The gap in our teeth | DD Guttenplan

It is shocking how much the state of someone's smile still reveals about their class

When you hear the words "class struggle", do you reach for your toothbrush? You should. According to a report on adult dental health released this week by the NHS, one adult in 10 in Wales has none of their own teeth left. Not one. The figures are slightly better for England and Northern Ireland – the report was ominously silent about Scotland – but the average British mouth is still missing upwards of six teeth.

As an American, I should be laughing at this. We are famous for our dazzling choppers. The British are not; I have heard a fellow American describe an unwelcome suitor as having "British teeth". There's even a website that displays pictures of dentally challenged British celebs. And although you may sneer at me – through yellow, decayed, gappy teeth – for peddling stereotypes, you may consider it a small recompense for the years of having to admit that a majority of Americans did vote for that idiot in the White House – at least the second time round.

Yet I'm not smiling – maybe because, like a lot of less wealthy Americans, I never went to a dentist as a child. I vaguely remember being examined by a visiting dentist at school. Many of my friends endured the torment of braces. My own overbite, my parents assured me, was charming. In our family a visit to the dentist was for emergencies, such as my father's root canal or my brother's impacted wisdom teeth. Our tap water was fluoridated (in Britain only 10% get fluoridated water) and we were encouraged to brush often, which may be why I still have all my teeth. But I recall the embarrassment when, as an undergraduate covered by the student health plan, I went to the university clinic and had to have 10 fillings in one go.

So I wasn't surprised to read, lower down in the survey: "There was a clear socioeconomic gradient in the proportion of adults who had 21 or more natural teeth, ranging from 91% of adults from managerial and professional occupation households to 79% of adults from routine and manual-occupation households." And this is in a country where dentistry is still officially part of the National Health Service.

The US probably has the best dentists in the world (ask Martin Amis). But all that artistry doesn't come cheap (ditto). The US is also pretty far ahead in making a visit to the dentist less of a test of courage – at least in New York, where my friends are often offered a choice of drugs (laughing gas is popular, with Percodan for afterwards) and entertainment that wouldn't shame a first-class cabin.

Some British dentists are catching up – I watched Gladiator in a dentist's chair here a couple of years ago. But that was at a private dentist; I had spent my first 10 years in London being looked after by an excellent NHS practice but it didn't have a hygienist, and at 50 keeping my own teeth did not seem like a luxury.

In the US, as in the UK, a person's class is etched in their teeth. In his 1991 classic, Savage Inequalities, author Jonathan Kozol wrote: "Bleeding gums, impacted teeth and rotting teeth are routine matters for the children I have interviewed in the south Bronx." A report by the US National Institute of Health says poor children today are far more likely to suffer from severe baby-tooth decay "caused by frequent or prolonged use of baby bottles that contain milk, sugared water, fruit juice or other sugary beverages". The US has more celebs with perfect teeth simply because it has more celebs (and maybe more rigid standards of celebrity appearance). But US government statistics still show deep racial differences in dental health, and just as steep a class divide as Britain. That, rather than the space between our incisors, is a gap we should all mind.


DD Guttenplan

The GuardianTramp

Related Content

Article image
Why am I so furious about teeth? They are deeply socially divisive | Emma Beddington
The gap between those who can or can’t afford a dentist is widening. There is a three-year wait for NHS appointments – while the market for whitening and tweakments booms, writes Guardian columnist Emma Beddington

Emma Beddington

25, May, 2021 @6:00 AM

Article image
The PIP breast implant scandal shows the real cost of private health | Richard Horton

Richard Horton: The PIP implant scare exposes serious flaws in British medical regulation and NHS policy

Richard Horton

11, Jan, 2012 @12:10 AM

American healthcare is in truth already rationed | Bee Lavender

Bee Lavender: Growing up sick in the US, and being treated by a humane NHS here, has shown me that Britain's system is far better

Bee Lavender

16, Aug, 2009 @7:30 PM

Article image
Patients pull own teeth as dental contract falters
· Survey reveals lack of access to NHS treatment
· Around 50% say they do not understand fee system

Sarah Boseley, health editor

15, Oct, 2007 @11:05 AM

Article image
Dentists warn of child tooth decay crisis as extractions hit new high
NHS surgeons removed multiple teeth from under-18s in England a record 42,911 times in 2016-17, figures show

Denis Campbell Health policy editor

13, Jan, 2018 @12:01 AM

Article image
Surge in teeth grinding is linked to stress of recession

Dentists say financial sector workers are most likely to suffer from problem due to anxiety about future

Denis Campbell, Health correspondent

28, Feb, 2010 @3:57 PM

Article image
Sugar-free drinks and chewing gum may cause damage to teeth

British Dental Journal paper finds products contain acidic additives that can lead to the erosion of tooth enamel

Denis Campbell, health correspondent

10, Oct, 2011 @5:25 PM

Article image
Targets matter – because a day with cancer worries feels like a year | Christina Patterson
New research reveals that more than 130,000 people were not seen or treated when they needed to be. The only solution is a properly funded NHS

Christina Patterson

11, Nov, 2016 @7:59 AM

Article image
This satnav of the labour ward is driving us the wrong way | Annalisa Barbieri
Annalisa Barbieri: Birth monitors cost the NHS millions, and were never meant to replace a labouring woman's default help: the midwife

Annalisa Barbieri

15, Apr, 2011 @8:00 PM

Article image
Childbirth is as awful as it is magical, thanks to our postnatal ‘care’ | Marina Hyde
Marina Hyde: Giving birth in hospital these days is a hallucinatorily exhausting experience – and the cuts mean it’s about to get even worse

Marina Hyde

05, Dec, 2014 @3:24 PM