Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America

by Mary Otto

“Show me your teeth,” the great naturalist Georges Cuvier is credited with saying, “and I will tell you who you are.” In this shattering new work, veteran health journalist Mary Otto looks inside America’s mouth, revealing unsettling truths about our unequal society.

Teeth takes readers on a disturbing journey into America’s silent epidemic of oral disease, exposing the hidden connections between tooth decay and stunted job prospects, low educational achievement, social mobility, and the troubling state of our public health. Otto’s subjects include the pioneering dentist who made Shirley Temple and Judy Garland’s teeth sparkle on the silver screen and helped create the all-American image of “pearly whites”; Deamonte Driver, the young Maryland boy whose tragic death from an abscessed tooth sparked congressional hearings; and a marketing guru who offers advice to dentists on how to push new and expensive treatments and how to keep Medicaid patients at bay.

In one of its most disturbing findings, Teeth reveals that toothaches are not an occasional inconvenience, but rather a chronic reality for millions of people, including disproportionate numbers of the elderly and people of color. Many people, Otto reveals, resort to prayer to counteract the uniquely devastating effects of dental pain.

Otto also goes back in time to understand the roots of our predicament in the history of dentistry, showing how it became separated from mainstream medicine, despite a century of growing evidence that oral health and general bodily health are closely related.

Muckraking and paradigm-shifting, Teeth exposes for the first time the extent and meaning of our oral health crisis. It joins the small shelf of books that change the way we view society and ourselves—and will spark an urgent conversation about why our teeth matter.

Genres: Nonfiction, History, Science, Health, Medicine, Medical, Sociology

341 pages, Kindle Edition

First published March 14, 2017

Reviews

[Anna · Rating 4 out of 5]

3.5 rounded up because of the importance of the message. The book tells the story not of teeth but of dentistry where it has been, where it is now and where it needs to go in the future. This book by turns made me sad, angry, frustrated and it also often made me squirm. I could never be a dentist or hygienist but I now have a much greater respect for those who are and for the importance and nobility of these professions.

[Lauren · Rating 3 out of 5]

Ahhhh I really wanted to like this book more because the message couldn't be more true; we do need to give greater focus to dental health. I just felt that Otto continuously repeated herself in regards to the failing dental health system while also not providing any specific solutions on how it could be fixed. I think if more time was spent describing the various ailments (which most non-dentist/dental assistant/hygenists readers are unfamiliar with) I would've been more engaged and had a better sense of the ramifications for neglecting certain treatments or types of preventative care. Than this laywoman could help spread the word by citing these examples. Instead I felt like I was slogging through all the specific failures of the bigger system, of which, as an individual, I feel like I very little direct control over.

[Malin Friess · Rating 5 out of 5]

Otto begins with a moving poem about teeth which I will paraphrase-

"The mouth is a portal, an interface, an erogenous zone...the grotto of the tongue...the teeth are part animal, and part mineral...they are whitened, straightened, amputated, and thrown away....Teeth endure longer than bone, withstand fires, floods, time....they keep a record of our lives, locked in their enamel."

As a dentist who has practiced for over 14 years teeth are no joke! It is about time we had a book that took a serious look at our profession, the connection between oral health and systemic health, and the troubling state of oral health in poor American inner cities.

72 million Americans are covered under Medicaid. But it is up to the States to decide whether dental benefits are included. 35 Million poor children have Medicaid benefits..but only 1/2 receive dental care. In 2007 a Maryland Schoolboy Deamonte Driver died of complications from an untreated dental infection just 12 miles from the Nation's first dental school: University of Maryland. From 200-2009 61,439 hospitalizations were attributed to dental abscesses at a cost of $858 million dollars (something a simple tooth extraction could have prevented).

Otto takes a journey into the mouth to look a the connections of oral disease and decreased job prospects (no one gets hired if they are missing a front tooth), low educational achievement (kids can't perform if they have a chronic toothache). Dentistry unfortunately evolved separately from medical schools as a cottage industry or a trade (much like a barber) and not a profession. Therefore the teeth have been separated from the body and often not included in important health care legislation. Even though there are correlations between the bacteria of the mouth and oral infection and diabetes, Coronary Heart Disease, failing orthopedic joint replacements, and rheumatoid arthritis and periodontal disease, and kids with otitis media and chronic dental abscesses...dental care is treated as a luxury.

