I was rigid in the chair crying from both fear and shame

It was so bad I would sit on a cold winter basement floor in pain swigging whiskey to dull the pain like I was a cowboy

Thanks to Longreads the only good website for including Welcome to Hell World on their holiday gift book guide alongside some other great ones.

“Luke O’Neil’s Welcome To Hell World is a vital and despairing collection of essays on modern American life,” they say and that is nice although questionably true.

If you missed this edition of Hell World the other day you should go back and read it.

Ok here’s todays thing bye.

I remember it being so much more violent than I was expecting. The dentist or oral surgeon or whoever it was — it could’ve been a hot dog vendor for all the skill involved  — needed to generate so much brute physical leverage to pull my tooth out. It was like when you’ve got a flat tire and you’re trying to unscrew the rusted lug nuts and the fucking thing won’t turn goddamnit and you’re putting all your weight on the tire jack getting sweaty there on the side of the road.

No offense to hot dog vendors.

Although my mouth was numbed up pretty good when a bone is being ripped out of your face you can still feel it reverberating throughout your body like your skeleton knows that something really bad is happening. Before we even got to that part though I remember the guy basically crushing the external part of the tooth with pliers. Imagine if you had to personally figure out on the fly how to get a tooth out of someone’s head right now. You’d stick the pliers in there and just smash and smash blindly and then there would be a little bony nub poking out when you were done smashing and you’d be like well now what. That is pretty much what the fancy tooth doctor does too. Then he looks at you like you’re an asshole for putting the two of you in this position. Look what you made me do he thinks.

That was roughly seven years ago I guess and it followed a couple of root canals I had had over the previous five years which were not much more pleasant. For the root canals I went to a dental school they have in Boston where it’s supposed to be a lot cheaper in theory but it’s still like three or four grand all told and what happens is you have to offer up your food hole as a training specimen for the students so the process requires a bunch of superfluous visits to get somewhat of a discount and when you are some random fucking schlub freelancer and waiter like I was for most of my life getting a thousand bucks knocked off a bill for something you can’t afford in the first place is a pretty big deal.

People always say haha well it wasn’t like getting a root canal to indicate that something wasn’t too bad but the root canal was preferable to the smashing and yanking in retrospect. The part where they have to yoink the deep nerve endings out one by one with tiny tweezers like you’d pluck your eyebrows out with wasn’t great I guess. Imagine each eyebrow was somehow connected to your entire spinal column and brain and it could shoot lightning throughout your body.

Teeth are fucking weird man who designed this idiot shit.

The reason I ended up needing all that work done was because for my entire twenties I didn’t go to the dentist or to the doctor for that matter because I couldn’t afford it and when you don’t go to get your teeth cleaned or looked at all the problems tend to compound themselves and next thing you are fucked. I am far from alone in that pattern of avoidance in America. Our teeth are all basically fucked.

Check this shit out:

In 2016 around 74 million Americans had no dental coverage according to the National Association of Dental Plans.

In 2017 15% of children aged 2-17 and 36% of adults aged 18-64  and 34% of adults 65 and over did not go to the dentist in the prior year according to the the Center for Disease Control and Prevention. From 2013-2016 17% of children aged 5-19 let a dental issue such as a cavity go untreated while almost 32% of adults aged 20-44 did the same. A lot of you nice people fall into that category I have come to find out and we’ll get to your stories later on hold on a minute.

The reason people don’t go to the dentist may be in part because dental insurance basically isn’t real (?) It’s the opposite of what we think of when we think of medical insurance in fact where you pay a lot in premiums and out of pocket costs but the idea in theory at least lol is that if something really terrible happens it will be capped off so you will only have to pay say $10,000 for a five minute ER visit and not the full $100,000 they want to charge.

With dental insurance your checkups and cleanings and other preventative shit like that is often free but if something really bad happens and you need a root canal or an extraction or replacement teeth or whatever you’re on the hook for thousands of dollars. The idea is that by getting the regular routine care you will prevent ever needing the serious shit down the line I guess. I don’t know dentists are fucking wild man who even knows anything.

