I grew up in Seattle, where my mother and I lived in a dilapidated apartment building on Cherry Street. When I was in elementary school, my classmates began showing up, one by one, with new metal contraptions in their mouths and those pretty colored rubber bands in their smiles. I wanted my teeth to be bright green, or red, or blue like theirs.
I remember telling my mother I wanted “those little jewels” that all the other girls had in their teeth. While we did discuss the possibility of braces—she probably nodded her head patiently and said “maybe”— I never got them. My mother was a nurse and a recovering alcoholic who struggled to save money and maintain the stability she worked so hard for after getting sober. She took me to the dentist once in a while, certainly not every year, to have my teeth cleaned; I remember I liked the way foamy fluoride felt in my mouth. That’s all I can recall of my childhood dental care.
Impoverished people—those with an income below 200 percent of the poverty level—rarely see the inside of dentist’s office. As of 2014, 180 million Americans didn’t have dental insurance , and 36 percent of Americans didn’t visit the dentist even once. One in five low-income Americans hasn’t had a teeth cleaning in at least five years. A 2009 study by the Kaiser Family Foundation found that poor kids are twice as likely to experience tooth decay than their higher-income counterparts. One-third of us experience untreated tooth decay between the ages of six and nineteen.
I never felt self-conscious about my teeth as a young child. No one ever teased me about the way my teeth looked. As far as I know, no adult ever chastised us about my lack of braces. I only became aware that my crooked teeth could serve as a class signifier when I was nineteen, newly arrived in New York, and surrounded by my wealthy classmates in the West Village. We all looked and dressed essentially the same the way; we all went to the same school—but their teeth were all white and straight. I didn’t have to say a word, I realized, for them to know I was not one of them. My teeth betrayed me.
In my last year of college, I’d heard about a NYU dental school program that offered poor college students who lacked dental insurance a chance to get cleanings on the cheap. When I went in for an appointment, I found out I had three cavities. The dental student noticed something curious during a routine X-ray: There were adult teeth that had never emerged, still stuck in my jaw.
The dental intern at NYU referred me to Jackson Heights Orthodontics, a practice close to my apartment in Queens. “Take care of your teeth this time,” she told me, as if I’d neglected them on purpose.
By then I was a graduate student; I still had no dental insurance. I signed up for a discount dental plan, which provided a slight drop in price for simple procedures like fillings, but Jackson Heights Orthodontics claimed they hadn’t heard of the plan. At my first consultation, one of the orthodontics assistants took new X-rays. Then she led me into a back office, where I sat down across the desk from a man just a couple of years older than me. He began pulling up color-coded spreadsheets on his computer. He explained that I needed braces because many of my bottom teeth were still baby teeth. They could make space for the adult teeth to finally come in.
It would cost three thousand dollars to fix the teeth that had been neglected in my youth. The young man pressured me to get another set of braces on my top teeth, for cosmetic reasons only. “Doesn’t a pretty girl like you want straight teeth?” he asked.
I held fast. I knew I would already be in debt for years to come thanks to the bottom set of braces. He offered to set me up with a payment plan.
When I talked with other low-income American women about their teeth, their stories were familiar. “I didn’t get dental care until I was twenty because of money,” a writer named Katie told me. “Now I have my own insurance. I have mixed feelings about getting braces as an adult, but I want them badly because I'm super insecure about [my teeth].”
Another woman, Sara, got adult braces in her thirties thanks to a Groupon. When she was a child, her parents couldn’t afford the braces she needed. “I was super self-conscious about my crooked teeth and ‘bad’ smile, to the point of learning to smile differently so that I could try to hide them as much as possible,” she said.
My mother gave me freedom in my childhood, and encouraged me to experiment and explore. She encouraged my love of thrift-store fashion, and we stocked up on recycled dresses and sweaters from Value Village. She never gave me a curfew because I maintained a 3.8 GPA in high school. I understood that academics, not aesthetics, should be my focus; that my teeth might one day mark me as an interloper never crossed my mind.
Growing up in Seattle, while I knew some families had more money than mine, the disparity never seemed so great; at most, some of my friends might wear jeans from Abercrombie, which my mother could never have afforded. I naively imagined most wealthy people were sequestered from the rest of the world, like celebrities, far from my daily life. When I moved to New York, I was shocked to discover what real wealth looked like, especially when flaunted. Until then, I had never been ashamed of my life with a mother who struggled financially and bounced between apartments, who bought me the knock-off version of Skechers at Payless. In my freshman dorm, where I lived with three girls who frequently spoke about debutante balls, “my parents’ driver,” and a Hummer that had been totaled, my slightly off-kilter smile immediately betrayed me as an imposter. At my first work-study job, the professor confirmed this: “You don’t look like someone who goes to Columbia.”