I would suggest ED's who have dental patients..stop and have them triaged at the door (rather than wasting money on medical codes an unneeded imaging/CT scans that can often range over $500) and are given a voucher (paid for by Medicaid or CHIPS) to visit a dentist or OMFS and have the tooth treated.

Otto takes some swipes at dentists as a profession that is too surgical minded (we always want to pick up a hand-piece and drill) when preventative care is more important (sealants and F- and oral hygiene instruction). I think this is unfounded..believe me I have treated children and adults--and just speaking about improved brushing or placing a few sealants or painting f- on teath--will do nothing when they have a PA infection with irreversible pulpitis and are in need of surgical extraction of offending teeth or first step root canal therapy).

Otto is right to note that midlevel providers (dental therapeuticians) could help solve the access problems. These providers who are now qualified to practice at Indian reservations in Alaska, Oregon, Vermont, and Washington and Minneapolis have 2-3 years of training and can treat simple cavities and extract primary teeth. Dental boards are adamantly opposed that these providers are endangering patients and not qualified (or the underlying reason is that they will suck up revenue from general dentists). These therapeuticians need to be given a chance...because they are going places (like bush towns in Alaska) where no dentists are available.

5 stars. All dentists and dental students should read this book. Teeth matter and our profession can do better job meeting the oral health crisis.

[Catherine · Rating 4 out of 5]

I purchased this book because it was inspired by the story of Deamonte Driver, a 12 year old PG County boy who died in 2007 of a brain infection from an abscessed tooth. That story, in the Washington Post, really hit my mother hard. She was livid that such a thing could happen. This book, by the Post reporter, tells Deamonte's story, the story of how dentistry became divided from medicine, and how oral health is a cause and consequence of societal inequality - not an area often discussed. Highly recommend.

[Marks54 · Rating 3 out of 5]

This book is not really about teeth but more about how teeth are intertwined with a large number of horrific experiences for people suffering from poor oral health for a variety of reasons, mostly related to childhood, poverty and class. It also provides a history of dentistry and how the practice of dentistry has evolved since the profession’s origins in the 1800s and before. It is also a book about the efforts to secure government supported provision of oral health and dental services to a broader and even universal population, expanded from the smaller served population under prevailing fee for service arrangements. This includes efforts to expand the number and backgrounds of people trained and eligible to provide some dental services to a broader population, and the reaction of the various dental association to such efforts. ...and all this is tied together by the story of a young boy in Maryland whose abscessed tooth morphed into a fatal brain inflammation when it should have been easily and inexpensively treatable. ...and there is also the move to cosmetic dentistry, which has become the hot new area for practice development with the overall reductions in dental disease in the general population.

An upbeat and happy story, right?

I was intrigued by the book because I have spent more than my fair share of time in my life suffering from, getting treated for, and recovering from various dental experiences. I do not want to go into details but I have for quite a while walked the straight and narrow on dental health out of complete terror of what might happen if I do not. My own experiences, coupled with what I know about the experiences of my friends and extended family, have convinced me that a very grim opera could be written tying dental torments to an operatic plot line, with necessarily tragic outcomes for all - sort of like Wagner in a white coat or a musical version of Marathon Man.

But I digress.

The story of Diamonte Driver is a good one and a nice choice for motivating the general narrative. The details of childhood dental health mix with Medicaid politics that makes well trodden arguments seem very alive. Ms. Otto is effective here in her reporting.

The history of the dental profession is less effective. Going back to the origin stories of various medical specialties will require some grit on the part of most readers and dentistry is no different. How do you think the details of extractions were worked out initially? There are more than a few “yikes” moments in the story. It is hard to describe the dental pain thing in black and white language, unless of course one has already experienced it.

The story that I found more interesting concerned the fight to authorize different sorts of para professionals and dental extenders to provide basic dental services to poor and hard to serve populations. There is a clear tension between quality of care and restraint of trade — a tension that has its own place in the evolution of health care more broadly — the Ms. Otto’s account of this is effect and relatively balanced. The “beauty” part of the subtitle got sidetracked after a promising start that examined cosmetic dentistry and beauty pageants.

