Smiling and Status
I recently had the privilege of undergoing a root canal.
I mean that only semi-sarcastically; the procedure was not exactly fun, nor how I would have hoped to spend the morning, and it wasn’t cheap. That’s where privilege comes into play.
Having a good paying job and dental insurance meant that I could undergo the procedure, sparing me the possibility of chronic pain and infection. The reason I went to the dentist in the first place was to get my routine six-month cleaning, which thanks to my insurance and socio-economic status is something I can afford to do regularly.
I had no symptoms, no toothache that might have led me for a visit otherwise. But after taking X-rays, my dentist saw that decay had spread into the dentin, and without a root canal the tooth could become infected.
This came as a surprise to me; not only do I go for my professional cleanings religiously, I brush my teeth three times a day and always floss. People who know me were shocked that I could need a root canal. So while personal failure could contribute to tooth decay, even someone who follows the rules may need serious dental work from time to time.
Let’s imagine I had no dental insurance, and maybe a job that didn’t pay as well. Especially since I felt fine, I might have skipped the visit and figured that all was well and I would only go in if I felt pain. By that time, I might have an abscess or an infection that could make the procedure far more painful.
Someone who can’t afford the treatment might just have their tooth pulled, making it harder to chew. After the treatment that part of my mouth was so sore I had to avoid chewing there, but it least it was temporary—and the teeth on the other side of my mouth are all intact, so I could still eat whatever I wanted, just carefully.
Teeth are more than just functional tools for eating; they are markers of status. Having straight, white teeth is about more than health, but connotes one’s class status as well, regardless of age. While I never had to wear braces, many kids I went to school with did. I’m sure they weren’t thrilled to wear them, but they had the benefit of straight teeth later in life. Children in less affluent families may not get braces because they might be too expensive, physically marking their status for years to come if their teeth are very crooked.
Sociologists Susan Starr Sered and Rushika Fernandopulle, authors “Sick out of Luck”, describe how inadequate access to health care not only creates physical problems for lower income individuals, but because these problems can be visible—like missing teeth—we have in effect created a caste system, where status becomes a visible marker. Imagine the challenges someone missing several teeth might find getting a job, especially one at a managerial level.
Some people who have health insurance at their job do not have dental insurance. According to a study released in 2010, approximately one in four Americans under 65 had no dental insurance in 2008. The study found that dental coverage was related to education and income; about 40 percent of those without a high school degree had no dental insurance.
Adults over the age of 21 poor enough to qualify for Medicaid (each state has its own guidelines and income limits) can get dental treatment in emergency situations in some states, but not most. States that do provide some coverage generally do not cover basic preventative care. People under 21 receiving Medicaid generally do receive dental care as part of the State Children’s Health Insurance Program (SCHIP), but these programs have been the victim of recent budget cuts, and many states have made it harder to qualify for them.
Of course the most serious dental problems tend to happen as people get older, so you might be surprised to learn that Medicare (government health insurance for Americans 65 and over) only covers emergency procedures like reconstructing a jaw after an accident if it is considered “an integral part … of a covered procedure.” In other words, if someone has a tumor in their jaw that would be covered, but the plan explicitly excludes dentures:
Medicare does not make payment for the cost of dental appliances, such as dentures, even though the covered service resulted in the need for the teeth to be replaced, the cost of preparing the mouth for dentures, or the cost of directly repairing teeth or structures directly supporting teeth.
Low-income people might find themselves at the mercy of clinics with limited hours or go to dental schools for discounted services. As a graduate student, I once had my teeth cleaned by a dental student. That experience alone could have soured me from regular dental care, had I not had prior experiences with seasoned dentists.
At the school’s clinic I had to wait quite a while in the lobby before going to two different places, one for X-rays and one for the cleaning, which all told took about three hours (I am in and out in under an hour in my current dentist’s office). The student frequently drew blood while cleaning my teeth, something that never happened before or since.
It’s interesting to consider why dental coverage seldom comes up in conversations about health care reform. After all, teeth are body parts we use regularly. Without them, we would have trouble eating healthy foods (like crunchy vegetables), and they can be gateways to infections. Gum disease has been associated with heart disease, the leading cause of death in the U.S.
I will soon return to the dentist to have a crown placed on the tooth that had the root canal. Am I looking forward to it? Not really. But I’m very fortunate to have the opportunity to receive proper dental care, which both reflects and replicates my socio-economic status.