Poor teeth, If you have a mouthful of teeth shaped by a childhood in poverty, don’t go knocking on the door of American privilege

[Free Richard]

I am bone of the bone of them that live in trailer homes. I grew
up next to Tiffany ‘Pennsatucky’ Doggett, the hostile former
drug addict from the prison TV drama Orange Is the New Black. I
know her by her teeth.

Pennsatucky – a scrappy slip of a woman menacing, beating and
proselytising to fellow inmates – stole the show during the
first season of the Netflix prison series. But amid an ensemble
cast of similarly riveting, dangerous characters, it was her
grey, jagged teeth that shocked viewers into repulsed fixation.
She was the villain among villains, a monster that fans loved to
hate; ‘Pennsatucky teeth’ became a pejorative in social media.

Actress Taryn Manning’s gnarly, prosthetic teeth startled
viewers because, by and large, poor characters in TV and film
are played by actors whose whitened, straightened, veneered
smiles aren’t covered up. It’s hard to think of characters
besides Pennsatucky through whom heinous teeth convey rather
than lampoon the physicality of the poor. The first that comes
to mind is the derelict serial killer in a movie actually called
Monster (2003); as with Manning, Charlize Theron’s Oscar-winning
transformation generated astonishment with fake teeth.

In my life, Pennsatucky and her teeth are entirely familiar.
She’s the slurring aunt who passed out in our farm’s swimming
pool while babysitting me, and later stole my mom’s wedding band
to buy the drugs that dug grooves in her cheeks. She’s the step-
parent whose brain, organs and teeth corroded over the years and
now lives in a mobile-home park with my construction-worker dad.

But Pennsatucky’s teeth aren’t just ‘meth teeth.’ They are the
teeth of poor folk, of the young grandma who helped to raise me
and for decades worked from diner to factory line to a desk job
as a probation officer for the county court system in Wichita,
Kansas. She was just 35 when I was born, so I knew her as a
radiant thing; at the downtown courthouse, where I tagged along
– babysitters are expensive – attorneys turned flirtatious near
her green eyes, long limbs and shiny, natural-blonde bob. Then
at night, in her farmhouse or the tiny brick house we fixed up
in a rough Wichita neighbourhood, I watched her take out her
teeth, scrub them with a rough brush, and drop them into a cup
of water with a fizzy tablet.

‘Brush your teeth and don’t eat too much candy,’ she’d tell me.
‘You don’t want to end up like Grandma.’ She’d widen her eyes
and pop her dentures forward so that they bulged from her lips,
sending me giggling. In the early 1970s, a dentist had pried
every one of her teeth, too far gone or too expensive to save,
from her 20-something skull. She’s 69 now and has worn false
teeth for more than 40 years.

‘I had bad teeth all my life. They were straight and looked OK,
but I always had toothaches,’ she tells me when I ask how she
ended up with dentures. As I was growing up, the story
fluctuated – she was in a car accident, her natural teeth just
fell out, and so on. ‘I was excited to have them, knowing I
would never have another toothache. Now I think it was pretty
stupid, but at the time it was really painful, and I thought I
was doing the right thing.’

More than 126 million people in the US – nearly half the
population – had no dental coverage in 2012, according to the US
National Association of Dental Plans. In 2007, the New York
State Dental Journal reported that while only one-tenth of
general physician costs were paid out of pocket, nearly half of
all dental costs were settled directly by patients. This
reflects spending by the uninsured but also those sharing costs
with coverage providers; most plans cover routine cleanings but
leave patients to pay for 20 to 50 per cent of fillings, crowns
and other big-ticket visits. For those who can’t afford to pay
that difference, treatment is delayed and teeth continue to
degrade.

But expense isn’t the only barrier to dental care. Those on
Medicaid find that few dentists participate in the programme due
to its low payout. And more than 45 million people in the US
live in areas, often rural or impoverished, with dentist
shortages, according to the US Department of Health and Human
Services. Medicare, as a general rule, doesn’t include dental.

In the past year, the Affordable Care Act, or ‘ObamaCare’, has
changed many lives for the better – mine included. But its
omission of dental coverage, a result of political compromise,
is a dangerous, absurd compartmentalisation of health care, as
though teeth are apart from and less important than the rest of
the body.

It wasn’t sugar that guided our dental fates. And it wasn’t
meth. It was lack of insurance, lack of knowledge, lack of good
nutrition

About a decade ago, at the age of 50, my dad almost died when
infection from an abscessed tooth poisoned his blood and nearly
stopped his heart. He has never had dental insurance and has
seen a dentist only a handful of times when some malady became
unbearable. In 2009, according to the US Agency for Healthcare
Research and Quality, dental issues caused about 936,000
emergency-room visits and almost 13,000 inpatient hospital
stays. Many of these patients had low incomes and dental
coverage that restricted care to emergencies or wasn’t accepted
by accessible dentists.