While most of the book was quite interesting, continuity was an issue and its seemed at times like the different parts of the story were cobbled together. Tying the book together in the context of the State of Maryland was a nice touch that helped continuity.

Overall, the book is a quick read and worth the time. “Teeth” is a bit odd as a title, since it is more about poor people and minorities and their need for access to dental care - but that would not have produced as good a title.

[Dan Connors · Rating 4 out of 5]

Why is dental insurance separate from health insurance?

Why are people showing up in hospital emergency rooms with teeth problems?

Why did a young 12-year-old boy die because of a tooth infection?

These and many other tooth-related questions are dealt with in this eye-opening book about a little-discussed topic- our dental health care system. Mary Otto is a healthcare journalist and one of the nation's experts on dental and oral care, and this book covers what she calls a crisis of poor care for a large number of Americans and their teeth.

Our dental care system is a microcosm of the rest of the for-profit healthcare system, and Ms. Otto places a lot of blame at the feet of the nation's dentists and dental societies. For those that can afford it, dental care in this country is excellent. Because a white, straight and strong smile is seen as vital to many for a positive image, there is a big emphasis on appearances. Tooth whitening and veneers help cover up blemishes and make teeth look unnaturally bright, but they have little to do with general oral health.

At the other extreme are the 100 million plus Americans who have no dental care at all and suffer with serious pain and decay that could be easily treated today. The author visits a Remote Area Medical facility in Appalachia where thousands of untreated adults and children come to a series of tents to have teeth pulled and long-neglected problems addressed. There's a disturbing racial aspect to this as well- people of color are much more likely to have untreated tooth decay and no dental insurance than white people.

Many dentists start out their practices with huge loads of student loan debt, often in the six figures. From the day they open their doors there are enormous pressures to maximize income with expensive treatments like veneers ($2000 per tooth), extractions, and crowns. Some dental practices have been taken over by private equity firms and are only about maximizing profits, while the lone dentist is more common but has bills to pay. (Dentists have one of the highest suicide rates of all health professionals.) They take on charity cases at their own financial peril. Even with Medicaid, which sometimes covers dental care and sometimes doesn't, the reimbursement rates are half of what privately paying customers bring in.

Ms. Otto goes back in history to show how dentistry evolved, and how, in 1840 it split with the medical profession to go down its own path. Early dentists knew little about germs and hygiene, and were mostly about pulling teeth. Gold and other metals were used for fillings back then. For a while dentists were pulling healthy teeth as protection from future problems, but thank goodness research into germs and bacteria stopped that practice.

"We don't know why teeth die," says Ms. Otto in a chilling admission from the dental profession. Our mouths are a delicate soup of 600 different types of bacteria that help us digest food, and if the balance gets off just a bit, tooth decay happens. The best protection against this onslaught on our teeth is regular brushing and flossing, but even that can't stop it completely. One of the biggest helpers in the fight for oral health has been fluoridation, which started in the 1940's because researchers noticed lower cavity rates where waters naturally contained fluorides. Now almost all water is fluoridated, and this type of public health approach is sorely missing in the rest of the dental profession.

Dentists, because they have invested so much in their craft, protect their turf zealously. Otto details how dental groups have opposed most attempts at nationalized healthcare, because the sad secret is that there just aren't enough dentists in America to treat everybody, even if they all could afford it. (We effectively ration dental care by ability to pay for it). Healthy teeth are more of a privilege than a right. Dentists have also fought against allowing hygienists and dental therapists- professionals with less training than dentists- to provide more routine dental care in schools, nursing homes, and in remote locations where there are no dentists. By protecting their high-income practices, they deprive the country

of lower-paid professionals who could fill in the gaps.

The main point in this book is that there is a crisis in dental care for nearly half of the nation. People don't go to see dentists because of fear of the pain, which is very real for those who've had bad experiences, and also because of the expense. Some have no dentists in their area at all. When people do finally go to get help, many of them go to the hospital emergency room, where the best they can hope for is some pain killers and a referral.

