Does Your Smile Have A Price Tag?

A few months ago I had to take a child to the dentist. The visit went smoothly, though there was a gentle suggestion that parents might need to take over flossing duties. Ahem. Duly noted…and subsequently ignored.

We were talking about an orthodontist consult we’d had and the costs associated with these procedures; the dentist mentioned several studies recently that have found people with straight, white teeth are more likely to end up in a higher wage-earning bracket as an adult. He said something along the lines of: It’s too bad society works this way…but it does.

During this same visit we talked about the wonderful provincial healthcare plan that covers most of the cost of dental work for children until they turn 15! (This is not standard across all provinces, strangely enough.) The dentist mentioned how, even though it’s free, many parents who don’t have the financial wherewithal to pay for their own dental work – out of a position of shame and/or concern about expensive procedures being recommended that wouldn’t be covered – don’t bring in their eligible children. It hadn’t crossed my mind that this free resource would be disproportionately accessed by people with more financial independence.

From having the flexibility to cart your children to appointments in the middle of the day, to being able to cover the bill to correct issues, in so many ways, the cascade effect of privilege can impact what the world sees when we smile.

I had never really thought about well-aligned, white teeth as being yet another form of socioeconomic privilege but, of course, they are. And that realization took me by (sad) surprise.

Your turn. How do you feel about the dentist? Did you have braces as a child – I, along with several other family members, have a slight gap in my front teeth and, through no virtue of my own, evaded orthodontic treatments. That’s fortunate because there is no way my parents would have been able to afford braces. Once, when my siblings were younger, a dental bill for our family totaled more than my father’s net salary for a MONTH.

Header photo by Nick Fewings on Unsplash

42 thoughts on “Does Your Smile Have A Price Tag?”

  1. How fitting this post is as I am sitting at the dentist for annual check up and cleaning and things. I actually have heard about this issue. Luckily insurance covers it until the age of 18 and we’ve been religiously stopping at the dentist every 6 month. And I’ve continued it on my own. I’ve never though thought about how much time my mom spend with us shuttle us back and forth.

    1. It does take a lot of time/logistics (even if everything is doing well with teeth).
      Hope your appointment goes smoothly!

  2. Teeth. ugh. I have had braces twice, all of my wisdom teeth surgically removed, four teeth pulled, many fillings as a kid and several crowns as an adult. I still have an overbite and my teeth do not align properly. They are straight though. It is something I haven’t considered when thinking about privilege but as you pointed out the time and money it takes are large barriers for many.

    The first time I had braces, I was a teenager and my parents did pay and have to drive me to a town 40 minutes away for the visits. They paid that out of pocket as our province does not cover costs for kids like you does. Basic visits are covered until they are five but after that they are not. Thankfully I have coverage for all the basics through work and enough coverage that the cost for orthodontics is manageable.
    Both of my kids will need braces. I was hoping they would genetically “get” my husbands teeth because his are straight and align naturally.

    1. I’ve had 2 wisdom teeth surgically removed, but just had another break through. The dentist offered to take it out in his office but we were about to leave on a roadtrip and I’ve had family that have gotten bad infections after a wisdom tooth removal, so I’ve pushed this off. Literally one of my to-do’s this week was: “think about getting wisdom tooth removed.” Oh the glamour of adulthood.

      Time and money (and flexible time often feeds back in to income) are such barriers!

      I will say that orthodontic work is NOT covered provincially, but things like X-rays (every 2 years?), flouride (every 18 months?) and a recall exam every year is covered, along with things like fillings. Our dentist writes off anything that MSI doesn’t cover in terms of these basic treatments as well, so he goes above and beyond.

  3. I have a lot of dental woes, to be honest. I didn’t receive any dental care until I was an adult and my gums are a disaster. There’s a very good chance I’ll have to have all of my bottom teeth removed in the next few years. I also have a couple of very yellow teeth from when I was given antibiotics when I was young. I’m incredibly self-conscious about my teeth and incredibly embarrassed about how they got this way. The price of poverty for young children is huge and long-lasting.

