social health structures that encourage and enable people to adopt these habits.

Access to the dentist is tremendously important and I'm not saying if your habits were perfect your whole life you'd never need work (that would be like saying you'd never need the doctor if you paid attention to exercise and vegetables).* But for most people a dentist cannot compensate for inconsistent brushing. So I think that's something that needs to be considered as well when looking at it from a public health standpoint.

* not to mention edge cases of people whose teeth/enamel are just not resilient
posted by Anonymous at 4:28 AM on August 4, 2021

It is unconscionable that Medicare (and many state Medicaid programs) doesn't cover dental.

Medicare? Try almost any medical insurance plan. Dental coverage is usually a highly expensive add-on to medical insurance, often doubling the total cost of the policy. And, absolutely it's unconscionable it's not included as part of standard medical coverage. Given the prices of dental work, it's almost as if the dental industry likes it that way.
posted by Thorzdad at 4:48 AM on August 4, 2021 [12 favorites]

not to mention edge cases of people whose teeth/enamel are just not resilient

It's worth asking why some folks have less resilient teeth -- some of that may have to do with lack of fluoridated water. Note that some municipalities have eliminated (or never started) water fluoridation due to pseudoscientific claims that sound a lot like antivax rationales.

I personally remember a well known local activist knocking on my door in the early 2000s with an anti-fluoride flyer -- and unfortunately, she and her cohort were successful in keeping our water unfluoridated. I was horrified even then -- the people who grew up in this town have so many more cavities and tooth issues than anywhere I've ever lived. It's an equity issue, too -- fluoridated water reduces disparities in dental health, and its lack disproportionately affects marginalized people.
posted by ourobouros at 5:09 AM on August 4, 2021 [13 favorites]

Oh my gosh yes. I spent much of my childhood in towns with town water systems with fluoridated water. When I’ve been to dentists in rural areas where fluoridated water is rare (generally not something people add to individual well water), they have on occasion correctly deduced that I didn’t grow up around there, without me mentioning anything. And that’s even with my average brushing habits and the somewhat inconsistent availability of dental care to me when I was younger.
posted by eviemath at 5:25 AM on August 4, 2021 [2 favorites]

Paging the French for a some possibly relevant cultural constrasts:
1. Guillaume Duchenne: Parisian neurologist who demonstrated that its not involvement of the eyes which are crucial to a smile that is bourne of actual happiness: the Duchene Smile. (the inverse of this, the smile that features the teeth but not the eyes - is the "Pan Am" smile).
2. The French expression Dents du bonheur to describe people with gapped teeth. The expression, is supposed to have dated from Napoleonic times when diastema (which made it impossible to tear open gunpower magazines with the teeth) made one exempt from conscription. Gapped teeth are still considered attractive in France for their air of luckiness and individuality.
3. The (much misunderstood) French smile - briefly smiling without a suitably clear motivation can be interpreted as a sign of being manipulative or just rather simple.
posted by rongorongo at 5:44 AM on August 4, 2021 [10 favorites]

I think the connection of dental health to general health is not well known, or at least not hammered into us like the importance of exercise and vegetables.
I feel like as Americans this is another one of those things where we learn the key parts but are hesitant to acknowledge because the cruelty of harming many people to allow rent-seeking for a few contrasts so sharply with the stories we like to tell about ourselves. Pretending dental care is mostly cosmetic or that problems are someone’s poor decisions is easier than changing the system and so millions of people will studiously not think about it.
posted by adamsc at 6:06 AM on August 4, 2021 [11 favorites]

Here in the land of socialism, while we have universal health care - and can treat as many internal skeletal issues/breaks as necessary, it just does not include our.... "mouth bones"... After all, that's just what they are...
posted by rozcakj at 6:46 AM on August 4, 2021 [4 favorites]

Medicare? Try almost any medical insurance plan. Dental coverage is usually a highly expensive add-on to medical insurance, often doubling the total cost of the policy.

With my work health insurance (queue in diatribe about how wrong it is to tie insurance to employment...), dental insurance is a really cheap add on. However, it barely covers anything, so if you were to have an expensive situation you'd be right back to paying most of it out of pocket. It does cover the routine checkups, so it pays for itself that way.