One reason the numbers for dental coverage overall are so low is that Medicare doesn’t offer it. 65% of people on Medicare do not receive dental coverage according to the Kaiser Family Foundation. You can be on Medicare and you still have to purchase add-on level up loot crates to get your teeth looked at.

Because of that Kaiser says “Almost half of all Medicare beneficiaries did not have a dental visit within the past year (49%), with higher rates among those who are black (71%) or Hispanic (65%), have low incomes (70%), and are living in rural areas (59%), as of 2016.”

“Almost one in five Medicare beneficiaries (19%) who used dental services spent more than $1,000 out-of-pocket on dental care in 2016” they add.

Dental care is of course not just about the teeth and studies too numerous to list point to all manner of serious illnesses that can arise from tooth issues not to mention all the indicators of diseases that can go unspotted when people avoid dentist visits in the first place.

It’s weird that we even think of teeth as a separate thing in the first place isn’t it? Why do we have to say things like if you don’t take care of your teeth it will lead to real health problems in the other parts of your body that actually count like I did in that paragraph above?

We do that with eyes too for that matter. And our brains. Dental and vision and mental health are all basically treated like bonus features that come with a new car. Oh cool it’s got a fuckin… blue tooth and… heated seats.

People online like to joke that teeth are essentially luxury bones and that is pretty accurate as far as jokes and truth go. It’s certainly a luxury to be able to have them taken care of.

I was curious how many other people let their teeth go to shit over the years like I did whether it was from fear of the pain or fear of the costs or fear of being shamed by the dentist and what other sort of general dental care nightmares people had experienced so I collected a bunch of stories which I will share below.

A curious thing about dental issues I heard from a lot people is the shame involved in taking your care of your teeth or the lack thereof. I don't think anyone is usually ashamed if they get sick in another type of way or break a bone or something but dental care comes with this inherent sense of moral failure on top of the pain and financial stuff. That has a lot to do with how dental hygiene has long been seen as a class marker of course as this fine piece in Dissent The Class Politics of Teeth points out.

Inequalities in oral health and dental access reflect our deepest social and economic divides. The “Hollywood Smile” has become a status symbol around the world, and better-off Americans routinely pay for elective procedures ranging from teeth whitening and veneers to complete “smile makeovers” costing many thousands of dollars. Meanwhile, more than one out of three low-income American adults avoids smiling because of poor oral health, according to a poll conducted for the American Dental Association (ADA) in 2015.

Ashamed and stigmatized, the poor are shut out of opportunities for social advancement as well as work that could help them escape poverty. “If you have lousy teeth, you can’t get a job,” observed Philip Alston, United Nations Special Rapporteur on extreme poverty and human rights. Alston was speaking in Washington, D.C. in December 2017 at the conclusion of a fact-finding mission to study extreme poverty in the United States, one of the world’s wealthiest countries.

So what is your own personal dental nightmare I asked readers. Did you avoid treatment for so long that it lead to something serious? Do you not have insurance or if you do do you still have to pay thousands of dollars to get work done? These are the stories they told me.

  • I haven't been in six plus years and I can't afford what needs to be done which is more than $5,000 of work. The last dentist I went to hinted that my teeth issues were from drugs. She hurt me and I’ve never gone back. I’m waiting for my two bottom front teeth to fall out. I wake up to excruciating pain if I grind them in my sleep. I get really depressed about it, worry about getting jobs, and just the general embarrassment of being toothless.  I worry my partner will leave me and I wont be able to be loved anymore. Anyway, Medicare For All all day.

I need to see a dentist but I can’t because I’m broke. I know like five days before I get money I’m going to crack a cavity tooth or a crown is going to fall off or some horrible bullshit. I’ll live in hell and then be immediately broke again.

It’s just been forever. I can feel cavities getting bigger every day in multiple teeth, and my fucking gums bleed. It’s gross. And I need one last wisdom tooth pulled because it’s crowding. But I’m not in actual pain again yet so I have the luxury of spending all my money on rent.