Children are especially vulnerable because once their teeth start going bad, they are prone to expect misery the rest of their lives. Medicaid often covers children's dental care, but only a minority of dentists see a significant number of these kids according to the book. There are some promising alternatives, such as group practices, remote clinics, and dental therapists that can drill and extract problem teeth.

Mixing medical care with the profit motive is a tricky situation, as has been found with pharmaceuticals and most medical procedures. Prevention is minimized and costly procedures are emphasized if they help the bottom line. The health of the patient is secondary to the health of the balance sheet.

The book closes with the story of Deamonte Driver, a 12 year old boy who died of a tooth infection that went to his brain. While Deamonte's single mother spent months trying to fix his brother's six rotted teeth, he quietly nursed a growing toothache that eventually took him to the emergency room. Dental sepsis entered his brain, and after $250,000 in treatments he still died- all for want of a single tooth extraction. Deamonte's death woke up a lot of politicians in Maryland where he lived, and brought the dental poverty crisis more to light nationwide.

Otto tells some inspiring stories of people who bucked the system to try to improve the dental health of those who need it most. They are the heroes of this book. The villain is a system that disappoints on so many levels. The world of dentistry is one few of us ever know, and this book made me appreciate my pain-free (though imperfect) mouth every day. Expanding health care is a great goal for the next decade, but for Medicare, Medicaid, and the Affordable Care Act, oral care is often not covered or subsidized, so people neglect it. Our mouths are forever our most important opening to the world, and it's high time we took better care of them.

[George Azar · Rating 3 out of 5]

I had the opportunity to meet the author and get my copy signed and she is the sweetest person I have ever met!

[Jessica · Rating 2 out of 5]

I always notice people's teeth - it's something I learned from my Dad. And as Georges Cuvier is credited with saying, "Show me your teeth and I will tell you who you are." Mary Otto examines both the history of dentistry in America and also how it continues to be a barometer of social inequality. Otto started working on this book after Deamonte Driver, who was 12 years old, died from an infected tooth that spread to his brain. Unfortunately Deamonte isn't unique in that children and adults still routinely die from infected teeth because of lack of access to dental care. One of the things I found most disturbing is how time and again people or groups - across different time periods and parts of the country - would try to create ways to bring preventative dental care to poor children in schools and be sued and fought tooth and nail by dentists. The dentists claim this would take business away from them, but these children are not getting ANY dental care and preventative care could help prevent massive problems for these kids in the future. While there were parts of the book that were very interesting, it was not arranged in a cohesive way. I wish it had flowed a little more naturally, but it was choppy and history was mixed in with current events and it was often hard to follow. But, I think she did do a good job of showing how dental health is equally important as overall physical health and our country is seriously lacking in dental care for a large part of the population.

Some quotes I liked:

"In Illinois, a team of research assistants posed as the mother of a fictitious child with a broken front tooth. They phoned eighty-five Illinois dental practices twice, a month apart, in an attempt to determine whether a child's Medicaid status affected a parent's ability to get a dental appointment. In 170 paired calls, a total of 36.5 percent of the Medicaid children obtained an appointment, compared with 95.4 percent of privately insured children." (p. 122)

"Alaska Native children suffer from tooth decay that has been estimated at rates more than twice as high as other American children. In Alaska, complete tooth loss by the age of twenty is not uncommon." (p. 173)

[Jordan · Rating 4 out of 5]

I read this book primarily so my sister wouldn’t have to, but it’s so fascinating and important, I think I might make her anyways.

[Steven · Rating 3 out of 5]

This is such a good example of medical journalism.

Otto explores issues related to oral health in the United States - how dentistry developed, current controversies, and the poor state of oral health among Americans who have the least. It's hard to know who's doorstep to place this problem at, but Otto points at several factors.

The way dentistry developed as a separate profession has developed in professionals who jealously guard their autonomy in the healthcare system. Too, dentists are reluctant to support changes in professional practice that would give more autonomy to dental hygienists or allow the development of mid-level dental professionals like the dental therapists being employed by some Native American groups. The problems with the way healthcare is funded (or rather, not funded) in this country is magnified for dentistry and oral health, as these are often underfunded by a hodgepodge of state policies toward Medicaid. And just the shear numbers are daunting -- not enough dentists in many of the areas of the country. Or at least not enough willing to accept poor patients.

