My last dentist, an amiable chap used by lots of people in our neighborhood, was very clear: Menopause has nothing to do with periodental disease or tooth loss. He looked at me like I was crazy for even suggesting it. I’m familiar with the look, with the abruptness, the quickness with which a doctor can simply make a statement as if it were really fucking obvious, dismiss your worry, and never look back. He didn’t even stop to consider what I said.

He did offer me a payment plan for $30,000 worth of dental work that involved taking every tooth out of my head, including the good ones, and replacing them with a full mouth of fake teeth. The whole experience was terrifying. I left and I won’t ever go back.

I, like many people, have a frought relationship with dentistry.

When I was a kid, I loved my small town dentist, Dr. Winslow. Every appointment was him using my pig tails as reins and following me around the office, driving me like I was his horse. I trusted him so much I let him fill my cavities without novocaine. Dental visits were the best, full of laughter, sweet attention, and gentle ribbing. But he eventually retired and his young replacement came with a lot of new fangled torture devices. I moved my tongue too much so the new dentist brought out a big metal device, inserted it into my mouth, clamped it down, and forcibly held my tongue to the side of my mouth for the entire exam. I cried and he called me a baby. I probably was. I felt vulnerable, distrustful, powerless.

Dental visits, for me, never really recovered. I never found a dental experience that allowed me to have faith again in the process. So I maneuvered.

I kept getting my teeth cleaned, brushing, flossing sometimes when the mood hit, being a good girl, but I feared major dental work and I avoided it. I made it my personal brand to never have to get a root canal. I’d rather let the tooth rot in my head than get a root canal, I’d say jokingly, but it wasn’t really a joke. I got anxious whenever I thought of going to the dentist. Cancelled appointments, no-showed procedures, made completely absurd, but plausibly-sounding excuses for why I couldn’t do this or that. I was more than anxious, I was avoidant. Filled with palpable terror everytime I got near a dentist’s office. The smell, the scary torture tools, the clamps and masks, feeling pinned down in the chair, all of it made me walk out of more than one dentist’s office without even opening my mouth.

Last week, my daughter Edie, who got the good hair, but not the good teeth, which are on David’s side of the family, was scolded by her dentist because she had cavities.

Why do they try to make their patients feel bad? she asked me on Facetime, walking home from her appointment in NYC. I’m doing all the right things.

The one thing dentists seem to have in common, and is different from other medical professionals, is the shaming. (Sorry, dentists. The anectodotal results are in.) Dentists, as a group, are keen to remind you how you have ignored your teeth. You don’t hear primary care physicians saying to a diabetes patient: I bet you wished you layed off the all-you-can-eat at The Golden Corral? Or Oof, yeah, that pack a day for 30 years is what got you here to a lung cancer patient.

We are humans, dentists! We do dumb shit and look to you to clean it up. Be cool.

Maybe part of the problem is that we separate dentistry from medicine in the first place. Why should we? Our oral health is connected to our overall systemic health. Our oral health is connected to gut health, heart health and whether or not we get diabetes or have a stroke. A poor oral biome can be linked to diminshed cognition and memory loss. Dentistry is medicine. And yet, we don’t see dentists as doctors in the same way. Our GPs and dentists and gastroenterologists and endocrinologists aren’t working together to support our health. No wonder dentists are such scolds. They know how important they are, and maybe some of us keep ignoring them.

In fact, British studies back this up. Scientists have found that tooth decay and gum disease involve diseased tissue, but those experiencing these states are generally not regarded as being ill. The analysis ends with this kicker: …this may be because oral health problems are seen as a failure of the individual responsibility rather than misfortune.

And this is truly a big issue for our health. If you get a cavity, it’s because you ate too much candy. Or you didn’t brush enough or floss. Tooth loss, either by rot or extraction, is a moral failing, even though some 60% of tooth decay risk can be genetic. Lacking teeth implies not just a kind of poverty, but poverty itself. Broken teeth imply a kind of broken personhood.

In Mary Otto’s excellent and eye-opening book, Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America. she explains:

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 a way that they are not heald accountable for other health conditions.

But our health systems are not set up to help people priotitize their teeth. Otto says that about 1/3 of Americans face significant barriers to obtaining dental care. The two national insurance programs that provide health care and insurance, Medicaid for the poor and Medicare for the elderly and disabled, do not prioritize dental care. For 72 million Medicaid users, dental care is an option that states can opt out of, and for the 55 million Medicare participants, dental care isn’t even provided. And less than half of all dentists even take Medicaid, so already there are dental deserts where people can’t easily access routine care of their teeth. And middle class health insurance is barely better, the more serious the condition, the less likely it is to be covered.

And the repercussions are huge. Take the case of 12-year-old Deamonte Driver who died in 2007 after having an abscessed tooth. A routine $80 extraction would have saved his life. But his mother was poor. She had lost her Medicaid after struggling to understand and manage Maryland’s complex paperwork requirements. But even if she still had Medicaid, there were so few Medicaid dental providers around her area that people in her neighborhood were traveling three hours to find one.

It is remarkable to me that even in Dr. Peter Attia’s transformative book, Outlive: The Science and Art of Longevity, which has sold more than three million copies and is considered to be the bible for prolonging the span of your healthy years, he devotes only part of one page (page 203) to dentistry and oral health as a part of the masterplan to live longer and better.

