Photo illustration. Detail of photo by Melissa Wiese via Flickr. CC 2.0

They say eyes are the windows to the soul, but maybe teeth are the portal to our personalities. “A smile that lights up a room.” Our first encounter with another person is their smile; teeth are often the first thing we notice about a person’s face.

Two years ago, I discovered that the periodontal disease I had suffered for years had advanced to the point where we could not save my front bottom four teeth. I have feared losing my teeth for a very long time. One of my most frequent recurring dreams was losing them or having them knocked out, disintegrating in my mind’s eye. I didn’t need a dream interpreter; I feared losing my teeth.

I was scared and depressed. The dentist told me that I would leave with a partial and that no one would know. They didn’t tell me that it can take up to eight months for extraction points to heal and the swelling to go down. Soon, the partial didn’t fit as my mouth healed. Now, not only do I feel deformed and ashamed, I’ve spent $2,000 on a working-class salary with paltry dental insurance on prosthetics I cannot wear. Ultimately, I went to a dentures-only office and shelled out another $1,800.

My story is not unique. According to the American College of Prosthodontists, roughly 178 million Americans are missing at least one tooth. That’s more than half of the U.S. population. In addition, approximately 40 million Americans are missing all of their teeth. It makes one wonder why people without teeth have been relegated to “toothless hillbilly” status rather than categorized as simply having a disability. A denture is a prosthetic, after all.

Tooth loss and tooth disease can cause significant challenges and severe health problems. Heart disease, diabetes, and stroke, among other issues, have been linked to gum disease. Tooth loss affects speech and bone density and is detrimental to the quality of life.

That quality of life is often a by-product of poverty and classism. Even though a significant portion of the populace is missing at least one tooth, it is the poor who are punished. Less able to afford proper dental care, periodontal disease progresses. That toothless grin becomes a point of shame and ridicule, as evidenced by how journalists discuss tooth loss amongst Appalachians.

In a pilot study I conducted for my dissertation, I found that regional and national newspapers described the poor with tooth loss in dehumanizing terms. The articles heavily focused on the worst cases, such as “Mountain Dew Mouth,” a pejorative term leveled specifically at rural people. Forgetting that many rural places do not have clean water, the joke is that hillbillies put soda in their babies’ bottles causing decay before adult teeth come in. There were stories about underground dentists and people extracting their own teeth with pliers and a bottle of whisky.

These stories hide the fact that dental health care in this country is a privilege even the middle-class struggle to afford. We make assumptions about people when we see they are missing teeth: they are dirty, ignorant, unhygienic … unworthy.  In my study, I saw no instances that acknowledged that those with means also experience tooth loss but have the option of implants, veneers, caps, or expensive acrylic dentures.

Nearly half of the world’s population, including the ruling class, experience some type of dental disability. Instead of shaming those without the ability to hide it, we should work toward universal healthcare that includes our entire bodies. Tooth loss is not a moral failing of the individual. It is a moral failing of a government that does not care for its citizens.

Alana Anton is working on a dissertation about the portrayal of Appalachian people in print media. She grew up in North Georgia and currently lives in South Carolina.

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