‘I notice people’s teeth because mine are so bad,’ Dad tells me
during a break from a side job renovating a fraternity house. He
has long been the handsome object of crushes, but his teeth have
become increasingly askew with time, one of his eye teeth now
ragged and long like a rabbit’s for lack of a carrot to file it
down. ‘Nutrition affects teeth, right?’

I point out that Gatorade, which he favours when he splurges on
a bottled beverage, is full of sugar. But it wasn’t sugar, heaps
of which are sucked down daily by the middle and upper classes,
that guided his and my grandma’s dental fates. And it wasn’t
meth. It was lack of insurance, lack of knowledge, lack of good
nutrition – poverties into which much of the country was born.

My family’s distress over our teeth – what food might hurt or
save them, whether having them pulled was a mistake – reveals
the psychological hell of having poor teeth in a rich,
capitalist country: the underprivileged are priced out of the
dental-treatment system yet perversely held responsible for
their dental condition. It’s a familiar trick in the
privatisation-happy US – like, say, underfunding public
education and then criticising the institution for struggling.
Often, bad teeth are blamed solely on the habits and choices of
their owners, and for the poor therein lies an undue shaming.

‘Don’t get fooled by those mangled teeth she sports on camera!’
says the ABC News host introducing the woman who plays
Pennsatucky. ‘Taryn Manning is one beautiful and talented
actress.’ This suggestion that bad teeth and talent, in
particular, are mutually exclusive betrays our broad, unexamined
bigotry toward those long known, tellingly, as ‘white trash.’
It’s become less acceptable in recent decades to make racist or
sexist statements, but blatant classism generally goes
unchecked. See the hugely successful blog People of Walmart
that, through submitted photographs, viciously ridicules people
who look like contemporary US poverty: the elastic waistbands
and jutting stomachs of diabetic obesity, the wheelchairs and
oxygen tanks of gout and emphysema.

Upper-class supremacy is nothing new. A hundred years ago, the
US Eugenics Records Office not only targeted racial minorities
but ‘sought to demonstrate scientifically that large numbers of
rural poor whites were genetic defectives,’ as the sociologist
Matt Wray explains in his book Not Quite White: White Trash and
the Boundaries of Whiteness (2006). The historian and civil
rights activist W E B du Bois, an African American, wrote in his
autobiography Dusk of Dawn (1940) that, growing up in
Massachusetts in the 1870s, ‘the racial angle was more clearly
defined against the Irish than against me. It was a matter of
income and ancestry more than colour.’ Martin Luther King, Jr
made similar observations and was organising a poor-people’s
march on Washington at the time of his murder in 1968.

Such marginalisation can make you either demonise the system
that shuns you or spurn it as something you never needed anyway.
When I was a kid and no one in the family had medical or dental
insurance, Dad pointed out that those industries were criminal –
a sweeping analysis that, whether accurate or not, suggested we
were too principled to support the racket rather than too poor
to afford it.

My baby teeth were straight and white, and I wasn’t obese – an
epidemic among poor kids that hadn’t yet taken hold in the 1980s
– but I had plenty of ‘tells’: crooked bangs, trimmed at home
with sewing shears; a paper grocery sack carrying my supplies on
the first day of school while other kids wore unicorn backpacks;
a near-constant case of ringworm infection (I kept a jar of
ointment on my nightstand year-round); the smell of cigarette
smoke on my clothes, just as cigarettes were falling out of
favour with the middle and upper classes; sometimes, ill-fitting
clothes, as when the second-grade teacher I revered looked at my
older cousin’s shirt sagging off my shoulder and said: ‘Tell
your mother to send you to school in clothes that fit you.’ In
fifth grade, a girl noticed my generic, plastic-smelling, too-
pointy boots – a Kmart version of the black leather lace-ups
that were in fashion – and for weeks hounded me before and after
school, kicking dirt on my shins and calling me Pippi
Longstocking.

I had moments of cool clothes and good haircuts, too, and I was
a confident child who earned friends and accolades. But I still
think of the boy who handed me a dessert cup from his lunch box
every day when a mix-up in the free-lunch programme left me
without a meal card for months.

He pulled from my skull the greyed tooth, cracked perfectly down
the middle

Common throughout those years was a pulsing throb in my gums, a
shock wave up a root when biting down, a headache that agitated
me in classrooms. While they looked OK, my baby teeth were
cavity-ridden. Maybe it was the soy formula in my bottle when
they were growing in, or the sugary cereals to which my brain
later turned for dopamine production in a difficult home. Maybe
it was because our water supply, whether from a rural well or
the Wichita municipal system, wasn’t fluoridated. But richer
teeth faced the same challenges. The primary reason my mouth
hurt was lack of money.