I spoke with a woman named Katie who similarly felt “socially disadvantaged” by her lack of braces. “The rich kids got braces. I didn't because [my family] couldn't afford it,” she told me. “I never had any sort of regular check-ups, and as a result feel uncomfortable navigating those systems because it never became normalized from me.”
Like her, when the time did come to address my oral health, I was forced to face what I had never needed to before: Just because I had worked hard to leave home and start a new life didn’t mean I had reinvented myself. My teeth seemed like the last barrier preventing me from entering the world of the privileged. And the only “solution” was money I still didn’t have.
For years, I had the same recurring nightmare: My mouth fills up with teeth. Rows and stacks of crowded, yellowed teeth. I can’t speak; my tongue disappears. My whole body is covered, with clumps of jagged squares taking the place of my skin. I lean over the sink and vomit a stream of them.
In her essay “Poor Teeth,” Sarah Smarsh writes, “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 . . . Often, bad teeth are blamed solely on the habits and choices of their owners, and for the poor therein lies an undue shaming.”
In 2016, the American Association of Orthodontics released a study showing that adults are seeking orthodontic treatment in record numbers. A separate study conducted by Wakefield Researchers for the AAO found that people “generally equate social and professional success with an attractive smile.” One-third of respondents “believed that with better teeth they could have a better social life, a better love life and a better job.”
Poor dental health can lead to serious medical problems, including heart disease; a recent study found that bacteria in your mouth could even spread to your brain and damage your memory. We have to take care of our teeth to be healthy, and most poor people without insurance can hardly afford to do that much.
But in many cases, people don’t go to the orthodontist out of true medical need—they go for cosmetic reasons. For women, the pressure to straighten their teeth is even greater than it is for men: Though only 1 percent of the population reported an orthodontist visit in 2008, women “had significantly higher odds” of looking into corrective treatments for their teeth. Young girls, too, can feel pulled toward orthodontic procedures even when they aren’t necessary, and are more likely than boys to want them. Sara told me that at first she thought getting braces past the age of thirty would be “stupid or vain.” Eventually she decided to do it, because she wanted to feel good about herself and “smile wide and proud.”
In American society today—and in every generation past—poor people have been expected to feel ashamed of their poverty, and do everything they can to appear less impoverished. Most dental insurance plans don’t cover orthodontic treatment for people over the age of eighteen, so in steadily increasing numbers adults are swallowing the cost of braces to avoid being sneered at for showing their under-privileged backgrounds. They live in a society that demands poor people feel ashamed for who they are, that makes them outcasts while expecting them to do everything they can not to appear impoverished. Straight teeth have become a conduit through which some measure their self-confidence, their self-worth in the eyes of the world. A quality education, a well-paying job earned and worked for, a family bonded by love—even if you have all these things, bad or crooked teeth can be a dead giveaway that you don’t really belong; that you snuck into the good life through the back door, uninvited.
Healthy teeth are essential to a healthy body, but they are not essential to be a good person, or one capable of giving and receiving love. Straight teeth will not make anyone smarter, better at their job, or more worthy of success. The illusion that cosmetic braces will erase the hardships of poverty, provide entrance into “superior” spaces and company, tricks many underprivileged people like me into paying for them. But this is just one more way the system is always working against poor people: We are told we must pay thousands of dollars to be allowed the privilege of appearing financially secure or well-off, as though the honor of that appearance should be enough. As though the money we spend on straightening our teeth is simply the penance we owe the world for being poor.
Years ago, Jackson Heights Orthodontics offered me the chance to erase the most visible outward sign of my poverty. But eventually I decided I didn’t want “perfect” straight teeth to give me a pass, or permission to feel worthy. I didn’t need a flawless smile to feel like I deserved respect.
I realized I had made a mistake: I wanted my old face back. When I moved back to Seattle after graduate school, I skipped out on my remaining $330 bill and had another orthodontist remove my braces.
In her poem “I Want A Dyke For President,” Zoe Leonard lists all the qualities she wants in a president: One who’s had an abortion. Who has stood in line at the clinic and the welfare office. Who has bad teeth.
When I was twenty-one, I swallowed a great and terrible lie in that orthodontist’s office: that my past was unworthy of remembrance. That I would be lucky if three thousand dollars was all I had to pay for the privilege of forgetting it. But I am the daughter of a nurse who struggled and sacrificed to support me in my childhood—a mother who couldn’t afford expensive shoes or braces, who still found a way to help me grow into a confident, ambitious woman. This is a history that makes me powerful, not ashamed. It is not a history I want to forget.