So I'd like to not just see dental insurance become a normal part of what a health plan (public or private) would cover, but also for it to be robust enough to support people when they have major needs.
posted by Dip Flash at 6:46 AM on August 4, 2021 [4 favorites]

The US as the foremost capitalist state demands a permanent underclass for schadenfreude / exploitation purposes, so I don't see dental care universal coverage in the near future, not without a fullscale revolution.
posted by Sheydem-tants at 7:07 AM on August 4, 2021 [2 favorites]

Oral health is systemic health. Crooked or missing teeth affect the quality of food you can chew and eat, leading to nutritional deficits that affect the rest of your body. Discrimination against candidates with unattractive teeth leads to loss of job opportunities or promotions, and from there you can see the connection to the housing and healthcare you can afford.

It is unconscionable that Medicare (and many state Medicaid programs) doesn't cover dental.

It absolutely is. In the reconciliation bill pending before the Senate, Bernie Sanders has included expansion of Medicare and Medicaid to cover dental. Let's hope it passes and that portion doesn't get stripped out by some preening deficit hawk.
posted by chimpsonfilm at 7:42 AM on August 4, 2021 [6 favorites]

I want to second fluoridation, although acknowledging that dental health care should be a standard part of medical care, not some odd secondary coverage. Also include eyes/vision care in that while we're at it!

But getting back to fluoride, it's so cheap, and so effective! We finally added it to our water in rural PA where I live after a concerted push by basically every health care and public health person in the county, and even then it caused a lot of controversy. But it works! I grew up with fluoridated water and have great teeth, even when I decided not to go to the dentist for ten years. I am not an amazing brusher/flosser, I just benefited from the development of teeth while drinking fluoride! It could alleviate so much pain and suffering.
posted by dellsolace at 7:46 AM on August 4, 2021 [8 favorites]

Dentistry isn't just about appearance or even eating, important as those are. There are some cancers of the mouth that a dental checkup should catch early if you're getting regular checks or can easily access dental care if something seems wrong. As with other healthcare, lack of easy, affordable access to practitioners and diagnostics can turn a treatable condition into something lethal or requiring major treatment quicker than you might think.
posted by YoungStencil at 7:54 AM on August 4, 2021 [3 favorites]

I have spent thousands. And thousands. And thousands and thousands.


I have never had a toothache or any indication perceptible by me that anything was wrong with a tooth. Definitely have had fillings fall out of my head. Definitely have a visible overbite and steadily increasing yellowing and have definitely heard about both of those for thirty or forty years until I quit going to commercial dentists and started dragging my teeth to the dental school faculty practice where they have that fat faculty salary in addition to the practice money plus don't have to pay for the infrastructure therefore don't tend to try to flog cosmetic "treatments."

Every time I spend another couple hundred plus, it's based on my teeth calving another old filling, or it's after a regular check-up wherein somebody pointed to what appeared to be nothing on an exray I couldn't read or the hygienist pounded the point of a sharp instrument into one of my supposedly unusually craggy molars and said "this one's a little sticky, let's have the doctor look at it" and then the doctor said "well, it may just be a natural declivity but out of an abundance of caution let's pave over it; that'll be another visit and an additional $200 please."

Aside from fillings painlessly falling out, there has never been anything wrong with a tooth of mine that I could perceive with any of my five senses without the aid of a dentist. Nevertheless I have a crown, four extracted wisdom teeth, jillions of fillings, and of course the aforementioned thousands and thousands and thousands of absent dollars.

Can anyone convince me that I did not just get a lifetime of dental care I didn't need simply because I had the wherewithal to shell out for it?

And did this poor baby child in Maryland in the video lose his life at TWELVE because dentists looked at the care he very definitely needed and didn't see a massive cash cow? Couldn't we do a thing where I go to the dentist, they say, "Oh, it's been six months, let's exray you again, let's find things, let's draw up a treatment plan" and I say, "Poof! Voila, I have for you here an indigent child who grew up in a no-fluoride county on poverty diet and who is thus about to die of an agonizing abscess, now you'll have an actually necessary treatment to put on your plan you're welcome!"

I am grateful to a series of hygienists for finally convincing me to floss and to one dentist for making me a bruxism mouthguard that I now can't sleep without. Everything else I resent mightily.
posted by Don Pepino at 7:58 AM on August 4, 2021 [4 favorites]

queue in diatribe about how wrong it is to tie insurance to employment

OT, but possibly of interest. The tie is generally ascribed to FDR's WWII Stabilization Act of 1942. Wages and Prices were frozen, no incentives permitted for the duration. There were two exceptions: "insurance and pension benefits in a reasonable amount". Employers desperate to fill jobs or retain good employees did what they had to do. There were tax reasons as well (insurance costs were deductible by corporations, just as the corporate tax rate had basically doubled).