Why is the mouth not considered part of the rest of the body? This year I had to pay my own huge dental bill when I thought I was covered. My work’s HR fucked up my enrollment and only did medical, and I’m thankful for that, but not dental. I found out when I needed a root canal. $1,682 for the root canal. $2,190 for the crown at a regular dentist.

I would have gone to a dental school if I had realized I was going to pay out of pocket. I had a root canal and at least one crown done at a school about five years ago, but it's further away, and takes at least half a day for each appointment.

  • I had to sell my car to pay for my wisdom teeth removal. I got my first cavity ever after I started freelancing. That required a root canal and wisdom teeth removal because of the position of the cavity. I needed a crown but I put that off  because of money until the molar cracked. I had to get it pulled too. It was $6,000 even with a friends and family discount, with zero help at all from my $700 a month marketplace insurance of course.

I found out last night I need at least $10,000 in dental work, maybe more, and 90% of it isn't covered by insurance. Life always brings us delightful surprises. I need implants for missing teeth and veneers for six of them. The enamel didn't form right on my teeth, but they consider my very real need for them “cosmetic.” It’s so dumb that they can't differentiate between needs and wants.

I have dental insurance but it's new so it doesn't cover anything but exams and cleaning for six months. Even after that $8,750.00 won’t be covered at all.

  • I’ve got top tier insurance and I’m still looking at $15-20,000 of work to repair and replace all the dental work I got as a kid that is currently falling apart.

    Basically all of the molar fillings I got thirty years ago started disintegrating at the same time. I was the sole income in my household and I couldn’t afford to take care of anything so I put it off and now I’m missing six of them. Two might be able to be saved, but under my current coverage cost per tooth (for implants) is still close to $3,000. My other option is extraction and a bridge/dentures which kinda sucks, but might be all I can afford.

    Also just thinking about starting this process sends me into this shame/anxiety spiral that just makes everything feel worse

    I don’t even know where to start but I really need to do something soon.

  • My teeth are ugly because of crowding and I constantly had cavities which no one ever said was genetic. Also my mom did not instill brushing habits at all, so I’m still bad about it and I’m deeply ashamed but I can only fix one thing at a time.

  • Last week I had to cut my gums open to remove bone spurs. They had been sticking out, as solid as an actual tooth, like broken glass while they horribly gouged the bottom of my tongue. Deep lacerations on my tongue would remain open and constantly keep my mouth full of blood. I couldn’t talk or eat properly because the pain was unbearable. My extreme depression and anxiety fueled the shame, while no insurance ensured that I’d be living with it. I could no longer take it and sterilized my pocket knife. I pulled three sharp little pieces of broken bone out. I can’t go to the dentist and it’s been severely personally damaging. The holes will heal now.

  • I used a textbook and the internet to teach myself to repeatedly drain a dental abscess, over the course of two years, when I was in college. How I didn’t die is beyond me.

  • I haven’t been to the dentist since I was in college about four years now. The last time they told me I had seven cavities. I haven’t had coverage since. I’m not in pain yet but there is something terrifying for sure happening to my end teeth in the back because I can see the discoloration. I’m supposed to have “full coverage” dental insurance from my job but I tried to use it and I would have to pay for anything and everything up front in full and then wait anywhere from three to nine months to be reimbursed in pieces.

  • I was missing a front tooth for a whole year back in 2009 because I was a waitress with no insurance and had to get it done step by step when I could save the cash. I got an implant at the Tufts Dental School and it took forever. It made my 2009/2019 decade photos a real no brainer.

    It wound up being around $3,500 broken up by procedure. I needed an extraction, a bone graft, the implant post, and then the actual tooth. I worked a lot of doubles and learned to smile with my mouth closed. A decade later it’s still in perfect shape, they did a great job.

My husband's bottom front tooth was completely dead and not attached and he kept putting it in the hole so that it would look like he had most of his front teeth. He finally came up with the funds for a partial thankfully.

