The Tragedy of ‘Mountain Dew Mouth’ and the U.S.’s Insane Approach to Dental Care

Yves here. I suspect that there are at least some who will read this post and regard the poor state of dental health in Appalachia as mainly the result of bad lifestyle choices (too much sugary foods and drinks, smoking, opioid addiction, etc). It’s hard to overstate the impact of something the author skips over: that many don’t drink fluoridated water at the critical juncture, when adult teeth are forming.

We had something of a natural experiment in my family. I’m the oldest child. I didn’t get fluoridated water at the right age. My brothers did. Despite obviously eating the same diet as kids, my becoming vigilant about my weight in my teens (which among other things meant cutting out sweets) and always seeing the dentist on schedule, while one of my brothers has become obese and eats sugary foods daily, I have a mouth full of dental work while my brothers have hardly any fillings. I joke that when I visit the dentist, I am going for a semi-annual assessment. Even with relentless maintenance, fillings eventually beget larger replacement fillings. So imagine what it’s like for people with vulnerable teeth who can’t get good care.

By Anna Sanford, an editorial assistant at AlterNet’s office in Berkeley, CA. Originally published at Alternet

Mountain Dew, the carbonated fluorescent-green soda that Willy the Hillbilly declared “will tickle your innards” in a 1966 commercial, has long been a staple of Appalachia. It was officially developed in Knoxville, Tennessee, in the mid-1900s, but it has ties to the wheat and rye distilled by Irish immigrants who settled in the region as coal miners during the previous century. Today, coal has left Appalachia, as have a host of other industries that brought economic opportunity. Mountain Dew, however, remains culturally significant. Sarah Baird, a writer who grew up in Eastern Kentucky, recently wrote about the importance of the drink to her sense of identity, saying, “It’s not just a beverage—it’s a portable sense of home.”

In a region long undergoing a cultural and economic crisis, Appalachia’s thirst for Mountain Dew is perhaps the lesser of many evils. Opioid addiction, smoking, chewing tobacco, lack of access to municipal water systems, and the necessary preoccupation with getting food on the table over worrying about nutritional value are also having an enormous effect on people’s teeth. The soda is ruining teeth, in an epidemic known as “Mountain Dew-mouth.” The acid causes erosion and the sugar abets decay.

“I would see a lot of kids who had a mouth full of rotting teeth,” Dr. Edwin Smith, a traveling dentist who drove his mobile dental truck for 12 years throughout Kentucky, told CNN last September. “They were in pain, and they’d be hurting at school.”

In Kentucky, the state with highest proportion of adults under 65 without teeth, Smith has witnessed the extremes of Mountain Dew-mouth—toddlers with baby teeth filled with cavities, kids who won’t brush their teeth because of inflamed gums, and teenagers who have pulled out their own rotting teeth with pliers.

Other forces are at play. Hundreds of prescription medications, as well as chewing tobacco and cigarettes, cause dry mouth, preventing the natural flow of saliva and making teeth more susceptible to decay. Use of these substances is rampant in Appalachia; a single Kentucky county filled prescriptions for over 2 million doses of painkillers last year, which is about 150 doses for every man, woman and child. Kentucky is also the state with the most smokers, followed closely by West Virginia, according to a Gallup study. On top of that, without municipal water systems, people rely on well water, which is unfluoridated—or they drink more Mountain Dew to quench their thirst. Nearly half of the people in Kentucky, and 25 percent of the national population, depend exclusively on well water, posing a threat to natural resources as well as people’s teeth.

With 26 percent of preschool-age kids suffering from tooth decay and 15 percent of young adults extracting a tooth because of erosion, Mountain Dew-mouth in Appalachia has created one of the worst dental health problems in the United States according to a legal brief by Priscilla Harris, an associate professor at the Appalachian College of Law. Nonetheless, the factors that contribute to poor dental health are not simply Mountain Dew; they are not even specifically linked to Appalachia. Noxious substances merely exacerbate a national problem that is affecting every region of the United States. Bad oral hygiene could be significantly remedied through the American health care system; that is, if the United States adopted a holistic approach to health care. However, as it stands now, dental care is treated separate from health care, launching an epidemic that weighs heaviest on those who need it most—the rural poor.

Dental health is essential to overall health, and serious and sometimes fatal illness can result from untreated oral conditions. A problem as common as gingivitis (excess plaque) can result in serious health problems such as heart disease, diabetes, or cancer. Yet throughout the United States, from remote areas of Alaska and across the contiguous 48, poor people struggle to get access to regular dental care, relying on charity clinics and hospital emergency rooms. According to the federal government, more than 50 million Americans live in areas officially designated as Dental Health Professional Shortage Areas, and must travel hundreds of miles to get help. A suburb of Washington, D.C., could have one dentist for 350 residents, while Dickenson County, Virginia, has one dentist for every 15,468 residents.

The distinction between dental care and health care extends to insurance. Medicaid, the joint federal-state health care program that provides health coverage for 72 million people, reckons dental benefits as optional for adults, leaving it up to states to decide. It was not until the Affordable Care Act passed under President Obama in 2010 when Medicaid gave dental care to children under 19. Medicare, the federal health care program that covers 55 million seniors and disabled people, has never included insurance for routine dental services.

While Medicaid, as the medical safety net for the poor, should provide help for those with dental needs who cannot afford to pay, only 15 states offer full dental benefits and five states offer nothing at all, as reported in a study by Pew. However, even in the states that do offer dental benefits, poor patients have difficulty getting appointments. As an isolated industry, dentistry has remained private and unencumbered by the brunt of market forces. Dentists cannot turn away patients based on “race, creed, color, sex, or national origin” according to the American Dental Association’s Principles of Ethics and Code of Conduct; however, dentists can turn away patients based on their ability to pay. In order to cover high overhead costs, pay back dental school bills and earn an income, many dentists refuse to treat people on Medicaid. In 2013, only 34 percent of general dentists accepted Medicaid patients, according to Pew.

With limited benefits through Medicaid and no benefits through Medicare, in order to receive insurance, people must purchase private plans or employer-provided plans. Most dental insurance limits annual benefits to between $1,000 and $1,500 per person—this cap has hardly changed since the mid-’80s, despite inflation. Employer-provided plans—assuming the patient has a job and the job offers a plan—can exceed $500 a year or more and do little to ease the burden when other concerns take priority. So millions of Americans go without dental insurance.

More than a third of Americans do not have dental coverage, according to a Washington Post article. Appalling already, the state of dental care in America faces even greater challenges with the threat of the Trump-backed American Health Care Act currently being debated in the Senate after passing in the House at the beginning of May. The ADA has reported that Obamacare’s requirement to provide dental care for children under 19 will be rolled back, and the 5.4 million adults who gained coverage under the Medicaid expansion will lose all dental benefits.

Without insurance, people often go years without seeing a dentist. Toothaches are the most common problem, causing lack of sleep and difficulty eating. With time, a toothache can become another entity entirely. Germs collect, white blood cells accumulate, pus escalates, and suddenly a swelling, debilitating dental carbuncle has taken residence in one’s mouth.

Dee Matello, a small business owner and mother of three in Laurel, Maryland, had not been to a dentist in nine years. To compensate for the cracked molar on the left side of her mouth, she had simply learned to chew on the right side. Like many Americans without dental insurance, it was not until Matello heard a free dental clinic would be held in the town of Salisbury, just 20 minutes away from her home, that fixing the cracked tooth seemed like a possibility.