    In 2011, I spent more on my dental bills than I earned all year long. I anticipate that I will never again have a pain-free mouth and it will always look a mess. It’s honestly really hard and I have spent lots of time, money, and tears dealing with it. It’s one of the greatest challenges in my life and honestly, I wish we could keep masking long-term so that I can continue hiding my mouth from the world.

    1. I’m so sorry. This sounds…painful and frustrating and just downright hard and awful. This is a heavy burden to carry and, as you mention, a remnant from childhood that has very real and long-lasting impacts. My heart hurts reading this and I wish I could take away all the pain – physical and emotional.

  4. Nowadays, it seems like everyone has braces, and you would be at a real disadvantage as a young adult with crooked teeth. I think I was the last generation where braces weren’t mandatory. My teeth were “good enough” not to need them, but I have a couple mildly crooked teeth that would definitely be corrected if I were a kid now.
    My daughter has braces now, and my son had braces for three years. His teeth were REALLY crooked. It was expensive and the trips to the orthodontist were a huge pain- but a couple years ago, after he had his senior pictures taken, he said “I’m so glad I have a nice smile!” Worth it!!!

    1. I knew a few people with braces growing up – but now it seems like everyone has them. I know of a lot of adults with them, too!
      I’m so glad your son appreciates the impact braces had and hope your daughter feels the same way (likely not now…I suspect braces are a source of complaint, which I can appreciate!…but when she’s older).

  5. I did not have braces, but both my sons have had them. My younger son is a wrestler and when I found out he wasn’t wearing his mouth guard to matches I almost died. That’s a $7000 smile you’ve got there, buddy. Wear the $15 mouth guard! I felt bad for him because he was only supposed to have braces for 12 months but it ended up being 26 because of Covid. He couldn’t get adjustments because the office closed, then they put the hooks for elastics on the wrong teeth and they had to be readjusted…it was awful. His teeth are great now, as are my older son’s, who had a pretty big overbite and buck teeth.

    1. Yes to the mouth guard! My word – you really hit on another point too which is trying to protect teeth. A friend of mine fainted once, fell onto pavement and had something like $10K worth of repair needed for her teeth. A relative of mine once was hit in the mouth with a golf club (standing behind someone and got hit in a backswing – OUCH!) and it was an outrageous sum of money to deal with the aftermath (I might be remembering this wrong, but I seem to recall something like $20-30K? That’s A nice NEW CAR or a downpayment on a HOUSE!!!)

      What a nightmare during COVID; that sounds horrible having to go so long between adjustments. Ugh. Glad it’s all done now though and he has that smile for life.

  6. It is amazing how big of an impact something as mundane as teeth can have… it is a huge, huge cause of pain and cosmetic issues for so many! I am very lucky to have always had access to dental insurance and good dental care, and genetically lucky that my teeth are pretty ok. I did have an expander, braces, and then braces again as a kid, BUT did not wear my retainer long enough so my bottom teeth are now VERY crooked. I did look into fixing this as an adult, but would need full braces again and I was NOT willing to do that. I would have considered Invisalign, but that wasn’t an option for me. I find a lot of dental work to be a huge racket – about 5 years ago I was told I NEEDED gum surgery (or….??? not sure still) and did proceed to do one side of my mouth, to fix a gum recession that was causing me zero problems or pain, and it was QUITE AWFUL. Even with insurance it was expensive, painful and took a long time to recover from. Since then, MYSTERIOUSLY not a single person has mentioned that I never did the other side of my mouth!! Very odd!!

    My mom and sister both have a lot of dental issues – root canals, constant cavities, etc. One of my sons seems to have similar issues and had 6 (SIX!!!!!) cavities last visit, after having 5 in another. My other 2 kids have been fine so far. My nearly 13 year old daughter has her first orthodontist consult soon, she’ll for sure have braces even though her teeth are pretty ok. Luckily, my dental insurance does cover quite a bit for orthodontics, so it isn’t such a financial burden for us.