And yet, we put the blame on people for letting their teeth go.

It’s almost as if I feel like I’ve failed because I have dentures, a woman confided to her dentist. I don’t think people feel that way about knee replacement.

By the time we moved to Vegas, 10 years ago from NYC, I was riding on the still in-tact youthfulness of my middle-aged body, alongside the solid dental care I got as a kid. My teeth were fine. I was going to the CNS Dental Hygiene Center, a training institution for hygienists, to have my teeth cleaned. It was perfect. Low cost, low effort, and they couldn’t do more than simply clean my teeth. The student hygienists didn’t bug me to make more appointments. They didn’t try to upsell me expensive cosmetic options that masqueraded as medical necessity. I could’ve gone on this way forever, I thought.

In 2021-2022, when I was writing The Meth Lunches, I started noticing changes in my memory, concentration, changes in focus. My manageable-without-meds ADHD was no longer manageable. I was scattered, lost, foggy. I had joint pain and restless leg, tummy weight, and I was awake from 3-6am pretty much every night. My memory was shot. But I was fighting through a manuscript. There was no time to go on a health quest.

Then, my molars started breaking. One cracked. The next one was more a mashing, a crunch with pieces. It felt like I was falling apart, literally. One molar after the other, four in all. It kept going. I was paralyzed by this. I pushed it away. I had dreams about losing my teeth. The master bath was my secret triage-torture room. I popped pus-filled cysts in my gums with a needle when I had to. I dropped a 1,000mgs of Tylenol for the pain. I kept infection at bay with old antibiotics I had in the med cabinet. It was invisible, in the back of my mouth. It could wait.

I vowed to get the work done after the book tour.

It is now, officially, after the book tour.

Teeth are signifiers. They mean something. They are our shop front in the world. Losing them is losing something built into us from our most embryonic selves. It is our way to get nutrition into our bodies, to survive and thrive, but it also slots us automatically into our social groups. And removes us from them.

People who can afford unnatural, but gorgeous, toothy, Hollywood-style smiles pay big money to have that perfection. In his book, Smile Stealers: The Fine and Foul Art of Dentistry, author David Barnett explains that we have little tolerance for the natural smile, opting for something much more manufactured. We don’t even like the sight of normal misaligned, stained, lived-in teeth. We want them pristine and perfect, fake. But we’ve removed almost all the avenues that allow people to access that perfection.

The “smile of success” is …burnished, expensive, ostensibly natural and deeply unnatural, Barnett writes, that’s why we still fear the dentist. We are not worried by experiences like the poor 17th-century man, whose dentist couldn’t extract his molar so hammered it into his jaw instead. We don’t just face pain any more, we face social exclusion, or better termed, extraction.

We are worried about all manners of extraction.

I made it my business to find the dentist that is going to usher me through the next 30 years. She is a biological dentist here in Las Vegas, who understands the impact of menopause and bone loss on my teeth. She is about oral health as it connects to overall health. She also understands my anxiety. When I had a panic attack and cancelled all my upcoming appointments in a rush of fear, she called me.

Kim, come in tomorrow just for a chat, she said, her voice kind and calm. Just talking.

I did. She hugged me when I cried about my upcoming procedures. I haven’t been hugged in a dentists office since Dr. Winslow. She didn’t upsell me cosmetic work posing as medicine. We will work with you on cost, and with your anxiety, she told me, We will make it okay for you to get to where you need to be. It made all the difference. Even David goes to her now.

I’m now venturing into the territory where by the time I’m dead, I will be the recipient of a lot of fancy dental work. This might be my personal nightmare. Not how I want to spend my time or money. But it also makes sense. In a few weeks, I will turn 60. If I live another 30 years, will my teeth last that long and still be healthy? Probably not. I didn’t win that particular lottery. There is, for me, no more resting on the strength and wellness of my youth. Thoughtful and intentional physical and emotional maintenance is what has to happen now.

The physical extractions of dead molars aren’t the scary parts. I’m not worried about pain, as modern meds have that handled. It’s what the extractions mean. It’s about carrying shame for not being a better steward of my body and mind. It’s guilt about the things I didn’t do when I should’ve, because I didn’t have the right self-knowledge, supports or cash. It’s about feeling marked as dysfunctional, and impoverished. It’s the worry that I’ll no longer be seen as competent, attractive, intelligent, or functional. It’s about having to confront my fading proximity to youth, my oldness, because I’ll have a couple partials stuffed into the back of my mouth and a vessel to put them in every night on my nightstand. It’s about worrying if my partner will still want to fuck me, if I have fewer teeth in my head. (Note, he has assured me he will have no problem with this. LOL)

But there is, also, a kind of relief here too. That I can right these wrongs. That I have what I need to take care of myself. That I can do something now that I couldn’t do before. That I don’t have to carry around all those old, ugly, shame-filled feelings, because I have found new ones, healthier ones, to replace them.

My first procedure is on the 18th. I will be out for most of it. David will be there. He was so sweet when I told him I wouldn’t be able to walk through the office door without him. We will make it a date-day at the dentist, he texted me with emoticons that made me laugh.

For a second, I was almost looking forward to it.

Thank you, as always, for reading. xo