Mary Otto

From cosmetic procedures to the tooth decay epidemic, from the development of dentistry as a profession to turf wars between dentists and hygienists, this informative, if rambling, book covers many subjects related to oral health.

The main point of the book is that the state of a person's teeth has a tremendous influence on the health of the entire body, but because there is a deep artificial split between dentistry and other medical specialties, this influence isn't always understood or appreciated. Moreover, many people, most of them poor, face a lack of access to dental care. For example, the author relates one tragic story in which an impoverished young boy developed severe meningitis and died as the result of an abscessed molar. This happened not in 1813 or in a developing country, but in 2013 in the United States. This particular case became a cause célèbre and was even the subject of congressional hearings.

This book covers a lot of ground and shines a light on often neglected topics. Dentists probably won't like it because it portrays them as locked into a surgical approach to oral diseases and more motivated by money than by the common good. Nonetheless, I recommended for those with a strong interest in dental issues.… (mais)

Basically a very extended Atlantic article. Oral health is strongly linked to overall health, but for historical reasons—including a feud between two Baltimore dentists, and dentists’ opposition to “socialized” medicine—dental care has long been excluded from standard health care coverage, with only some recent attempts to fix that for kids. Medicaid pays so little that many dentists don’t accept Medicaid patients; cosmetic procedures are more profitable and thus more pursued than basic care. There’s one dentist for every 350 people in my community, while one for every 15,000 residents of a poorer county nearby. Dentists, of course, have resisted the use of lower-cost dental technicians to provide community care and routine cleanings. Dental visits to ERs cost lots and rarely result in any help, other than short-term pain relief at best. Poor kids thus often have rotting teeth, with consequences for school performance, employability (more than one out of three low-income adults avoids smiling), and daily pain in everyday life.

One heartbreaking story comes from Alaska, where a dental technician explains that you have to ask why people are doing things before you can give them the right care: a mother puts soda pop in her baby’s bottle to keep him quiet; it’s important to be quiet because if he cries when his uncles are around, they’ll beat him. This mother had managed to get her child and a sibling on a plane from her remote village to get a checkup; she prioritized survival over good teeth, and the technician could give her tips but not change her priorities. Our deeply disturbed health care system also produces moments of black humor, such as when an anti-segregation Jewish dentist gets called in front of HUAC and refuses to name names of members of “subversive” organizations. Told he’s not a good sport, he says, “I don’t think this is a sporting situation, actually.” After being lectured by the congressmen, he goes back to work—and eventually invents dental insurance.… (mais)