There are countless scars left on kids who grow up in poverty, and one of them is their relationship with food. When most meals at home are prepackaged or bulk food bought on a tight budget, food that really tastes good becomes a “treat”. Cakes on birthdays, a special trip to McDonald’s for a sundae, these become deeply associated with happiness and reward. For me, it was Little Debbie brownies. At the time, they were $0.99 for a box of six, and my mother would occasionally splurge on a box as a treat. We were a family of five, which meant there was one extra, and she would use that as a bribe for volunteering for chores. “Sweet” became synonymous with “good”.
By the time I reached high school, I was an accomplished shoplifter, loading up on all of the sweets we couldn’t normally afford to buy. I drank a two liter bottle of coke every day. My weight began ballooning around this time, but that wasn’t even the biggest side effect. One of the aspects of growing up dirt poor is that you never see a dentist. No annual cleanings, maybe a filling if critical, but in American healthcare, teeth are luxury bones, and the poor do not deserve to have good dental health. Standard health insurance doesn’t cover dental procedures, and the ancillary dental insurance offerings are expensive while offering very little actual coverage.
It’s not as though my parents didn’t teach me to brush and floss, mind you. It’s that the combination of a lack of professional dental care and a diet high in sugars does damage that isn’t well handled by basic dental hygiene. And when I moved out on my own at 17, and then ended up homeless at 19, even the basics became inconsistent. When you have $20 to your name for the week, and nowhere to sleep, you’re unlikely to spend $3 of those dollars on toothpaste when it could be a meal for the evening.
The foundation for my teeth being weak had been set, but that was just the beginning. First, a car wreck, where as a passenger I smacked my face into the dashboard resulting in a hairline fracture above my gum line that I wasn’t even aware of for several years. Then a fight where several teeth were broken. Dental abscesses became a regular occurrence, and with no doctor or dentist to prescribe antibiotics, I became proficient in draining them with a sterilized needle, piercing them repeatedly until the pressure began to subside, and gargling with peroxide to disinfect the area.
There are limited dental services available to the poor and uninsured, in small poorly funded clinics and dental training schools. Much like day labor, they were first come first serve, which meant lining up outside their location with all of the other poor people with swollen mouths and a hurt look in their eyes. Dental pain is a motherfucker; unlike many other types of pain, it’s right in your face, which makes it incredibly hard to dissociate from it. And there are only two services offered at these clinics, typically: filling, or extraction. More often than not, extraction becomes the go-to treatment for teeth that are broken, rotted under the gum line, or damaged from the years of wear that drug use like meth or crack causes. In any poor neighborhood, and especially among the homeless, you will see gap toothed smiles, sometimes only a single tooth, often a large set missing.
It became almost a routine; a massive infection, self treating the abscess, feeling the damage once it receded, followed by extraction at a clinic. Sometimes the damage was so bad I could extract them myself with just my fingers and something to clamp my other fist on for the pain. Eventually, my wisdom teeth came in impacted, and one by one I lost my molars.
In my late twenties, as I found my footing in the tech world, having access to both money and good dental insurance prompted many attempts to rebuild. I maxed out my coverage every year in repairs, from veneers that would eventually break off, to bonding and bridges, and eventually crowns. I had three separate cosmetic dentists do a full mouth rebuild, only to eventually need repairs and further work, and finally to getting partials that were poorly fit and painful to wear. Not to mention that they are impossible to eat with, with the majority of your food ending up trapped in the plate fitted to the roof of your mouth. I often went without them, resulting in pictures where I have perfect crowns in the front, with a just visible gap at the back of both sides of my smile.
Think about the last time you saw someone smile with an obvious missing tooth or teeth near the front.
What was your instant gut reaction assessment of them?
Exactly.
As I began to achieve some success in the tech space, I was always conscious of my mouth. Don’t smile too wide. Be careful when you eat. You see their eyes track down to your mouth, and the microexpressions as they register that your smile is incomplete. You hear their thoughts in your head. “Oh, didn’t realize he’s poor white trash.”
More than anything else, the single biggest sign of someone who grew up financially comfortable is a perfectly aligned mouth full of all natural teeth. And because dental damage done early in life tends to become progressive, and isn’t truly healable (in that once a tooth is extracted, it cannot be regrown), it’s one of the most difficult markers of poverty to remove. Sure, there are options like implants, but they often require bone grafting, and are prohibitively expensive for most (my case was quoted out at around $17,000).
Poor dental health is also a precursor to early death and other chronic conditions, with a high correlation to heart disease, pancreatic cancer, and rheumatoid arthritis. And because it becomes more difficult to eat as your mouth degrades, fresh produce, raw fruits like apples, and many nuts and seeds are passed over in favor of softer foods, including many processed foods, leading to an increase in poor health outcomes.
This is distinctly an American problem, as many nationalized healthcare systems such as the UK’s NHS cover necessary dental services by default. But because our economic system is fundamentally built around punishing the poor as part of a classist system of assigning value to lives based on their net worth, our healthcare system colludes in this dehumanization by permanently marking early on those who belong in the lower classes. The cold accounting and human cruelty inherent in this approach is one of countless examples of how even when people make it out of poverty, they continue to be punished for the crime of being born poor for the rest of their lives.
All humans, regardless of economic class, deserve the dignity of a healthy smile. Treating teeth as luxury bones is an especially egregious example of the secret barbarities waged against the poor. It’s far past time we ended this terrible practice.