    I just had my checkup yesterday at the dentist, and it went fine, but I do spent 1-2 weeks prior to the visit completely dreading it.

    1. The gum issues sound frustrating and very confusing. Ugh.
      There are definitely genetic issues; one of my kids has “pitted” teeth and they told me from the get-go they’d be susceptible for cavities. I had great teeth…until pregnancy. I had 4 cavities after I had Abby, and my teeth have never been the same since. But I am fortunate to have a lot of extra space in my mouth and that was all genetics (several other people in my family have too little space, and one of my siblings ended up with braces as an adult; she also is a dental hygienist, so has flawless and white teeth these days!).

      I had quite a few teeth pulled as a kid because of baby teeth not falling out, but I have a high pain tolerance for dental work so it’s not something that seems to bother me much, but going to the dentist is universally considered one of the most dreaded things, I think?! I also don’t have a bad gag reflex, which I know is a major source of challenges for many people.

  7. I feel this post so much. I had braces as a kid. We didn’t have money, or insurance, and didn’t go to the dentist for a couple of years. My mouth was overcrowded with teeth, and when the dentist convinced my mom to take me to the orthodontist at the age of 9, the orthodontist took one look in my mouth and said “Fuck” (sorry to swear in your comments, but it’s indicative of how bad it was). So I had braces, and due to financial constraints there were times when I could not go to get them tightened, and thus they would go too far the other way, and so had to be adjusted. It was a real hardship on my single mom, and none of us went to the dentist during that time, 5 1/2 years, because there wasn’t money for both. We all have the fillings and crowns (and in my brother’s case, root canals) to show for it. I wish my teeth were whiter, but I drink a lot of tea, which doesn’t help at all.

    My daughter had similar issues, with a small crowded mouth and an overbite. Thankfully we had insurance, and when her pediatric dentist said that she needed braces at age 7 (which seemed VERY young to me, I was the only 9 year old at my large elementary school to have them), I took her to my dentist for a second opinion. He said, “You know she needs ortho, right?” And I said yes, my question was when. “Today.” The difference that modern orthodontia and dentistry, and having insurance, made is amazing. They gave her an expander to help her palate accommodate her teeth as she grew, so she didn’t lose any permanent teeth (I lost 5). She had a neck gear to help with her severe overbite (she had to bite things from the side, because her front teeth were so far off that her bottom teeth and top teeth never met.) Thankfully we own our home, and we refinanced to cover the couple of thousand dollars that insurance did not pay.

    Both she and my husband have zero cavities. She has a beautiful smile (she did have to have braces twice, which I also ran by my older, more conservative dentist, and he explained the reason that phase 2 was necessary). So they won’t have crowns or root canals or anything like that.

    1. Oh J – this sounds so hard for you and for your Mom. It is an enormous financial burden and, of course, people who have dental coverage tend to be people who already fall into a higher wage-earning bracket so paying the full price on these expensive procedures tends to fall to people who cannot afford these services. The deck is so stacked. (Where we live our dentist, and the orthodontist, have specific times each year where they offer free clinics. I’m not sure how it works and I’m sure many people who need it most don’t make it in, but I really hope it casts a wide net and helps alleviate some of the physical and financial pain of dental work).
      I’m glad your daughter has been able to get the work done and that she’s left with teeth that are aligned, cavity-free and won’t need extensive work when she’s an adult! What a gift you’ve given her.

      1. Such a thoughtful post, and so many stories in your comments. It makes me feel not so alone in my situation to hear other people had similar situations. And yes, because of my situation growing up, it was really important to me to be able to do better for our daughter. I’m so glad I was able to. She has her own challenges, as we all do, but that isn’t one.

        1. This makes me think of the C.S. Lewis quote that goes something like: friendship begins in the moment when one person says to someone else: What! You too? I thought I was the only one.
          Telling our stories is empowering and restorative!