(No idea why toothwork wasn't part of the deal. Not really sure what coverage looked like back in the day. Considering what medicine could do for you in 1945 vs what it can do for you today, well, it makes you think. Curious is anyone here has an answer.)
posted by BWA at 8:21 AM on August 4, 2021 [2 favorites]

Can anyone convince me that I did not just get a lifetime of dental care I didn't need simply because I had the wherewithal to shell out for it?

This seems like an odd complaint. How dare those dentists fix problems before they become painful! Dentists don't have bouncers. Just wait until it hurts next time and then get on the schedule.
posted by The_Vegetables at 8:54 AM on August 4, 2021 [6 favorites]

I grew up on well water, so missed out on the benefits of fluoride as a kid. And as an adult I'm a diet coke idiot. I work at a major technology company and my *medical* insurance is great but the dental has been identical to what I had as a cashier at Home Depot. This past year they increased our dental allowance by $400/yr and I'm one of those folks for whom that was incredibly meaningful. Dental should be medical. My insurance didn't blink about covering my surgery for cancer. I know it can't be the cost, so I have a hard time finding any justification for not covering people's ability to chew. Or the effects of job-related stress making me grind my poor teeth down every night.
posted by taterpie at 9:09 AM on August 4, 2021 [3 favorites]

My wife and I both have been the victims of dentists doing unnecessary work, so I'm afraid it does it happen. In my wife's case, it probably led to a root canal.

One of the things I've figured out is run very far and very fast from dentists' offices that try to get you to spend your maximum insurance benefits by the end of the year. This only benefits them, especially considering the out-of-pocket costs associated with maximizing what the dental insurance companies pays.

I've had some deep and discolored grooves on my molars for 25 years now that have caused me no problems. If a new dentist wants to take a wait and see approach on them, I'll schedule another check up with them. If they want to immediately drill and fill, I don't go back.
posted by mollweide at 9:26 AM on August 4, 2021 [3 favorites]

How dare those dentists fix problems before they become painful!
I have no issue with them fixing problems. I appreciate that they fixed my ailing gingiva and they fixed my teeth-grinding problem. It's their tendency to charge me thousands to cause me problems that I'm growing really tired of.

A crown was what finally convinced me to stop just doing everything they said to do no questions asked and furthermore to dispense with for-profit dentists forevermore. I needed a dentist because I busted a filling trying to get a wine cork off a corkscrew with my back teeth like a complete imbecile, so I asked my friends and then broke out the yellow pages (which gives you an idea how long I've had this crown) and picked the dentist partly because my friend recommended her and partly, I am ashamed to say, because she had the best ad. (She looked really friendly in her ad photo.) She was friendly, in fact. She was very sweet to me and so were all the people who worked there, but I should have thought about what that photo ad meant. (Money! It meant lots and lots of money, that's what it meant!)

I didn't know what a crown was--that they scrape away almost the whole tooth that has served you uncomplainingly all your life and leave you with nothing but a horrifying little nubbin that they then encase in a tiny little $2000 suit of armor. So I said okay, sure, you're the doc!

I like my teeth. I take middling care of them. I brush twice a day and floss (now, anyway); I don't drink soda or chew Altoids constantly (anymore, anyway); and I'm addicted to coffee, so I sluice down buckets of fluoridated water every day. Pretty sure this is why my teeth have never given me a problem. Nevertheless, and despite never having had any evidence of trouble, I now have five fewer teeth and way more plastic than I would like in my head than when I began my Journey of Discovery with Dentistry.

After the first crown, the friendly rich dentist started lobbying hard to set up a second one in a neighboring molar. That's when I defected to the dental school. The dentists there did not undercut the friendly rich dentist's diagnosis. They said, "I see what she's talking about. We can wait and watch." We have waited and watched for over 15 years. I've been through three faculty dentists and a couple of hygienists. After the first dentist left for North Carolina, subsequent dentists have forgotten that I have a problem tooth. I have not heard thing one about a crown in all this time. Was the first one necessary? We will never know, but if you take a tour of the friendly rich dentist's waiting room you will see, I am sure, blazingly haute couture interior design. In the parking lot you will see a fleet of Beemers. In the mouths of the patients, many many crowned teeth.
posted by Don Pepino at 11:09 AM on August 4, 2021 [6 favorites]

