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The Story of Beauty, Inequality, and the Struggle for Oral Health in America

By Mary Otto

An NPR Best Book of 2017—now in paperback


“Show me your teeth,” the great naturalist Georges Cuvier is credited with saying, “and I will tell you who you are.” In this shattering new work, veteran health journalist Mary Otto looks inside America’s mouth, revealing unsettling truths about our unequal society.

Teeth takes readers on a disturbing journey into America’s silent epidemic of oral disease, exposing the hidden connections between tooth decay and stunted job prospects, low educational achievement, social mobility, and the troubling state of our public health. Otto’s subjects include the pioneering dentist who made Shirley Temple and Judy Garland’s teeth sparkle on the silver screen and helped create the all-American image of “pearly whites”; Deamonte Driver, the young Maryland boy whose tragic death from an abscessed tooth sparked congressional hearings; and a marketing guru who offers advice to dentists on how to push new and expensive treatments and how to keep Medicaid patients at bay.

Photo © Nancy Crampton

In one of its most disturbing findings, Teeth reveals that toothaches are not an occasional inconvenience, but rather a chronic reality for millions of people, including disproportionate numbers of the elderly and people of color. Many people, Otto reveals, resort to prayer to counteract the uniquely devastating effects of dental pain.

Otto also goes back in time to understand the roots of our predicament in the history of dentistry, showing how it became separated from mainstream medicine, despite a century of growing evidence that oral health and general bodily health are closely related.

Muckraking and paradigm-shifting, Teeth exposes for the first time the extent and meaning of our oral health crisis. It joins the small shelf of books that change the way we view society and ourselves—and will spark an urgent conversation about why our teeth matter.

Mary Otto is a former reporter for the Washington Post, where she covered social issues including healthcare and poverty. She is the oral-health topic leader for the Association of Health Care Journalists. (@mottomatic)


“[Teeth is] … more than an exploration of a two-tiered system—it is a call for sweeping, radical change.” The New York Times Sunday Book Review

“Heartrending and incisive … Otto’s book sympathetically explores a range of ideas for improving the current system.” —Adam Gaffney, The New Republic

“With many adults still uninsured, children’s dental care far from universal, and the future of government-supported health care unclear, Otto’s sobering report should not go unheeded.” Publishers Weekly

“Otto’s well-reported and important book will arouse concern over the fact that dental health, which is so essential to our well-being, gets such short shrift, and, hopefully, help instigate reform.” Booklist

“An astute examination of the complex, insular business of oral health care.” Kirkus Reviews

“Mary Otto hits us right in the face—our teeth—with this important book. The lack of dental care for millions of Americans is a national shame. Teeth breaks new ground in the canon of books about poverty. It should be read by anyone concerned about the class divide in the U.S.” Dale Maharidge, author of the Pulitzer Prize–winning And Their Children After Them

“I can’t remember the last time I read a book that so brilliantly yokes physiological, political and cultural systems. Rife with discovery, and a spur to social action, Mary Otto’s book is a beautifully readable and essential testament for these times.” —Mary Cappello, author of Swallow: Foreign Bodies, Their Ingestion, Inspiration, and the Curious Doctor who Extracted Them

“Mary Otto brings history, policy and painful personal realities together in this compelling and engaging book about our nation’s highly preventable epidemic of oral disease. Teeth should be read by every policy maker and health professional who believes we can and must act to reduce the current barriers to dental care.” —Louis W. Sullivan, MD, U.S. Secretary of Health and Human Services, 1989–1993, and chairman of the Sullivan Alliance to Transform the Health Professions

“Who eats too much sugar, leading to dental trauma? Primarily the poor. Who cannot sleep because of continuing dental pain and no available dental care? Primarily the poor. Even with Medicare and Medicaid, dental care has remained a stepchild—and these programs are in jeopardy now. ‘The teeth are no match for . . . a life of poverty,’ Otto says. More teeth failure and its consequences are on their way.” —Peter Edelman