“It’s always bothering me,” Matello told the Washington Post as she waited outside the Wicomico Civic Center in Salisbury. Over the course of two days, among the reclining chairs and portable dental equipment that had been erected on the civic center floor, 116 dentists provided $1 million worth of care to 1,165 patients, many of whom had traveled across state lines to endure long lines and the bitter cold as they waited for treatment. After getting an x-ray and having the tooth extracted—a procedure that would have cost from $600 to $800 in a regular dentist’s office—Matello left the clinic, wondering why people who work hard and put faith in their government for help are obligated to endure such demeaning treatment.

At the University of Maryland dental school, a team of researchers explored the effect of toothaches in poor Maryland adults like Matello: 44.3 percent of their respondents reported having experienced more than five toothaches in the past 10 years. Nearly half said that their most recent toothache had caused them the worst pain possible and interfered with many aspects of their daily lives. When initial strategies to remedy their pain, such as nonprescription medicines, failed, many resorted to seeing a dentist.

For Americans who do not have health insurance and need dental treatment immediately, the emergency room remains the only option. However, this poses a significant problem because, in the eyes of the American health care system, the mouth is separate from the rest of the body. So even though hospital visits for dental problems cost an enormous amount to the health care system as a whole—an estimated $2.7 billion over a three-year period according to one major study—people rarely receive the treatment they need.

Dr. George Kushner, the director of oral and maxillofacial surgery at the University of Louisville in Kentucky, explained that he sees ER patients with dental pain on a daily basis. “I take out teeth every week that could have been saved with restorative work,” he told a reporter for USA Today. The vast majority of doctors lack the knowledge and tools to treat dental ailments. They offer the services they can, provide prescriptions for painkillers and antibiotics, and recommend a dental clinic for a follow-up. However, clinics are often too crowded to meet the demand. Thus, patients leave the ER with no long-term solution for treatment.

Though pain and discomfort are unfortunate enough, lack of dental care presents other, more enduring problems. While millions of Americans suffer because of their teeth, another portion of America supports a $110 billion-a-year dental industry, investing in procedures such as gum contouring and spending up to $2,000 on a single veneer. As the wealth gap continues to increase, teeth represent the dividing line between the classes.

Glimmering pearly whites have long been a symbol of social and financial success in America. Consider what every movie star, news anchor and television personality has in common: not height, weight or ethnicity (though there is certainly an enormous amount of room for more diversity). All share an enviable smile—gleaming, bright white, smooth, ovular teeth.

In a country where significant value is placed on a perfect smile, bad teeth prevent economic mobility. The predominant jobs of the working class—waitressing, housekeeping, nursing, etc.—are in the service sector, yet these jobs are hard to come by without a certain degree of oral health. A study published in the Nation Bureau of Economic Research found that a missing tooth can result in a loss of $720 of earnings (and 178 million people are missing at least one tooth).

As she waited to have teeth removed at a free clinic in Jonesville, Virginia, Emma Marsee told Mary Otto, the author of Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America, that people only want “a healthy-looking individual” taking care of them. In areas where jobs are scarce, a person’s financial security depends on her teeth. For 10 years, Otto researched and conducted interviews about oral health in America, traveling across the country attending beauty pageants and clinics, talking to dentists and patients alike. In her book, she writes:

In the way that they disfigure the face, bad teeth depersonalize the sufferer. They confer the stigma of economic and even moral failure. People are held personally accountable for the state of their teeth in ways that they are not held accountable for many other health conditions.

Regardless of cultural influences—Mountain Dew-mouth or not—the dental health epidemic in America is rooted in the historical and political legacy of an unequal system. Without access to preventative measure like regular oral checkups and teeth cleanings, as well as comprehensive care, America’s poor fight an uphill battle, involving increased health risk, social stigma and reinforced economic disadvantage.

 

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94 comments

    1. Yves Smith Post author

      I hate to tell you, this study is bullshit. China is a country full of pollution by the time this study was done. There are no controls and there is no way to isolate the impact of fluoride to 1. exposure to other chemicals which could be the primary cause; 2. interactions of fluoride with other chemicals being the cause (particularly because high fluoride areas are likely to be more polluted generally) and 3. effects like 1 and 2 due instead to air pollution.

      On top of that, you have no idea how “high” and “low” levels in the study relate to the levels of fluoride in fluoridated water. And many things taken in high doses will kill you, including water, salt, and caffeine. I had a chemist friend (12 patents to her name) who had to take a job below her skill level for a while as a result of moving for her hubby’s dream job running a testing lab. For reasons too complicated to explain, they had a pound of pure caffeine in the lab. She was terrified. One pound of pure caffeine in a municipal water system would kill about 50,000 people. If anyone had gotten some on his fingertip and put it in his mouth, it would kill him.

      Reply
    2. Joel

      The study Chris linked to looked at populations drinking water with naturally occurring fluoride levels (fluoroide is a common naturally-occurring mineral) that are much higher than that of fluoridated drinking water in the US.

      This analysis of the study explains why that study doesn’t cast doubt on water fluoridation programs in the US and that antifluoridationists are deliberately misconstruing it: http://thelancet.com/journals/laneur/article/PIIS1474-4422(14)70119-X/fulltext

      It’s unfortunate that access to scientific studies by the general public leads to misinformation. As an educator, I believe we badly need to do a better job of teaching students critical reading skills and how to evaluate arguments and evidence. Too many people have managed to get a BA or BS degree without the reading comprehension level necessary to understand an academic study.

      Reply
  1. Juneau

    In the New York city hospitals it used to be routine to send the homeless to the dental consult for extractions of decayed, broken, abscessed teeth (medicaid would only cover extractions and antibiotics) during hospitalizations. Not sure what happens now probably worse if anything. Abscesses can cause sepsis and even brain abscesses, are quite serious if untreated.

    And good luck getting dentures they are even more expensive than routine care. And the dental schools are very limited in terms of how many people they can help and it seems they still charge there is no real charity care even in our great state of NY.

    An important topic. Dental insurance even for the middle class is quite limited but at least routine care is covered.

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    1. Left in Wisconsin

      I have a friend who is an emergency room physician here in Madison. He said you would not believe the number of emergency room patients that are there for teeth issues. Lots of children and everyone without regular dental care. He also said there is virtually nothing that they can do for them in the emergency room except give them painkillers. He said there used to be a small practice right in the hospital specifically for these cases but they did away with it some years ago.

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  2. Eureka Springs

    And good luck getting dentures they are even more expensive than routine care.

    This is not the case in my area. Crown maintenance, a partial here and there, or gum surgery being the most common routines needed for people I know in their 40’s/50’s is at least an order of magnitude more expensive than admitting dentures are inevitable and just doing it. For the cost of a crown, maybe two if you don’t shop around, people can save tens of thousands and eliminate years of rot in their head if they just set aside denial. I’m always amazed how much people with some money will do to keep shards of metal, drills and knives in their head.

    I had one cavity before the age of forty, but when things went south, they went south quickly. I’m thankful all the time I didn’t wait.

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    1. Darius

      My grandfather was a genius on the trumpet as a young man. In his thirties, he had all his teeth pulled and got full dentures. That was the end of his trumpet playing career.

