The Class Politics of Teeth
Inequalities in oral health and dental access reflect our deepest social and economic divides.
On a cold fall morning, about four hundred people lined up on the outskirts of the mountain community of Jonesville, Virginia. News had spread about a free weekend health clinic, organized by the Knoxville, Tennessee–based Remote Area Medical Volunteer Corps, or RAM.
Since it was founded more than three decades ago, the nonprofit has headed hundreds of missions, airlifting medical relief to some of the poorest places on the planet. This was RAM’s first visit to this isolated pocket of Appalachia, in 2014. The clinic was offering a wide range of services, everything from chest x-rays to eye exams. An overwhelming number of people in the line, however, were worried about their teeth.
“I’ve got a couple of broken ones and a couple of bad cavities,” Randy Peters, a fifty-one-year-old former miner and mattress factory worker with multiple sclerosis, told me. “It’s getting so I can’t eat.”
Ernest Holdway, a disabled miner in his early sixties, said he came to get a tooth extracted. “It ain’t hurting but it will,” he predicted. He said his dental insurance ended when he left the coal mine. He said he just finished paying off the $1,500 he owed for the extraction of three bad molars, which he was told to get removed before a knee surgery. He was still fighting to save his leg, which looked fearfully swollen.
“I’m a good person but I sure have been tested,” he added.
In poor and remote Lee County, where Jonesville is located, shortages of all kinds of healthcare have been a chronic problem, but the dearth of dental care has been most acute. Lee County is not alone. By federal estimates more than 50 million Americans live in communities that face a federally designated shortage of dental professionals. Their teeth suffer and so does their general health. Pain is common. During free clinics like these, hundreds, sometimes thousands of ruined teeth are extracted.
Scenes such as these, which I observed over the decade I spent writing a book on America’s dental care system,