Once, around third grade, an upper molar that had menaced beyond
all – the worst toothache I ever had – finally rotted so
thoroughly that it cracked in half while still in my jaw. Mom
took me to the dentist, somehow. The pain was tremendous, he
explained, because the pulpy nerve at the tooth’s centre was
exposed. He pulled from my skull the greyed tooth, cracked
perfectly down the middle, and let me take it home. For years, I
kept the two pieces in a tiny jewellery box, sometimes taking
them out and joining them like interlocking sides of the heart-
shaped friendship necklaces I coveted.

Around that time, I had my jaw X-rayed for the first time. The
results were grim.

‘You might as well start saving for braces right now,’ my mom
recalls the dentist saying. We were at the outset of a post-
divorce period that would include much moving and a slew of
partial-coverage dental insurance plans: employer-based, which
would be cancelled with Mom’s regular job switches, and
variations on state-funded, poor-kid programmes in between. Each
time the policy changed, Mom had to find a new dentist who would
accept our coverage. Then we’d ride out a waiting period before
scheduling a cleaning or filling. My dental records were often
lost in this shuffle, as was the case with my general health
files in doctors’ offices and school districts – I got a new
round of shots just about every year for lack of immunisation
records on file.

There would, of course, be no saving for braces.

It took years to find out whether the X-raying dentist’s
pessimistic prediction would come true. My baby teeth were slow
to fall out, their replacements slow to grow in. But at some
point came the unequivocal, surprising verdict: my teeth grew in
straight.

I don’t just mean straight enough. I mean 99th-percentile
straight. I mean dentists call hygienists over to take a look.

‘Doesn’t she have pretty teeth?’ they say, my mouth under hot
lamps. ‘Are you sure you didn’t have braces? But you whiten
them, right?’

I shake my head no and in the dentist’s chair tingle with the
bliss of gratitude. That my environment and genes somehow
conspired to shake out a bright, orderly smile is a blessing I
can’t explain. But I can tell you what preserved the blessing:
me.

When a health teacher said brush your teeth twice a day, I
brushed my teeth twice a day. When a TV commercial imparted that
dentists recommend flossing daily, I flossed daily. A college
room-mate once remarked on the fervour of my dental regimen.
After boozy nights, when other kids were passing out, I held on,
stumbled to the bathroom and squeezed paste onto a brush.
However tired, however drunk, I scrubbed every side of every
tooth, uncoiled a waxed string and threaded it into sacred
spaces.

Privileged America judges harshly the mouths that chew orange
Doritos, drink yellow Mountain Dew, breathe with a sawdust rattle

Poor teeth, I knew, beget not just shame but more poorness:
people with bad teeth have a harder time getting jobs and other
opportunities. People without jobs are poor. Poor people can’t
access dentistry – and so goes the cycle.

If Pennsatucky ever gets out of poverty, it will be thanks in
part to a prison-yard fight in the season-one finale, when the
upper-class protagonist knocks out her nasty grill; early in the
second season, her rotten gums nearly toothless, she blackmails
the warden into a new set of teeth. Upon incarceration,
Pennsatucky traded meth for ‘born-again’ religious fanaticism,
but her new teeth are a harbinger of a more substantive rebirth.
If the eyes are the soul’s windows, its door is the mouth – the
fence across which pass food, drink, words, our very breath.

Privileged America, ever striving for organic purity, judges
harshly the mouths that chew orange Doritos, drink yellow
Mountain Dew, breathe with a sawdust rattle, carry a lower lip’s
worth of brown chaw, use dirty words and bad grammar. When
Pennsatucky gets out of prison, she’ll need respect,
rehabilitation, employment. To that end, for all her praying and
testifying, Pennsatucky’s pearly gates might be her pearly,
albeit prosthetic, whites. She cries with joy in a prison van on
the way to get them, and later shows off with an over-the-top
smile during laundry duty.

‘You’re acting a little, like, retarded,’ an envious inmate
tells her.

‘I’m not retarded,’ she says. ‘I got new teeth!’

When I was a young adult, I learnt I’d been born without wisdom
teeth. The dentist told me I was ‘evolutionarily advanced’ since
human beings, no longer in the business of tearing raw flesh
from mastodon bones, don’t need so many teeth now. So many TV
shows, bad jokes and bucktoothed hillbilly costumes in Halloween
aisles had suggested that my place of origin made me
‘backwards’, primitive and uncivilised, that the dentist’s
comment struck me deeply, just as in fourth grade when I read
the word ‘genius’ in a school psychologist’s evaluation notes to
my mother and wept on the sidewalk.