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    2. Anon

      Dentures (removable) are far from having capped, bridged, filled, real teeth. Many folks get used to them (my parents did) but they do not provide the same level of chewing/stability as the real thing.

      Yes, crowns and bridges have a limited lifetime (~ 20yrs. w/good care), but the alternative is not the best practice. Good oral health is essential to good overall health and should become an integral part of health insurance/care.

      Reply
  3. Glen

    To bad they don’t live in an advanced country like Mexico. Dental care is very good and much less expensive.

    Reply
  4. mle detroit

    Having Olde English genes for bad teeth, being pre-fluoride, and poor at the time, I went full plastic decades ago. I’ve been happy with the decision, and have avoided the “Hollywood Chiclets” look.
    Heard a dentist once say toothpaste does nothing but if the taste causes people to brush, it’s worth it. My grocery chain’s pharmacy gives free basic antibiotics, free pill boxes; maybe they should also give free toothbrushes.

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  5. From Cold Mountain

    Yves, the evidence for fluoride is not as clear as you make it seem:
    http://onlinelibrary.wiley.com/doi/10.1111/jphd.12207/full

    People still get cavities even though they have fluoridated water, so fluoride does not prevent cavities, it only lowers the odds of getting cavities for a certain population.

    There is a correlation of a poor immune system and dental caries, and it may be that we only need the higher level of fluoride to overcome the weaker immune system.

    So even though you and your family ate the same food, it could be as simple as you having a bacterial imbalance that they did not have, either from infection or just by being female.

    So yeah, just like the gut, it is all about the microbiome:
    http://onlinelibrary.wiley.com/doi/10.1111/jcpe.12671/full

    There is increasing evidence to suggest that both caries and periodontal disease represent dysbiotic states of the oral microbiome. The mode of acquisition of the oral microbial communities may be less passive than previously recognized but once established remains relatively stable within an individual although there are very significant site variations. A repertoire of stable dysbiotic states may occur in both caries and periodontitis involving different microbial community structures with potentially similar functional properties.

    As far as Appalachia, this is a poverty and a non-holistic view of health issue. The fact that we have “health insurance” that does not include dental is an economic and philosophical problem that will take a spiritual revolution to get over.

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    1. Yves Smith Post author

      I never said fluoride means no cavities. But across the population, the evidence is unquestionable that fluoridation makes a huge difference, to the degree that revenues in dentistry have dropped dramatically since fluoridation has become. It became common in the US before I was a kid, I was unlucky in being the wrong age in the wrong community. People in the ten year older than me cohort have much worse teeth than my peers. Ask any older or retired dentist andthe will affirm that there’s a big age break in the general quality of teeth due to fluoridation.

      I’ve eaten tons of probiotics (yogurt before it was fashionable) so that theory does not make sense. Even now, I get winter flus and colds less often than most people. I’m hardy save having a lot of orthopedic issues.

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      1. TheCatSaid

        There is much more to creating microbial balance than eating probiotics. Our microbial population is part of of us in many more ways than in our digestive system.

        Here is a wonderful mini-introduction to microbes in relation to human health, including this tidbit:

        And finally, my favorite fact about our microbes: The number of individual bacteria in one healthy human mouth could easily exceed the number of people living on earth. (You might want to reconsider that anti-bacterial mouthwash you are using. You could be causing more damage and problems than you realize!)

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      2. From Cold Mountain

        Fluoride is not a nutrient. That is the first thing to understand. The fact that might help reduce dental caries is secondary.

        There have been no long term studies on the effects of fluoridating water outside of the teeth. But fluoridating water only reduces cavities in children by 60% and in adults by 35%.

        That is not huge, almost a 50/50 chance? No thanks. Besides, cavities have been falling worldwide even in place that do not use fluoride.

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          1. From Cold Mountain

            In a way I am saying people should quit caffeine.

            Caffeine is like a bank bail out where you delay the onset of the problem without fixing the underlying cause.

            Caffeine will make someone with AD worse as well, increasing agitation.

            It is not a lack of caffeine that causes AD, just as it is not a lack of fluoride that causes cavities. That is why I feel it is important to distinguish drugs from nutrients.

            Both AD and dental caries have roots in the gene/environment interaction. Taking drugs that mask that interaction make it difficult to find the root cause of the imbalance. All the recent evidence is pointing to an energy rich diet to be the cause of those at risk for AD. So I would rather tell people to eat less and not drink coffee and not GET AD, rather than tell them to just drink coffee so you get AD a little bit later.

            So,as well, fluoride is covering up our shitty diets, which is maybe why the government like sit so much, since it is much cheaper than giving us healthy food.

            Reply
            1. Yves Smith Post author

              Stop making stuff up. It is against site rules. I’m quite serious. You are in moderation because you’ve done too this sort of thing too often before. You are accumulating more troll points. If you don’t drop this line of discussion I will take action. You need to read our site Policies. This is not a chat board and I have no tolerance for agnotology.

              High doses of caffeine are dangerous, as are high doses of salt and water. But a toxic dose is 10 grams a day, which is the equivalent of 100 cups of coffee. Salt is bad for people with high blood pressure, yet you are trying to make caffeine sound as if it is even more problematic. It isn’t.

              From WebMD:

              Caffeine Myth No. 8: Caffeine Has No Health Benefits

              Caffeine has few proven health benefits. But the list of caffeine’s potential benefits is interesting. Any regular coffee drinker may tell you that caffeine improves alertness, concentration, energy, clear-headedness, and feelings of sociability. You might even be the type who needs that first cup o’ Joe each morning before you say a single word. Scientific studies support these subjective findings. One French study even showed a slower decline in cognitive ability among women who consumed caffeine.

              Other possible benefits include helping certain types of headache pain. Some people’s asthma also appears to benefit from caffeine. These research findings are intriguing, but still need to be proven.

              Limited evidence suggests caffeine may also reduce the risk of the following:

              Parkinson’s disease
              liver disease
              colorectal cancer
              type 2 diabetes
              dementia

              Despite its potential benefits, don’t forget that high levels of caffeine may have adverse effects. More studies are needed to confirm both its benefits and potential risks.

              http://www.webmd.com/diet/caffeine-myths-and-facts#1

              And I don’t use caffeine, so I’m not defending my own habits. But I’m not going to have anyone peddling faddy and fact free health extremism.

              Reply
                1. Yves Smith Post author

                  Some energy drinks have as much as 250 MG of caffeine. A large coffee can have as much as 300 MG. A Mountain Dew would be less than 100 MG. At the tops, he could have had the equivalent of six cups of coffee. In two hours, that could really mess you up (as in drive your blood pressure low and speed up your heart rate). I’m told runners actually often have irregular heart beats, which seems counterintuitive. It’s also possible that whatever energy drink he had had poor quality controls and he got a really high dose of caffeine (this happened in Australia with some dietary supplements, people died because the dose of the active ingredient was too high).

                  In other words, the equivalent of three cups of coffee, even in two hours (which is the dose this would appear to be) shouldn’t kill anyone, even someone young. That suggests something else was going on, either a weird genetic weakness or another factor. Caffeine degrades pretty quickly in your system so they probably could not measure how much he got via an autopsy.