  8. No braces! Hate the dentist even though I have never had any major work done and LOVE to bleach my teeth. I feel like it’s really scammy– every time they x-ray, there’s magically something to fill, and I hate that.

    1. I asked my (older, more conservative) dentist about this once, about how some old school dentists were willing to keep an eye on a micro cavity, while others want to fill anything as soon as it pops up. He said (as you suspected) that it is money. Younger dentists have new, very expensive equipment, and often huge student loans. He had an old office with older equipment, only one employee, and no debt, so he was able to take a more conservative approach. He was a great dentist, I was sad when he retired.

    2. There does always seem to be something that needs doing, eh?
      Our dentist seems very honest and has several times said: “we’ll keep a watch on such-and-such tooth.” Having a dentist you can trust is HUGE.

  9. I go to the dentist regularly and always have. I knew that well-aligned, white teeth are a sign of socioeconomic privilege because I grew up in a small town that was mostly blue collar. We kids who got braces and saw the dentist were subtly mocked by the kids whose parents couldn’t afford to pay for such. There was no dental health insurance at the time, so having money to spend on teeth was noticed.

    1. An interesting perspective – a set of circumstance where having money for dental work was noticeable and unusual.

  10. Ah dentists. Even with insurance in our case it is still quite expensive but we all go twice a year for check-ups. I have the feeling that a lot of dentists in the US suggest procedures that are not always necessary (for reasons J mentioned above) but we settled on an office that has a more conservative approach and are happy with them (it’s a dentist couple and we see both).
    My son in theory needs braces but for various reasons we did not get him started yet. One being that we had a slightly traumatic experience with the orthodontist we went to the first time. She is said to be very good but she expects kids to cooperate. I have a kid who is afraid of needles and very suspicious of doctors in general. When the technician asked him to open his mouth he did not comply and we were unceremoniously send home. I think we would have gotten there (him opening his mouth) but they had zero interest in working it out. We were supposed to come back when he is ready. Needless to say we have not been back. I should look for another one and as much as I know that the sooner we start the easier it would be to get the teeth where they ought to go, I also know that it would be traumatic if we start before he is ready.
    I had braces as a child but it was not too bad. I sometimes wonder if I would have been ok without but during that time everyone had them.

    1. Dentists and kids are such a tricky balance – we once had a child that had an issue and the freezing wouldn’t take (there was an abscess). It was horrible and I felt so helpless. I was so frustrated the child in question wouldn’t cooperate and I just assumed the dentist was doing everything properly, but because the gum was abscessed, it wouldn’t take freezing. I felt horribly guilty after (the dentist – who we’ve never actually seen again – couldn’t get our child settled down) and decided to go to a pediatric dentist and it was 100% the right choice and I’ve thought about my own kid’s responses to the dentist differently ever since!!

  11. This is such an interesting post and interesting comments! I came from a place where everyone had braces – I had them for years. I probably needed them too as I had a totally sideways tooth as a child. At the same time, I love my smile. I became aware of the benefit of having a nice smile when I was working my first job and I honestly think it has paid off for me. I know I have a strong bubbly personality, but people mention my smile so often too. I always smile on the phone because I know people can hear a smile. I think that if I didn’t have straight teeth I would maybe not feel so confident in my own smile, and then I wouldn’t smile as much. Perhaps my smiling is reinforced through the compliments on my smile? It’s interesting to think about. But now, as I write this, I wonder if that is how people feel about breast implants…

    I also think the difference are even more stark now that I live in the UK and tooth care just isn’t as strong. There is also a huge shortage of NHS dentists, so I know people are struggling to access the funded care they are supposed to receive. I have so many friends in their early 30s needing root canals. I’m mocked for going to a private dentist but I really want to look after my teeth and I’m terrified of cavities and root canals*. I also know my parents invested a lot in my teeth and I want to keep them nice… although I stopped wearing my retainer at night when I had kids and now one of my teeth has moved. Maybe someday I’ll get Invisalign to correct it, because it does bother me.