Having straddled a class divide and been wrongly stereotyped on
both sides of it, throughout my life I’ve found peace in the
places and things that don’t evaluate my status: nature,
animals, art, books. ‘I sit with Shakespeare,’ wrote du Bois in
The Souls of Black Folk (1903), ‘and he winces not.’ Social
disadvantage and hazard engender what he called ‘double
consciousness’, the ever-present awareness of more than one
self. For du Bois, his most challenging two-ness in the wake of
slavery was to be educated and black – a tension of
socialisation still at work, to be sure, as President Barack
Obama’s raw first memoir attests. Today, for me and millions of
people in the US living on one side of a historic income gap,
the defining double consciousness is to be educated and poor.

The latter, for many of those who suffered losses after the
economic collapse of 2008, is a terrifying new identity, its
horror projected on to Pennsatucky’s serrated mouth and hard to
reconcile with the Americans they thought they were. But in my
academic and professional ‘climbing’, I learnt early and often
that one doesn’t leave a place, class or culture and enter
another, but rather holds the privilege and burden of many
narratives simultaneously.

Friends who know my background sometimes kid me when I’m drunk
and misconjugate a verb or slip into a drawl, or when,
thoroughly sober, I reveal a gross blind spot in the realm of
book-learning (if, say, the question involves whatever one
learns in sixth grade, most of which I spent playing in red dirt
outside a two-room schoolhouse near the Oklahoma state line).
They smile at the pleasure I take in scoring solid furniture
from yard sales or, once, for expressing delight over a tiny
cast-iron skillet, a miniature version of the pan my grandma
once used to fight a drunken stepfather off her mother. I enjoy
the kidding and feel appreciated when they recognise the true
clichés that weave my story.

But here’s the thing: wealthy people use cast-iron skillets and
bad grammar, too. It’s just not their narrative and thus passes
without remark. I’ve observed fellow journalists, the same ones
who made trailer-park tornado survivors famous for a loose grip
on the past participle, edit dumb-sounding quotes by city
commissioners to suit the speaker’s stature. And while I took
the education I wasn’t given through libraries, encyclopedias
and my former stepfather’s New Yorker subscription, plenty of
members of the middle and upper classes refuse or lack the
ability to seize the opportunities handed them. It can be useful
to acknowledge the cultural forces that carve us, or edifying to
indulge in the tropes of our assigned narratives, but true
distinctions of character, intelligence, talent and skill exist
at the level of the individual, not of the class – or the
ethnicity, the gender, the sexual orientation, the religion and
so on. To claim otherwise, as we’ve discovered across time and
countless persecutions of our own doing, is at best an insult
and at worst an excuse for enslavement and genocide.

The liberal proponents of Occupy Wall Street are often the same
people who think Southerners are inbred and Walmart shoppers
slovenly miscreants

In Thomas Harris’s best-selling crime-novel series, the FBI
consults the imprisoned serial killer and mastermind
psychiatrist Hannibal Lecter in its search for ‘the Tooth
Fairy’, a family-slayer who bites his victims with dentures made
from a mould of his grandmother’s distorted, razor-sharp teeth.
Years after that manhunt, the FBI again turns to Lecter for
help; this time, the refined sociopath – a former philharmonic
orchestra board member and mannerly purveyor of his victims’
flesh – finds it more interesting to analyse the agent than the
latest case.

‘You know what you look like to me, with your good bag and your
cheap shoes?’ he asks the young agent Clarice Starling – who
comes from the same place as Pennsatucky but whose intellect,
health, grit and ambition, presumably, landed her on the right
side of the prison bars. ‘You look like a rube. A well-scrubbed,
hustling rube with a little taste. Good nutrition’s given you
some length of bone, but you’re not more than one generation
from poor white trash, are you, Agent Starling? And that accent
you’ve tried so desperately to shed: pure West Virginia. What is
your father, dear? Is he a coal miner?’

Lecter’s condescending soliloquy from a cell decorated with
sketches of the Duomo cathedral in Florence – a place Starling
surely hadn’t heard of when she left her family sheep farm for
the FBI Academy at Quantico – hits home but doesn’t derail her.
His most famous line – the aggressive posturing about fava beans
and good Italian wine – happens when Starling sends a
psychological evaluation through the glass and tells him to look
at his damn self. We should do the same in the US, where the
liberal proponents of Occupy Wall Street are often the same
people who think Southerners are inbred and Walmart shoppers
slovenly miscreants with no social awareness.

A century ago, du Bois wrote: ‘The problem of the 20th century
is the problem of the colour line.’ The problem of the 21st
century is that of the class line. For the American Dream to put
its money where its mouth is, we need not just laws ensuring,
say, universal dental care, but individual awareness of the
judgments we pass on people whose teeth – or clothes, waist
lines, grocery carts, or limps – represent our worst nightmares.

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