                  I was going on the Wikipedia level of toxicity, but yes, 10G seems too high. I know someone in college who wound up in the infirmary for having some diet cola and then drinking a pot of coffee while cramming. Not a fatality but messed him up for a day.

                  My best guess would be he was also taking ephedra. It’s not legal to sell in the US but it is legal to buy, so you can get it from Canada. Body builders take it with caffeine because it’s a thermogenic, as in elevates your metabolism and helps them get that “cut” look. It is super synergistic with caffeine, like 1+1 = 5 or more.

                  Reply
          2. From Cold Mountain

            I want to add as well that both fluoride and caffeine are treated as xenobiotics by the human body and are metabolized by the liver. They are poisons by definition.

            Reply
            1. Yves Smith Post author

              What tripe. You imply that coffee is dangerous when it is actually beneficial to the liver.

              Whereas the data on a potential procarcinogenic effect in some organs remained inconclusive, epidemiology has clearly revealed coffee drinkers to be at a lower risk of developing cancers of the colon and the liver and possibly of several other organs. The underlying mechanisms of such chemoprotection, modifications of xenobiotic metabolism in particular, were further investigated in rodent and in vitro models, as a result of which several individual chemoprotectants out of the>1000 constituents of coffee were identified as well as some strongly metabolized individual carcinogens against which they specifically protected.

              http://www.greenmedinfo.com/article/coffee-may-exert-its-chemopreventive-properties-through-metabolism-and

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              1. frankjr

                I would be careful Yves…my father had Huntigton’s and in my research I found that coffee can speed up the age of onset.

                http://www.movementdisorders.org/MDS/International-Congress/Past-Future-Congresses/15th-International-Congress/15th-International-Congress-News-Releases/Caffeine-shown-to-influence-age-at-onset-of-Huntingtons-disease.htm

                “This abstract suggests that onset is earlier in subjects whose intake over the prior 10 years was greater than 185 mg/day (about 2 cups of coffee) compared to those whose intake was less than 185 mg/day.”

                Reply
                1. Yves Smith Post author

                  I hate to tell you but this study is garbage. Studies of retrospective recollections of consumption over long period of time are fabulously unreliable. The only studies of this sort that are considered to be any good are of nurses who have been enlisted to record on a daily basis what they consume over long periods of time (literally decades). Nurses have low fallout rates in these studies and have high compliance rates in their record-keeping. And even then you have sample bias because nurses are overwhelmingly female.

                  Another issue in a study like this is the participant propensity to provide answers that they think the researchers want them to provide. That is why double-blind, placebo controlled studies are the only ones considered to be reliable. There is tons of psychological research that shows that participants are highly sensitive to investigator predispositions and seek to please them. And this is not conscious.

                  Finally, even allowing for the above issues, 80 is too small a sample to conclude anything. You need a minimum of 100 in the test group and 100 in the control group to reach any statistically valid conclusion.

                  Reply
                  1. frankjr

                    Yves, I do not understand your response. I only linked one study for brevity. Did you do a more in depth search before you responded? I do not think these studies are perfect, but they often provide clues. Through studies like this they have found that adenosine receptor agonists might be helpful to halt HD.

                    As you can imagine, I spent some amount of time studying this and talking to specialists about it.

                    Reply
    2. Anon

      Speaking to the oral microbiome concept. My dentist now recommends using baking soda w/toothpaste when brushing. It raises the pH around the gum tissue and reduces acidification of tooth calcium. Seems to work, for me.

      Reply
      1. Yves Smith Post author

        One issue seems to be that merely cleaning and maintaining teeth doesn’t do anything for gums, contrary to prior beliefs. You need to floss and potentially use other methods like a water pic. I recently started swishing coconut oil in my mouth for 20 mins a day (you need to do it on an empty stomach, so before you go to bed or when you get up is best). The results were astonishing. I don’t have gum problems yet in two days my gums became smaller and firmer right next to my teeth. And it’s whitened my teeth and evened out the coloring of my fillings and crowns compared to my own teeth, something bleaching didn’t do. The coconut may actually be staining everything to that white coconut color rather than bleaching, but regardless, the results are noteworthy.

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        1. Banana Breakfast

          There’s not much evidence that home flossing is effective at all, nor that toothpaste has any beneficial effect over just brushing with water. The state of dental health research is bad to say the least, with heaping doses of corporate funding and outright fake research a la the petroleum industry muddying the waters of what is effective in favor of “what moves the most product”. Emerging DNA sequencing evidence from pre-Neolithic dental plaques indicates that the oral microbiome was a lot less dangerous back then. The industrial revolution dramatically shifted the population of bacteria in human mouths towards cariogenic s. mutans bacteria even further. Recovering that bacterial balance, both gut and mouth, is going to be more complicated than eating “probiotic” products and will likely take a major shift in human diet.

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        2. From Cold Mountain

          My story; My father had really bad gums. So did I. They used to bleed every time I brushed. I started taking high dose riboflavin (for me it lowers oxidative stress). My gums are fine now.

          I have had several cavities and root canals as a child. Today and for the last 10 years, I do not brush with fluoride toothpaste nor do I drink fluoridated water (I have a fluoride sensitivity that makes my lips turn bright red). I have not had a cavity in the last 15 years and I go to the dentist once every five years.

          Coconut oil will change the microbiome for sure. Many people do not realize that a lot of yeasts live on fat, so change the type of fat and you change the microbiome. Also, the polyphenols in coconut oil are antioxidants.

          And yeah, flossing is a myth in regards to gum health.

          Reply
          1. Yves Smith Post author

            I have recently taken to using a “brush-pick” to clean between my teeth (not the soft bristle kind, this one is kinda hard). Unlike floss, you of course push sideways (not down) and my teeth are closely spaced enough that it scrapes the side of the teeth, and so may be reducing plaque. It logically ought to do so better than floss.

            Reply
  6. marieann

    I grew up in Scotland in the 50’s. While dental care for children was covered my Mum could not afford the bus fare to get us to a dentist. There were no dentists in our little town, I do remember a doctor pulling out 2 rotted back teeth when I was around 5. We also did not have toothbrushes or toothpaste…those also cost money.
    By the time I was 15 all my front teeth had holes in them. It was not until I was 17 that my boyfriend (now my husband) took me to a dentist.
    After we came to Canada I spent an enormous amount of time and money at the dentist.I finally had my 6 front teeth pulled when I was 24 after frequent abscesses and root canals.
    We did not have any dental insurance until I was nearly 40, thank goodness my husband had a good job and we lived very,very cheaply.
    I don’t know if we had fluoride in the water, but we never had any sugary drinks/foods growing up, just no dental care.
    Now at 67 I have ongoing dental issues, we have some coverage about 40% so a crown costs $600 instead of $1000 Thank goodness we can afford that.
    When I read the stories about what folk go through to get dental care it breaks my heart

    Reply
    1. paul

      Grew up in scotland in the sixties unfluoridated, annual visits to the local dentist. Eventually, I suspect out of frustration on the dentist’s part, I got two minor fillings at about 10 years old. I felt at the time they were unnecessary and I haven’t visited a dentist since. Still got all my choppers (and the fillings).

      My better 50% had the misfortune of having an uncle who, as nhs dentistry was paid as piece work, ruthlessly excavated for those fees, and she ended up with more mercury amalgam than teeth by the time she was an adult.In the thirty years we’ve been together she’s never been to the dentist either,voluntarily or out of necessity.