    *not terrified enough to floss though. Terrified enough to spend £200 a year at the dentist (that’s what 2 private cleanings and 1 dentist visit costs here)

    1. Oh and I’m adding to my own comment here, but I definitely had unnecessary dental procedures as a kid. I remember when my mom got a job with Dental insurance she asked the orthodontist about anything I might need and they recommended a gum graft. I don’t think a seventeen year old needs a gum graft. I am fairly sure that was done just because there was money to pay for it. I also had my wisdom teeth taken out because they wanted it done while insurance would cover it. I’ve not suffered any negative effects from either of these, but it does seem indicative of a broken US healthcare system.

    2. I am just so fortunate to not have had any of these things! No retainer! No braces. It was 100% genetics because I didn’t brush or floss very well as a child – I just naturally had a big mouth!

      The dentists that are covered in Canada under provincial public health care plans are the same as “regular” dentists, but it sounds like in the UK the NHS vs private dentists are different?

  12. What a really insightful post this is. I think the equity factor is really highlighted by the fact that in Canada such things are covered for children, but still there is a disparity between those who chose to get them and those who don’t. So clearly it’s about something deeper than just money.
    I did have braces growing up, but unfortunately did not wear my retainer as often as I should have afterwards and now thirty years later, my teeth are not as straight as they once were. My dentist has suggested Invisalign because she says it will every so gradually affect how my teeth come together which leads to problems with teeth grinding and jaw movement. Orthodontics isn’t covered for adults, so I’m not sure if I will ever follow through… but then I think how I have to live with these teeth for another 30-40 years… maybe I should treat them better?

    1. I don’t think dental work was covered for kids when I was a kid – and definitely not when my siblings were little. What a blessing it is now covered (at least in part) – but still, it’s not necessarily accessible for everyone and yet dental care is such a huge part of overall health! Even for broader issues; one of my sister’s is a hygienist and she has spotted early signs of things like mouth and throat cancer!
      It’s hard to pay out of pocket when you’re not sure how much of an impact something will have (like getting Invisalign).
      Orthodontics aren’t covered for kids by medicare, so they are definitely a BIG out-of-pocket expense. We don’t have coverage for them either – but they can be used as a tax writeoff…

  13. I have a gap in my teeth! And my top teeth all very slightly angle inward. It’s not something that I normally notice, but the dentist mentioned it so I am ever so slightly self-conscious about it.

    Also, I had braces in fourth/fifth grade, only on my bottom teeth, and they are NO LONGER STRAIGHT. Ugh. Oh well.

    My daughter is probably going to need braces, and intervention for her phrenum (the flap of skin between her top front teeth), but nothing anytime soon. Orthodontics is definitely a realm of privilege. And straight white teeth are kind of silly — I mean, sure, there is probably some sort of evolutionary advantage to having straight teeth. Maybe you can eat better or they stay in your mouth longer. I don’t know. But it’s mainly a silly aesthetic that we’re force-fed into thinking is “better,” right? Ugh. We are all so brainwashed in so many ways.

    1. Hmmm. There is a common theme of braces not permanently keeping teeth straight which worries me slightly as we consider orthodontics!

      1. I also had braces (and expanders) as a kid – from second grade until seventh, in two phases. They put a permanent retainer on my bottom teeth in the form of a thin metal wire that’s glued behind my teeth. I was another non-retainer-wearer for my top teeth, and got clear braces on them as an adult. I only had them on for a year before my wedding, but have had them off for over five years now, and wear my new retainer almost nightly with no signs of tooth movement!
        As a side note, my dad’s company insurance covered about half of my childhood orthodontic work, and when I got braces as an adult, my insurance as a public school teacher also would’ve covered half of work for kids under 18. Over 18 years old, they covered 0% of it.