He would take the tooth out, brush it, and put it back. When he called the denturist finally he was horrified and told my husband he was going to make a gaping hole that would never go away. Now under his partial there is a gaping hole that has not gone away. I did not know these details about the hole until he just told me.

My dentist growing up didn't think I should get my wisdom teeth removed. I think because he was retiring. So I put it off for twenty years due to poor or no insurance. The last five years were spent with migraines, constant sickness due to infections, and pain.

I finally did a GoFundMe. It raised about half of what I needed. I went to the supposed best dentists. I came to the in the middle of the procedure when she was using what felt like a mini crowbar to get one out.

When she was breaking off part of my jaw to get one out she did a poor job sewing up one of the holes and it has never fully healed. It’s two years later and I'm hesitant to go back due to money and the memories. Four wisdom teeth and all the other things I needed to have done was just under $3,000.

  • This is real fucking small beans compared to what a lot of people go through but I always feel this one as being just real American Health Care Hell World in its banal cruelty.

    I had just gotten a job in the mid-2000s after not having one for a while, and of course you don't get insurance right away, you have to wait, for “reasons”, that I guess amount to “Well, what if it turns out he's a shit head and gets cancer right away, we don't want to have to pay for a shit head's cancer treatments.”

    Like the week I got the job, and thirty days or so before I got coverage, I shattered a tooth. It didn’t hurt at first, so I tried to just roll with it, eating soft foods only, chewing on the other side of my mouth, all good stuff. But eventually I just can't keep going. The pain is just excruciating. I can't sleep. It's affecting my work at my new job…So I call around where I lived on the south side of Chicago to find a dentist who would a) Take cash and b) Take this goddamned thing out of my mouth now.

    I find a Korean strip mall dentist at Ford City who says he'll rip the tooth out for $50. That's a lot of cash for a guy who just got back to work after a long layoff, but I need this thing out, so I pay it and he clambers up onto my chest with some dental pliers and just goes to town ripping the mess out by the roots. After a really long painful time, he hops off and says “almost done”, but he's a jokester and he shows me two long shards of tooth and pile of tooth rubble and says “Just kidding, we’re all done.” Haha I guess.

    I felt like shit for being a pussy who couldn't hold out two more days until I had coverage and also for now having yet another gaping hole in my gums where a tooth should be for a tooth that other dentists have since told me could probably have been saved. Thanks for that useless yet somehow blame-giving knowledge, other dentists. 

    It was great to think of that whole episode again today as I paid out a mere $150 for a basic six month cleaning and wonder what people who don't have my reasonably “good” health insurance that covers fuck all for dental or vision do when shit like this happens.

  • I've never had dental insurance, plus I grew up with a mother who had a phobia of dentists — her childhood dentist didn't use novocaine for her fillings — so I’ve literally never been to the dentist. I got my teeth cleaned by a visiting hygienist at my elementary school once but I don't think that counts.

    I brush and floss and am anxiously awaiting the inevitable mind-rending pain.

  • I avoided going for years then I got married and insured and went. I was absolutely taken advantage of with multiple root canals and expensive as fuck crowns, not all of which were necessary and one I explicitly said I did not want.

    Dozens of procedures and thousands of dollars later I'm back to avoidance. I'm walking around with two holes in my mouth where crowns used to be. Crowns I didn't want because they weren't visible in my smile and there was enough tooth left for fillings. But the dentist insisted… I relented and they were garbage and so they fell out.

    If I get insured again I should go back. But how do you know a dentist isn't predatory beforehand? How do you even know some are predatory until you read an article about it years after it's happened to you and you just sit in shock with it for a night?

  • My partner's uncle who was on disability for a long time and worked part-time hourly at a local hardware store suffered, and still suffers, from a debilitating brain abscess that stemmed from an un- or under-treated severe tooth infection.

  • I never liked taking care of my teeth and right now on my fridge is a different kind of dental plan. It's the oral surgeon's plan to take eleven of my teeth out for replacing next year when my insurance pays for this thing.