      It is, like many health issues, very much the luck of the draw, and that can vary dramatically within families. A friend, for instance, spent much of his youth in the local dental school while his brother did not.

      I do not have any problem with responsible dentistry, which I would classify as the least intrusive/destructive approaches. The friend I mentioned above benefitted greatly (mainly psychologically) from having veneers on his rather grotesque china.

      Fluoridation has several problems, its medical intervention without consent, a convenient way of disposing of chemical waste, what benefits it conveys are topical rather than nutritional. If you think it works,apply it through toothpaste, I’m not sure there is any proven pathway to deliver it to your teeth through ingestion.

      However that is just my opinion

      Reply
      1. marieann

        Where I live in Canada had Fluoride in the water up till about 5 years ago. I haven’t formed an opinion on it as I continued to have fillings over here and now it is crowns as my teeth are not in good shape.
        So fluoride didn’t help me as an adult. My husband has great teeth his first filling was when he was around forty. We both grew up in the same area.
        Sometimes I think teeth health are all about heredity.

        I make my own toothpaste now and I don’t think I’ll add fluoride to it :)

        Reply
          1. TheCatSaid

            This is not your area of expertise, so be careful!

            Your personal experience is not something that could or should be appropriately generalized to an assumption of 1) what caused your personal dental issues; 2) what relationship absence of fluoride may or may not have played in your dental health; and 3) whether or not fluoride is a generally beneficial thing to add to water or to dental care products.

            I am a qualified and experienced healthcare professional.

            I value your opinions on the topics on which you have knowledge and deep experience. While you do have more experience with your unique mouth than anyone else on the planet (!), your comments on this post & thread remind me of times you & Lambert have warned against an expert commenting on areas outside their area of expertise.

            Reply
            1. Yves Smith Post author

              I have had enough dentistry (a dentist in Australia said to me, “You have the entire history of dentistry in your mouth”), grilled enough dentists, and done enough research that this is an area of expertise of mine. And the statement about when it is critical to have fluoride is factually correct. Dentists push fluoride washes and whatnot on adults when there’s no proof of benefits in adults, save in-office fluoride treatments which may make a difference, but the other stuff is hype:

              http://www.rdhmag.com/articles/print/volume-36/issue-7/contents/topical-fluoride-for-adults.html

              Note I haven’t looked at the underlying studies. A lot of studies are dubious by virtue of not having large enough sample sizes, not having a control group, and not having the study run double-blind, placebo controlled.

              And in general, dentistry is lousy in terms of the research underpinnings for their recommendations. An academic MD contact says it’s where medicine was circa 1960. One of many examples: it used to be standard practice to use screws in the posts in root canals where you needed a post to anchor the restoration. They’ve now found out those screws produce cracked. When that happens, the tooth will have to be extracted.

              Ironically, private insurance forced conventional medicine to become more scientific since the insurers wouldn’t pay for treatments that didn’t have some evidence of efficacy. Even so, another medical research expert says, “Medicine is a medieval art.”

              Second, it’s very well established that fluoridated water made a huge difference in dental health in America, to the degree that it’s radically affected the economics of the profession. Dentists used to be assured a good living cleaning teeth and doing fillings. Most had a five day a week practice when I was a kid (and remember I lived in tons of different communities). You can confirm that if you speak to any retired dentist. The generational improvement in teeth in areas with fluoridated water has mean most dentists do a fair bit to a lot of cosmetic dentistry. Saying fluoridated water has made a big difference is an utterly uncontroversial statement.

              Reply
          2. Heraclitus

            I’m not sure about that, Yves. Hurricane Hugo took out our city water system when everyone in our household was an adult and we used a well for twenty years afterward. We all got more cavities, whereas since we went back on city water, we’ve had no more. It took me a long time to realize why we were getting cavities.

            Reply
  7. jfleni

    While jumped-up-generalisimos and their Repug buddies scream for even more defense dollars, the starving, jobless, toothless rabble gets shafted again and sgain! Its not just insane, but deranged, and completely unknown elsewhere outside Somalia!

    Reply
      1. Anon

        Didn’t Kentucky vote overwhelmingly for Trump? Isn’t the leader of the Senate from Kentucky? What are these dental disasters thinking about in the voting booth? (Maybe the tooth pain keeps them out of the booth?)

        Reply
        1. Big River Bandido

          Hillary Clinton not only campaigned against single-payer, she belittled the idea and the people who favor it. In Iowa, no less. It’s not rocket science why so many Democrats wouldn’t bother to come out for her at the polls. People get pissed off when you mock their values, especially when those values have been central to your party’s identification for generations.

          Reply
      1. Darius

        I once worked with the nephew of a well-known bluegrass musician from Tennessee. His favorite breakfast was Loops and Dew, Froot Loops with Mountain Dew instead of milk. We all got a kick out of that. I like Loops. I like Dew. But I draw the line at Loops and Dew.

        Reply
      2. rps

        abcnews writes, “Mountain Dew seems to be used as a kind of anti-depressant for children in the hills.” “Seems” is the operative word passing the buck onto the children who “seem” depressed instead of addressing addictions to high fructose/caffeine sodas produced by PepsiCo. These sodas sugar and caffeine levels intentionally target the brain’s addictive centers also known as the “bliss” point.

        Same think logic of the tobacco industry, smoking cigarettes doesn’t cause lung cancer- its seems to be used as a kind of anti-depressant. As they raise nicotine levels to ensure addicts for life.

        Reply
        1. Vatch

          I think the parents deserve some criticism. Even if a family can’t afford to go to the dentist, they ought to be able to brush their teeth and the teeth of their young children. From the ABC News article:

          Smith says he’s seen firsthand the results of neglect among these children. Teenagers have pulled their own teeth with pliers because of tooth pain, and he’s treated 2-year-olds with up to 12 cavities in their baby teeth.

          Reply
        2. jrs

          I think it’s more likely to *cause* depression, even excess caffeine might for some people. But also the sugar crash from soda has to be considered, not to mention all the other garbage in soda.

          Reply
      3. Edward E

        In the Ozarks​ we sometimes have what’s called Sam’s Choice mouth. Maybe more often referred as Cott ‘n mouths or Walton’s rotting toofers. Re Cott Beverage.

        My dentist crew gives prescription fluoride toothpaste to be used right before sleep and left without rinsing. We pretty much only drink natural spring water from trusted source, the best tasting water.

        I’m a grinder, but pretty much quit colas and tobacco. Hopefully

        Reply
  8. JEHR

    When my mother told me about her going to the hospital to have all her teeth pulled out at once (!!!), I made a vow to look after my own teeth even going so far as getting my own dental appointments as a teenager. I have moved around the country a lot in my life so have not enjoyed water fluoridation during some of that time. Even though I was very aware of the need for good dental health, I still unnecessarily lost some teeth: two impacted wisdom teeth and two others.

    When I was younger, dentists would often prefer to pull teeth rather than fill them.

    Early and continuous education regarding brushing, flossing, fluoridation, and eating properly does make for vastly better health overall.

    All human beings should have free access to dental education and/or dentistry.

