This story is part of a special Slate Plus feature package on June Thomas’ long-form reported story “Disrupting Dentistry.” Be sure to check out the other Slate Plus exclusives related to this story, including a behind-the-scenes conversation between writer June Thomas and editor Laura Helmuth and a full audio version of the piece.
Why am I so obsessed with dentistry? Because I was a kid with bad teeth who grew up to be a teenager with really bad teeth and, after I moved to America, a young adult with terrible toothaches and big dental bills.
As I wrote back in 2009, thanks to two strokes of unexpected fortune—getting a job at Microsoft and finding a dentist willing to take on my very complicated restoration project—I was able to transform myself into a middle-aged woman with presentable teeth that rarely cause me pain. It changed my life.
I’m often asked why I’m interested in dentistry—a field that is often, incorrectly, thought to be deadly boring. I’ll be honest: My motivations are selfish. It drives me crazy that so many of the super-smart people I mix with—individuals who can recite all manner of obscure facts on a ridiculous range of subjects—know absolutely nothing about the terrible access problems that put dental care out of the reach of millions of Americans. During the decade or so when I spent countless hours in the dentist’s chair, acquaintances kept asking why it was taking so long—apparently oblivious to the cost of dental treatment and the consequent need to spread out the work.
I understand why my friends were ignorant: If you’ve always had healthy teeth—if you’ve taken good care of them, avoided harmful habits, and have regularly seen a dentist—you almost certainly have no idea how much a crown costs, or how many work-interrupting appointments, quite possibly with more than one dentist, will be necessary to place it. If you’ve got good teeth and employee-provided dental coverage, you’re doubly likely to be under the impression that it covers all the costs of care—because, well, it does take care of your twice-yearly cleanings. Why should people who’ve never had to endure excruciating pain and stretched-out treatment plans be expected to understand how it feels?
In a way, the weird mismatch between the number of people who have teeth and the portion of the population that understands the peculiarities of the health care system designed to take care of them is a boon to me. Dentistry is fascinating, and since very few people write about it, there are lots of great stories for the picking.
Three ideas appear in pretty much everything I’ve written about dentistry: First, that there are two Americas, dentally speaking—millions of our countrymen have beautiful, gleaming smiles, and millions more are embarrassed to open their mouths. (See, I already deployed that notion a few paragraphs ago.) Second, that dentistry is different from the rest of medicine because most practitioners are owner-operators—and, because they are small-business owners, dentists have absolutely no financial incentive to set up shop in rural or low-income areas or to work for lower Medicaid rates if they can fill their appointment book with full-fee patients. Third, that because they train for many years, dentists come out of dental school with exceedingly high student debt, and invest huge sums into setting up a practice, the proceeds of which they hope to retire on, they are highly motivated to protect their businesses by resisting any kind of disruptive innovation that comes to the profession.
Because I keep saying these things, some dentists think that I am an enemy of their profession. Nothing could be further from the truth. I love, admire, and am endlessly fascinated by dentists. The awesome, patient Seattle dentist who did the bulk of my restorative work saved my life—or at least allowed me to eat better, feel better, and look better. She also provided a huge assist to my career: If she hadn’t sorted out my messed-up mouth, I’m convinced that I could never have thrived in the predominantly upper-middle-class world of magazine journalism. And the work dentists have done on prevention—educating people about good oral hygiene and nutrition, pushing for the fluoridation of community water supplies, and encouraging checkups and cleanings—has reduced costs, not to mention pain and suffering, and is the envy of the medical profession.
But 10-plus years of intensive dental work—by The Greatest Dentist in the World ™, as well as an orthodontist, an endodontist, a periodontist/implantologist, an oral surgeon, and surely some other specialists I’ve forgotten about—cost me more than $50,000 in out-of-pocket expenses. It’s a miracle that I was able to afford that—and I know that most people can’t.
I also know from comments and emails I’ve received after writing dentistry-related stories that whenever a writer suggests that people can’t afford dental treatment, others—some of whom claim to be dentists—point out that many of those people have made terrible choices. Many of the people who say they can’t afford dental treatment didn’t take care of their oral health, but they found money to buy fancy new trucks (cartons of cigarettes and sleeves of tattoos are also often cited), so why should dentists—who studied for years and went into debt and perform microsurgery on a daily basis—have to work for less than the cost of doing business in order to help them?
My answer is that they shouldn’t have to do that. People choose a career based on how it is today, not how it might change years down the road. No dentist should be forced to take Medicaid patients (and currently very few of them do) or to work with dental therapists—a role akin to medicine’s nurse practitioner, used in more than 50 countries around the world but fought tooth and nail by the U.S. dental establishment—or to work for a corporate overlord rather than for themselves.
But I do wish that dentists would stop blocking new ways of doing things because they want to protect their own practices. The more they fight against the licensing of dental therapists or use dental practice acts to prevent nonprofits like Sarrell Dental from providing care to the poor, the harder it is for dentist lovers like me to correct the stereotype of dental surgeons as corrupt meanies.
My own dental work was done in private offices, but in the last decade or so, I’ve visited safety-net clinics in Alabama, Alaska, Illinois, Minnesota, New York, and Washington—and they’ve all been places where I’d be very happy to be a patient. Everyone was caring and dedicated (and overwhelmed). They didn’t want to put anyone out of business—they just wanted to relieve people’s pain. They should be allowed—nay, helped—to do so.