    My first band practiced in the basement of my guitarist's parents house for like a long time before we got a practice space and we were definitely too old to be doing that. My wisdom teeth were coming in and eventually one of those things got rotted and abscessed. The reason I mentioned the band was I would carry a fifth of Jim Beam with me because the pain was so bad I would sit on a cold winter basement floor in pain swigging whiskey to dull the pain like I was a cowboy or some shit.

    I finally went to one of these Gentle Dental places. The dental assistant finally says ok, open it up, say ah all that shit. I open my mouth and they look in there, and without skipping a beat, calmly but quickly turns around, picks up a literal phone and says, and I'll never forget it, “You need to see this guy RIGHT NOW.”

    I'm whisked to another room, loaded up with novocaine, and they extract a rotten abscessed tooth that could have easily killed me from the infection itself.

    I haven't had a drink to dull the pain in over ten years and I look forward to these new chompers I'm getting if I get up the nerve to go back to this new guy. Wish me luck on taking advantage of every benefit available to me while I have it. Since everything is terrible you never know when it goes away.

  • I was working in Mexico last year and took advantage of a full dental exam and teeth cleaning done by an actual oral surgeon herself for sixty bucks. Walked right in. Wasn’t insured in USA at the time. It would’ve been impossible.

  • I had to have a ton of work done when I first got into the military. The few years after getting out, but before getting insurance, coincided with the expiration of most of that work. I put off the smaller problems in order to deal with the big things and root canals.

    By the time I got insured the smaller problems had become big ones. All dental insurance is a joke. It won't even cover a whole root canal, and you're on your own for the crown. Can't afford the crown? Might as well have had the tooth pulled to begin with because it's going.

    From about fourteen to sixteen, knowing we had no dental, I ignored an exposed cavity until the resulting abscess had me sobbing. I had an emergency root canal at Gentle Dental with the meanest fuck in dental history. Getting a permanent crown was out of the question and I was so traumatized from that procedure anyway that I refused to even think about the dentist. By the time I joined the military at twenty two that tooth had long become just a hole in my gums. I'd gotten pretty used to not getting food down in there. Lucky me, it was in the very back, because when the military dentist pulled it, the one above had to come too. Without a lower contact it was migrating downward. Wisdom teeth came out on that side too because why not? It wasn't a bad experience, despite the novocaine-only procedure.

    That's all only because I'd been able to get past my trauma a couple months earlier, when they fixed the six cavities that had occurred over six years without dental care. I was rigid in the chair crying from both fear and shame.

    What fixed it? The insane empathy of a dental team that had seen who knows how many young troops (read: more likely to be working class/poor) like me. You wouldn't expect a military dental technician to be the one stroking your forehead and taking all the time you needed, but there we were.

  • I make an average salary for my area and I put off the dentist for four years resulting in multiple root canals and cavities over ten visits. The worst was the money obviously but second worst was telling my boss I had to go to the dentist ten times in a year and feeling like a dumb ass. It was $5,000 out of pocket with one more root canal to go. My dental insurance maxes out at $1,000 so I’m waiting until next year to get it covered. I will also need an implant eventually but I’m putting that one off.

  • I didn't have any insurance but thought I was going to die because my mouth hurt so bad. In retrospect that probably doesn’t happen. There is this place in Nashua, NH that will give you antibiotics if your mouth is infected or other minor things. They hooked me up with antibiotics but couldn't do anything about the wisdom teeth until I got this other tooth out. I don't really remember. I loosened the tooth and pulled it out myself like maybe two months after but I didn't even end up getting my wisdom teeth out until I had union insurance like five years later.

    I waited so long to do anything I ended up having to pay like $5,000 to get all my other teeth fixed when I had money.

  • Here’s my nightmare. I got root canal a year and a half ago. It was $750. Turns out they didn’t do it correctly, so I had to get it done again. Hopefully it was right this time. It was $2,000 this time because they had to destroy an old crown. It’s worth noting both of these were done and covered under “good insurance plans.”

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