    Reply
    1. JohnnySacks

      It appalls me to hear some of the CT rants against fluoridated public water supplies. What an ignorant way to ruin your children’s future and/or saddle them with a lifetime of pain, stigma, and cost. We grew up on well water and I still remember having to take our daily fluoride ‘tooth pills’, otherwise I can’t imagine what the state of my teeth would be, especially after the damage of several years of working at a job in my teen years where we drank a lot of free soda. Another case where the government SHOULD take an interest and at least attempt to do something to reduce the externalized costs of of consumption of health damaging products.

      Reply
      1. TheCatSaid

        Sounds like you’re not familiar with the history of how fluoride came to be used and added. It had to do with money, and that financial history would be a more fitting topic for NC.

        Reply
  9. Vatch

    If we had a rational system of government, Senator Mitch McConnell of Kentucky would make this a huge priority.

    Reply
  10. dk

    It should be noted that sugary drinks/foods impact dental health not only in the mouth, but afterwards from elevated sugar levels in the bloodstream. Bacteria in infected sites derive sustenance from elevated sugar levels in blood and surrounding flesh.

    I found that completely eliminating sugar from my diet could reduce or eliminate dental pain (in 12 hours or less). This allowed me to continue to function (and earn) while delaying the financial impact of dental care.

    Reply
  11. Beans

    Dental Medicaid is by and large a conduit of $$ from the government to corporations and PE groups that own dental businesses. The fraud and overtreatment in pediatric dental medicaid has been well documented at Dentist the Menace blog and takes very little effort to find well documented evidence throughout the USA.
    The answer is not more Medicaid or expansion – it isn’t that simple. Regulation and oversight, prosecution of existing Medicaid fraudsters, removal of Private equity from the dental business all would have to go hand in hand with governmental expansion of Medicaid dental care for it not to be simply a new way to enrich the 1% at the expense of the poor/ struggling.

    Reply
      1. Mike

        Right on, Lambert – and to think, those Russkies have graduated from gunking up our bodily fluids to jamming up our programming “fluids”. Smart, AND they’ve advertised, so we know it’s them what is doin’ it.

        Reply
    1. Mike

      Appalachia does have a higher rate of flouride treatment, but it is concentrated in urban/suburban sectors (small towns, areas close to TVA development), and this is recent compared to other areas outside Appalachia.

      The third leg of this crime, in addition to poor health care and sugary drinks, is the wholesale pollution of streams and groundwater (which feeds into wells) that is the product of DT’s favorite industry. Coal has given jobs and the resultant wages that failed to cover the deleterious effects it brought to the region.

      I had grandfathers grossly injured by the polluting industries they worked in (black lung in one, metal poisoning the other). If industry ran as it did before WW1, they’d still be importing labor at the rate they did then – to replace the dead and debilitated. We are both lucky and cursed by a system that bred growth and death at the same time.

      Reply
  12. MonSov

    100% free, government run dental schools are of course one of the main solutions here. Same of course goes for doctors and veterinarians. The schools themselves provide some care as well with government run small clinics everywhere else.

    A monetarily sovereign government which forces people to pay a single cent for education, healthcare or basic survival needs is not only illegitimate but immoral too.

    Reply
  13. rps

    I had watched Australian director Damon Gameau’s 2014 documentary “That Sugar Film.” He visits Appalachia, where mountain dew- caffeine/high fructose syrup junkie effect destroys lives. And its generational- it starts with baby bottles filled with mountain dew. By nineteen, your teeth are rotted.

    Gameau embarks on a unique experiment to document the effects of a high sugar diet on a healthy body, consuming only foods that are commonly perceived as ‘healthy’ for 6 weeks. He needed to eat 40 teaspoons per day of sugars which is the average amount consumed. I thought I was careful watching my sugar intake, diligent about avoiding high fructose and reading foods labels. Ha-, beware of all processed ‘healthy’ foods. The effect of these sugars on the body’s functions and systems are disastrous.

    The worse part are the premeditated actions of the food industry infusing toxic sweeteners at the right levels to produce the “bliss” effect in our brain’s addiction center. Yep- food junkies generated by the drug dealing food industry.

    Reply
  14. Arizona Slim

    One of my pet peeves about dentistry: Selling you services that you don’t need.

    Happened to me a few years ago. A local private practice urged me to have a deep cleaning. Cost was around $650. That’s a lot of wampum.

    So, I went to the community college dental hygiene clinic for a second opinion. Bot the student hygienist and his instructor said that I didn’t need a deep cleaning.

    More recently, I’ve found myself on the receiving end of sales pitches for mouthguards that are worn at night. Cost: $700 for what are, in essence, two pieces of plastic.

    Now, if you tell these salespeople, er, health professionals, that you can’t afford this stuff, well, look out. Here comes the pitch for financing via Care Credit. Which has a 27% interest rate. Yup, you read that right. A whopping 27%.

    Reply
    1. jrs

      yea it’s all true, xray techs have told me I don’t need as many xrays as the dentists says and that far fewer would do the job. So great radiation exposure that’s not needed just to pad the bottom line. I’ve been told I have cavities and need a bunch of drilling by one dentists only to be told I don’t have any cavities by a more senior dentist (otherwise I would have had a bunch of unnecessary drilling, maybe I already have in life, maybe everyone who has “regularly gone to the dentists” has had some drilling that didn’t need to happen). A bad dentist basically ruined my dad’s mouth. It’s better to err on the side of overtreatment, than not seeing the dentist and having ones teeth fall out for that reason though. Certainly if one is in pain they obviously need to get to the dentist, just regular checkups will lead to overtreatment, which might be better than undertreatment.

      Reply
    2. Yves Smith Post author

      “Deep cleaning” sounds like a euphemism for scaling. That’s what they do if you have early stage periodontal disease. You have enough large enough pockets around your teeth that normal cleaning won’t get at all the exposed enamel. So they numb the gum tissue and then clean below the gum line.

      I grind my teeth when I sleep, and I would not underestimate the value of getting bite guards. It’s not good even if you have good teeth, and the grinding shortens the life of fillings. My dentist told me to get one at a sports store, because if you can tolerate sleeping with one (they are bulky) they are a ton cheaper. You used to be able to get them for $1.50 or $1.99, but now the sports folks seem to have figured out the dental application, and I see the same sort of thing in my drugstore for $15 and up. And suddenly the athletic bite guards are very hard to find at sporting goods stores.

      Reply
      1. Blennylips

        You might also consider an anti-snoring device. A decade or so ago I had a relationship ending level of snoring. I was pointed at a snorban (??). You fit by soaking in hot water and then bite down and mold it while it cools. To stop snoring, you hold your lower jaw slightly forward while it is setting. Worked wonders for me — we did not split because of snoring at least:) YMMV

        Reply
    3. ChrisPacific

      I was on the receiving end of both of those recommendations as well and was similarly suspicious, but I’ve found both to be good value in the long run. It turned out I had periodontitis, which was more serious than I realized at the time. I am now stuck with a more involved daily routine and a more comprehensive cleaning at checkup, but seem to have avoided other complications or long term health issues as a result (there can be many).

      I have noticed a tendency of US dentists to over-treat, and the quality of care seems a bit more uneven than in other Western countries (and the good ones tend to be very expensive). At the time I left the country, I was on a 3 times a year cleaning schedule, which they were trying to get me to increase to four. My new dentists in New Zealand announced that this was unnecessary and they were moving me back to twice a year, and they have kept me in better oral health on that schedule than any of the US dentists did.