So many interesting topics are covered in this book -- new dental health delivery models, the rise of dental insurance, how poverty and race continue to be barriers to treatment and the development of dental professions, conflicts and tensions between dentists and hygienists over their roles, the fact that dentistry and its economics are set up as a restorative (and now cosmetic) profession rather than one of prevention, and just the plain lack of access.

Otto's writing is fairly clinical at times, and much of her coverage concerns Maryland, a kind of lab school for the best and worst of dental health -- and the home of the oldest dental college in the world. A fact she mentions perhaps a few too many times...Still, an excellent overview. And as the sad and completely avoidable fate of Deamonte Driver illustrates in the book, a story that really needs to be heard. I'll be getting a copy of this for my library and recommending it to our dental hygiene students.

[Shelby Bedell · Rating 2 out of 5]

I’m conflicted.
I was so looking forward to reading this book. I have always found the oral health industry in America to be so…interesting? And I mean that in the worst way possible.

Parts of this book I found very provocative, informative, and successful at telling the hundred-year story of America’s failing dental system (and how it has failed in different ways for different people over and over and over again). Some of the things said put words to thoughts I’ve had for years but couldn’t quite pin down.

As someone who has struggled with oral health for her entire life, this book tackles the stigma and pain behind it amazingly well (I know, bc even admitting about my own struggles in a review that no one will read is making me spiral.)

That being said, I was hoping for SO much more. It felt like so much of the book, especially the key figures and statistics, were repeated and rephrased countless times. What was a 250-page book could easily have been 150 or less had the author been more succinct. This is an issue that I think does a disservice to a very important topic and what could have been a very impactful book.

I’ll end this with a quote from the book’s preface that in itself makes me want to give it more than two stars:
“Stigma is an ancient word: a brand or mark of subjugation or disgrace. In the way that they disfigure the face, bad teeth depersonalize the sufferer. They confer the stigma of economic and even moral failure. People are held personally accountable for the state of their teeth in ways that they are not held accountable for many other health conditions.”

[Holly McIntyre · Rating 4 out of 5]

As a middle-class boomer I have been blessed to consider regular dental visits an expected, if unenjoyable, fact of life. Despite liberal application of Crest, my childhood teeth untouched by fluoridated water sported enormous amalgam fillings which over time have come to depict a veritable history of 20th and 21st century crowning procedures. Never once have I had a toothache. Until reading this book, I did not know how atypical my experience has been.

A weakness of this book is that it tries to cover so much that often the thematic connections do not hold. The sweep moves from the history of dentistry, to professional infighting, to the money-making potential of cosmetic dentistry, to the complex policies of Medicaid, interspersed with vignettes of real people and their teeth. In the end, it is the vignettes that I will remember, especially the death of 12 year-old Deamonte Driver from an abscessed tooth.

This book explicates how and why dental health care is unavailable to at least one-third of Americans and for that enlightenment alone is well worth reading.

[Joanne · Rating 3 out of 5]

Very interesting facts but the book could have been much shorter as the author keeps repeating the same ideas over and over again.

[Rebecca · Rating 4 out of 5]

Finally finished this book! (It’s hard for me to get into nonfiction...)

This book, while dry at times, is so important. Otto captures the history of the dental profession as a whole and puts the state of the US’s oral health into context- from barber shop dentists to starting our own schools to mobile dental clinics.

For anyone in the dental field, it provides much needed background of why we are so separate from medicine, how we have progressed, but also how we may have held on to traditions to the detriment of being universally accessible to all.

I don’t believe I’ve read as detailed of an account of dentistry before, but it’s important to know how far we’ve come and how much more we have to go.

However, as someone who studied public health and is a dentist, I think there were times when Otto’s tone expressed her disapproval of the American Dental Association’s position on increasing the scope of dental auxiliaries, for instance. I completely understand the necessity in areas lacking dental care, but she did not really dive as deeply into the ADA’s position as thoroughly as she had for many other topics throughout the book. There is a definite need for reform, but I don’t know if the solution is as cut and dry as she may have made it out to be.

