Publisher’s View: The Tooth

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Teeth are strange. We’re born with the seeds of two sets, the first marching forth as we become toddlers, then, having done their duty, falling out and being replaced in adolescence.   Nothing else in the body works quite this way. Skin constantly sheds and is replenished. Hair and nails need to be trimmed. None emerge so crooked that almost half the time they have to be pushed into their proper positions with metal or plastic braces and rubber bands.  

Then there’s wisdom teeth, a third set of molars, evolution’s answer to our ancestors’ diet of coarse food – leaves, roots, nuts and raw meat – which required substantial chewing power. Softer prepared and processed foods, along with such technology as silverware, made wisdom teeth obsolete, vestigial. Our jaws shrunk over time. Wisdom teeth’s passage is now often blocked by what’s come before them, prompting the need to dig them out in a kind of painful revenge of the apes.

No other body part has its own dedicated fairy. We don’t put hair or fingernails under our pillows in the expectation that a late-night visitor will transmute these relics into a shiny coin, or maybe non-fungible token for today’s youth. 

The loss and resurrection of teeth is uniquely magical. Where all those used baby teeth go is anyone’s guess. One well-regarded theory has them being implanted in a future mother’s womb, seed for the next infant. Which would explain population growth.

Teeth’s singularity is further evidenced by the way in which they’re cared for. Hair and nails have dedicated salons, but these aren’t medical services. Skin has dermatologists, feet podiatrists, eyes optometrists, but the scope and scale of independent clinics in these realms is modest compared to the dental-industrial-complex, virtually all of which is outside the rest of the health care system.  Neither Kaiser nor Sutter offer dental services. Insurance, even generous employee-sponsored coverage, barely takes a bite out of costly procedures. Medicare only pays for dentistry in limited circumstances, though Democrats in the U.S. Congress are trying to change that. Those insufficiently poor to qualify for Medi-Cal have to wait for an occasional free dental clinic to popup, pay out of pocket, or tie a rope to a doorknob and hope for the best.

My grandma admonished my siblings and me to take good care of our teeth, lest we lose them. In 1960, roughly half of all Americans had lost all their teeth by the time they were 74.  Today that happens to less than a fifth of that age group, though racial inequalities persist.  

Over the past 60 years the number of dentists has well more than doubled, increasing significantly faster than population growth, from about 90,000 to more than 200,000. An average adult with good dental health, but a few modest problems, such as a cavity or gingivitis, invests $1,000 a year in dental services. 

Some, me included, spend much more. I’ve had intermittent tooth problems throughout my life, including serious orthodonture and extraction of four wisdom teeth. After a period of dental quiescence, in middle age I started grinding as I slept, ruining four molars. I now have three implants, with a fourth on its way, at an all-in cost of roughly $15,000, mostly out-of-pocket. I’m both aware of my privilege in being able to afford this expense, and resentful of the time and money expended, along with the sometimes excruciating pain of this jaw dropping journey.

There’s nothing quite like lying prone in a chair, helpless, as a generally good-natured, quite well-intended, professional bends over ones’ mouth with sharp, whirring, instruments.  I’ve enjoyed a few of the trappings of my lifelong experience with dentistry: the gurgling sounds of bubbles in a soothing waiting room tank filled with colorful fish, a once ubiquitous feature; paging through the quaintly colorful Highlights for Children and Reader’s Digest, themselves now obsolete; waking up from a deep drug-induced slumber, teeth missing.  Mostly, though, I wish what was in my mouth was more like fingers or toes. Permanently attached, easy to wash, requiring nothing more than an occasional clipping. Evolution, are you listening?