      Reply
  15. SubjectivObject

    The sugars (any of them) feed bacteria that produce acids as a metabolic waste.
    Carbonation adds carbonic acid to the mix.
    I have “weak” teeth”, had early frequency of dental visits, my teeth are permanetly yellowed from an early age, am missing two molars, but
    I religiously brush with original Listerine (generic of same alcohol content good too) to beat back the offending mouth cultures, and it appears to work as I have for the 30 year duration now have had no further new dental issues (excepting replacement of existing and grit and cherry pit traumas).
    To good effect, I have recommended the Listerine routine of brushing/flushing to others including children with tooth aches, and the aches go away after the source of acid is stopped.
    I have used chewing raw comfrey (prickly stuff though), keeping the masticated pulp/juice in the mouth, to beat back an abcess without medical intervention.

    Reply
  16. MBC92028

    I grew up in CA and grew up on flouridated water. Now live in OR, where water is not flouridated. When I go to the dentist they take one look in my mouth and know immediatley. I did not grow up in Oregon. We have been giving my daughter flouride pills her whole life.

    Reply
  17. kareninca

    The article mentioned free clinics, but it did not name the organizations that run them. Here is one: Remote Area Medical (https://en.wikipedia.org/wiki/Remote_Area_Medical) They go out to “remote” areas in the U.S. and provide people with glasses and dentures and other vision and dental help. I donate to them. No, they aren’t the big picture answer at all, but a set of dentures can change someone’s life today.

    If you know someone who needs this help, here is a schedule of their upcoming clinics in Memphis Tennessee (Memphis is this weekend!!), Virginia, Texas, Oklahoma, South Dakota, and so on: http://ramusa.org/events/

    Reply
  18. robnume

    Thanks for all of the links on dentistry today provided by the commentariat and a big thank you to Yves for covering this important and all too neglected subject.
    I worked for a plastic surgeon years ago and I once asked him what he considered to be the worst food item consumed by people as far as his own practice was concerned. Without any hesitation whatsoever he stated that drinking soda was the worst thing a person could do to their body. I was very surprised with his “quick as I could ask the question” answer.
    I have had the experience of going to a dentist who cared far too much for his own personal wealth at the expense of his duty of care to patients. This dentist, who had just acquired real fancy schmancy, and probably extremely costly, office space told every family member that I had seeing him that they had fractured molars. Every single one. Naturally, they would need crowns, root canals, bone grafts – bone grafts are expensive and are generally not covered under most dental plans – and so on.
    Like Lambert and Yves say, grifters gotta grift.

    Reply
  19. KFritz

    “US’S insane Approach to Dental Care”

    Exhibit A: Standard health insurance and Medicare don’t cover dental.

    Reply
    1. Jim Haygood

      In the eyes of the American health care system, the mouth is separate from the rest of the body.

      This arose because of two different professional guilds (doctors and dentists) carving out their own jurisdictions. Then health insurance, and later Medicare, entered the picture:

      Medical insurance was designed specifically to cover large, unpredictable expenses, while dental insurance was and is intended to fund predictable and lower-cost preventive care. While protection from catastrophic medical costs was perceived as a necessity, coverage of dental services, from its origin, was conceived as a benefit.

      Both the American Dental Association (ADA) and the American Medical Association (AMA) were founding members of the Joint Council to Improve the Health Care of the Aged, one of the most powerful voices of opposition to Medicare. The AMA did not achieve its political goals in 1965, but the ADA did, and dental coverage was excluded from Medicare.

      http://journalofethics.ama-assn.org/2016/09/pfor1-1609.html

      Salvatore Durante DDS of Brooklyn NY rails against Medicare dental coverage:

      Fixed fees and giant steps toward total government control of the profession have occurred — in medicine. But they have not occurred in dentistry, yet, because we have escaped government funding through Medicare; “basic” dental benefits are still excluded from Medicare.

      The economic and political evidence allows for only one conclusion to be drawn: the only rational policy for organized dentistry is active opposition to government funding.

      http://doctordurante.com/wordpress/medicare-what-it-did-for-medicine-it-can-do-for-dentistry/

      Reply
  20. clarky90

    (1) I eat a Ketogenic diet (80% fat, 10% protein, 10% fibrous carbs) and no teeth problems since I started. We did not brush our teeth for a gazillian years in the past. Why now? It is not just the Mountain Dew. It is also, the $80 wine and the Schwarzwälderkirschtorte (Black Forest Cherry Torte). Refined carbs are refined carbs, bought at the 5 and Dime, or at the French Patisserie.

    (2) Oil Pulling, using coconut oil is a miracle!

    I do this. I enjoy the ancient, multicultural weirdness of it! This is a good conversation topic if you get sick of politics, or want to change the subject away, quickly, from politics. You can thank me later!

    https://wellnessmama.com/7866/oil-pulling/

    “Put 1-2 teaspoons of oil into the mouth…. organic coconut oil…
    Swish for 20 minutes. Apparently the timing is key, according to Dr. Bruce Fife, author of Oil Pulling Therapy, as this is long enough to break through plaque and bacteria but not long enough that the body starts re-absorbing the toxins and bacteria. The oil will get thicker and milky as it mixed with saliva during this time and it should be creamy-white when spit out. It will also double in volume during this time due to saliva. At first, it can be difficult to make it the full 20 minutes, and I didn’t stress if I could only swish for 5-10 minutes when I first started.

    Spit oil into the trash can. Especially if you have a septic system like I do… don’t spit into the sink! The oil may thicken and clog pipes. Do not swallow the oil as it is hopefully full of bacteria, toxins and pus that are now not in the mouth!

    Rinse well with warm water. Warm water seems to clean the mouth better (my opinion). I swish a few times with warm water to get any remaining oil out of my mouth. Some sources recommend swishing with warm salt water.

    Brush well.”

    Reply
  21. Jeffrey

    This article is remiss without noting the extraordinary cost of dental school. Have you looked recently what dental school costs? Check out NYU (I did because it’s close to me): Tuition and fees for the incoming class: $87,000. That doesn’t include living expenses of about $34,000. So that’s $121,000 for one year. Borrow for four years and you’re $500,000 in debt!!!
    Of course NYU is expensive, so I checked U. of Kentucky. Resident tuition and fees: $44,000. Living expenses: $27,000 for living expenses. So that’s $71,000 per year and about $284,000 for four years.
    The bottom line is that if you borrow anywhere near these ungodly sums of money to attend dental school, you’re likely looking to practice cosmetic dentistry on Park Avenue instead of treating poor kids in Appalachia.

    Reply
    1. Sue

      “$500,000 on debt” . My town orthodontist yearly profits are a multiplier of that. Uniformized aesthetics and school peers’ bullying are his office crowding force. BTWY kids must get their braces before their puberty years to avoid serious stigmatization. Neither all dental businesses are created equal, nor all dental matters are alike.

      Reply
  22. Sue

    I am very much an American outlier. When one’s positive comments on a third-subject’s smile go along this forever heard line, “she has a nice smile”, it unequivocally matches the picture of white acrylic brush painted teeth and straight perpendicular lines. I find behind an untimid natural smile which unveils imperfect teeth the deepest and most interesting of the souls. Rest assure this does not have anything to do with pyorrhea or terribly sick teeth.