[Chris D'Antonio · Rating 4 out of 5]

Teeth provides a compelling survey of the history of dental care, and several present day case studies which are pushing the frontier of dental care into populations which receive very little of it. It covers the glamorous nature of modern cosmetic dentistry, and uses it to contrast the failure to extend basic dental care reliably to poor populations throughout the United States. The separation of dentistry and physical medicine and its absurdity is highlighted, and the role it has played in diminishing dental care funding in public health programs such as CHIP and Medicaid. Efforts to extend more affordable care are explored through dental therapists serving Alaska Natives, dental hygienists seeing more independence and versatility in South Carolina, and past movements to create dental auxiliaries, much of which has been opposed by the American Dental Association as a threat to dentist's privileged economic well-being. The ADA figures prominently as a force of reaction, fighting against innovation and new approaches attempting to expand dental care. The book ends on remembrances of the deaths of two young children from infections stemming from wholly preventable tooth decay, and challenges us to do better. I think it accomplishes its aim admirably and gives us much to discuss about improving our system of dental care, and its reach.

[Matt · Rating 4 out of 5]

This book was exceptional in its ability to show that oral health matters far more than most realize. As an oral health advocate, I had struggled at times to convince people that they should dedicate their time and/or resources to address oral health issues when seemingly larger problems (like pediatric cancer, for instance) persist. The disruption that poor oral health causes in many people's lives--inhibiting their personal and professional relationships, causing them tremendous pain, and sapping them of confidence and joy within--is real. Teeth matter. Oral health matters. Oral health is a winnable battle if we start at the start with education and loving preventive care. The lessons in this book can help to create a culture in which people make oral health a priority, in which care is more readily accessible, and where we all live better lives as a result.

[maven calore’s venice b!tch · Rating 3 out of 5]

3.65
super important message and i wish i liked it more!
guys i suffered a lot reading this book 😭😭 not that it was bad per say, just that i found the more paperwork like aspects of dental history deathly boring and that in the middle, a huge chunk of the book felt repetitive.
there were certainly very eye opening histories captured here and i learnt a lot about the failures of the american dental system. it was very heartbreaking to read.
would recommend, just be willing to trudge through the boring history parts and the repetitive passages!

also i swear it didn’t actually take me two months to read this. i took like a month long break and i probably only actually read the book over the course of around 7 days (i prefer to read in large chunks rather than a couple pages at a time

[Elizabeth · Rating 5 out of 5]

This book effectively makes the case that lack of access to dental care is a public health crisis. Although a bit dry in places, the author does a good job of keeping the reader engaged by sharing stories of hygentists and dentists who are trying make preventative dental care available to children and the dentists and the professional associations fighting their efforts. We also meet parents who have literally lost a child to an infected tooth.

The author outlines the history of the dental profession, and explains that the historic separation between dentists and other medical doctors is one of the primary reasons so many are not able to obtain dental services. The healthcare situation in the US is shameful, and the oral health care situation is even worse.

[Diana · Rating 3 out of 5]

I’m kind of meh about this book. It seemed scattered and disjointed and repetitive to me. A lot of it was dry history and dry policy. It focused on the state of Maryland. Surprisingly to me there wasn’t much on the physiology of teeth or the mechanism by which neglect of oral care damages overall health beyond the extreme cases where sepsis occurs due to dental infections. The author half heartedly argues dental care should be part of medical care rather than separate but doesn’t really make this case.

[Dave Neary · Rating 3 out of 5]

A part-muckraking (in the good sense), part-historical perspective on dentistry and dental care in the USA. Some heartbreaking stories about children and adults who have died of infection related to gym disease and abscessed teeth. I was curious if the book would talk about straight, white teeth as a status/class/wealth identifier in the USA, but while the book touched on that in the first section, it really focused more on the total lack of dental care to the poor, and some of the campaigns that are trying to change that.

[Niko · Rating 2 out of 5]

I was hoping for an investigation into the nuances of how lack of dental care affects people living under extreme poverty, where a critical component of health is out of reach. While there is some of that, it was also a surface level overview of tangentially related topics like cosmetic dentistry, teeth in archaeology and the history of the dentistry profession. Maybe interesting to a dentist, but for me it felt disjointed and ineffectual

[Doug · Rating 5 out of 5]

Going to the dentist is something I have always simply taken for granted. But it seems I am in the minority. Do to medical culture, politics, and poverty, oral health is much less available to large portions of the US population than regular medical care. This for me was an eye-opening book and is a must-read for all who care about health, especially our children's health. Readable and well-researched.

