An Open Letter Regarding A Recent Dental Visit

To Whom it May Concern,

I went to the dentist recently.

I hadn’t been in a while; I lost my job in mid-2019, and my health insurance shortly after. I couldn’t afford to see one anymore, so I simply didn’t bother; this, despite the fact I have a long history of oral health issues. As a minor I rarely went a year without needing a cavity filled or a crown put in. Once, I had a filling fall out of my head while out getting coffee. I was in middle school at the time, and yes, I know coffee is bad for your teeth, your brain, and your overall health, especially at a young age. I was young, and had trouble with insomnia that persists to this day. That’s only tangentially related to my main point. Feel free to disregard the details. What matters is that I have always had bad teeth, no matter how hard I try to take care of them, so going for an extended period without seeing a dentist was a matter of financial necessity, and not common sense or personal preference.

I knew I needed some work done – the dentist I saw before my unplanned unemployment warned me that, since I couldn’t sit for a root canal, I would need to see an oral surgeon to have a couple teeth pulled. I’d actually already had a few teeth removed the summer before, for the same issue, so neither of us were panicking over the short-term problems. He told me to come back for a referral when the pain got too bad, and we went our separate ways.

The pain wasn’t that bad, in the beginning. It only really flared up when the seasons changed, or when it got too hot. For those of you who have never been to southern California, that means from April to September I was fairly miserable, which played no small part in the breakdown that led to me being fired. I still wasn’t panicking. I assumed I would be able to find another job soon enough, not fully appreciating the truth of the matter. The pain was bad, but it was manageable.

But in mid-June of this year it got worse, longer, and more frequent. About once a week I would be woken up by the pain in my mouth; over the last couple weeks I have not been able to go a night without it waking me. Eating is a uniquely torturous experience; one of the molars on the left side of my mouth is broken open, so trying to chew on that side has a decent chance of me having to abandon my meal in favor of downing more painkillers than recommended without consideration for how recently I have taken painkillers and then shoving my head under some hot running water for a bit to relax my jaw so the painkillers can actually do their job. Two of the teeth on the right side of my mouth are also beginning to chip away, which leads to the same problem, although significantly less frequently. Swallowing anything causes my right molar to ache. A couple times a week I have trouble remembering to breathe through the pain.

So a couple days ago, in a fit of exhausted pain, I scheduled a (free, first-time) consultation with a local dentist, which also happened to come packaged with a (free, first-time) consultation with an orthodontist in the same building. The orthodontist appointment came after the general dentistry appointment, which is a fun fact, and we’ll get back to what the orthodontist told me in a bit.

The dentist’s first reaction, upon seeing my X-rays, was to tell me I needed to have four of my teeth removed as soon as possible. He did this by telling me he was calling the oral surgeon they had on staff to get started immediately, and if I had not had a panic attack and been left alone to calm down, I would have let him.

In the bygone day of summer 2018, on my father’s health insurance, with a steady income, having three teeth cut out of my head set me back on rent a bit, and caused me no end of anxiety, but it was not an insurmountable obstacle. I managed to get through it without being sedated, at least, although it was a close call.

I need five extractions done now, because I cannot sit for the root canal suggested for one of them. I will need to be sedated for the procedure to be done safely, because I barely got through three without panicking and biting through my surgeon’s fingers, and that was before two plus years of declining mental health and a year of a global pandemic. If I can’t get insurance between now and the point where I have no choice but to undergo the procedure, it will cost me over $2000 to have the work done, without the sedation, and without the implant the dentist recommended so my chewing ability isn’t significantly impacted. With the sedation, it will be over $3300.

After I finally talked the dentist and his assistant into not having me sent for surgery immediately, I got to go to my orthodontist appointment, where I discovered that I have a crossbite. For those who don’t know, that means my jaw is misaligned; it’s actually crooked, with one side of my upper jaw dipping over my bottom teeth the way they’re supposed to, and the other side slipping behind them. That means that my teeth are wearing themselves down, which is probably a part of why I’ve had so many dental issues through my life. According to the orthodontist, it would require surgery to correct. Uninsured, that would cost thousands of dollars. My teeth will keep getting worse, because I will never be able to afford it, even with insurance.

Health care in the United States is, in general, obscenely expensive. That’s especially true of oral health care; to paraphrase the viral tweet, our teeth are luxury bones, and we must pay extra for the privilege of keeping them.

I cannot eat without hurting myself.

And here’s the thing: this situation is not rare.

These issues affect millions of Americans, and they disproportionately harm the most vulnerable members of our society. People of color, queer people, and poor people routinely are denied access to health care, are forced to settle for subpar care, or have to go without entirely for fear of the way our health care systems are designed to discriminate against them. And let me be clear; this is a systemic failure on the part of our government, not one of personal or moral deficiency. Your circumstances should not dictate the quality of care you receive. It does not matter if you have bad habits. It does not matter if you cannot “contribute.” It does not, for the record, matter if you are a convicted felon, or currently serving in our corrupt, broken prison system.

The duty of any society or government should be, first and foremost, to care for its people – all of its people. The fact that our representatives so often ignore that fact in favor of their own personal wealth and that of the interests that would rather we waste billions of dollars on military spending when we could house, feed, and care for all of our people for a fraction of that is morally reprehensible. The fact we have been so wholly taken in by the American religion of capitalism that even those in Congress who genuinely want to institute changes to these policies so often end up failing in the face of political pressure from every party is a foundational rot it will take extreme measures to correct, assuming it is still possible to correct.

I won’t claim that I don’t want some good Samaritan to pay for my dental bills, because god knows I need the help. But the solution to these issues should not, and can not, be provided on a case by case basis. We as a society need, at the least, universal health care, of every type. We need a universal basic income to help with the issues that are born of living in a society where money is more valuable than human lives. We need to stop letting companies like Amazon and Tesla get millions of dollars in our tax dollars while we sicken, starve, and die without access to basic human needs.

We should not be paying thousands of dollars for necessary medical treatment, with or without insurance. That is not our responsibility. And the fact our government has treated us otherwise is unforgivable.

Yours in dissatisfaction,

Noah

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