“Here’s a book that will enlighten you, upset you, and give you hope. I highly recommend it.” —Bob Herbert, Distinguished Senior Fellow at Demos and former Op-Ed columnist for the New York Times

“Mesmerizing and important. Mary Otto’s unflinching work on the miserable state of oral health in America gnaws at you like a toothache.” —Congressman Jamie Raskin (MD-8)

“Former Washington Post reporter Otto, oral health topic leader for the Association of Health Care Journalists, writes compellingly about the integral role of oral health in overall wellness and how seldom dental care is available to low-income families, Medicaid patients, and nursing home residents. Surgeon General David Satcher’s 2000 report, “Oral Health in America,” warned of a “silent epidemic.” While the biological understanding of oral health continues to evolve, access to dental care remains uneven, subject to the vagaries of state funding and “dental deserts.” Tooth decay, largely preventable, remains the most prevalent chronic disease in America. Residents who live in rural areas are particularly subject to dental health disparities. Lack of access to routine dental care led to the 2007 death of 12-year-old Deamonte Driver, of Baltimore, who suffered from a brain infection caused by an infected tooth, which could have been prevented by an $80 extraction. His death led to Congressional hearings. This eye-opening look at the abyss between medicine and dentistry, between the mouth and the rest of the body, is not just about dentistry. It is about public health and health-care economics. VERDICT Timely and highly recommended for all readers concerned about public wellness, health-care disparities and outcomes, and the rising costs of treatment. —Library Journal (★’d review)

“An astute examination of the complex, insular business of oral health care. Former Washington Post journalist Otto recognizes poor oral hygiene and maintenance as a major public health problem, and she adroitly probes the ramifications of this persistent “silent epidemic of oral disease.” While those in disadvantaged communities cite affordability, accessibility, and shame as factors in their lack of dental care, the opposite can be said for more privileged socio-economic groups, in which vanity and self-consciousness inspire an obsession with teeth bleaching, porcelain veneers, and spatial alignment. “Bad teeth depersonalize the sufferer,” writes the author. “They confer the stigma of economic and even moral failure.” Aside from economic variances, Otto charts the history of American dentistry, including the astronomical educational debt of dental school students and, consequently, why more progressive dental offices are often established within wealthier enclaves. The author meticulously examines the inexplicable fragmentation of oral health from established American health care systems, the increase in emergency room dental visits by uninsured patients, and how unregulated costs, a shortage of free clinics, and plans like Medicaid further isolate poorer populations from obtaining dental care. She also addresses the widely debated medical claim directly connecting oral health to overall health. Otto presents several case studies reflecting the state of the industry, including a young Miss USA pageant contestant’s pursuit of the “Hollywood smile” and the shocking deaths of two young men from untreated dental abscesses. Though the situation is certainly a grim national concern, Otto presents hope via radical initiatives to stave off the flow of dental demand. Still, she implores, prevention and upkeep are paramount, as “people are held personally accountable for the state of their teeth in ways that they are not held accountable for many other health conditions.” A focused, well-researched depiction of the dental industry’s social and cultural relevance and its dire need for reform.” —Kirkus Reviews

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The New Press, March 2017

Now in paperback (June 2019)

Winner of the Studs and Ida Terkel Prize

An NPR Best Book of 2017

Eight printings in hardcover.

Mary Otto explains that “it’s incredibly hard to get dental care in rural America” (Mother JonesSept/Oct 2017)

Read Mary’s interview in the Atlantic.

Mary’s spoke with Tom Ashbrook (“On Point” 6/15/17) 

Read the preface on the WBUR website, or via Scribd

Read the Guardian’s “Long Read” excerpt

Mary spoke with the Times (podcast @ 19:40)

Mary was interviewed on NECN-TV (Boston) on Sept 13, 2017

Follow Mary on Twitter @mottomatic