[Peter Degallier · Rating 5 out of 5]

Inspirational

As a future dental professional, I found this book so moving and inspiring. I hope that these pages will continue to help me aspire to use my training and career to help those in need.

[Ngan Nguyen · Rating 4 out of 5]

Quite dense and therefore hard to read, but once I got over that it's absolutely worthwhile. The book provides a good narrative while also being objectively informative. Things get sad here and there, but that's alright.

[Brenden Gill · Rating 5 out of 5]

Enlightening book! Great insight and thoughts on the dental profession, how it came to be, and what should be done for oral healthcare moving forward.

[Leslie Butikofer · Rating 4 out of 5]

Fascinating! Who knew dental health was such a public health crisis and politically charged issue in America! I recommend.

[Gregory · Rating 5 out of 5]

This book is phenomenal. I rarely will want to slow down while reading, but I found myself wanting to reread segments over and over immediately after finishing it.

[Kaytlyn · Rating 2 out of 5]

Teeth exposes the holes in our current public health system for oral health; however the way in which the information is presented is atrocious. There is no flow to the chronological presentation; the book jumps decades in a matter of lines with no warning. There are stories that seem to hold no value or connection to rest of the book. Repetitive. Repetitive. Repetitive. Overall this book reads similar to that of a poorly executed research paper, but the core information is needed. This book could prove helpful to those in the dental field, but I would not suggest this for a casual read.

[Libby · Rating 3 out of 5]

DNF @ page 30.

I picked this up to learn something new about a topic I know nothing about. Unfortunately this just didn't keeper engaged. There did not seem to be enough content to fill the book, and instead the anecdotes and quotes were used to fill the pages. For me, these failed to connect and be successful. I will read an article this topic instead.

[Nell · Rating 5 out of 5]

Documents another failure of the fragmented health care in the U.S. Because of a historical fluke, oral health has never been integrated into the rest of the health care system, despite the close connection of oral health to overall health. As a result, millions of people suffer from preventable but untreated dental caries, which progress into toothaches, abscesses, and even death, at great and unnecessary suffering to people and cost to taxpayers. This integration is opposed by dentists and the American Dental Association, which also fights the licensing of advanced dental care practitioners (analogous to nurse practitioners) who would provide care that dentists themselves cannot or will not provide, such as cleanings, temporary fillings, dental sealants, and extractions in school or clinic settings, especially in rural or inner city areas that are typically underserved. As in medicine, the dental care system rewards fixing problems rather than preventing problems, and also more lucrative cosmetic procedures such as straightening, whitening, and veneers over basic services such as cleaning, applying sealants, and teaching tooth brushing that can be provided by hygienists.

A friend of mine, a retired dental hygienist, manages a charity dental clinic in Florida and has seen the overwhelming need firsthand. She told me how difficult it is to get dentists to volunteer at the clinic. A shortage of dentists caused the clinic to close for over a year. Now, one dentist has volunteered one morning a month—six appointments per month. This is another example showing that charity, however laudable, cannot replace sound public policy. Medicaid usually does not cover dental treatment. Even when it does in theory, in practice it is next to impossible to find a dentist who participates, especially for people with limited access to transportation or the inability to miss work for one or more appointments.

In addition to the pain they suffer, kids and adults with chronic dental problems get poor nutrition from the inability to eat properly, miss school and work, and make poor candidates for military service because of their underlying lack of dental health. Indeed, my hygienist friend worked on military bases and treated recruits, and can attest to the sad condition of their teeth. Decayed or missing teeth are a barrier to advancement at work and in life because of the background of deprivation that poor dental health signals.

For what would appear to be a dry topic, this was pretty interesting. The author dives into the history of dentistry and tells the stories of real people. Another reason to go to bookstores and libraries rather than buying online—this was a staff pick on display that I’d never have known about, despite being an NPR best book of 2017.