Review by New York Times Review
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, however. 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-ayear 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 1800 s, 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 change. ? All the problems with health care exist in the dental system, but exponentially more so. SARAH jaffe is the author of "Necessary Trouble: Americans in Revolt."
Copyright (c) The New York Times Company [March 26, 2017]
Review by Booklist Review
*Starred Review* Eyes may be the window to the soul, but teeth may well trump them when it comes to their importance to overall health. Former journalist Otto covered an impoverished 12-year-old boy who died in 2007 when bacteria from a rotted tooth spread to his brain. (A routine $80 extraction might have saved his life.) This inspired her to investigate America's neglected dental system. She found that more than one in three low-income adults avoid smiling to conceal the fact that they're missing teeth. Yet Medicare doesn't cover routine dental care, and Medicaid treats dental benefits for the 72 million poor Americans it covers as optional. In 2000, then U.S. surgeon general David Satcher issued a report on Oral Health in America that stated it was inseparable from general health. Yet wealthy Falls Church, Virginia, boasts one dentist for every 350 people, whereas poorer Dickenson County boasts only one for every 15,486 people. Preventable tooth decay is the most common chronic disease of childhood in the U.S. and the cause of life-altering medical problems. Otto's well-reported and important book will arouse concern over the fact that dental health, which is so essential to our well-being, gets such short shrift and, hopefully, help instigate reform.--Springen, Karen Copyright 2017 Booklist
From Booklist, Copyright (c) American Library Association. Used with permission.
Review by Publisher's Weekly Review
This full-length debut from Otto, a health journalist who writes for the Washington Post, takes a hard-hitting look at the current state of oral health in a beauty-obsessed America. She highlights access disparities, poorly addressed by our national support networks, that can have lifelong devastating, or even fatal, effects. Otto's complex history of dentistry depicts dental care as a field on the fringes of modern medicine. She begins in 1840 with the founding of the Baltimore College of Dental Surgery, elevating dentistry from a trade to a profession, and traces its evolution perpetually in isolation from the rest of America's health care system. More moving are the book's portraits of the effects of neglected dental health care in poor communities: chronic pain is a given, the stigma of missing teeth hinders job prospects, untreated infections lead to emergency room visits, and traveling clinics are left to pull teeth too rotted to repair. Otto highlights the case of 12-year-old Deamonte Driver's death from complications of an untreated abscessed tooth, which eventually led to the 2009 expansion of the Children's Health Insurance Program. With many adults still uninsured, children's dental care far from universal, and the future of government-supported health care unclear, Otto's sobering report should not go unheeded. (Mar.) © Copyright PWxyz, LLC. All rights reserved.
(c) Copyright PWxyz, LLC. All rights reserved
Review by Library Journal Review
Former Washington Post reporter Otto, oral health topic leader for the Association of Health Care Journalists, writes compellingly about the integral role of oral health in overall wellness and how seldom dental care is available to low-income families, Medicaid patients, and nursing home residents. Surgeon General David Satcher's 2000 report, "Oral Health in America," warned of a "silent epidemic." While the biological understanding of oral health continues to evolve, access to dental care remains uneven, subject to the vagaries of state funding and "dental deserts." Tooth decay, largely preventable, remains the most prevalent chronic disease in America. Residents who live in rural areas are particularly subject to dental health disparities. Lack of access to routine dental care led to the 2007 death of 12-year-old Deamonte Driver, of Baltimore, who suffered from a brain infection caused by an infected tooth, which could have been prevented by an $80 extraction. His death led to Congressional hearings. This eye-opening look at the abyss between medicine and dentistry, between the mouth and the rest of the body, is not just about dentistry. It is about public health and health-care economics. VERDICT Timely and highly recommended for all readers concerned about public wellness, health-care disparities and outcomes, and the rising costs of treatment.-Mary Chitty, Cambridge Healthtech, Needham, MA © Copyright 2017. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.
(c) Copyright Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.
Review by Kirkus Book Review
An astute examination of the complex, insular business of oral health care.Former Washington Post journalist Otto recognizes poor oral hygiene and maintenance as a major public health problem, and she adroitly probes the ramifications of this persistent "silent epidemic of oral disease." While those in disadvantaged communities cite affordability, accessibility, and shame as factors in their lack of dental care, the opposite can be said for more privileged socio-economic groups, in which vanity and self-consciousness inspire an obsession with teeth bleaching, porcelain veneers, and spatial alignment. "Bad teeth depersonalize the sufferer," writes the author. "They confer the stigma of economic and even moral failure." Aside from economic variances, Otto charts the history of American dentistry, including the astronomical educational debt of dental school students and, consequently, why more progressive dental offices are often established within wealthier enclaves. The author meticulously examines the inexplicable fragmentation of oral health from established American health care systems, the increase in emergency room dental visits by uninsured patients, and how unregulated costs, a shortage of free clinics, and plans like Medicaid further isolate poorer populations from obtaining dental care. She also addresses the widely debated medical claim directly connecting oral health to overall health. Otto presents several case studies reflecting the state of the industry, including a young Miss USA pageant contestant's pursuit of the "Hollywood smile" and the shocking deaths of two young men from untreated dental abscesses. Though the situation is certainly a grim national concern, Otto presents hope via radical initiatives to stave off the flow of dental demand. Still, she implores, prevention and upkeep are paramount, as "people are held personally accountable for the state of their teeth in ways that they are not held accountable for many other health conditions." A focused, well-researched depiction of the dental industry's social and cultural relevance and its dire need for reform. Copyright Kirkus Reviews, used with permission.
Copyright (c) Kirkus Reviews, used with permission.