  14. I had braces as a child and even though I am sure my parents made sure I brush my teeth regularly and I had frequent visits at the dentist, I also had all of my wisdom teeth removed, four teeth pulled (both my sister and I apparently have “small jaws”), a few fillings and two crowns. Unfortunately, a lot comes down to genetics, but also dental hygiene.
    Funnily enough, when I started seeing the dentist here in the States, they commented on how beautiful my teeth are (they’re not really and they’re also not beautifully white) and how beautiful the dentist work was that I had done. They couldn’t believe that the two crowns I had were 20 years old! German workmanship – haha.

    The truth is that you can have braces but then your teeth move again. My dentist recently suggested Invisalign (because I apparently developed a small overbite/jaw misalignment since my brace days). While I usually trust my dentist’s assessment, I do believe that this is purely cosmetic at this point and I don’t see the need to spend $4000… but yeah, I did notice that especially in the US, teeth straightening and whitening is very important.

    1. Can I just admit right now – even with a hygienist in my family – that I didn’t even know what a crown is until I looked it up just now?! Ditto for “a bridge.”

  15. I did not have braces but 3 of my siblings did. I have a lot of cavities but I think that comes down to genetics. I always saw a dentist, probably when I started elementary school? I bring my kids to the dentist when they turn 2. But like you said, privilege is such a factor in things like going to the dentist. I have dental insurance which is very cheap and luckily have not had to pay for much since I don’t have any issues besides all the fillings from my many cavities in my young.

    The cosmetic thing is disappointing to hear. My husband was getting pressure to get veneers from his previous dentist so he changed to my practice where they have never suggested such a thing. He has great teeth – or fine enough I guess? Same story with mine – they are fine. My bottom teeth are kind of crooked but not bad enough to necessitate braces. But no one sees them!

    1. Yes to genetics and also weird changes over the course of our lives – I had great teeth with no cavities for my childhood (I had my first cavity as a university student and then didn’t any another one until after I was pregnant when I had FOUR cavities develop over that 9 months). It was crazy. My dentist said that pregnancy can really impact dental health!

  16. Dentistry is such an expensive business and I definitely didn’t have access to braces when I was a kid. I did Invisalign in my 30s. Every time I go to the dentist I wonder how others can afford this. I’m lucky to have good insurance for the whole family so I don’t really think about its cost, but I know many others don’t have that.
    and also it’s true that if one doesn’t have flexible work arrangement, how can they take kids to dentist?

    1. There are many layers of priviledge – both financial and in terms of flexibility (which feeds back into finances of course)…

  17. I wanted braces SO BADLY when I was in middle school. It seemed like ALL of my classmates had them and I wanted to fit in. Isn’t that crazy? I could have probably used a year or so of braces (and sometimes I think about doing Invisalign or something like that), but it was unaffordable for my parents. I don’t like my smile at all, though. My mom has a wonderful wide smile where she can show her teeth but my mouth is small and even when I smile wide, my teeth don’t show. It’s something I’m very self-conscious about!

    1. Aww. That makes total sense, honestly. Someone I know once pretended they needed glasses because they thought it would make them look cool…(as someone who has needed glasses almost my whole life, this does NOT compute!).

  18. Oh, my, dental and orthodontic histories and experiences are clearly traumatic for so many. This is a clear contributor to health equity and disparities – and just recently (post-you-writing-this/pre-me-writing-my-late-response), on November 29, the WHO raised attention to the epidemic of untreated cavities, gum disease, and tooth decay ( Reading the stories here of so many who did not have access to dental care – let alone GOOD dental care – is heartbreaking. And of course it’s essential for overall health – if you have gum or tooth disease, you are at much higher risk of OTHER health conditions! Teeth are important – and I’m so glad your province is supporting oral health in children, at least in some way.
    My own experience is in the middle – great dental care as a kid + crappy teeth + lack of fluoride in our water = terrible enamel, predisposition to cavities, and… an unknown number of crowns. I’ve had one root canal (not fun but not awful) and the hilarious related thing is that my endodontist literally lives 2 apartments away from me. I see him all the time! So yes, teeth are a fraught and emotional issue. I wish those whose childhoods lacked what mine did had the chance to “catch up” but unfortunately life does not work that way. 🙁

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