College Success Depends on the Dentist

College Success Depends on the Dentist
At first glance, what follows sounds trivial—or at least very low down on the list of reasons why some kids succeed in going from high school to college, and some don’t. But it’s not.

A few years ago, a colleague and I noticed that one of our students had extraordinarily white teeth. They were so very, very white—like a refrigerator, or like the newly fallen snow, or like Moby Dick seemed to be to Ahab—so brilliantly white that it was next to impossible to look away from them whenever the student opened her mouth to smile or speak.

It was obvious to me that the student in question had overdosed on teeth-whitener, whitening her teeth way beyond the max. In aiming for the perfect smile, she’d unknowingly overshot her mark and ended up with a set of choppers that were so startling in their whiteness as to look fake.

Although I never encountered another student who overdosed on teeth whitener quite this dramatically, my encounter with this one super-white-toothed student caused me to begin consciously observing the teeth of college kids, practically everywhere I went. I’ve concluded what should have been obvious to me in the first place: Colleges never have students with bad teeth—teeth that are severely crooked, stained, decayed, or missing.

According to the government (cited in an article, in 2007, in The Washington Post), despite the introduction of fluoride in almost all of our town drinking water, tooth decay is the most common illness of American children. Surprisingly, it’s five times more common than asthma.

Whereas 8 million children have no health care, 25 million have no dental care. Poor children, who are twice as likely to get cavities than children who are above the poverty level, are also far less apt to get treatment. Their dental treatment is supposedly covered by Medicaid, but there aren’t enough dentists willing to treat them. Many dentists, in fact, refuse to participate in Medicaid because reimbursement is often so minimal that it actually costs them money to participate. When poor children do get treatment, it’s rarely prophylactic care. The usual treatment is to pull the tooth.

It’s sobering to realize that the problem of dental care isn’t restricted to the very poor. A third of Americans have no dental insurance. People who fear the “moral hazard” consequences of insurance (i.e., that having insurance makes you go to the dentist or doctor more frequently than you really need to go, thus driving up costs) probably approve our low level of dental insurance coverage. In practical terms, however, since half of all dental procedures are paid for out of pocket, many people who are neither ignorant nor poor delay going to the dentist until the only treatment possible is tooth extraction.

As the artist Willem de Kooning demonstrated in his famous Women paintings (a series of paintings made in the early 1950s), the perfect smile, marked by perfect, even white teeth, helps define Americans. In his paintings, the smile symbolized not just happiness and success, but also an ominous and scary side to our culture. Its artificiality—even in the 1950s, long before the introduction of teeth-whiteners—shocked Europeans especially. Having been through the Second World War, many, of course, had teeth that were either decayed or gone.

In some cultures, stained, rotten or missing teeth are no big deal, even today. If you travel around Britain, for example, you see plenty of pretty ugly teeth, as well as mouths with gaping holes where teeth used to reside. But in America, our visual tolerance—defined as it is by advertising, movies and television—for people with rotten or missing teeth, is exceedingly low. Who hires the person with rotten or missing teeth, even if it’s only to work the checkout line?

It’s not surprising, then, that American college kids always have great teeth. It’s not that we require great teeth to get into college, but that college kids come from a select and privileged group within the middle class who grew up with good dental care. Kids ending up with bad teeth, on the other hand, come from families who skipped dental care for them. They were weeded out of the college pool long before they could ever even know what “college pool” meant—not by intelligence tests, or subject mastery test scores, or high school grades, but by having to spend their K-12 years in constant, bitter pain.