I am in the same boat as Don Pepino . . . I have two crowns and a whole lot of fillings and it is not clear to me whether the fillings were necessary. The crowns I got to correct badly done fillings (crowns are indeed horrifying). There is no dental school near me so I am left hoping beyond hope that the dentist I have is not a scammer.
posted by Anonymous at 5:47 PM on August 4, 2021

It's worth asking why some folks have less resilient teeth

"non-secretors" (people who don't secrete blood group antigens in bodily fluids) constitute something like 20% of the population and are more susceptible to dental cavities.
posted by Pseudonymous Cognomen at 10:06 PM on August 4, 2021 [3 favorites]

One random factoid I heard on an old episode of QI was that young and newly-married Victorian-era women would be "given" the opportunity to have all their teeth removed and replaced with a set of dentures. Presumably the expense and pain of treating ailing teeth was such that it was considered a gift to remove them all outright (though, only for the women, of course). I was surprised to read some independent validations of this story online from others about their grandparents. I was further surprised that the practice had extended into the first half of the 1900s.
posted by They sucked his brains out! at 2:18 AM on August 5, 2021 [2 favorites]

I wonder how much of the US cost and class disconnect thing is that you lot idealise the sort of teeth nearly nobody has naturally, so that $XXK of dental work is de rigeur for everyone who wants to fit the minimum standard, including whitening treatments, veneers and crowns that damage healthy teeth and cause structural teeth issues further down the road. Over here in central Europe braces are a thing for adults more than kids, and a "Hollywood smile" with that blinding blue-white colour and a ruler-straight line of teeth is bound to get you teased more than praised. Or suspected of wearing dentures.

After an abusive dentist in my childhood (slow-rotation drilling in all molars without any pain relief FTW if you want a lifelong dental phobia) I fix things that actually need fixing - poor enamel, the one tooth that came in sideways - and leave the rest alone. I'm lucky enough to live in a country where slightly crooked is charming.
posted by I claim sanctuary at 4:23 AM on August 5, 2021 [5 favorites]

the mary otto book is great! finished it earlier this year.
posted by misanthropicsarah at 7:21 AM on August 5, 2021

My dad had *all* his teeth yanked early in his Air Force career in the 50s and was given dentures...he was in his 20s. He may have had terrible teeth but it may also have been a cost-cutting decision on the military's part.

My mom had terrible crumbling teeth her whole life...I don't know if her town refused flouride or she just got a bad genetic hand. Or possibly shady dentists also took advantage.

Anyway, one benefit of dentistry being treated as a medical specialty might be a little more oversight, regulation, and effective research.
posted by emjaybee at 4:20 PM on August 5, 2021 [1 favorite]

Mr. Roquette had all his teeth removed when he was in the Navy. Apparently he had teeth with tangled roots. The dentures he received were not made correctly and are painful. He never could afford to get better dentures. A lady here used to bug him about not wearing his dentures. I don’t bug him to wear them, he’s had enough pain.
posted by Katjusa Roquette at 6:43 PM on August 5, 2021

I'm sorry to hear that.
posted by They sucked his brains out! at 11:06 PM on August 5, 2021 [1 favorite]

Have you ever watched a makeover tv show where dental work is needed? The resulting reveal is always so sad, you can see the person smile and see that yes they have nice teeth now, but it's clear they are damaged by the years of not wanting to smile (and maybe the extensive dental work they just had to endure on camera!) It's a heavy topic. I remember reading a discussion on mefi years ago where someone mentioned a potential date was missing teeth. The comments were, "no way! yuck that's a deal breaker!" I think the kindest was, "well, maybe it's understandable if he's a boxer." And I can't blame mefi too much, because that kind of snobbiness is common everywhere. I worked at a local fundraiser when a woman I previously thought was a generous patron remarked on the venue being in a neighborhood of "people with missing teeth." I guess it wasn't her typical wine bar crowd. Ahhh, how the group laughed with her.
My partner was missing teeth for decades. A combination of bad genetic luck, neglectful parents and years of him learning to kind of disguise or minimize it because of his shame. Finally found a dentist he loves and we paid for all the needed dental work a few years ago, which is wonderful. Now we have kids orthodontics and dental surgery bills to look forward to.... yikes.
posted by areaperson at 7:18 AM on August 6, 2021 [3 favorites]

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