Teeth

I have disliked my teeth for as long as I can remember. In elementary school, I burst into tears leaving the orthodontist's office after hearing him describe all my oral imperfections to my parents. Braces and retainers made my teeth straight, but I developed cavities around the brackets, necessitating white fillings on the surface of my front teeth. Now stains form around the fillings, and they need to be replaced every 10 years or so. As the rest of the nation pursues eerily white smiles, I am left out. The dentist has explained to me that for roughly $10,000 I can get veneers on all my front teeth and have a perfect smile. In the mean time, even though sometimes I wonder if I have more fillings than teeth, everything seems to be holding up fine in there. We have new dental insurance, and I need to find a new dentist and get a checkup soon.

Two recent articles led me to reflect on the state of my teeth. In an article in this week's New Yorker, Malcom Gladwell writes about the concept of "moral hazard," which is used as a justification for shifting health care costs onto consumers, especially poor ones. In the lead, he notes that uninsured people often discuss their teeth first when asked about the impact of being uninsured. When money for healthcare is tight, visits to the dentist are often the first to go. Gladwell notes that poor teeth can lead to poor eating habits (since it's difficult to eat fresh fruits and vegetables), which can exacerbate problems such as diabetes. Unsightly smiles can lead to difficulty obtaining jobs in which people interact with the public, which can make it harder to find jobs with health and dental insurance.

On the front page of today's Post-Dispatch an article describes the impact of Missouri Medicaid cuts. One woman, knowing that her dental insurance will be cut on Thursday, opted to have all her bottom teeth removed so she wouldn't have to worry about paying to take care of them.

My friend Joy was poor growing up. Her parents didn't have dental insurance, so while I suffered through years of orthodontic work, her prominent front teeth were never fixed. I lost touch with Joy after high school, and when we met up again last year, she had had all her teeth removed and was getting fitted for dentures. She was hoping to have her new teeth in time for our 10-year high school reunion.

I find it amazing that there are such disparities in health care across this country. I find it saddening that we as a society are unable to provide basic care for children and other vulnerable people. I find it inexplicable that even as premiums and copays are going up, our elected leaders are at best doing nothing and at worst cutting programs to help people.

I have awful teeth, by which I mean I wish they looked better. I can still eat an apple, though, and I have never felt any pain. With luck and consistent visits to the dentist, my teeth will last for a long time yet. My parents had health and dental insurance when I was growing up. We can provide the same for Ben. All families should be so fortunate.


Photo by arimoore on flickr.com.