    Reply
  23. kareninca

    There are teeth, there are gums, and then there are the bones underneath. I’ve had excellent dental care all my life, and fluoride when young. But – the bones underlying my lovely teeth and lovely gums (which do look naturally nice) are rotting away. It’s progressive inflammation. It’s heavily genetic. Nothing to be done about it, really. I’m 53, and am expecting dentures by the time I’m 60.

    The same thing happened to my grandmother, who was a dental assistant and did all the right things; gorgeous teeth that then fell out almost all at once around age 48 due to the underlying bone going away. Really, people who strictly have tooth problems could have it worse; you can fix a tooth. At least my problem is cheap, since there is nothing much to do. We spend about $4,000/year on my husband’s soft teeth.

    Reply
  24. Heraclitus

    I have one bone to pick with the author of this fine article:

    The ‘Irish’ who came to these areas a hundred years ago or more are more likely ‘Scots-Irish’, who spent a hundred years or so in Ulster before immigrating to the US. They were Protestants. If this is not the case, I’d like to know it.

    Reply
  25. wilroncanada

    A couple of anecdotes:
    I recall a couple of experiments/demonstrations by teachers in elementary school. One teacher put some rusty nails in a dish of cola; the next day the rust had been removed. another teacher put a piece of beef in a bath of cola; within a few days (I’m not sure how many) the meat had disappeared.

    We drove south to Washington state one year, in the late 1980s when my children were in their teens, to visit my wife’s cousins and their children. Their girls were older, 18 to 22. When we went into their kitchen for breakfast the first morning, we discovered they kept no milk for cereal. They drank soft drinks (sodas for USites) for breakfast, lunch, and dinner.

    I did not look after my teeth, either as a child or as an adult. Consequently, at 65, even though I had very hard teeth, I had to have the last of them pulled in favour of dentures. We made sure, on the other hand, that my daughters looked after their teeth. I had a company dental plan for just a couple of years, but made sure my wife and 3 girls had their checkups (all I could afford) throughout the girls’ childhood. It included fluoride “painting” as part of the checkups. Incidentally, we lived on an island, with well water, for fifteen years. They are now between 39 and 43. None of them has ever had a cavity.

    When I had the dental plan, our dentist tried to sell us on the idea of braces for two of the girls, to prevent overbite and more expensive orthodontics later. (I had a severe overbite. Just call me bucky; other kids did.) We said no, until they had grown. They developed perfectly straight teeth as later teens and adults.

    Reply
  26. Stephen Douglas

    I, too, have an entire history of dentistry in my mouth. But I have something additional that I do not believe that you have, Yves: an entire history of the state of dentistry in the United States in my mouth.

    Since the age of about 7, when on my first visit to a dentist I was diagnosed with 10 cavities (and, in those days, it was believed that children were harmed by novocaine, so my cavities were removed and filled without anesthetic) to my first root canal at age 21 (I have had 7 more since) to braces in junior high (and the acoompanying bicuspid extractions that were common theory at that time in orthodontics), gum disease, curatage, wisdom tooth extractions (still have one left), crowns on almost every tooth, veneers on one, two implants, re-crowns, several more extractions in middle age due to being poor and not being able to root canal the teeth that were already too far gone. And there are more I am not mentioning here.

    I’ve been worked on by 5 different dental colleges and schools (from NYU Dental to UCSF to UOP), under private plans, under Medicaid, under San Francisco County clinics and the County General hospital, private for-profit clinics, MediCal, cash-only dentists, Mexican dentists, Iranian dentists, bad dentists, good dentists, kind dentists, mean dentists. The implant dentists are the most profit-oriented. I’ve been to 4. They have dedicated staff solely to find out if you have the money and to get it first and foremost (even if you are a childhood friend of the dentist).

    I have endured months and sometimes years of nearly unbearable pain when being in situations where I could not get the dental care I needed to solve a particular problem. For example, I went for nearly 5 years with a wire digging into my tongue 24/7 from a fix a NYC dentist did to try to keep a shattered shard of a middle bottom front tooth in place (a bridge was out of the question for that period of time).

    I finally discovered two things that have brought me to the state of stasis and bliss I am in today, and flouride is not one of them. The first is dentists in countries other than the United States. Dental work of all kinds, done professionally and competently is from 1/10th to 1/6th the US cost in Mexico. In other countries (Thailand, India) it is even less. Many of the dentists in those countries were trained in dental schools in the United States. But doctors and dentists are treated differently in those countries and looked upon as just another service provider. They must price according to what the market will bear in order to have patients.

    That’s why you have people taking dental “vacations” if they can possibly do it. I have been able to do that and was finally able to fix some long-standing problems once and for all.

    The other thing I have discovered is Vitamin D and magnesium intake. First it was the D. I could not believe what taking it did to my bone structure in my mouth. Everything strengthened, and believe me, up until then, I didn’t have the underlying strength in the jaw to get certain finish procedures finished (look up a Maryland bridge for further info, as one example).

    Magnesium was the final ingredient though.

    It’s difficult to absorb correctly, but if you get even some absorbed in combination with the Vitamin D, your teeth become practically impervious to Mountain Dew and other sodas (Coca Cola was and is my favorite). Plaque is history too as your mouth chemistry changes from the use of that vitamin and that mineral.

    This is a good article, thougth I don’t think the writer needed to focus on Appalachia: the entire dental mess is throughout America and affects the poor and the aged everywhere there. My mother, in her 90s, who has very good supplemental medical (that they pay for) still has to pay thousands of dollars for any dental work at all. It’s just criminal the way dental is run in the US.

    And I used to be very vocal about it to the last few US dentists and implant dentists I saw, telling them, I would have to leave the country just to get dental care that I could pay for. They either ignored it or knowingly smiled or just shrugged their shoulders. Though I truly believe that if there was universal dental care in the US, the dentists would have more business and probably be remunerated even better than they are now, no dentist pushes for this. The system goes on and those that are insured or have savings are cared for.

    This is also the case, exactly the same, for eye care in the United States. Same system, same attitude, same outcome.

    The writer is dead on in showing how missing teeth affect your ability to earn and your social standing. People blame things like Mountain Dew and being a hillbilly and being lazy, etc. and treat you accordingly, their attitude toward you either overt or subconscious.

    Finally, on the flouride issue. I have a friend, about 20 years younger than me. Her teeth are gray. I asked a mutual friend of ours if she knew why. She said that in our friend’s community where she grew up flouride was used in the water. I guess that graying of the teeth can be a side effect. One thing I do know about flouride. It is toxic. The flourine molecule takes the place of iodine in the body (bromine, found in breads and sodas, does this, too) and contributes to poor health.

    Finally, sodas make you fat and can bring on assorted ills related to bromine and sugar or aspertame intake, so I don’t drink them any longer. But if you change your mouth chemistry via Vitamin D and magnesium intake, worrying about Mountain Dew mouth can be the least of your worries.

    Any single-payer system instituted in the United States must also include dental and eye care. Both are integral to overall health.

    Reply
    1. SubjectivObject

      Particular D# vitamin?
      Particular magnesium mineral type/Mfgr/brand?
      Thanks.

      Re greying/yellowing of teeth, keep in mind the potential for a significant genetic predisposition.

      Reply

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