That our teeth are in our heads seems natural, though the location is something of a liability. The trouble starts with tooth decay, which permits the usually harmless bacteria in our mouths to enter the spongy, supportive core of the tooth (the “pulp”). Something untoward can then unfold. The germs proliferate, white blood cells amass, pus accumulates, and a dental abscess is born. Hence the liability: It’s not good to have all this happening so close to one’s brain.



An untreated dental abscess can invade the tissues of the head and chest. It can infect and clot the veins of the neck, and spread between the skull’s many sinuses. If it reaches the brain, it can result in a brain abscess or meningitis. This is now a rare event, but it wasn’t always. In the seventeenth century, “ ‘teeth’ were continually listed as the fifth or sixth leading cause of death,” a 1999 article in the Journal of the History of Dentistry asserts. Two hundred years ago, the author notes, tooth pain was a killer.

TEETH: THE STORY OF BEAUTY, INEQUALITY, AND THE STRUGGLE FOR ORAL HEALTH IN AMERICA by Mary Otto The New Press, 304pp., $26.95

But here’s an unfortunate rule in medical history, at least in the United States: The untreatable conditions of the past become the untreated tragedies of the present. Mary Otto’s heartrending and incisive book, Teeth, builds on her Washington Post story on Deamonte Driver, a black twelve-year-old from Maryland who “died of a toothache” in 2007. His life could have been saved, she wrote, if his family had insurance, or if they had not been stripped of Medicaid for a time when they were homeless, or if Maryland’s underfunded Medicaid program had provided adequate access to dentists. “By the time Deamonte’s own aching tooth got any attention,” Otto reported, “the bacteria from the abscess had spread to his brain.” Surgeries and no doubt much suffering followed, but it was too late.

Deamonte Driver’s death was the direct result of a system of commoditized dental care. Some 114 million people lack any sort of dental coverage in the United States, and about half of children on Medicaid did not receive a single dental service in 2012. We could implement a system of universal coverage that would make treatment available on the basis of health needs, not means. But we have not. As Otto traces the history of modern dentistry, from eighteenth-century surgical experiments to the founding of the first American school of dentistry in 1840, she explains how the United States instead developed a “carefully guarded, largely private system,” one that is “enormously difficult to reach for those without mobility or money.” The state of our teeth, she argues, reveals—and reinforces—deep inequalities in society.

The story of our privatized dental system runs parallel to the more familiar story of America’s health care system. Over the past century or so, right-wing political forces have again and again impeded efforts to create some sort of national health insurance system. In the early postwar era, when many countries in Europe were creating or expanding systems of national health care, a health insurance plan proposed by President Truman was famously sunk by a vitriolic campaign of red-baiting, spearheaded by the American Medical Association—a historical episode Monte M. Poen relates in his book Harry S. Truman Versus the Medical Lobby. “Would socialized medicine lead to socialization of other phases of American life?” an AMA pamphlet asked in the late 1940s. “Lenin thought so,” it groundlessly answered.