A look at the coming crisis.

I embraced American dentistry unreservedly: braces, new crowns, gum grafts, implants. The June Thomas Wing of Dr. Lifesaver's office housed a file as thick as a phone book, and I had so many specialists with offices on the 15^th floor of Seattle's Medical-Dental Building—orthodontist, endodontist, periodontist—that some people thought I worked there.

Because my dental coverage, like most, had an annual reimbursement cap and because the procedures were complicated, the reclamation project took more than a decade and about $45,000 of my own money to bring to a state of near-completion. I moved to New York before finishing the treatment, but I finally felt good about my teeth. I opened my mouth when I smiled, and even though I didn't have a glittering grin (the gradual nature of the process prevented a dramatic change of shade), my teeth were healthy. I could chew and—most important—I had no dental pain.

A few weeks after I started researching this story, I developed a sore throat. My glands were swollen, and I felt tired and lightheaded. I'd been traveling a lot—by planes, trains, and subway—and I had spent time on college campuses and in clinics. Since swine flu had just hit the United States, I wondered whether I'd picked up the virus somewhere along the way. Then one morning, I bit into a piece of toast and felt a sharp pain. It was as if I had driven a pin deep into the gum under that same tooth that a cough had smashed all those years earlier. Every subsequent bite seemed to drive the sharp point a little deeper. I still didn't know whether it was a medical or a dental problem—the flu can sometimes bring on a toothache—but I knew which one I was pulling for. If the sickness was located anywhere other than in my mouth, a visit to the doctor would be covered by my medical insurance. A trip to the dentist's office, on the other hand, could cost me serious money.

The problem turned out to be "internal resorption"—a suicidal tooth, as it seemed to me. The area had become infected, and Tooth No. 26 had to come out. I'd lost a lot of bone, so we couldn't just slap in an implant. Instead, an oral surgeon pulled the tooth and inserted some artificial bone in the hope that it would fuse with my own and provide a stable home for a new titanium anchor. For the four or five months it would take to see if the bone "took," I would have to wear a "flipper," which turned out to be a euphemism for a partial denture.

At first, the flipper didn't fit—it was painful, and it would become detached at the slightest provocation, especially when I was eating or speaking. My diction was a little less crisp, and suddenly I remembered those years of social awkwardness—the worry that people were looking at my mouth in dismay, the fear that the device would fly out as I bit into my lunch or launched into a presentation. But I also knew that it was temporary. I had a job that allowed me both the time to return to the dentist's office for adjustments until the device fit comfortably and the means to attempt this complicated treatment. My missing tooth is artfully disguised, and within a year, the flipper should be out of my life. The final out-of-pocket cost will be somewhere between $4,000 and $5,000.

What if I didn't have that kind of money?

Everybody knows about the crisis in American medical care. Nobody knows about the crisis in American dentistry, which shares some symptoms with the larger health care mess and differs from it in other, more intriguing, ways. Dentistry is the shirttail cousin of the health care system. It is the branch of medicine the affluent use most, but in many ways it is the least familiar, its shortcomings and inequities hiding in plain sight. Few people take dentistry seriously enough to contemplate the possibility that it might be in a dire state. But it is. In the coming days I'll try to explain why.

The Disappearing Dentist

Besides the six mournful concertina airs, the dentist knew one song. Whenever he shaved, he sung this song; never at any other time. His voice was a bellowing roar, enough to make the window sashes rattle. Just now he woke up all the lodgers in his hall with it. It was a lamentable wail: "No one to love, none to caress, Left all alone in this world's wilderness."
—Frank Norris, McTeague

Dentists have never gotten much respect. Just look at The Hangover, this summer's surprise movie hit. Ed Helms' character, a dentist named Stu Price, is presented as a henpecked, insecure second-rater. Even his best friends don't think he deserves to call himself "doctor," a title they reserve for physicians. When novelists or screenwriters want to telegraph that a character is boring or unimaginative, they often make him a dentist—in the Harry Potter series, for example, Hermione Granger's parents aren't just muggles, or nonmagical people; they're dentists. This is of a piece with the widespread myth that dentistry is the profession with the highest suicide rate. In fact, there is no evidence that dentists kill themselves in greater proportion than the population at large. If anything, the data suggest the opposite.