In the dinner party scene of Spike Jonze’s ‘Adaptation’ Meryl Streep, as Susan Orlean, tells her New York bourgeois friends about her latest writing assignment, an orchid thief named John Laroche. Surrounded by books and stylish Manhattan décor, Orlean’s friends top up their wine glasses and laugh as they mock Laroche’s appearance and call him sociopathic for not getting his missing front teeth fixed and ‘…making everybody look at that.’ Laroche is further denigrated by a joke about his potential to give superior blow jobs. This impulse to belittle and treat visibly poor people with contempt sets up a divide important to the film’s narrative—but it’s a divide not limited to fictitious bougie dinner parties.
As a young social work student with hopes of changing the world, I was shocked when my Out of Home Care teacher said, ‘Child protection caseworkers have a saying, “If nothing else, I’m getting that kid braces.”’ I did not then understand what those caseworkers did; that all the counselling, case plans and art therapy in the world was not going to prevent vulnerable kids being treated like John Laroche. But braces could.
If you are host to thirty-two straight white teeth, braces and tooth replacement might seem like a cosmetic luxury rather than a necessity for social equality. But the evidence is abundant and clear: teeth matter. Research participants in the Kelton and California University studies overwhelmingly assessed people with missing teeth as less attractive, less healthy, less trustworthy and less intelligent. Participants said they were less likely to date, employ, live next door to, or value the opinions of someone with missing teeth. And the more teeth missing: the harsher the judgement.
Orthodontists regularly cite an improved dating life or ‘pretty privilege’ as reason to spend thousands of dollars on braces. But straight teeth are not pretty privilege—they are class privilege, and that makes the stakes much higher. A 2015 Yale University study revealed people are significantly less likely to cooperate with people who they know are poor. People are however more likely to cooperate when they don’t know if someone is poor. The impact of ‘visible disadvantage’ is understood by child protection caseworkers and it’s why, in the absence of universal dental care, they fight so hard for orthodontal funding. They can’t fix poverty, but they know the value of at least concealing it.
Melbourne-based linguist (who wishes to remain anonymous and will be referred to as KC) recalls attending yearly appointments at Melbourne’s Royal Dental Hospital when she was a teenager. Each year the staunch atheist would pray for the dentist to tell her that her teeth were bad enough to require government subsidised braces. Instead, she was routinely told to come back again the next year to see if they’d gotten worse. Even as a teenager she could feel middle class slipping further from her reach.
With the cost of braces ranging from $6 000 to $15 000 depending on the type and length of treatment, KC clung to academia. With scholarships, luck and Invisalign—bought and worn in her late twenties—she infiltrated the class that seemed determined to exclude her. But KC’s happy ending is not common. The Australian Bureau of Statistics says one in four people live in a low-income household. For those who are not academically gifted, the cost of appearing trustworthy, dateable, and intelligent is simply too high.
Since its creation and implementation, Australia’s universal healthcare system, Medicare, has evolved to include nursing, psychology, physiotherapy, dietetics, occupational therapy, osteopaths, audiologists, exercise psychologists and speech pathologists. Yet for some reason, the mouth is inexplicably treated differently to every other part of the body. The 2019 Grattan Institute report found no reason that the mouth should be excluded by Medicare and recommended a move towards a commonwealth funded dental care system.
The National Oral Health Plan, subtitled Healthy Mouths Healthy Lives, highlights the undeniable connection between poor oral health and poor overall physical and mental health. People with missing teeth are at increased risk of heart disease, early death, and diabetes. People on low incomes are more likely to have periodontal disease, tooth decay and missing teeth, and those with missing teeth report discrimination and poor mental health. The National Advisory Council of Dental Health reports that ‘A person whose appearance and speech are impaired by dental disease can experience anxiety, depression, poor self-esteem, social stigma, and poor social outcomes.’
Every year, The Australian Dental Association writes a pre-budget submission asking the Australian government to fund the National Oral Health Plan, and every year they are ignored. When evidence-based calls from experts to fund dental care are consistently rejected—it is for reasons of ideology. What became obvious with the temporary doubling of JobSeeker payments (when unemployment became a middle-class issue due to the global pandemic) is that governments categorise people into ‘deserving’ and ‘undeserving’ of being poor. We do not apply the same passion, concern, or financial support to long-term poor people as we do to those who we assume are good, hardworking people having a spot of bad luck. We view entrenched poverty as a character flaw and largely the fault of the individual.
Physically, emotionally and socially: teeth matter. That is what my social work teacher tried to explain to me while I was distracted by my privilege and self-righteousness. Of course, my teacher was right. Once employed, I routinely picked up clients from the Royal Dental Hospital after they had waited years for appointments. Teeth, where gaps used to be, were life changing. While I still cling to our capacity to not perceive crooked or missing teeth as a character flaw, I am old enough to know that my desire to change the world does not have the impact I once hoped it would. Universal dental care however can change social and health outcomes. It can change the world.
Amanda Johnson (she/her) is a Melbourne (Naarm)-based writer, social worker and teacher. She studied Small Companies and Community Theatre at Swinburne where she developed a love of stories. She has seen stories generate compassion and understanding in the social sector, and wants to see more of it. Her work is accessible on Instagram @thesocialworkstoryteller